Diagnostic accuracy of helical CT arterial portography and CT hepatic arteriography for hypervascular hepatocellular carcinoma in chronic liver damage - An ROC analysis

Purpose: To evaluate the detectability of hypervascular hepatocellular carc inomas (HCCs) in chronic liver damage with helical CT arterial portography (CTAP) and CT hepatic arteriography (CTHA). Material and Methods: Thirty-nine HCC patients who underwent CTAP and CTHA were studied. Diagnostic abilities of CTAP alone, CTHA alone, or combined C TAP and CTHA were evaluated by receiver operating characteristic (ROC) anal ysis. Fifty-three images with 53 HCC nodules were evaluated. Tumor size ran ged from 5 to 90 mm (mean 22.8 mm). Sensitivities and specificities for all techniques were calculated. Results: ROC analysis showed the diagnostic ability significantly better wi th combined CTAP and CTHA (mean area under the ROC curve (Az)=0.95), or CTH A alone (Az=0.93) than CTAP alone (Az=0.87) (p<0.01). Combined CTAP and CTH A showed the best sensitivity (95.0%), followed by CTHA alone (88.1%) and C TAP alone (85.5%). The specificities of all three imaging techniques were r elatively low (54.1% for combined CTAP and CTHA, 71.1% for CTHA alone, and 54.1% for CTAP alone) because of perfusion abnormalities of the liver paren chyma. Conclusion. The combination of CTAP and CTHA is superior to CTAP alone for detection of hypervascular HCCs. However, its specificity was relatively lo w in chronic liver damage.