Individualized lesion-oriented test-bolus arterial-phase CT improves lesion enhancement and conspicuity in hepatocellular carcinoma

European Journal of Radiology, vol. 200, pp. 112875

Abstract

Background Accurate arterial-phase timing in contrast-enhanced CT (CECT) is critical for evaluating hepatocellular carcinoma (HCC). Standard-delay methods may fail to capture peak arterial enhancement due to interindividual hemodynamic variability, potentially reducing lesion conspicuity. This study evaluated whether individualized, dynamically tailored arterial-phase CT (t-CT) based on test-bolus peak in the lesion or, if not feasible, within the portal vein, improves quantitative enhancement and lesion conspicuity compared with standard-delay CT (s-CT). Materials and methods This intraindividual study included 39 patients with 60 HCC lesions who underwent both t-CT and s-CT. Maximum and mean lesion attenuation (HU max , HU mean ), relative lesion-to-liver attenuation (relative HU max , relative HU mean ), and image noise were measured. Four readers rated lesion conspicuity on a five-point Likert scale; inter-reader agreement was assessed using weighted κ, Krippendorff's α, and intraclass correlation coefficient (ICC). Results All quantitative parameters differed significantly between protocols. HU max was greater in t-CT than on s-CT (151.0 [130.0–199.8] HU vs 113.5 [97.0–150.0]; p < 0.001), as well as HU mean (124.5 [104.5–144.8] HU vs 90.5 [79.8–112.8]; p < 0.001), relative HU max (1.9 [1.7–2.3] vs 1.8 [1.5–2.2]; p = 0.009) and relative HU mean (1.6 [1.4–1.9] vs 1.4 [1.3–1.7]; p < 0.001). Image noise was lower on t-CT than on s-CT (8.4 [6.7–9.7] vs 11.1 [9.6–12.9]; p < 0.001). Median lesion conspicuity was higher on t-CT (4.0 vs 3.0; p < 0.001). Conclusion Individualized lesion-oriented test bolus arterial-phase timing in CECT demonstrated higher lesion attenuation, greater lesion-to-liver contrast, lower image noise, and higher visibility compared with standard arterial-phase timing in HCC.

Authors 14

1. Christian Schmidt corresponding Aachen Department of Diagnostic and Interventional Radiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany. Electronic address: chrischmidt@ukaachen.de

2. Can Yüksel Aachen Department of Diagnostic and Interventional Radiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany

3. Roman Iwa Aachen Department of Diagnostic and Interventional Radiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany

4. Eric Corban Aachen Department of Diagnostic and Interventional Radiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany

5. Emona Staudacher Aachen Department of Diagnostic and Interventional Radiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany

6. Martina Distelmaier Aachen Department of Diagnostic and Interventional Radiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany

7. Youssra Obeidi Aachen Department of Diagnostic and Interventional Radiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany

8. Narine Mesropyan

   University of Bonn · University Hospital Bonn

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany

9. Kunpeng Xie Aachen Department of Oral and Maxillofacial Surgery Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany

10. J Lemessa Aachen Department of Diagnostic and Interventional Radiology

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany

11. Florian Haag

    Heidelberg University

    Affiliation as printed

    Department of Radiology and Nuclear Medicine, University Center Mannheim, Heidelberg University, Germany

12. Christiane Kuhl Aachen Department of Diagnostic and Interventional Radiology

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany

13. Philipp Bruners Aachen Department of Diagnostic and Interventional Radiology

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany

14. Felix Barajas Ordonez Aachen Department of Diagnostic and Interventional Radiology

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany