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

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).

View larger version (116K): [in a new window]   Figure 1a. Transverse triple-phase helical CT images in a 69-year-old man with hepatic metastasis from adenocarcinoma of the rectum. CT of the liver was performed because US images depicted a single liver lesion. (a) Unenhanced, (b) arterial-dominant, and (c) portal-dominant phase images depicted a single hepatic metastasis (arrow), 22 mm in diameter, located in segment V.

View larger version (112K): [in a new window]   Figure 1b. Transverse triple-phase helical CT images in a 69-year-old man with hepatic metastasis from adenocarcinoma of the rectum. CT of the liver was performed because US images depicted a single liver lesion. (a) Unenhanced, (b) arterial-dominant, and (c) portal-dominant phase images depicted a single hepatic metastasis (arrow), 22 mm in diameter, located in segment V.

View larger version (112K): [in a new window]   Figure 1c. Transverse triple-phase helical CT images in a 69-year-old man with hepatic metastasis from adenocarcinoma of the rectum. CT of the liver was performed because US images depicted a single liver lesion. (a) Unenhanced, (b) arterial-dominant, and (c) portal-dominant phase images depicted a single hepatic metastasis (arrow), 22 mm in diameter, located in segment V.

View larger version (125K): [in a new window]   Figure 2a. Transverse triple-phase helical CT images in a 68-year-old woman with hepatic metastases from adenocarcinoma of the right colon. US examination of the liver was normal; CT was performed because of an elevation in the carcinoembryonic antigen level. (a) Unenhanced phase image did not show any metastasis. (b) Arterial-dominant and (c) portal-dominant phase images depicted a single hepatic metastasis (arrow), 15 mm in diameter, located in segment VII. The hypoattenuating area, which in retrospect was visible at the same location on the unenhanced phase image, was not detected at the separate reading session of unenhanced phase images alone.

View larger version (121K): [in a new window]   Figure 2b. Transverse triple-phase helical CT images in a 68-year-old woman with hepatic metastases from adenocarcinoma of the right colon. US examination of the liver was normal; CT was performed because of an elevation in the carcinoembryonic antigen level. (a) Unenhanced phase image did not show any metastasis. (b) Arterial-dominant and (c) portal-dominant phase images depicted a single hepatic metastasis (arrow), 15 mm in diameter, located in segment VII. The hypoattenuating area, which in retrospect was visible at the same location on the unenhanced phase image, was not detected at the separate reading session of unenhanced phase images alone.

View larger version (119K): [in a new window]   Figure 2c. Transverse triple-phase helical CT images in a 68-year-old woman with hepatic metastases from adenocarcinoma of the right colon. US examination of the liver was normal; CT was performed because of an elevation in the carcinoembryonic antigen level. (a) Unenhanced phase image did not show any metastasis. (b) Arterial-dominant and (c) portal-dominant phase images depicted a single hepatic metastasis (arrow), 15 mm in diameter, located in segment VII. The hypoattenuating area, which in retrospect was visible at the same location on the unenhanced phase image, was not detected at the separate reading session of unenhanced phase images alone.

View larger version (153K): [in a new window]   Figure 3a. Images in a 69-year-old woman with hepatic metastasis from adenocarcinoma of the sigmoid colon. The patient had undergone a prior resection of the right hemiliver, and the results at US examination of the liver were negative. CT was performed because of an elevation in the carcinoembryonic antigen level. Transverse triple-phase helical CT images obtained in the (a) unenhanced and (b) arterial-dominant phase did not show any metastasis. (c) Transverse triple-phase helical CT image obtained in the portal-dominant phase depicted a single metastasis (arrow), 9 mm in diameter, located between the left and medial hepatic vein, which indicates that the metastasis was in segment IV. (d) Image obtained at intraoperative US of the liver depicted the metastasis (arrowhead).

View larger version (150K): [in a new window]   Figure 3b. Images in a 69-year-old woman with hepatic metastasis from adenocarcinoma of the sigmoid colon. The patient had undergone a prior resection of the right hemiliver, and the results at US examination of the liver were negative. CT was performed because of an elevation in the carcinoembryonic antigen level. Transverse triple-phase helical CT images obtained in the (a) unenhanced and (b) arterial-dominant phase did not show any metastasis. (c) Transverse triple-phase helical CT image obtained in the portal-dominant phase depicted a single metastasis (arrow), 9 mm in diameter, located between the left and medial hepatic vein, which indicates that the metastasis was in segment IV. (d) Image obtained at intraoperative US of the liver depicted the metastasis (arrowhead).

View larger version (144K): [in a new window]   Figure 3c. Images in a 69-year-old woman with hepatic metastasis from adenocarcinoma of the sigmoid colon. The patient had undergone a prior resection of the right hemiliver, and the results at US examination of the liver were negative. CT was performed because of an elevation in the carcinoembryonic antigen level. Transverse triple-phase helical CT images obtained in the (a) unenhanced and (b) arterial-dominant phase did not show any metastasis. (c) Transverse triple-phase helical CT image obtained in the portal-dominant phase depicted a single metastasis (arrow), 9 mm in diameter, located between the left and medial hepatic vein, which indicates that the metastasis was in segment IV. (d) Image obtained at intraoperative US of the liver depicted the metastasis (arrowhead).

View larger version (156K): [in a new window]   Figure 3d. Images in a 69-year-old woman with hepatic metastasis from adenocarcinoma of the sigmoid colon. The patient had undergone a prior resection of the right hemiliver, and the results at US examination of the liver were negative. CT was performed because of an elevation in the carcinoembryonic antigen level. Transverse triple-phase helical CT images obtained in the (a) unenhanced and (b) arterial-dominant phase did not show any metastasis. (c) Transverse triple-phase helical CT image obtained in the portal-dominant phase depicted a single metastasis (arrow), 9 mm in diameter, located between the left and medial hepatic vein, which indicates that the metastasis was in segment IV. (d) Image obtained at intraoperative US of the liver depicted the metastasis (arrowhead).