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Hepatocellular Carcinoma: Detection with Triple-Phase Multi–Detector Row Helical CT in Patients with Chronic Hepatitis¹

¹ From the Departments of Radiology II (A.L., R.I., I.C., R.F., F.M., R.P.), Radiology III (P.R.), and Experimental Medicine and Pathology (I.N.), University of Rome-La Sapienza, Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy. Received December 13, 2001; revision requested February 22, 2002; revision received April 18; accepted June 5. Address correspondence to A.L. (e-mail: andrea.laghi@uniroma1.it).

View larger version (141K): [in a new window]   Figure 1a. Transverse CT scans of an HCC nodule of 15 mm in diameter in a 54-year-old man. (a) Early arterial phase image reveals no hyperattenuating nodule in the liver parenchyma. (b) Late arterial phase image clearly depicts a hypervascular HCC nodule (arrow) in the left lobe. (c) On a portal venous phase image, the nodule (arrow) shows persistent enhancement greater than that of the liver. This nodule was proved at biopsy to be HCC.

View larger version (141K): [in a new window]   Figure 1b. Transverse CT scans of an HCC nodule of 15 mm in diameter in a 54-year-old man. (a) Early arterial phase image reveals no hyperattenuating nodule in the liver parenchyma. (b) Late arterial phase image clearly depicts a hypervascular HCC nodule (arrow) in the left lobe. (c) On a portal venous phase image, the nodule (arrow) shows persistent enhancement greater than that of the liver. This nodule was proved at biopsy to be HCC.

View larger version (140K): [in a new window]   Figure 1c. Transverse CT scans of an HCC nodule of 15 mm in diameter in a 54-year-old man. (a) Early arterial phase image reveals no hyperattenuating nodule in the liver parenchyma. (b) Late arterial phase image clearly depicts a hypervascular HCC nodule (arrow) in the left lobe. (c) On a portal venous phase image, the nodule (arrow) shows persistent enhancement greater than that of the liver. This nodule was proved at biopsy to be HCC.

View larger version (151K): [in a new window]   Figure 2a. Transverse CT scans of an HCC nodule 32 mm in diameter in a 62-year-old man. (a) On an early arterial phase image, a hypovascular HCC nodule (arrow) is faintly visible in the right lobe. (b) On a late arterial phase image, no enhancement is observed in the lesion (arrow). (c) On a portal venous phase image, the lesion (arrow) is better appreciated as a hypoattenuating nodule. The diagnosis of HCC was confirmed at US-guided percutaneous liver biopsy.

View larger version (151K): [in a new window]   Figure 2b. Transverse CT scans of an HCC nodule 32 mm in diameter in a 62-year-old man. (a) On an early arterial phase image, a hypovascular HCC nodule (arrow) is faintly visible in the right lobe. (b) On a late arterial phase image, no enhancement is observed in the lesion (arrow). (c) On a portal venous phase image, the lesion (arrow) is better appreciated as a hypoattenuating nodule. The diagnosis of HCC was confirmed at US-guided percutaneous liver biopsy.

View larger version (148K): [in a new window]   Figure 2c. Transverse CT scans of an HCC nodule 32 mm in diameter in a 62-year-old man. (a) On an early arterial phase image, a hypovascular HCC nodule (arrow) is faintly visible in the right lobe. (b) On a late arterial phase image, no enhancement is observed in the lesion (arrow). (c) On a portal venous phase image, the lesion (arrow) is better appreciated as a hypoattenuating nodule. The diagnosis of HCC was confirmed at US-guided percutaneous liver biopsy.

View larger version (30K): [in a new window]   Figure 3. Bar graph shows mean conspicuity ratings of HCC nodules on images at four different image reading sessions. Light gray bars = early arterial phase images, dark gray bars = late arterial phase images, black bars = double arterial phase images, white bars = triple-phase images.

View larger version (137K): [in a new window]   Figure 4a. Transverse CT scans of an HCC nodule of 55 mm in diameter in a 58-year-old woman. (a) Early arterial phase image shows a large hyperattenuating HCC nodule (arrow) in the left lobe. (b) On a late arterial phase image, conspicuity of the lesion (arrow) is greatly increased; multiple satellite nodules, not evident on the early arterial phase image, are also seen.

View larger version (146K): [in a new window]   Figure 4b. Transverse CT scans of an HCC nodule of 55 mm in diameter in a 58-year-old woman. (a) Early arterial phase image shows a large hyperattenuating HCC nodule (arrow) in the left lobe. (b) On a late arterial phase image, conspicuity of the lesion (arrow) is greatly increased; multiple satellite nodules, not evident on the early arterial phase image, are also seen.

View larger version (124K): [in a new window]   Figure 5. Volume-rendered three-dimensional CT angiographic reconstruction obtained in a 51-year-old man shows the anomalous origin of the right hepatic artery (solid arrow) from the superior mesenteric artery; the common hepatic (open arrow) and left hepatic (arrowhead) arteries have a normal appearance.