| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Gastrointestinal Imaging |
1 From the Department of Radiology, Osaka University Medical School, 2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan (T.M., T.K., M.T., M.H., S.T., K.T., K.O., S.K., H.N.); the Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.P.F.); and GE Yokogawa Medical Systems, Tokyo, Japan (M.K.). Received May 10, 2000; revision requested June 18; revision received July 20; accepted August 29. Address correspondence to T.M. (e-mail: murakami@radiol.med.osaka-u.ac.jp).
 |
ABSTRACT |
|---|
 TOP ABSTRACT INTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
MATERIALS AND METHODS: Fifty-one patients with 96 hypervascular HCCs underwent double arterial phase imaging of the entire liver. At measured delay after intravenous administration of 2 mL/kg of contrast medium at a rate of 5 mL/sec, the early and late arterial phase images were obtained serially during a single breath hold with interscan delay of 5.0 seconds. Detector row configuration of 2.5 x 4 mm, pitch of 6, and scanning time of 10.5 seconds for each phase were used. Forty 5-mm-thick reconstruction images were obtained for each phase. Each image set was interpreted separately by three observers, who were unaware of tumor burden in the liver, to detect hypervascular HCC. Sensitivity, positive predictive value, and area below the receiver operating characteristic curve (Az) for early and late arterial phases separately and together were calculated.
RESULTS: Mean sensitivity and positive predictive value for hypervascular HCC were 54% and 85% for the early arterial phase, 78% and 83% for the late arterial phase, and 86% and 92% for the double arterial phase, respectively. Double arterial phase imaging showed significantly superior sensitivity compared with early or late arterial phase imaging alone for detecting HCC (P < .05). The mean Az value for double arterial phase was significantly higher than that for early or late arterial phase imaging alone (P < .05). Double arterial phase imaging showed the lowest number of false-positive lesions.
CONCLUSION: Double arterial phase imaging is recommended to improve detection of hypervascular HCCs and reduce false-positive lesions.
Index terms: Computed tomography (CT), helical, 761.12115 • Computed tomography (CT), technology • Liver, CT, 761.12115 • Liver neoplasms, diagnosis, 761.12115, 761.30
|
INTRODUCTION |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
The purpose of our study was to assess whether double arterial phase imaging with multi–detector row helical CT improves detection of hypervascular HCC compared with either early or late arterial phase imaging alone.
|
MATERIALS AND METHODS |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
Hypervascularity was defined as focal lesion hyperattenuation relative to liver during at least one of the two arterial phases of CT scanning. Proof of hypervascular HCC consisted of surgical resection of 18 tumors in 10 patients and 21-gauge needle biopsy of 12 tumors in 12 patients. The other lesions were confirmed by using a combination of clinical and radiologic criteria, including response to transcatheter arterial chemoembolization or progression or regression in size. For confirmatory imaging studies, the 42 patients with 96 HCCs underwent CT hepatic arteriography, CT during arterial portography with a technique previously described (13), and follow-up CT examinations performed more than 6 months later. Of the 42 patients, the 32 without surgery also underwent CT after arterial administration of iodized oil, with a technique previously described (13). The other nine patients without HCC underwent follow-up CT more than 6 months later.
The CT scanner (LightSpeed QX/i; GE Yokogawa Medical Systems, Tokyo, Japan) detector configuration was 2.5 x 4 mm in the interspaced high-speed mode, in which four interspaced helical data sets are collected from eight 1.25-mm detector rows. The high-speed mode is equivalent to a pitch of 6, with the table speed set at 15-mm rotation. One rotation of the x-ray tube was 0.8 seconds. The transverse images were reconstructed and displayed as 40 sections 5 mm thick for each arterial phase set.
All patients received low osmolarity contrast medium (Omnipaque [300 mg of iodine per milliliter]; Daiichi Pharmaceutical, Tokyo, Japan) by means of a power injector (Autoenhance A-50; Nemotokyorindou, Tokyo, Japan) at a rate of 5 mL/sec through an 18- or 20-gauge plastic intravenous catheter placed in an antecubital vein. The volume of contrast medium delivered was 2 mL per kilogram of body weight, and the patient weights were 41–91 kg (mean, 59 kg). Therefore, the volume of contrast medium administered was 82–182 mL (mean, 114 mL).
The scanning delay was determined by using a test bolus of 15 mL of contrast medium at 5 mL/sec followed by acquisition of a series of single-level CT scans at low dose (120 kVp, 10 mA). The scanning location was 20 cm below the dome of the liver, and the monitoring scans were acquired every 2 seconds from 10 to 40 seconds. A cursor was placed over the abdominal aorta at this level, and the time to peak aortic enhancement was used to determine the scanning delay for the early arterial phase images.
Scanning began 20 cm below the dome of the liver, with the location determined by means of a scout digital radiograph, and proceeded in a cephalic direction for 10.5 seconds, covering a z axis distance of 20 cm. These CT images constituted the early arterial phase images. After an interscan delay of 5.0 seconds for table movement, scanning resumed from 20 cm below the dome of the liver in a cephalic direction for 10.5 seconds. These images constituted the late arterial phase images. The total acquisition time was 26 seconds and was accomplished in a single breath hold. The mean scanning delay for the early arterial phase was 19.4 seconds (range, 14.0–36.0 seconds), whereas the mean delay for the late arterial phase was 34.9 seconds (range, 29.5–51.5 seconds).
The early, late, and double (early and late arterial phases combined) arterial phase images were interpreted separately and independently by three experienced abdominal radiologists (S.T., T.K., M.T.). They knew that the patients were at risk for HCC but did not know how many, if any, HCC lesions were present in any patient. For each phase, each reader recorded the size of focal hepatic lesions and indicated for each lesion his confidence level for a diagnosis of malignant tumor. Each reader assigned one of five confidence levels as follows: 0, no lesion; 1, probably absent; 2, possibly present; 3, probably present; 4, definitely present.
To assess interobserver variability, the 
statistic for multiple readers was calculated by using the nonweighted binary statistic. Those lesions among the 96 proved HCC lesions that were assigned a confidence level of 2 or greater were considered true-positive findings. A lesion assigned a confidence level of 0 or 1 when a lesion was actually present was considered a false-negative lesion. The degree of disagreement was not factored into the calculation. A value of 0.01–0.20 was considered a slight agreement; 0.21–0.40, fair; 0.41–0.60, moderate; 0.61–0.80, substantial; and 0.81–1.00, almost perfect. Sensitivity and positive predictive values for early arterial phase alone, late arterial phase alone, and double arterial phase were also calculated. Sensitivity for each phase was compared by means of the McNemar test. A two-tailed P value less than .05 was considered significant.
For imaging for each phase, alternative–free response receiver operating characteristic (ROC) curve analysis was performed on a tumor-by-tumor basis. Although the conventional ROC method allows only one response per image, the alternative–free response ROC method allows an observer response for all of the lesions present, and we analyzed all 96 lesions in this study (14). An alternative–free response ROC curve was fitted to each reader’s confidence rating by using a maximum-likelihood estimation (ROCKIT 0.9B; Metz CE, University of Chicago, Ill, 1998). The diagnostic accuracy of imaging for each phase for each reader and their composite data was estimated by calculating the area below the ROC curve (Az). Differences between the imaging techniques in terms of the mean Az values were analyzed statistically by means of the two-tailed Student t test for paired data. A two-tailed P value less than .05 was considered significant.
|
RESULTS |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
values for the three observers, calculated on the basis of each observer’s confidence level for the ROC analysis, were 0.69 for the early arterial phase, 0.64 for the late arterial phase, and 0.76 for the combination of early and late arterial phases. The values for the three observers showed substantial agreement with regard to the presence of lesions. The detection sensitivity for tumors of two size categories (<2 or 
2 cm) and the positive predictive values of each of the three readers are shown in Table 1. Mean sensitivity and positive predictive value for hypervascular HCC were 54% and 85% for the early arterial phase, 78% and 83% for the late arterial phase, and 86% and 92% for the double arterial phase, respectively. For all three readers, double arterial phase imaging showed sensitivity significantly superior to that for the early arterial phase for depicting HCC (P < .05). The late arterial phase images showed significantly superior sensitivity compared with that for the early arterial phase images for depicting HCC (P < .05) (Figs 1, 2). Double arterial phase imaging showed sensitivity significantly superior to that for the late arterial phase for depicting HCC (P < .05) in readers 1 and 3, especially for depicting HCC less than 2 cm in diameter, although there was no statistically significant difference in sensitivities for reader 2 (Fig 3). Double arterial phase imaging showed better positive predictive values than did early or late arterial phase imaging alone, which indicates the lowest number of false-positive lesions.
|
|
|
|
|
|
Results of calculating the Az values for each phase are shown in Table 2. All three observers achieved the best performance for detection of hypervascular HCC with the double arterial phase images. The Az values for the late arterial phase images were significantly higher than those for the early arterial phase images. The Az values for the double arterial phase images were significantly higher than those for the early or late arterial phase images alone.
|
|
|
DISCUSSION |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
The advent of multi–detector row helical CT allows acquisition of two complete sets of images through the liver during a single breath hold. By controlling for patient-related variables, we were able to study the relative contributions of two separate hepatic arterial phase imaging sequences in detection of HCC. We minimized patient size as a variable by administering the contrast medium at a volume of 2 mL/kg. Cardiovascular status as a variable was controlled by using a test dose of contrast medium and acquiring a set of bolus-tracking CT scans.
As a result of this bolus-tracking technique, the scanning delays for the two arterial phases were variable, ranging from 14.0 to 36.0 seconds (mean, 19.4 seconds) for the first arterial phase and from 29.5 to 51.5 seconds (mean, 34.9 seconds) for the second. Therefore, we doubt that a standard scanning delay would reliably result in optimal timing for either arterial phase set of CT images.
Our multiple independent observer method and alternative–free response ROC measurements allowed us to measure and control for human observer performance and variability. We demonstrated good to excellent agreement among the three readers and were able to confirm a significant difference between the early and late arterial phases of hepatic CT for detection of HCC lesions.
If the late arterial phase images always were optimal, we might be able to eliminate the early arterial phase images. However, all three readers achieved greater sensitivity and positive predictive value by using both sets of images, and two readers had significantly better performance reading the double arterial phase images. We think this reflects other variables that are impossible to predict or control, namely, tumor variability and vascularity. Some hypervascular tumors become nearly isoattenuating to hepatic parenchyma during the portal venous and even during the late arterial phase (Fig 3a). Even with use of a bolus-tracking technique, some of our late arterial phase images showed substantial hepatic venous and parenchymal enhancement (Fig 3a). In addition, comparison of the early and late arterial phase images allowed us to recognize pseudolesions due to arterial-portal venous shunts (Fig 4).
We did not evaluate portal venous phase images in the study, because hypervascular tumors are usually not detected well at CT during maximum hepatic enhancement. Nevertheless, we believe that portal venous phase images should be obtained routinely in any CT evaluation in patients who are known to have or who are suspected of having primary or metastatic tumor (6–8,16). Some hypervascular tumor types may demonstrate little enhancement in individual patients, especially after treatment. In addition, the portal venous phase is usually optimal for additional characterization of hepatic tumors and demonstration of vascular anatomy and pathologic conditions.
One criticism of our study could be the lack of histologic proof for every lesion that we believe to represent HCC. However, all lesions had several confirmatory studies, such as CT hepatic arteriography, CT during arterial portography, CT after arterial infusion of iodized oil, and follow-up CT. Each of these studies, especially in combination, has been found to depict hypervascular HCC with an accuracy approaching 100%. Moreover, we were able to follow the course of most lesions over time and in response to therapy, especially transcatheter arterial chemoembolization.
Because cirrhosis markedly alters hepatic hemodynamics, we cannot predict whether the double arterial phase CT technique or timing that we used would be as effective in evaluation of hypervascular metastases to otherwise normal liver.
In conclusion, multi–detector row helical CT allows acquisition of both an early and late arterial set of hepatic images. Although the late arterial phase images reveal more hypervascular HCC lesions than do the early phase images, review of images obtained during both arterial phases yields the greatest sensitivity and positive predictive value.
|
FOOTNOTES |
|---|
Author contributions: Guarantors of integrity of entire study, H.N., T.M.; study concepts and design, T.M., T.K.; definition of intellectual content, T.M., T.K., M.P.F.; literature research, M.K., M.T.; clinical studies, S.K., S.T., K.T., K.O.; data acquisition, S.T., T.K., M.T.; data analysis, T.M., M.H.; statistical analysis, M.H.; manuscript preparation, M.K., T.M.; manuscript editing, M.P.F., T.M.; manuscript review, M.P.F.; manuscript final version approval, T.M., H.N.
|
REFERENCES |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
1.5 cm) malignant hepatic neoplasms. AJR Am J Roentgenol 1995; 164:879-884.This article has been cited by other articles:
|
|
 |
|
  X. Ma, A. E. Samir, N.-S. Holalkere, and D. V. Sahani Optimal Arterial Phase Imaging for Detection of Hypervascular Hepatocellular Carcinoma Determined by Continuous Image Capture on 16-MDCT Am. J. Roentgenol., September 1, 2008; 191(3): 772 - 777. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-J. Chung, J. S. Yu, J. H. Kim, M.-J. Kim, and K. W. Kim Nonhypervascular Hypoattenuating Nodules Depicted on Either Portal or Equilibrium Phase Multiphasic CT Images in the Cirrhotic Liver Am. J. Roentgenol., July 1, 2008; 191(1): 207 - 214. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Okada, T. Murakami, S. Kumano, I. Imaoka, T. Shimono, R. Ashikaga, and M. Hosono Comparison Between One-Route and Two-Route Injection for Liver and Aortic Enhancement Using MDCT Am. J. Roentgenol., June 1, 2008; 190(6): W323 - W326. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Willatt, H. K. Hussain, S. Adusumilli, and J. A. Marrero MR Imaging of Hepatocellular Carcinoma in the Cirrhotic Liver: Challenges and Controversies Radiology, May 1, 2008; 247(2): 311 - 330. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Yanaga, K. Awai, T. Nakaura, T. Namimoto, S. Oda, Y. Funama, and Y. Yamashita Optimal Contrast Dose for Depiction of Hypervascular Hepatocellular Carcinoma at Dynamic CT Using 64-MDCT Am. J. Roentgenol., April 1, 2008; 190(4): 1003 - 1009. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Nakaura, K. Awai, Y. Yanaga, Y. Nakayama, S. Oda, Y. Funama, and Y. Yamashita Detection of Early Enhancement of Hypervascular Hepatocellular Carcinoma Using Single Breath-Hold 3D Pixel Shift Dynamic Subtraction MDCT Am. J. Roentgenol., January 1, 2008; 190(1): W13 - W18. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. L. Chu, B. N. Joe, A. C. A. Westphalen, E. M. Webb, F. V. Coakley, and B. M. Yeh Patient-specific Time to Peak Abdominal Organ Enhancement Varies with Time to Peak Aortic Enhancement at MR Imaging Radiology, December 1, 2007; 245(3): 779 - 787. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Kim, J. M. Lee, Y. J. Kim, J. Y. Choi, G. H. Kim, H. Y. Lee, and B. I. Choi Detection of Hepatocellular Carcinoma on CT in Liver Transplant Candidates: Comparison of PACS Tile and Multisynchronized Stack Modes Am. J. Roentgenol., May 1, 2007; 188(5): 1337 - 1342. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Sultana, K. Awai, Y. Nakayama, T. Nakaura, D. Liu, M. Hatemura, Y. Funama, S. Morishita, and Y. Yamashita Hypervascular Hepatocellular Carcinomas: Bolus Tracking with a 40-Detector CT Scanner to Time Arterial Phase Imaging Radiology, April 1, 2007; 243(1): 140 - 147. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Takayasu, Y. Muramatsu, Y. Mizuguchi, T. Okusaka, K. Shimada, T. Takayama, and M. Sakamoto CT Evaluation of the progression of hypoattenuating nodular lesions in virus-related chronic liver disease. Am. J. Roentgenol., August 1, 2006; 187(2): 454 - 463. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kanematsu, S. Goshima, H. Kondo, R. Yokoyama, K. Kajita, H. Hoshi, M. Onozuka, A. Nozaki, M. Hirano, Y. Shiratori, et al. Double hepatic arterial phase MRI of the liver with switching of reversed centric and centric K-space reordering. Am. J. Roentgenol., August 1, 2006; 187(2): 464 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.-J. Kim, J. Y. Choi, J. S. Lim, J. Y. Kim, J. H. Kim, Y. T. Oh, E. H. Yoo, J. J. Chung, and K. W. Kim Optimal scan window for detection of hypervascular hepatocellular carcinomas during MDCT examination. Am. J. Roentgenol., July 1, 2006; 187(1): 198 - 206. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Goshima, M. Kanematsu, H. Kondo, R. Yokoyama, T. Miyoshi, H. Nishibori, H. Kato, H. Hoshi, M. Onozuka, and N. Moriyama MDCT of the liver and hypervascular hepatocellular carcinomas: optimizing scan delays for bolus-tracking techniques of hepatic arterial and portal venous phases. Am. J. Roentgenol., July 1, 2006; 187(1): W25 - W32. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Schima, R. Hammerstingl, C. Catalano, L. Marti-Bonmati, E. J. Rummeny, F. T. Montero, A. Dirisamer, B. Westermayer, M. Bellomi, D. Brisbois, et al. Quadruple-phase MDCT of the liver in patients with suspected hepatocellular carcinoma: effect of contrast material flow rate. Am. J. Roentgenol., June 1, 2006; 186(6): 1571 - 1579. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Ichikawa, H. Nakajima, A. Nanbu, M. Hori, and T. Araki Effect of Injection Rate of Contrast Material on CT of Hepatocellular Carcinoma. Am. J. Roentgenol., May 1, 2006; 186(5): 1413 - 1418. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. T. Johnson and E. K. Fishman IV Contrast Selection for MDCT: Current Thoughts and Practice Am. J. Roentgenol., February 1, 2006; 186(2): 406 - 415. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. K. Kim, C. S. Kim, G. H. Chung, Y.-M. Han, S. Y. Lee, S. B. Chon, and J. M. Lee Comparison of Gadobenate Dimeglumine-Enhanced Dynamic MRI and 16-MDCT for the Detection of Hepatocellular Carcinoma Am. J. Roentgenol., January 1, 2006; 186(1): 149 - 157. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. K. Kim, H. S. Kwak, C. S. Kim, G. H. Chung, Y. M. Han, and J. M. Lee Hepatocellular Carcinoma in Patients with Chronic Liver Disease: Comparison of SPIO-enhanced MR Imaging and 16-Detector Row CT Radiology, December 21, 2005; (2005) 2381042193. [Abstract] [Full Text]
|
|
|
|
|
|
Y. Funama, K. Awai, Y. Nakayama, K. Kakei, N. Nagasue, M. Shimamura, N. Sato, S. Sultana, S. Morishita, and Y. Yamashita Radiation Dose Reduction without Degradation of Low-Contrast Detectability at Abdominal Multisection CT with a Low-Tube Voltage Technique: Phantom Study Radiology, December 1, 2005; 237(3): 905 - 910. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Yagyu, K. Awai, M. Inoue, R. Watai, T. Sano, H. Hasegawa, and Y. Nishimura MDCT of Hypervascular Hepatocellular Carcinomas: A Prospective Study Using Contrast Materials with Different Iodine Concentrations Am. J. Roentgenol., May 1, 2005; 184(5): 1535 - 1540. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Kim, D. Choi, S. H. Kim, J. H. Lim, W. J. Lee, M. J. Kim, H. K. Lim, and S. J. Lee Ferucarbotran-Enhanced MRI Versus Triple-Phase MDCT for the Preoperative Detection of Hepatocellular Carcinoma Am. J. Roentgenol., April 1, 2005; 184(4): 1069 - 1076. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y.-Y. Yau, W.-S. Chan, Y.-M. Tam, P. Vernon, S. Wong, M. Coel, and S. K.-F. Chu Application of Intravenous Contrast in PET/CT: Does It Really Introduce Significant Attenuation Correction Error? J. Nucl. Med., February 1, 2005; 46(2): 283 - 291. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Mori, H. Yoshioka, N. Takahashi, M. Yamaguchi, T. Ueno, T. Yamaki, and Y. Saida Triple Arterial Phase Dynamic MRI with Sensitivity Encoding for Hypervascular Hepatocellular Carcinoma: Comparison of the Diagnostic Accuracy Among the Early, Middle, Late, and Whole Triple Arterial Phase Imaging Am. J. Roentgenol., January 1, 2005; 184(1): 63 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Seror, G. N'Kontchou, D. Haddar, M. Dordea, Y. Ajavon, N. Ganne, J. C. Trinchet, M. Beaugrand, and N. Sellier Large Infiltrative Hepatocellular Carcinomas: Treatment with Percutaneous Intraarterial Ethanol Injection Alone or in Combination with Conventional Percutaneous Ethanol Injection Radiology, January 1, 2005; 234(1): 299 - 309. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Ito, T. Fujita, A. Shimizu, S. Koike, K. Sasaki, N. Matsunaga, S. Hibino, and M. Yuhara Multiarterial Phase Dynamic MRI of Small Early Enhancing Hepatic Lesions in Cirrhosis or Chronic Hepatitis: Differentiating Between Hypervascular Hepatocellular Carcinomas and Pseudolesions Am. J. Roentgenol., September 1, 2004; 183(3): 699 - 705. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. H. Y. Lee, M. E. O'Malley, M. A. Haider, and A. Hanbidge Triple-Phase MDCT of Hepatocellular Carcinoma Am. J. Roentgenol., March 1, 2004; 182(3): 643 - 649. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Awai, K. Hiraishi, and S. Hori Effect of Contrast Material Injection Duration and Rate on Aortic Peak Time and Peak Enhancement at Dynamic CT Involving Injection Protocol with Dose Tailored to Patient Weight Radiology, January 1, 2004; 230(1): 142 - 150. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. A. S. Ianora, M. Memeo, C. Sabba, A. Cirulli, A. Rotondo, and G. Angelelli Hereditary Hemorrhagic Telangiectasia: Multi-Detector Row Helical CT Assessment of Hepatic Involvement Radiology, January 1, 2004; 230(1): 250 - 259. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Murakami, T. Kim, M. Hori, and M. P. Federle Double Arterial Phase Multi-Detector Row Helical CT for Detection of Hypervascular Hepatocellular Carcinoma [letter] Radiology, December 1, 2003; 229(3): 931 - 932. [Full Text] [PDF]
|
|
|
|
|
|
J. L. Fidler, J. G. Fletcher, C. C. Reading, J. C. Andrews, G. B. Thompson, C. S. Grant, and F. J. Service Preoperative Detection of Pancreatic Insulinomas on Multiphasic Helical CT Am. J. Roentgenol., September 1, 2003; 181(3): 775 - 780. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.-J. Kim, J. H. Kim, J.-J. Chung, M. S. Park, J. S. Lim, and Y. T. Oh Focal Hepatic Lesions: Detection and Characterization with Combination Gadolinium- and Superparamagnetic Iron Oxide-enhanced MR Imaging Radiology, September 1, 2003; 228(3): 719 - 726. [Abstract] [Full Text] [PDF]
|
|
|
|
|
