Goshima Satoshi, Kanematsu Masayuki, Kondo Hiroshi, Yokoyama Ryujiro, Miyoshi Toshiharu, Nishibori Hironori, Kato Hiroki, Hoshi Hiroaki, Onozuka Minoru, Moriyama Noriyuki
Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
AJR Am J Roentgenol. 2006 Jul;187(1):W25-32. doi: 10.2214/AJR.04.1878.
The purpose of our study was to determine the optimal scan delays required for hepatic arterial and portal venous phase imaging and for the detection of hypervascular hepatocellular carcinomas (HCCs) in contrast-enhanced MDCT of the liver using a bolus-tracking program.
CT images (2.5-mm collimation, 5-mm thickness with no intersectional gap) detected an increase in the CT value of 50 H in the lower thoracic aorta. The images were obtained after an IV bolus injection of 2 mL/kg of nonionic iodine contrast material (300 mg I/mL) at 4 mL/s in 171 patients, who were prospectively randomized into three groups with scans commencing at 5, 20, and 45 seconds; 10, 25, and 50 seconds; and 15, 30, and 55 seconds for the first (acquisition time: 4.3 seconds), second (4.3 seconds), and third (9.1 seconds) phases, respectively, after a bolus-tracking program. CT values of the aorta, spleen, proximal portal veins, liver parenchyma, and hepatic veins were measured. Increases in CT values from unenhanced to contrast-enhanced CT were assessed using a contrast enhancement index (CEI). Spleen-to-liver and HCC-to-liver contrasts were also assessed. A qualitative degree of contrast enhancement in each organ was prospectively assessed by two independent radiologists.
At 10-15 seconds, the CEI of the aorta reached 300-336 H and that of the spleen reached 97-108 H without significant enhancement of liver parenchyma (15-25 H). The CEI of the proximal portal veins moderately increased (75-104 H) at 10-15 seconds, but no significant enhancement of hepatic veins was observed (24-51 H). The CEI of liver parenchyma peaked (59-63 H) at 45-55 seconds, when the CEIs of the aorta (117-125 H) and spleen (73-82 H) decreased. Spleen-to-liver contrast (81-84 H) was highest at 10-20 seconds and HCC-to-liver contrast (39-44 H) was highest at 10-15 seconds. The qualitative results correlated well with quantitative results.
The optimal scan delays for hepatic arterial and portal venous phases after the bolus-tracking program detected threshold enhancement by 50 H in the lower thoracic aorta for the detection of hypervascular HCCs were 10-15 and 45-55 seconds, respectively.
我们研究的目的是通过团注追踪程序确定肝脏对比增强MDCT中肝动脉期和门静脉期成像以及检测高血供肝细胞癌（HCC）所需的最佳扫描延迟时间。
CT图像（准直2.5mm，层厚5mm且无层间间隙）检测到胸主动脉下段CT值增加50H。171例患者经静脉团注2mL/kg非离子型碘对比剂（300mgI/mL），注射速率为4mL/s，之后前瞻性随机分为三组，分别在团注追踪程序启动后的第1阶段（采集时间：4.3秒）、第2阶段（4.3秒）和第3阶段（9.1秒）的5、20和45秒；10、25和50秒；以及15、30和55秒开始扫描。测量主动脉、脾脏、门静脉近端、肝实质和肝静脉的CT值。使用对比增强指数（CEI）评估从平扫CT到对比增强CT的CT值增加情况。还评估了脾肝对比和HCC肝对比。两位独立的放射科医生前瞻性地评估了每个器官对比增强的定性程度。
在10 - 15秒时，主动脉的CEI达到300 - 336H，脾脏的CEI达到97 - 108H，而肝实质无明显增强（15 - 25H）。门静脉近端的CEI在10 - 15秒时适度增加（75 - 104H），但肝静脉无明显增强（24 - 51H）。肝实质的CEI在45 - 55秒时达到峰值（59 - 63H），此时主动脉（117 - 125H）和脾脏（73 - 82H）的CEI下降。脾肝对比（81 - 84H）在10 - 20秒时最高，HCC肝对比（39 - 44H）在10 - 15秒时最高。定性结果与定量结果相关性良好。
团注追踪程序后，检测高血供HCC时胸主动脉下段CT值阈值增强50H的肝动脉期和门静脉期最佳扫描延迟时间分别为10 - 15秒和45 - 55秒。
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