title: Multiphase multi-detector row computed tomography in the setting of chronic liver disease and orthotopic liver transplantation: can a series be eliminated in order to reduce radiation dose?
abstract: OBJECTIVE
  The objectives of this study were to explore utilization of multi-detector row computed tomography (MDCT) in screening for hepatocellular carcinoma (HCC) and to modify a liver CT protocol with a goal of dose reduction.
  
  
  METHODS
  An electronic mail survey querying HCC surveillance practices was sent. One hundred forty consecutive patients referred for HCC indications underwent 4-phase MDCT of the liver. The unenhanced and delayed phases were evaluated by 3 readers for identification of HCC and reader confidence. The estimated effective dose (ED) was calculated.
  
  
  RESULTS
  Computed tomography is primarily used to screen for HCC. Average estimated ED was 35.5 mSv. Unenhanced phase did not add to reader confidence; delayed phase increased confidence in 47% of cases. Thirty-two percent of the screening population had cumulative ED of greater than 200 mSv.
  
  
  CONCLUSIONS
  Multi-detector row CT of the liver is used frequently in screening for HCC. Unenhanced phase imaging does not add to HCC detection and may be eliminated to reduce radiation dose.
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Frank E
authors.initials: FE
authors.lastname: Luke
authors.forename: Brian C
authors.initials: BC
authors.lastname: Allen
authors.forename: Sara T
authors.initials: ST
authors.lastname: Moshiri
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Ho
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Massey
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Stinnett
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Muir
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Jaffe
mesh_terms: D000328:Adult; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires