Quadruple-phase MDCT of the liver in patients with suspected hepatocellular carcinoma: Effect of contrast material flow rate

Wolfgang Schima, Renate Hammerstingl, Carlo Catalano, Luis Marti-Bonmati, Ernst J. Rummeny, Francisco Tardáguila Montero, Albert Dirisamer, Bernd Westermayer, Massimo Bellomi, Denis Brisbois, Patrick Chevallier, Martin Dobritz, Jacques Drouillard, Francesco Fraioli, Maria Jesus Martinez, Sandro Morassut, Thomas J. Vogl

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Abstract

OBJECTIVE. The purposes of this study were to evaluate the effect of contrast material flow rate (3 mL/sec vs 5 mL/sec) on the detection and visualization of hepatocellular carcinoma (HCC) with MDCT and the safety profile of iodixanol at different injection rates. SUBJECTS AND METHODS. In a prospective, randomized multicenter trial, 97 patients (83 men and 14 women, with a mean age of 64 years) suspected of having HCC underwent quadruple-phase (double arterial, portal venous, delayed phase) 4- 16-MDCT. Patients were randomized to receive iodixanol, 320 mg I/mL (1.5 mL/kg body weight), at a flow rate of 3 mL/sec (48 patients) or 5 mL/sec (49 patients). Qualitative (lesion detection, image quality) and quantitative (liver and aortic enhancement, tumor-liver contrast) analyses and safety assessment were performed. RESULTS. Overall, 145 HCCs were detected in the 5 mL/sec group and 100 HCCs in the 3 mL/sec group (p <0.05). More lesions equal to or less than 1 cm were detected at 5 mL/sec (33 vs 16 lesions). The late arterial phase showed significantly more lesions than the early, arterial phase (133 vs 100 and 96 vs 67 lesions, respectively, p <0.0001). Hyperattenuating HCCs were better visualized in the late arterial phase at 5 mL/sec (excellent visualization: 54% vs 27%). Using a flow of 5 mL/sec did not increase the rate of patient discomfort or contrast media-related adverse events. Most discomfort in both groups was of mild intensity and there was no severe discomfort. CONCLUSION. For detection of HCC with MDCT, a higher flow rate of 5 mL/sec is recommended. Visualization of hyperattenuating HCC is improved with no greater discomfort or adverse events.

Original languageEnglish
Pages (from-to)1571-1579
Number of pages9
JournalAmerican Journal of Roentgenology
Volume186
Issue number6
DOIs
Publication statusPublished - Jun 2006

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Keywords

  • Contrast media
  • CT
  • Liver disease
  • MDCT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Schima, W., Hammerstingl, R., Catalano, C., Marti-Bonmati, L., Rummeny, E. J., Montero, F. T., Dirisamer, A., Westermayer, B., Bellomi, M., Brisbois, D., Chevallier, P., Dobritz, M., Drouillard, J., Fraioli, F., Martinez, M. J., Morassut, S., & Vogl, T. J. (2006). Quadruple-phase MDCT of the liver in patients with suspected hepatocellular carcinoma: Effect of contrast material flow rate. American Journal of Roentgenology, 186(6), 1571-1579. https://doi.org/10.2214/AJR.05.1226