title: Combination of CT during arterial portography and double-phase CT hepatic arteriography with multi-detector row helical CT for evaluation of hypervascular hepatocellular carcinoma.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of the combination of computed tomography (CT) during arterial portography (CTAP) and double-phase CT hepatic arteriography (CTHA) with multidetector-row CT (MDCT) for the evaluation of hepatocellular carcinomas (HCCs) in patients with cirrhosis.
  
  
  METHODS
  The combination of CTAP and double-phase CTHA was performed on 46 patients with 54 nodular HCCs. Three readers reviewed the images obtained with CTAP alone, first-phase CTHA alone, double-phase CTHA, and the combination of CTAP and double-phase CTHA. The review of the images was conducted on a segment-by-segment basis, with 368 hepatic segments, including 50 segments with 54 HCCs, reviewed for detection of HCCs with the aid of a five-point confidence scale. Diagnostic accuracy was evaluated by comparing the receiver-operating characteristic (ROC) analysis results.
  
  
  RESULTS
  The sensitivity for detecting HCCs was significantly higher with either double-phase CTHA or the combination of CTAP and double-phase CTHA than with first-phase CTHA alone (90 and 93 versus 85%, respectively, p<0.01). The specificity for detecting HCCs was significantly higher with the combination of CTAP and double-phase CTHA than with CTAP alone (97 and 94%, respectively, p<0.01). The positive predictive values for detecting HCCs were significantly higher with double-phase CTHA than with first-phase CTHA alone (86 and 82%, respectively, p<0.05). The area under the ROC curve (Az) values were significantly higher with the combination of CTAP and double-phase CTHA (0.983) than with first-phase CTHA alone (0.959; p<0.05).
  
  
  CONCLUSIONS
  The combination of CTAP and double-phase CTHA with MDCT significantly enhances the detection of HCC.
authors.affiliation: Department of Radiology, Kobe University, Graduate School of Medicine, Chuo-ku, Kobe, Japan. mtsuru@dk2.so-net.ne.jp
authors.forename: M
authors.initials: M
authors.lastname: Tsurusaki
authors.forename: K
authors.initials: K
authors.lastname: Sugimoto
authors.forename: M
authors.initials: M
authors.lastname: Fujii
authors.forename: T
authors.initials: T
authors.lastname: Fukuda
authors.forename: S
authors.initials: S
authors.lastname: Matsumoto
authors.forename: K
authors.initials: K
authors.lastname: Sugimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011172:Portography / Q000379:methods; D012372:ROC Curve; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods