Kim Tonsok, Murakami Takamichi, Hori Masatoshi, Takamura Manabu, Takahashi Satoru, Okada Atsuya, Kawata Shuji, Cruz Modesto, Federle Michael P, Nakamura Hironobu
Department of Radiology, D1 Osaka University Medical School, 2-2 Yamadaoka, Suita City, Osaka 565-0871, Japan.
AJR Am J Roentgenol. 2002 Apr;178(4):899-904. doi: 10.2214/ajr.178.4.1780899.
The purpose of this study was to evaluate the usefulness of double arterial phase CT for the detection of small hypervascular hepatocellular carcinomas, using an automated bolus-tracking technique to initiate the hepatic arterial phase CT.
Double arterial and late phase contrast-enhanced helical CT scans were obtained on 287 consecutive patients suspected of having hepatocellular carcinoma. These included 56 patients with 90 small (< or 3 cm) hepatocellular carcinomas and 50 patients with no hepatocellular carcinomas. CT scans of these patients were interpreted by three reviewers. The first arterial phase scan was initiated automatically 10 sec after the bolus-tracking program detected the threshold enhancement of 50 H in the abdominal aorta. Three reviewers interpreted the late phase CT scans in combination with the first, second, or both hepatic arterial phases. Measures of the reviewers' detection of hepatocellular carcinoma included analysis of interobserver variation, sensitivity, specificity, and area under receiver operating characteristic curve (A(z)).
The time elapsed from bolus initiation to threshold aortic enhancement ranged from 10 to 24 sec (mean, 13 sec), resulting in initiation of the first arterial phase CT scan from 20 to 34 sec (mean, 23 sec). The combination of late phase CT and both first and second arterial phase images showed significantly better performance than the combination of the late phase and either the first or second arterial phases, although the difference was most evident in comparison with the combination of second arterial and late phases.
An automated bolus-tracking program can be used to optimize the timing of hepatic arterial phase CT. Multiphasic CT performed using this technique is useful in detection of small hepatocellular carcinoma.
本研究旨在评估双动脉期CT在检测小的富血供肝细胞癌方面的有效性，采用自动团注追踪技术启动肝动脉期CT扫描。
对287例疑诊肝细胞癌的连续患者进行双动脉期和延迟期对比增强螺旋CT扫描。其中包括56例患有90个小（≤3 cm）肝细胞癌的患者和50例无肝细胞癌的患者。三位阅片者对这些患者的CT扫描结果进行解读。在团注追踪程序检测到腹主动脉强化阈值达到50 H后10秒自动启动首次动脉期扫描。三位阅片者结合首次、第二次或两次肝动脉期图像对延迟期CT扫描结果进行解读。阅片者对肝细胞癌的检测指标包括观察者间差异分析、敏感性、特异性以及受试者操作特征曲线下面积（A(z)）。
从团注开始到主动脉强化达到阈值的时间为10至24秒（平均13秒），从而使首次动脉期CT扫描在20至34秒（平均23秒）启动。延迟期CT与首次和第二次动脉期图像相结合的表现明显优于延迟期与首次或第二次动脉期图像相结合的表现，尽管与第二次动脉期和延迟期图像相结合相比差异最为明显。
自动团注追踪程序可用于优化肝动脉期CT扫描的时机。采用该技术进行的多期CT扫描有助于检测小肝细胞癌。
