MALIGNANT LIVER-LESIONS - COMPARISON OF SPIRAL CT ARTERIAL PORTOGRAPHY AND MR-IMAGING FOR DIAGNOSTIC-ACCURACY, COST, AND EFFECT ON PATIENT-MANAGEMENT

We compared two imaging techniques, spiral CT arterial portography (CT AP) and MR imaging, for diagnostic accuracy, procedural cost, and effe ct on management of 26 patients referred for hepatic surgery for suspe cted limited malignant liver disease. CTAP and MR imaging were done wi thin a 1-week period (19 within 24 hours); the results of the studies were interpreted prospectively by separate reviewers. Surgical data we re evaluated in conjunction with imaging data in 10 patients, Lesion d etection and segmental involvement were determined and sensitivity and specificity were calculated. Procedural cost was determined from hosp ital billing codes, Effect on patient management was determined by the referring oncologic surgeon, CTAP and MR imaging showed 185 and 176 t rue-positive malignant lesions, 15 and zero false-positive malignant l esions, zero and 18 true-negative malignant lesions, and 13 and 22 fal se-negative malignant lesions, respectively. CTAP and MR imaging showe d 107 and 105 true-positive segments, 11 and zero false-positive segme nts, 80 and 91 true-negative segments, and four and six false-negative segments, respectively, There was a significant difference in specifi city of segmental involvement between MR imaging (1.0 +/- 0) compared with CTAP (0.88 +/- 0.05), P = .03. Total procedural cost was $3,499 f or CTAP and $1,224 for MR imaging, CTAP findings did not change patien t management over MR imaging findings in any patient, whereas MR imagi ng findings resulted in a change in patient management over CTAP findi ngs in seven patients (P = .015), The results of our study suggest tha t MR imaging has higher diagnostic accuracy and greater effect on pati ent management than CTAP does and is 64% less expensive.