HEPATIC LESION CHARACTERIZATION IN CIRRHOSIS - SIGNIFICANCE OF ARTERIAL HYPERVASCULARITY ON DUAL-PHASE HELICAL CT

OBJECTIVE. Our goal was to evaluate the diagnostic significance of the presence and pattern of arterial hypervascularity in lesions detected on dual-phase helical CT in cirrhotic patients. MATERIALS AND METHODS . Fifty-eight lesions greater than 1 cm in size were prospectively ide ntified in 26 patients with end-stage liver disease who had undergone dual-phase helical CT for preoperative liver transplantation evaluatio n. All 26 patients had diagnoses proven by histologic evaluation or by clinical criteria. All arterial phase scans were retrospectively revi ewed and lesions were categorized for the presence and pattern of arte rial hypervascularity. Radiologic findings were correlated with histop athologic data. RESULTS. Thirty-seven of the 58 lesions had hypervascu lar components on arterial phase scans, All 37 of these lesions were f ound to represent hepatocellular carcinoma (HCC) (positive predictive value, 100%). Of the 21 remaining hypovascular lesions, 17 were HCC an d four were benign (positive predictive value, 81%). Of the nine patie nts in whom all lesions were hypovascular, six had HCC (positive predi ctive value, 66%), The value of the presence of arterial hypervascular ity for diagnosing HCC was statistically significant (p < .05). Howeve r, the presence or absence of arterial hypervascularity and the specif ic enhancement pattern revealed by helical CT did not correlate with h istologic grading.CONCLUSION. The presence of hypervascularity in hepa tic masses found in cirrhotic patients is highly predictive of maligna ncy.