The Diagnostic Role of Dynamic Triphasic Spiral Computed Tomography in Liver Metastases

Abstract

Objectives: To evaluate the role of dynamic Triphasic Spiral Computed Tomography in liver metastases Material and Methods: Total 50 patients with focal liver lesions were evaluated with dynamic spiral CT. Liver was scanned three times in arterial, portal and equilibrium phases in order to determine enhancement patterns of the lesions. Hence, enhancement patterns of metastases and hemangiomas were evaluated separately. Results: We detected uniformly hypodense or peripherally enhanced hypodense appearances at arterial and portal phases in 96.6% of metastatic cases. While same pattern was observed in arterial and portal phases of 93.7% of hemangiomas, delayed phases revealed totally hyperdense or isodense appearance with central opacification. Hypervascular metastasis of pancreatic islet cell carcinoma, known as a hypervascular tumor itself, were visualized only in the arterial phase as hyperdens foci. Conclusion: Triphasic dynamic spiral CT is decided to be a useful technique in patients with focal liver lesions, since it provides valuable information about the nature and differentiation of focal liver lesions as well as their relations with the neighboring vascular structures. ©2007, Firat University, Medical Faculty

Keywords

• -

Karaciğer Metastazlarında Dinamik Spiral Bilgisayarlı Tomografinin Diagnostik Rolü

Öz

Giriş: Karaciğer metastazlarında dinamik spiral bilgisayarlı tomografinin rolünü incelemektir. Gereç ve Yöntem: Karaciğerde fokal kitle lezyonu olan toplam 50 hasta dinamik trifazik spiral BT ile incelenmiştir. Karaciğer lezyonların boyanma paternlerini saptamak için arteriel, portal ve geç fazda ayrı ayrı 3 kez taranmıştır. Böylece metastaz ve hemanjiomların boyanma karakteristiklerini ayrı ayrı değerlendirmek mümkün oldu. Bulgular: Bu çalışmada, karaciğerdeki metastatik lezyonların %96.6'nın arteriyel ve portal fazda, üniform hipodens veya periferal hiperdens boyanma paterni gösterdiğini saptadık. Ancak hemanjiom olgularımızda da %93.7 oranında arteriyel ve portal fazda aynı boyanma özelliği gözlenmekte, fakat geç fazda lezyonlar total hiperdens veya total izodens hale gelmekte veya santral opasifikasyon artmaktaydı. Hipervasküler bir tümör olarak bilinen pankreas islet cell karsinomlu olgumuzda hipervasküler metastazlar sadece arteriyel fazda hiperdens olarak izlendi. Sonuç: Trifazik dinamik spiral BT incelemesi karaciğerdeki fokal lezyonların ayırıcı tanısında önemli bilgiler vermesi ve lezyonların komşu vasküler yapılarla olan ilişkisini değerlendirmesi nedeniyle, klinik kullanımda karaciğerde fokal lezyonları olan hastalarda seçilebilecek değerli bir yöntem olduğu kanaatine varılmıştır. ©2007, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

• Spiral bilgisayarlı tomografi, karaciğer, metastaz

Kaynakça

1. Ch'en IY, Katz DS, Jeffrey RB, ve ark. Do arterial phase helical CT images improve detection or characterization of colorectal liver metastases? J Comput Assist Tomogr. 1997; 21: 391-397.
2. Leslie DF, Johnson CD, Johnson CM, Ilstrup DM, Harmsen WS. Distinction between cavernous hemangiomas of the liver and hepatic metastases on CT: value of contrast enhancement patterns. AJR Am J Roentgenol. 1995; 164: 625-629.
3. Mahfouz AE, Hamm B, Wolf KJ. Peripheral washout: a sign malignancy on dynamic gadolinium-enhanced MR images of focal liver lesions. Radiology 1994; 190: 49-52.
4. Karahan OI, Yikilmaz A, Isin S, Orhan S. Characterization of hepatocellular carcinomas with triphasic CT and correlation with histopathologic findings. Acta Radiol 2003; 44: 566-571.
5. Güney D. Karaciğer kitlelerinde bilgisayarlı tomografi. TRD yayınları 23. Radyoloji Kongresi Bilgisayarlı Tomografi kitabı Ankara 2002;122-127
6. Lim JH, Choi D, Kim SH, Lee SJ, Lee WS, Lim HK, et al. Detection of hepatocellular carcinoma: value of adding delayed phase imaging to dual-phase helical CT. AJR Am J Roentgenol 2002;179:67-73.
7. Stoker J, Romijn MG, de Man RA, Brouwer JT, Weverling GJ, van Muiswinkel JM, et al. Prospective comparative study of spiral computer tomography and magnetic resonance imaging for detection of hepatocellular carcinoma. Gut 2002; 51: 105-107.
8. Miller FH, Butler RS, Hoff FL, ve ark. Using triphasic helical CT to detect focal hepatic lesions in patients with neoplasms. AJR Am J Roentgenol. 1998; 171: 643-649.

9. van Leeuwen MS, Noordzij J, Feldberg MA, Hennipman AH, Doornewaard H. Focal liver lesions: characterization with triphasic spiral CT. Radiology. 1996; 201: 327-336
10. Burgener FA, Hamlin DJ. Contrast enhancement of focal hepatic lesions in CT: effect of size and histology. AJR Am J Roentgenol. 1983; 140: 297-301.
11. Honda H, Ochiai K, Adachi E, ve ark. Hepatocellular carcinoma: correlation of CT, angiographic, and histopathologic findings. Radiology. 1993; 189: 857-862.
12. Stafford-Johnson DB, Francis IR, Eckhauser FE, Knol JA, Chang AE. Dual-phase helical CT of nonfunctioning islet cell tumors. Comput Assist Tomogr. 1998; 22: 335-339.
13. Hollett MD, Jeffrey RB, Nino-Murcia M, Jorgensen MJ, Harris DP. Dual-phase helical CT of the liver: value of arterial phase scans in the detection of small (< or = 1.5 cm) malignant hepatic neoplasms. AJR Am J Roentgenol. 1995; 164: 879-884.
14. Freeny PC, Gardner JC, vonIngersleben G, ve ark. Hepatic helical CT: effect of reduction of iodine dose of intravenous contrast material on hepatic contrast enhancement. Radiology. 1995; 197: 89-93.
15. Gualdi GF, Casciani E, D'Agostino A, Polettini E. [Triphasic spiral computerized tomography of the liver: vascular models of non-cystic focal lesions] Radiol Med. 1998; 96: 344-352.
16. Freeny PC, Marks WM. Hepatic hemangioma: dynamic bolus CT. AJR Am J Roentgenol. 1986; 147: 711-719.
17. Kabul Tarihi: 03.04.2007