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Published online before print March 24, 2004, 10.1148/radiol.2312021639
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231/2/413    most recent
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(Radiology 2004;231:413-420.)
© RSNA, 2004

Gastrointestinal Imaging

Detection of Hypovascular Hepatic Metastases at Triple-Phase Helical CT: Sensitivity of Phases and Comparison with Surgical and Histopathologic Findings1

Philippe Soyer, MD, PhD, Marc Poccard, MD, Mourad Boudiaf, MD, Martine Abitbol, MD, Lounis Hamzi, MD, Yves Panis, MD, PhD, Patrice Valleur, MD and Rolland Rymer, MD

1 From the Departments of Radiology (P.S., M.B., M.A., L.H., R.R.) and Surgery (M.P., Y.P., P.V.), Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475 Paris cedex 10, France. Received December 2, 2002; revision requested February 6, 2003; final revision received September 17; accepted October 21. Address correspondence to P.S. (e-mail: philippe.soyer@lrb.ap-hop-paris.fr).

PURPOSE: To compare the respective sensitivities of unenhanced, arterial-dominant, and portal-dominant phase helical computed tomography (CT) in the preoperative depiction of hypovascular hepatic metastases by using intraoperative ultrasonographic (US) and histopathologic findings as the standard of reference.

MATERIALS AND METHODS: In this prospective study, 32 patients with 59 surgically and histopathologically proved hypovascular hepatic metastases underwent triple-phase helical CT of the liver, which included unenhanced, arterial-dominant, and portal-dominant phase scanning. Images from each phase were separately analyzed by three readers, and disagreements were resolved with consensus readings. The findings on CT images were compared with intraoperative US and histopathologic findings on a lesion-by-lesion basis to determine the sensitivity of each imaging phase. Statistical review of the lesion-by-lesion analysis was performed by using the Wilcoxon rank sum test.

RESULTS: Among 59 hepatic metastases, unenhanced, arterial-dominant, and portal-dominant phase helical CT imaging depicted 39 (66.1%; 95% CI: 53.3%, 76.8%), 44 (74.5%; 95% CI: 62.2%, 83.9%), and 54 (91.5%; 95% CI: 81.6%, 96.3%) metastases, respectively. Portal-dominant phase imaging depicted significantly more hypovascular hepatic metastases than did unenhanced (P < .001) or arterial-dominant (P < .01) phase imaging (Wilcoxon test).

CONCLUSION: Preoperative use of triple-phase helical CT in patients with hypovascular hepatic metastases may not be warranted. Portal-dominant phase helical CT imaging allows depiction of significantly more hypovascular hepatic metastases than does imaging during any of the other phases.

© RSNA, 2004

Index terms: Computed tomography (CT), phase imaging • Liver neoplasms, CT, 761.1211, 761.12113 • Liver neoplasms, diagnosis, 761.33 • Liver neoplasms, metastases, 761.33




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