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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).

View larger version (35K): [in a new window]   Figure 1. Alternative-free response ROC. AUC was 0.84, 0.83, and 0.85 for the three reviewers, respectively.

View larger version (128K): [in a new window]   Figure 2a. Transverse helical CT images of true-positive finding obtained in (a) the arterial and (b) the portal venous phases in a 64-year-old man with colon cancer. A lobulated mass is seen on both sides of the falciform ligament, with peripheral enhancement consistent with metastasis (arrow). All reviewers reported the lesion as malignant, and findings were confirmed at surgery.

View larger version (121K): [in a new window]   Figure 2b. Transverse helical CT images of true-positive finding obtained in (a) the arterial and (b) the portal venous phases in a 64-year-old man with colon cancer. A lobulated mass is seen on both sides of the falciform ligament, with peripheral enhancement consistent with metastasis (arrow). All reviewers reported the lesion as malignant, and findings were confirmed at surgery.

View larger version (133K): [in a new window]   Figure 3. Transverse helical CT image of true-positive finding obtained in the portal venous phase in a 66-year-old man with colon cancer. A low-attenuating lesion (arrow) seen in segment IVA has peripheral contrast enhancement, which is consistent with metastasis. A cyst (arrowhead) is also identified in segment II. Both lesions were confirmed at central hepatectomy (true-positive findings), and segments IV, V, and VIII were resected.

View larger version (127K): [in a new window]   Figure 4. Transverse helical CT image in the portal venous phase in a 52-year-old woman with papillary thyroid carcinoma and metastases to the neck. A small cyst (straight arrow) (true-positive) was seen in the right lobe segment VIII. A second cyst (curved arrow) was reported as malignant (type II false-positive), benign (true-positive), and indeterminate by the three reviewers. A third cyst (arrowhead) in the caudate lobe was not reported by two reviewers (type I false-negative). Lesions were documented with use of intraoperative US.