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Surgically Staged Focal Liver Lesions: Accuracy and Reproducibility of Dual-Phase Helical CT for Detection and Characterization¹

¹ From the Russell H. Morgan Department of Radiology and Radiological Sciences (I.R.K., K.M.H., H.J.V.B., E.K.F., D.A.B.) and Department of Surgery (M.A.C.), Johns Hopkins Hospital, 600 N Wolfe St, Rm 100, Baltimore, MD 21287; Department of Radiology, New York University Medical Center, New York (B.A.B.); and Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (R.E.T.). Received October 31, 2001; revision requested January 18, 2002; final revision received October 2; accepted November 5. Address correspondence to I.R.K. (e-mail: ikamel@jhmi.edu).

PURPOSE: To assess the accuracy and reproducibility of dual-phase helical computed tomography (CT) in enabling preoperative detection and characterization of surgically staged focal liver lesions.

MATERIALS AND METHODS: Surgically and histopathologically proven liver lesions were evaluated by three experienced CT readers. These lesions were present in 77 patients who underwent dual-phase helical CT. Images were interpreted separately by the three blinded reviewers. Each lesion was graded on a nine-point scale of confidence, with 1 being definitely benign, 9 being definitely malignant, and 5 being indeterminate. The ² test was used to determine if the distribution of lesion classifications was different between readers.

RESULTS: There was a total of 237 lesions: 73 were benign and 164 were malignant. Sensitivity for lesion detection was 69%, 70%, and 71% for the three reviewers, respectively. Specificity was 91%, 86%, and 90%, and the area under the curve for the alternative-free response receiver operating characteristic curve was 0.84, 0.83, and 0.85, respectively. The difference in the distributions of lesion classification between the three reviewers was not statistically significant (P = .67) as determined by ² analysis.

CONCLUSION: Dual-phase CT has sensitivity of 69%–71% and high specificity (86%–91%) in enabling the detection and characterization of focal liver lesions. Interpretation is highly reproducible, as there is minimal variation between experienced reviewers.

© RSNA, 2003

Index terms: Liver neoplasms, CT, 761.12112 • Liver neoplasms, diagnosis, 761.31, 761.32 • Liver neoplasms, metastases, 761.33

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