title: Depiction of hypervascular hepatocellular carcinoma with 64-MDCT: comparison of moderate- and high-concentration contrast material with and without saline flush.
abstract: OBJECTIVE
  The purpose of this study was to evaluate prospectively the depiction of hypervascular hepatocellular carcinoma on 64-MDCT scans obtained with contrast agents of varying iodine concentrations administered with and without saline flush.
  
  
  METHODS
  The study included 149 patients, among whom 36 patients with hypervascular hepatocellular carcinoma were identified. Patients were randomly assigned to one of three protocols: A, contrast material of 300 mg I/mL; B, 370 mg I/mL; C, 370 mg I/mL plus saline flush. In all protocols, the same iodine load per kilogram of body weight (516 mg/kg) was administered for the same injection duration (30 seconds). Enhancement values in the aorta, liver, and portal vein and tumor-liver contrast were measured at multiphase CT.
  
  
  RESULTS
  Aortic enhancement was significantly different between protocols A and B (p = 0.04, p < 0.0001) and protocols B and C (p = 0.02, p < 0.001) in the first and second phases. Portal venous enhancement was significantly different between protocols B and C (p = 0.02) in the first phase and between protocols B and C and protocols A and C (p < 0.01, p = 0.02) in the second phase. Tumor-liver contrast was significantly different between protocols A and B (p = 0.03, p = 0.02) and protocols B and C (p = 0.03, p = 0.04) in the first and second phases but not between protocols A and C. There was no significant difference in hepatic enhancement among the three protocols.
  
  
  CONCLUSIONS
  Use of moderate concentration was more effective than use of a high concentration of contrast material for depiction of hepatocellular carcinoma. Adding a saline flush to the high-concentration protocol eliminated the difference in depiction of hepatocellular carcinoma between the moderate- and high-concentration protocols.
authors.affiliation: Department of Radiology, Kanazawa Medical University, Daigaku 1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan. m-matoba@kanazawa-med.ac.jp
authors.forename: Munetaka
authors.initials: M
authors.lastname: Matoba
authors.forename: Masataka
authors.initials: M
authors.lastname: Kitadate
authors.forename: Tamaki
authors.initials: T
authors.lastname: Kondou
authors.forename: Hajime
authors.initials: H
authors.lastname: Yokota
authors.forename: Hisao
authors.initials: H
authors.lastname: Tonami
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007472:Iohexol / Q000008:administration & dosage*; D007479:Iopamidol / Q000008:administration & dosage*; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol; D012965:Sodium Chloride; D007479:Iopamidol