title: Hepatocellular carcinoma: role of unenhanced and delayed phase multi-detector row helical CT in patients with cirrhosis.
abstract: OBJECTIVE
  To determine, by using multi-detector row helical computed tomography (CT), the added value of obtaining unenhanced and delayed phase scans in addition to biphasic (hepatic arterial and portal venous phases) scans in the detection of hepatocellular carcinoma (HCC) in patients with cirrhosis.
  
  
  METHODS
  Local ethical committee approval and patient consent were obtained. One hundred ninety-five patients (129 men, 66 women; mean age, 61 years; age range, 39-78 years) with 250 HCCs underwent multi-detector row helical CT of the liver. A quadruple-phase protocol that included unenhanced, hepatic arterial, portal venous, and delayed phases was performed. Analysis of images from hepatic arterial and portal venous phases combined, hepatic arterial and portal venous phases with the unenhanced phase, hepatic arterial and portal venous phases with the delayed phase, and all phases combined was performed separately by three independent radiologists. Relative sensitivity, positive predictive value, and area under the receiver operating characteristic curve (A(z)) were calculated for each reading session.
  
  
  RESULTS
  Mean sensitivity and positive predictive values, respectively, for HCC detection were 88.8% (666 of 750 readings) and 97.8% (666 of 681 readings) for the combined hepatic arterial and portal venous phases, 89.2% (669 of 750 readings) and 97.8% (669 of 684 readings) for hepatic arterial and portal venous phases with the unenhanced phase, 92.8% (696 of 750 readings) and 97.3% (696 of 715 readings) for hepatic arterial and portal venous phases with the delayed phase, and 92.8% (696 of 750 readings) and 97.3% (696 of 715 readings) for all four phases combined. The reading sessions in which delayed phase images were available for interpretation showed significantly (P < .05) superior sensitivity and A(z) values.
  
  
  CONCLUSIONS
  Unenhanced phase images are not effective for HCC detection. Because of the significant increase in HCC detection, a delayed phase can be a useful adjunct to biphasic CT in patients at risk for developing HCC.
authors.affiliation: Department of Radiological Sciences, University of Rome La Sapienza, Policlinico Umberto I, Rome, Italy. r_iannaccone@yahoo.it
authors.forename: Riccardo
authors.initials: R
authors.lastname: Iannaccone
authors.forename: Andrea
authors.initials: A
authors.lastname: Laghi
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.forename: Plinio
authors.initials: P
authors.lastname: Rossi
authors.forename: Filippo
authors.initials: F
authors.lastname: Mangiapane
authors.forename: Takamichi
authors.initials: T
authors.lastname: Murakami
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Hori
authors.forename: Francesca
authors.initials: F
authors.lastname: Piacentini
authors.forename: Italo
authors.initials: I
authors.lastname: Nofroni
authors.forename: Roberto
authors.initials: R
authors.lastname: Passariello
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods*