title: Comparison of unenhanced, hepatic arterial-dominant, and portal venous-dominant phase helical CT for the detection of liver metastases in women with breast carcinoma.
abstract: OBJECTIVE
  The purpose of this study was to evaluate triple-phase helical CT for detection of hepatic metastases from breast carcinoma.
  
  
  METHODS
  Breast cancer patients were studied prospectively with triple-phase helical CT in 300 consecutive examinations. Hepatic arterial-dominant and portal venous-dominant phase scans were initiated at 20 and 65 sec, respectively, after IV injection of 175 ml of iopamidol (30 mg/ml) at 5 ml/sec. Three independent observers each reviewed 200 cases of the portal venous-dominant phase for lesion number, conspicuity, and attenuation. Subsequently, portal venous-dominant phase images were reevaluated in conjunction with hepatic arterial-dominant phase or unenhanced images.
  
  
  RESULTS
  Hepatic metastases were identified in 79 (26%) of 300 cases. Lesions detected on portal venous-dominant, hepatic arterial-dominant, and unenhanced images were as follows: observer 1, n = 198, 164, and 171; observer 2, n = 254, 233, and 233; and observer 3, n = 291, 270, and 276 (p > .05). The mean total lesion count was 387, with more lesions detected on portal venous-dominant phase than on either hepatic arterial-dominant phase or unenhanced images (p < .001 and p < .0001, respectively). For individual observers, 10-26% of lesions were hypervascular on hepatic arterial-dominant phase images. Two to 4% of lesions were identified only on hepatic arterial-dominant phase or unenhanced images. However, in these few cases, the lesions either were false-positives or were seen in conjunction with additional metastases on portal venous-dominant images.
  
  
  CONCLUSIONS
  Routine use of triple-phase CT in patients with breast carcinoma may not be warranted: Addition of the hepatic arterial-dominant phase or unenhanced images revealed few additional lesions in our group of 300 patients.
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: D H
authors.initials: DH
authors.lastname: Sheafor
authors.forename: M G
authors.initials: MG
authors.lastname: Frederick
authors.forename: E K
authors.initials: EK
authors.lastname: Paulson
authors.forename: M T
authors.initials: MT
authors.lastname: Keogan
authors.forename: D M
authors.initials: DM
authors.lastname: DeLong
authors.forename: R C
authors.initials: RC
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008875:Middle Aged; D015588:Observer Variation; D011169:Portal Vein; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*