Detection of focal hepatic masses: prospective evaluation with CT, delayed CT, CT during arterial portography, and MR imaging.

Abstract

The sensitivities of contrast medium-enhanced computed tomography (CT), delayed CT (DCT), CT during arterial portography (CTAP), and magnetic resonance (MR) imaging for detecting focal liver lesions were prospectively evaluated in eight patients who subsequently underwent hepatic lobectomy or transplantation. Pathologic evaluation of the resected liver specimens demonstrated 37 lesions. The sensitivities were 81% (30 of 37 lesions) for CTAP, 57% (21 of 37 lesions) for MR imaging, 52% (12 of 23 lesions) for DCT, and 38% (14 of 37 lesions) for contrast-enhanced CT. The difference between the sensitivity of CTAP and the sensitivities of the other imaging tests was statistically significant (P less than .004). Of the lesions smaller than 1 cm in diameter, CTAP depicted 61% (11 of 18 lesions), MR imaging 17% (three of 18 lesions), CT 0% (zero of 18 lesions), and DCT 0% (zero of nine lesions). It is concluded that for preoperative detection of focal hepatic masses, CTAP is the most accurate technique available to most radiologists. Patients with primary or secondary hepatic neoplasms who are being considered for hepatic resection should undergo CTAP as part of their preoperative examination.

Portal-phase contrast-enhanced helical CT for the detection of malignant hepatic tumors: sensitivity based on comparison with intraoperative and pathologic findings.

“…The mean maximum diameter of the missed lesions was 9 mm (range, 4-20 mm). The subsegmental location of the missed nodules was as follows: n = 1 in segment 2, n = 2 in segment 4, cm or less, ranging from 0% to 47% [1][2][3][4]. In this study, the sensitivity for nodules 1 cm on less was 56%, which is manginally better than the results reported for incremental CT, but which is still quite low.…”

Diffuse Liver Metastasis of Small Cell Lung Cancer Causing Marked Hepatomegaly and Fulminant Hepatic Failure

“…These patients cannot undergo contrast CT because of poor renal function. The sensitivity of contrast CT for a liver tumor smaller than 2 cm is 20% (11). The hepatic tumor in the current patient had invaded diffusely and each tumor was too small to be visualized.…”

“…The sensitivity of MRI in detection of the liver tumor smaller than 2 cm is 33% (11). These patients cannot undergo contrast CT because of poor renal function.…”

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

“…CTHA and CTAP have been used for preoperative evaluation of HCC, although they are uncommonly used except in Japan [227][228][229]. However, the benefit of CTHA and CTAP compared with MRI for the diagnosis of HCC is not yet clear because it is more invasive than MRI and does not appear to be more accurate than MRI [230].…”