CT Evaluation of the Liver: Principles and Techniques

ABSTRACT

Technical advances within the past decade have dramatically improved the diagnostic capabilities of CT, primarily due to helical CT scanners coupled with mechanical injectors for IV administration of contrast media. There is no such thing as a generic ``abdominal CT scan''; rather, specific protocols should be utilized for optimal detection and characterization of hepatic masses (or other suspected pathologic processes). Multiphasic CT protocols are especially important for detecting hypervascular liver tumors. We present the principles and rationale for various CT protocols along with some of the common pitfalls. Understanding this background material will allow the reader to better understand subsequent articles dealing with specific applications of CT and other abdominal imaging techniques.

KEYWORD

Computed tomography - liver

REFERENCES

• 1 Federle M P. Current status and future trends in abdominal CT.  RadioGraphics . 1998;  18 1555-1568
• 2 Oliver J H, Baron R L, Federle M P, Rockette H P. Detecting hepatocellular carcinoma: value of unenhanced or arterial phase CT imaging or both in conjunction with conventional portal venous phase contrast CT imaging.  Am J Roentgenol . 1996;  167 71-77
• 3 Baron R L, Oliver J H, Dodd G D. Hepatocellular carcinoma: evaluation with biphasic contrast-enhanced helical CT.  Radiology . 1996;  199 505-511
• 4 Hollett M D, Jeffrey Jr B R, Nino-Murcia M. Dual-phase helical CT of the liver: value of arterial phase scans in the detection of small (≤1.5 cm) malignant hepatic neoplasms.  Am J Roentgenol . 1995;  164 879-884
• 5 Bonaldi V M, Bret P M, Reinhold C, Atri M. Helical CT of the liver: value of an early hepatic arterial phase.  Radiology . 1995;  197 357-363
• 6 van Leeuwen S M, Noordzij J, Feldberg M A. Focal liver lesions: characterization with triphasic spiral CT.  Radiology . 1996;  201 327-336
• 7 Weg N, Scheer M R, Gabor M P. Liver lesions: improved detection with dual-detector array CT and routine 2.5 mm thin collimation.  Radiology . 1998;  209 417-426
• 8 Oliver J H, Baron R L. Helical biphasic contrast-enhanced CT of the liver: indications, interpretation, and pitfalls.  Radiology . 1996;  201 1-14
• 9 Federle M P, Chang P J, Confer S, Ozgun B. Frequency and effects of extravasation of ionic and nonionic CT contrast media during rapid bolus injection.  Radiology . 1998;  206 637-640
• 10 Federle M P, Willis L L, Swanson D P. Ionic versus nonionic contrast media: a prospective study of the effect of rapid bolus injection on nausea and anaphylactoid reactions.  J Comput Assist Tomogr . 1998;  22 341-345
• 11 Bluemke D A, Soyer P, Fishman E K. Helical (spiral) CT of the liver.  Radiol Clin North Am . 1995;  33 863-886
• 12 Baron R L. Understanding and optimizing use of contrast material for CT of the liver.  Am J Roentgenol . 1994;  163 323-331
• 13 Peterson M S, Baron R L, Marsh J W. Pretransplantation surveillance for possible hepatocellular carcinoma in patients with cirrhosis epidemiology and CT-based tumor detection rate in 430 cases with surgical pathologic correlation.  Radiology . 2000;  217 743-749
• 14 Kim T, Murakami T, Takahashi S. Optimal phases of dynamic CT for detecting hepatocellular carcinoma: evaluation of unenhanced and triple phase images.  Abdom Imaging . 1999;  24 473-480
• 15 van Hoe L, Baert A L, Gryspeerdt S. Dual-phase helical CT of the liver: value of an early-phase acquisition in the differential diagnosis of noncystic focal lesions.  Am J Roentgenol . 1997;  168 1185-1192
• 16 Matsui O, Takashima T, Kadoya M. Liver metastases from colorectal cancers: detection with CT during arterial portography.  Radiology . 1987;  165 65-69
• 17 Soyer P, Levesgre M, Elias D. Detection of liver metastases from colorectal cancer: comparison of intraoperative US and CT during arterial portography.  Radiology . 1992;  183 541-544
• 18 Soyer P, Bluemke D A, Hruban R H. Primary malignant tumors of the liver: detection with helical CT during arterial portography.  Radiology . 1994;  192 389-392
• 19 Soyer P, Bluemke D A, Hruban R H. Hepatic metastases from colorectal cancer: detection and false-positive findings with helical CT during arterial portography.  Radiology . 1994;  193 71-74
• 20 Kondo H, Kanamatsu M, Hoshi H. Preoperative detection of malignant hepatic tumors: comparison of combined methods of MR imaging with combined methods of CT.  Am J Roentgenol . 2000;  174 947-954
• 21 Foley W D, Hoffmann R G, Quiroz F A. Hepatic helical CT: contrast material injection protocol.  Radiology . 1994;  192 367-371
• 22 Silverman P M, Brown B, Wray H. Optimal contrast enhancement of the liver using helical (spiral) CT: value of Smart-Prep.  Am J Roentgenol . 1995;  164 1169-1171
• 23 Lacomis J M, Baron R L, Oliver J H. Cholangiocarcinoma: delayed CT contrast enhancement patterns.  Radiology . 1997;  203 98-104
• 24 Ueda K, Matui O, Kawamori Y. Hypervascular hepatocellular carcinoma: evaluation of hemodynamics with dynamic CT during hepatic arteriography.  Radiology . 1998;  206 161-166
• 25 Murakami T, Oi H, Hori M. Helical CT during arterial portography and hepatic arteriography for detecting hypervascular hepatocellular carcinoma.  Am J Roentgenol . 1997;  169 131-135
• 26 Choi B I, Lee H J, Han J K. Detection of hypervascular nodular hepatocellular carcinomas: value of triphasic helical CT compared with iodized-oil CT.  Am J Roentgenol . 1997;  168 219-224
• 27 Katyal S, Oliver J H, Buck D G, Federle M P. Detection of vascular complications following liver transplantation: early experience of multi-slice CT angiography using volume-rendering techniques.  Am J Roentgenol . 2000;  175 1735-1739
• 28 Kuszyk B S, Heath D G, Ney D R. CT angiography with volume rendering: imaging findings.  Am J Roentgenol . 1995;  165 445-448