Murakami Takamichi, Kim Tonsok, Kawata Syuji, Kanematsu Masayuki, Federle Michael P, Hori Masatoshi, Okada Atsuya, Kumano Seishi, Sugihara Eiji, Tomoda Kaname, Nakamura Hironobu
Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan.
Invest Radiol. 2003 Aug;38(8):497-503. doi: 10.1097/01.rli.0000074584.12494.e3.
We evaluated the optimal timing of arterial phase imaging for detection of hypervascular hepatocellular carcinoma by using triple arterial phase imaging with multidetector-row helical computed tomography.
Forty-nine patients with 90 hypervascular hepatocellular carcinomas (3 to 50 mm in diameter; mean, 18.7 mm) underwent triple arterial phase imaging of the whole liver using a multidetector-row helical computed tomography. At 20 seconds, 30 seconds, and 40 seconds after intravenous administration of 100 mL of 300 mgI/mL of nonionic contrast medium at a rate of 4 mL/s, early, middle, and late arterial phase images were obtained serially during a single breath-hold with an interscan delay of 5 seconds. Detector-row configurations of 4 mm x 4, scan pitch of 5.5, and scan time of 5 seconds for each phase were used. Forty prospective reconstruction images of 5-mm thickness for each phase were obtained. The images from each phase were interpreted separately for detection of hypervascular hepatocellular carcinoma by 3 observers independently who were unaware of tumor burden in the liver. Sensitivity, positive predictive value, and area under the receiver operating characteristic curve values for each arterial phase were calculated and compared statistically.
The mean sensitivity and positive predictive values for hypervascular hepatocellular carcinoma diagnosis of blind readers were 37% and 87% for the early arterial phase, 73% and 85% for the middle arterial phase, and 49% and 81% for the late arterial phase, respectively. The middle arterial phase imaging showed significantly superior sensitivity compared with the early and late arterial phase for detecting hepatocellular carcinoma (P < 0.05). Mean area under the receiver operating characteristic curve value of the middle arterial phase imaging (0.84) was significantly higher that that of the early (0.56) or late arterial phase (0.62; P < 0.05).
If a single arterial phase is used for diagnosis of hypervascular hepatocellular carcinoma, the middle phase (delay time of 30 seconds) is optimal.
我们通过使用多排螺旋计算机断层扫描的三期动脉期成像，评估检测高血供肝细胞癌的动脉期成像的最佳时机。
49例患有90个高血供肝细胞癌（直径3至50毫米；平均18.7毫米）的患者接受了使用多排螺旋计算机断层扫描对全肝进行的三期动脉期成像。以4毫升/秒的速率静脉注射100毫升300毫克碘/毫升的非离子型对比剂后20秒、30秒和40秒，在单次屏气期间以5秒的扫描间隔连续获取早期、中期和晚期动脉期图像。使用4毫米×4的探测器排配置、5.5的扫描螺距以及每个期相5秒的扫描时间。每个期相获得40幅5毫米厚的前瞻性重建图像。由3名独立的观察者分别解读各期相的图像以检测高血供肝细胞癌，这些观察者不知道肝脏中的肿瘤负荷。计算并统计比较各动脉期的敏感性、阳性预测值和受试者操作特征曲线下面积值。
盲法阅片者对高血供肝细胞癌诊断的平均敏感性和阳性预测值在早期动脉期分别为37%和87%，中期动脉期分别为73%和85%，晚期动脉期分别为49%和81%。中期动脉期成像在检测肝细胞癌方面显示出比早期和晚期动脉期显著更高的敏感性（P < 0.05）。中期动脉期成像的平均受试者操作特征曲线下面积值（0.84）显著高于早期（0.56）或晚期动脉期（0.62；P < 0.05）。
如果使用单一动脉期诊断高血供肝细胞癌，中期（延迟时间30秒）是最佳的。
