Quadruple-Phase MDCT of the Liver in Patients with Suspected Hepatocellular Carcinoma: Effect of Contrast Material Flow Rate

Abstract

For detection of HCC with MDCT, a higher flow rate of 5 mL/sec is recommended. Visualization of hyperattenuating HCC is improved with no greater discomfort or adverse events.

Enhancement patterns and signal-intensity characteristics of small hepatocellular carcinoma in cirrhosis: pathologic basis and diagnostic challenges

“…These fine intranodular changes in arterial supply, although better demonstrated by CTAP and CTHA, can also be demonstrated by noninvasive methods, such as dynamic CT, dynamic MRI, Doppler or contrast-enhanced US (Figs. 13, 14) [5,9,62,63]. However, the slight changes in portal supply cannot be accurately evaluated by noninvasive techniques-a possible exemption might be contrast-enhanced US [63,64]-therefore, CTAP may be necessary for evaluation.…”

“…Different techniques of liver enhancement to distinguish benign from malignant nodules in the cirrhotic liver, such as dynamic multiphase CT or MRI, CT during hepatic arteriography (CTHA), and CT during arterial portography (CTAP) have been used with good results [4][5][6][7]. Contrast media with special physiologic properties and biodistribution have also been utilized in MRI to successfully address specific diagnostic problems in some cases [8,9].…”

Focal Liver Lesions

“…The timing of the image acquisition in relation to contrast media administration depends on whether imaging is required during early arterial phase (for arterial anatomy only), late arterial phase (for hypervascular tumor detection and characterization), or venous phase (for follow-up imaging and hypovascular tumor detection). For the detection and characterization of focal liver lesions, late arterial phase imaging (with a delay of aortic transit time plus 15-18 s) [6,7] and a venous phase scan (20-30 s interscan delay or with fixed delay of ~60-70 s) are performed. However, the use of combinations of these imaging phases also depends on specific indications [8].…”

“…Late arterial-phase imaging is the most sensitive for detecting small lesions [6,49,50]. A venous phase is always necessary for tumor detection/characterization and (Fig.…”

Early detection of liver cancer: Diagnosis and management

“…Imaging of the cirrhotic liver is challenging because of the presence of regenerative nodules that can mimic dysplastic nodules or even HCC. Various technical aspects such as the number of detectors, strength of the magnet, and timing and flow rate of the contrast [13] are important for differentiating between benign and malignant lesions. In particular, it is crucial that the scan be performed using a contrast agent, and that images be taken during the arterial phase, followed by a portal venous phase, and finally a delayed phase; these steps are all included in a triple-phase examination [14•].…”