title: Does iodine concentration affect the diagnostic efficacy of biphasic spiral CT in patients with hepatocellular carcinoma?
abstract: BACKGROUND
  We investigated the effect of iodinated contrast medium concentration on increased neoplastic lesion enhancement and its direct relation to diagnostic efficacy in biphasic spiral computed tomography for detection of hepatocellular carcinoma.
  
  
  METHODS
  A pilot, single-center, randomized, double-blind, crossover, comparative study was performed and included 22 participants. Each patient underwent two separate biphasic contrast-enhanced spiral computed tomographic examinations. Scans were performed with iomeprol containing 400 (iomeprol 400) or 300 (iomeprol 300) mg of iodine per milliliter (Iomeron, Bracco Imaging SpA, Milan, Italy) with a 2- to 12-day window scan; patients were given an equal total dose of 45 g of iodine at a fixed injection rate of 4 mL/s. Comparison included assessment of quantitative and qualitative parameters.
  
  
  RESULTS
  Lesion density and lesion-to-liver contrast increased more markedly with the higher concentration of contrast medium during the arterial phase (p = 0.0016 and 0.0005, respectively). There was no significant difference in any parameter between the two concentrations during the portal phase. Number of lesions detected during the arterial phase increased from 37 with iomeprol 300 to 42 with iomeprol 400; in the portal phase, the respective numbers were 34 and 36.
  
  
  CONCLUSIONS
  Even though a small number of patients was examined, our study suggests that, in patients with cirrhosis, an increased concentration of iodine improves liver-to-lesion contrast and may improve the detection of hepatocellular carcinoma.
authors.affiliation: National Cancer Institute, Via Venezian 1, 20123 Milan, Italy. alfonso.marchiano@istitutotumori.mi.it
authors.forename: A
authors.initials: A
authors.lastname: Marchianò
authors.forename: C
authors.initials: C
authors.lastname: Spreafico
authors.forename: R
authors.initials: R
authors.lastname: Lanocita
authors.forename: L
authors.initials: L
authors.lastname: Frigerio
authors.forename: G
authors.initials: G
authors.lastname: Di Tolla
authors.forename: G
authors.initials: G
authors.lastname: Patelli
authors.forename: F
authors.initials: F
authors.lastname: Garbagnati
authors.forename: F
authors.initials: F
authors.lastname: Heiman
authors.forename: P
authors.initials: P
authors.lastname: Taroni
authors.forename: B
authors.initials: B
authors.lastname: Damascelli
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D036542:Tomography, Spiral Computed / Q000379:methods
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol