Role of Triphasic Computed Tomography during Arterial Portography in Distinguishing Pseudolesion and Hepatocellular Carcinoma

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To retrospectively evaluate the clinical efficacy of triphasic computed tomography during arterial portography (CTAP) for a pretreatment survey of patients with suspected hepatocellular carcinoma (HCC) and to compare the dynamic image features of HCCs and pseudolesions during triphasic CTAP.Between May 2007 and September 2010, 129 patients with known or suspected HCC underwent triphasic helical computed tomography (THCT) and triphasic CTAP at our institution. The HCC image characteristics and pseudolesion dynamic changes in enhancement, size, shape, and location were reviewed. The sensitivity, positive predictive rate (PPV), and area under the receiver operating characteristic curve of triphasic CTAP were calculated and compared.Of 129 patients, 103 with 184 HCCs and 134 pseudolesions were enrolled. The PPVs for triphasic CTAP and monophasic CTAP were 90.2% and 53.9%, respectively (P＜0.05). During the precontrast phase of triphasic CTAP, low attenuation of HCCs and pseudolesions occurred in 96.3% and 3% of the cases, respectively (P＜0.05). After contrast administration, 133 (99.3%) low-attenuation pseudolesions that appeared during the first phase of CTAP, 66 (49.3%) during the second phase, and 121 (90.3%) during the third phase because iso-attenuated to normal liver parenchyma. The proportion of HCCs with low attenuation during the first, second, and third CTAP phases was 100%, 97.5%, and 97.5%, respectively. During the third phase of triphasic CTAP, low attenuation was more likely associated with HCC than pseudolesions (97.5% vs. 9.7%, P＜0.05).The PPV was significantly increased by triphasic CTAP compared to monophasic CTAP. The dynamic image features of triphasic CTAP are useful for distinguishing pseudolesions from HCC.