Multidetector CT of the Liver and Hepatic Neoplasms: Effect of Multiphasic Imaging on Tumor Conspicuity and Vascular Enhancement

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Abstract
OBJECTIVE. Our aim was to determine which of three contrast-enhanced phases (early arterial, late arterial, or portal venous) was optimal for achieving maximal enhancement of the celiac artery, portal vein, and hepatic parenchyma. We also wanted to learn which phase provided the maximal tumor-to-parenchyma difference when using multidetector CT (MDCT) with fixed timing delays. MATERIALS AND METHODS. Fifty-two patients with suspected or known hepatic tumors underwent multiphasic contrast-enhanced MDCT using double arterial (early and late arterial) and venous phase acquisitions with fixed timing delays. All patients were administered 150 mL of IV contrast material at an injection rate of 4 mL/sec. Images were acquired at 20 sec for the early arterial phase, 35 sec for the late arterial phase, and 60 sec for the portal venous phase. Attenuation measurements of the celiac artery, portal vein, normal hepatic parenchyma, and the hepatic tumor were compared. Three reviewers independently and subjectively rated tumor conspicuity for each of the three phases. Ratings were compared using kappa statistics. RESULTS. Late arterial phase images showed maximal celiac axis attenuation, whereas portal venous phase images revealed the highest portal vein and normal hepatic parenchymal attenuation. Maximal tumor-to-parenchyma differences for hypovascular tumors was superior in the portal venous phase, but we found no significant differences in maximal tumor-to-parenchyma differences for hypervascular tumors among the evaluated phases. On subjective analysis, interobserver agreement was moderate to very good for the three phases. All three reviewers graded both hypovascular and hypervascular tumor conspicuity as superior in either the late arterial phase or the portal venous phase in most patients. In only one patient was the early arterial phase graded as superior to the late arterial and portal venous phases (by two of the three reviewers). CONCLUSION. When MDCT of the liver is performed using fixed timing delays, maximal vascular and hepatic parenchymal enhancement is achieved on either late arterial phase or portal venous phase imaging. In most patients, early arterial phase imaging does not improve tumor conspicuity by either quantitative or subjective analysis.