Dynamic + hepatobiliary phase MRI improved detection and characterisation of HCC in cirrhotic patients. The greatest benefit is for diagnosing lesions between 1 and 2 cm.

The combined interpretation of dynamic and hepatobiliary phase MR images improves diagnostic accuracy of gadobenate dimeglumine-enhanced MR imaging for the detection of HCC compared with either dynamic MR or multiphasic multidetector CT images alone.

No abstract

The adjunction of DWI does not significantly improve the diagnostic accuracy in the detection of small HCC.

Objectives: The aim of this study was to compare the intraindividual effects of contrast material with two different iodine concentrations on the conspicuity of hepatocellular carcinoma (HCC) and vascular and hepatic contrast enhancement during multiphasic, 64-section multidetector row CT (MDCT) in patients with cirrhosis using two contrast medium injection techniques. Methods: Patients were randomly assigned to one of two groups with an equal iodine dose but different contrast material injection techniques: scheme A, fixed injection duration (25 s), and scheme B, fixed injection flow rate (4 ml s 21). For each group, patients were randomised to receive both moderate-concentration contrast medium (MCCM) and high-concentration contrast medium (HCCM) during two CT examinations within 3 months. Enhancement of the aorta, liver and portal vein and the tumour-toliver contrast-to-noise ratio (CNR) were compared between MCCM and HCCM. Results: 30 patients (mean age 59 years; range 45-80 years; 16 patients in scheme A and 14 in scheme B) with a total of 31 confirmed HCC nodules were prospectively enrolled. For scheme B, the mean contrast enhancement of the aorta and tumour-to-liver CNR were significantly higher with HCCM than with MCCM during the hepatic arterial phase (+350.5 HU vs +301.1 HU, p50.001, and +7.5 HU vs +5.5 HU, p50.004). For both groups, there was no significant difference between MCCM and HCCM for all other comparisons. Conclusion: For a constant injection flow rate, HCCM significantly improves the conspicuity of HCC lesions and aortic enhancement during the hepatic arterial phase on 64-section MDCT in patients with cirrhosis. Along with MRI, multidetector row CT (MDCT) is the modality of choice for the diagnosis and follow-up of patients with hepatocellular carcinoma (HCC), as well as for tumour burden assessment. With the advent of volume MDCT, enabling the acquisition of 64 or more sections during a single gantry rotation, it has become possible to scan the entire abdomen with submillimetre section widths within a short scan time (less than 5 s for 300 mm of coverage). Although this technique has shown several advantages over conventional CT, including better discrimination between different circulatory phases, the potential for scanning during peak organ enhancement throughout the entire imaging volume and true isotropic CT data sets, it has raised considerable challenges for the design of scanning and contrast material injection protocols that are optimised for the detection of hypervascular HCC lesions [1]. Recent investigations have emphasised the importance of using test bolus or bolus-tracking methods to synchronise CT data acquisition with the peak tumourto-liver contrast for hypervascular HCC lesions [2,3]; however, the most effective contrast medium injection technique for maximising tumour enhancement during the narrow temporal acquisition of modern MDCT systems remains largely unexplored. Previous studies with early generation MDCT scanners reported conflicting results with varying volumes a...