Hepatic Parenchymal Enhancement during Triple-Phase Helical CT: Can It Be Used to Predict Which Patients with Breast Cancer Will Develop Hepatic Metastases?

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Abstract
To evaluate the efficacy of hepatic enhancement characteristics for identification of patients with breast cancer who are at risk for future hepatic metastases. Triple-phase helical computed tomography (CT) was performed in 60 patients with known breast cancer without visible hepatic metastases. Peak hepatic attenuation and enhancement, and attenuation and enhancement at 25 and 30 seconds were obtained. Ratios of hepatic attenuation or enhancement at 25 and 30 seconds to peak hepatic attenuation or enhancement were calculated. A Wilcoxon rank sum test was used to compare patients with and those without subsequent hepatic metastases. During a mean 18-month follow-up, 18 patients (30%) developed hepatic metastases. Decreases in peak hepatic attenuation and enhancement and increases in hepatic attenuation and enhancement ratios at 25 and 30 seconds were seen in patients who developed metastases compared with those who did not (P < .05). When corrected for chemotherapy interval, these differences were not statistically significant. Using a threshold value of 0.40 or more for the enhancement ratio at 30 seconds resulted in sensitivity of 28%, specificity of 92%, and accuracy of 55%. Patients with breast cancer who develop subsequent hepatic metastases have higher relative hepatic arterial perfusion during triple-phase CT; however, after correction for chemotherapy interval, this difference was not statistically significant. Threshold values cannot be used reliably to identify patients who will develop metastases.