title: Hepatocellular carcinoma in cirrhotic patients at multidetector CT: hepatic venous phase versus delayed phase for the detection of tumour washout.
abstract: OBJECTIVE
  Our aim was to compare retrospectively hepatic venous and delayed phase images for the detection of tumour washout during multiphasic multidetector row CT (MDCT) of the liver in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  30 cirrhotic patients underwent multiphasic MDCT in the 90 days before liver transplantation. MDCT was performed before contrast medium administration and during hepatic arterial hepatic venous and delayed phases, images were obtained at 12, 55 and 120 s after trigger threshold. Two radiologists qualitatively evaluated images for lesion attenuation. Tumour washout was evaluated subjectively and objectively. Tumour-to-liver contrast (TLC) was measured for all pathologically proven HCCs.
  
  
  RESULTS
  48 HCCs were detected at MDCT. 46 of the 48 tumours (96%) appeared as either hyper- or isoattenuating during the hepatic arterial phase subjective washout was present in 15 HCCs (33%) during the hepatic venous phase and in 35 (76%) during the delayed phase (p<0.001, McNemar's test). Objective washout was present in 30 of the 46 HCCs (65%) during the hepatic venous phase and in 42 of the HCCs (91%) during the delayed phase (p=0.001). The delayed phase yielded significantly higher mean TLC absolute values compared with the hepatic venous phase (-16.1±10.8 HU vs -10.5±10.2 HU; p<0.001).
  
  
  CONCLUSIONS
  The delayed phase is superior to the hepatic venous phase for detection of tumour washout of pathologically proven HCC in cirrhotic patients.
authors.affiliation: Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia Udine, Italy. furlana@upmc.edu
authors.forename: A
authors.initials: A
authors.lastname: Furlan
authors.forename: D
authors.initials: D
authors.lastname: Marin
authors.forename: A
authors.initials: A
authors.lastname: Vanzulli
authors.forename: G Palermo
authors.initials: GP
authors.lastname: Patera
authors.forename: A
authors.initials: A
authors.lastname: Ronzoni
authors.forename: M
authors.initials: M
authors.lastname: Midiri
authors.forename: M
authors.initials: M
authors.lastname: Bazzocchi
authors.forename: R
authors.initials: R
authors.lastname: Lagalla
authors.forename: G
authors.initials: G
authors.lastname: Brancatelli
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000378:metabolism; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000378:metabolism; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods