Evaluation of Scan-Initiating Techniques of Arterial Phase in CT Triple-Phase Liver Scan in Patients with Hepatocellular Carcinomas
Keywords:
triple- phase CT, arterial phase, fixed time delay, bolus trackingAbstract
Background and objectives: The methods of initiating arterial (A) phase scans in triple- phase CT of abdomen (liver ) in patients with hepatocellular carcinomas (HCCs) are important. Starting a scan at the right time will clearly reveal the extent of the diseases. This study evaluated the A phase scanning initiation techniques in comparison between bolus tracking (BT) and fixed time delay (FTD) techniques.
Methods: A qualitative study was performed by questionnaires asking opinions of 9 radiologists, with 8 radiologists responded on CT triple- phase liver images quality. And a retrospective study was done to review CT images of A phase scanning by BT and FTD techniques of patients with HCCs on radiographic database, 100 cases per group. The images obtained by 128- slice MDCT scanner, with IV contrast media 555 mg I/kg body weight, contrast injection rate 1.8- 2.5 ml/sec, FTD technique started scanning at 30-45 seconds after contrast media administration. CT number (HU) measurements were done at aorta, portal vein and liver parenchyma, presented value as percent, range and mean (SD).
Results: Radiologists had a high level of satisfaction on the triple phase liver CT images (4/5), but the A phase images were uneven, subtle enhancement, and started scanning too early. The retrospective study showed that A phase images of both methods yielded indifferent aortic attenuation. Liver enhancement of FTD technique (15.48±9.66 HU) was significantly higher than that of BT technique (12.11±7.70 HU), p <0.01 by t-test. The mean scan- initiating time of the BT technique was 35.5 ± 5.9 (24-51) sec. The A phase images of both techniques were mostly under criteria standards, with 20-30 HU liver enhancement being only 27% and 17% among the groups FTD and BT, respectively.
Conclusion: The initiation of the A phase scan in triple- phase CT of the liver in patients with HCCs by both techniques yielded mostly suboptimal enhancement images and should be improved.
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