Kanematsu M, Oliver J H, Carr B, Baron R L
Department of Radiology, University of Pittsburgh Medical Center, PA 15213-2582, USA.
Radiology. 1997 Oct;205(1):75-80. doi: 10.1148/radiology.205.1.9314965.
To assess the role of helical biphasic computed tomography (CT) versus CT during arterial portography (CTAP) in the detection of hepatocellular carcinoma (HCC).
Helical biphasic CT and CTAP examinations were performed in 33 patients with biopsy-proved HCC. Three blinded radiologists retrospectively evaluated portal venous phase images, portal venous phase plus hepatic arterial phase images (helical biphasic CT), and CTAP plus portal venous phase images at separate sittings. In 23 patients with pathologic proof of total tumor burden, the readers conducted a consensus matched-pair reading to determine the sensitivity of each method.
In the 23 patients with a proved tumor burden of 100 HCC lesions, the observers detected 74 tumors on portal venous phase images, 82 tumors on hepatic arterial phase images, 87 tumors on CTAP images, 87 tumors on helical biphasic CT images, and 96 tumors on portal venous phase plus CTAP images. Hepatic arterial phase images and CTAP images, respectively, depicted 13 and 23 tumors not seen on portal venous phase images in eight (35%) and 13 (56%) of 23 patients. Ten tumors were seen on portal venous phase images but not on CTAP images owing to the presence of central tumors or segmental portal venous thrombi that obstructed the flow of contrast material to more peripheral portions of the liver.
The addition of hepatic arterial phase imaging to portal venous phase imaging (helical biphasic CT) provided an incrementally increased yield in HCC tumor detection. Helical biphasic CT should be used as the initial screening examination in patients with suspected or known HCC.
评估螺旋双期计算机断层扫描（CT）与动脉门静脉造影CT（CTAP）在检测肝细胞癌（HCC）中的作用。
对33例经活检证实为HCC的患者进行了螺旋双期CT和CTAP检查。三名不知情的放射科医生分别回顾性评估门静脉期图像、门静脉期加肝动脉期图像（螺旋双期CT）以及CTAP加门静脉期图像。在23例有肿瘤总负荷病理证据的患者中，阅片者进行了一致性配对阅读，以确定每种方法的敏感性。
在23例经证实肿瘤负荷为100个HCC病灶的患者中，观察者在门静脉期图像上检测到74个肿瘤，在肝动脉期图像上检测到82个肿瘤，在CTAP图像上检测到87个肿瘤，在螺旋双期CT图像上检测到87个肿瘤，在门静脉期加CTAP图像上检测到96个肿瘤。肝动脉期图像和CTAP图像分别在23例患者中的8例（35%）和13例（56%）中显示了13个和23个在门静脉期图像上未发现的肿瘤。由于存在中央肿瘤或节段性门静脉血栓，阻碍了对比剂向肝脏更外周部分的流动，有10个肿瘤在门静脉期图像上可见，但在CTAP图像上未见。
门静脉期成像（螺旋双期CT）增加肝动脉期成像可使HCC肿瘤检测率逐步提高。螺旋双期CT应用于疑似或已知HCC患者的初始筛查检查。
