Combination of CT during arterial portography and double-phase CT hepatic arteriography with multi-detector row helical CT for evaluation of hypervascular hepatocellular carcinoma

Tsurusaki, M.; Sugimoto, K.; Fujii, M.; Fukuda, T.; Matsumoto, S.; Sugimura, K.

doi:10.1016/j.crad.2007.05.005

« Previous Next »Clinical Radiology
Volume 62, Issue 12 , Pages 1189-1197, December 2007

Combination of CT during arterial portography and double-phase CT hepatic arteriography with multi-detector row helical CT for evaluation of hypervascular hepatocellular carcinoma

M. Tsurusaki
- Department of Radiology, Kobe University, Graduate School of Medicine, Kobe, Japan
- Guarantor and correspondent: M. Tsurusaki, Department of Radiology, Kobe University, Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo-ku, Kobe 650-0017, Japan. Tel.: +81 78 382 6104; fax: +81 78 382 6129.
- Current address: 101-U Copperline Dr, Chapel Hill, NC 27516-0412, USA.
K. Sugimoto
- Department of Radiology, Kobe University, Graduate School of Medicine, Kobe, Japan
M. Fujii
- Department of Radiology, Kobe University, Graduate School of Medicine, Kobe, Japan
T. Fukuda
- Department of Radiology, Kobe University, Graduate School of Medicine, Kobe, Japan
S. Matsumoto
- Department of Radiology, Tenri Hospital, Tenri City, Japan
K. Sugimura
- Department of Radiology, Kobe University, Graduate School of Medicine, Kobe, Japan

Received 18 July 2006; received in revised form 3 May 2007; accepted 22 May 2007.

Aim

To evaluate the diagnostic accuracy of the combination of computed tomography (CT) during arterial portography (CTAP) and double-phase CT hepatic arteriography (CTHA) with multidetector-row CT (MDCT) for the evaluation of hepatocellular carcinomas (HCCs) in patients with cirrhosis.

Materials and methods

The combination of CTAP and double-phase CTHA was performed on 46 patients with 54 nodular HCCs. Three readers reviewed the images obtained with CTAP alone, first-phase CTHA alone, double-phase CTHA, and the combination of CTAP and double-phase CTHA. The review of the images was conducted on a segment-by-segment basis, with 368 hepatic segments, including 50 segments with 54 HCCs, reviewed for detection of HCCs with the aid of a five-point confidence scale. Diagnostic accuracy was evaluated by comparing the receiver-operating characteristic (ROC) analysis results.

Results

The sensitivity for detecting HCCs was significantly higher with either double-phase CTHA or the combination of CTAP and double-phase CTHA than with first-phase CTHA alone (90 and 93 versus 85%, respectively, p<0.01). The specificity for detecting HCCs was significantly higher with the combination of CTAP and double-phase CTHA than with CTAP alone (97 and 94%, respectively, p<0.01). The positive predictive values for detecting HCCs were significantly higher with double-phase CTHA than with first-phase CTHA alone (86 and 82%, respectively, p<0.05). The area under the ROC curve (Az) values were significantly higher with the combination of CTAP and double-phase CTHA (0.983) than with first-phase CTHA alone (0.959; p<0.05).