[en] This paper compares the CT intensity of contrast material enhancement of the hepatic parenchyma during uniphasic and biphasic bolus contrast material injections to determine the best method of contrast material administration. Two-hundred patients underwent dynamic hepatic CT with a GE 9800 CT/T scanner. One-hundred patients received 150 mL of 60% iodinated contrast material at a rate of 2.5 mL/sec times 20 seconds and 1 mL/sec times 100 seconds, and 100 patients at a rate of 2.5 mL/sec for 60 seconds. Aortic enhancement was measured on each scan. Hepatic attenuation was measured from 2 or 3 locations in the liver, and the average of the measurements and the time from initiation of the bolus were recorded. Uniphasic injection produced an earlier (81 seconds vs 119 seconds) and higher (118 HU vs 105 HU) peak hepatic enhancement, which was sustained (minimum, 2.5 HU last scan; maximum, 22.5 HU at 81 seconds) over the entire scan sequence. Peak aortic enhancement also was earlier (56 seconds vs 89 seconds) and higher (242 HU vs 188 HU) with the uniphasic injection

[en] In 18 patients with 27 infected pancreatic fluid collections (FC) or abscesses, CT was used to detect the collection or abscess and to guide percutaneous catheter drainage. Abscesses or FCs were associated with pancreatic duct communication in four cases and with gastrointestinal fistulas in seven cases. Sixteen patients were treated only with catheter drainage and two patients required subsequent surgery. Complications of drainage consisted of two cases of hemorrhage and one case of empyema. CT can be used to detect remote abscesses and FCs for precise planning of access routes

[en] Published in summary form only

[en] This paper determines the value of sequential, multi-modality imaging for preoperative detection of hepatic tumor nodules in candidates for liver resection. Prospectively and preoperatively, we evaluated 26 patients (seven with hepatocellular carcinoma, one with liver cell adenoma, and 18 with metastatic colorectal carcinoma) to determine number and location of tumor nodules. After bolus dynamic CT (BDCT), patients underwent hepatic angiography, CT angiography (CTA), delayed iodine CT scanning (DIS), and MR imaging. Fifty-six tumor nodules were confirmed by surgery and biopsy, 20 patients had hepatic resection

[en] This paper reviews the features of hepatocellular carcinoma (HCC) as depicted by state-of-the-art bolus dynamic CT to ascertain if previously described unique findings (e.g., capsular enhancement, arterioportal shunting) are present with a frequency as that reported in the series from Japan. Bolus dynamic CT scans were reviewed in 81 consecutive patients with proved HCC. The tumor was identified in all 81 patients as either a unifocal mass (35/81, 43%); a multifocal mass (31/81, 38%); or a diffusely infiltrating disease (15/81, 19%). Tumor capsule was seen in only 13/81 (16%) cases, much less frequently than in the Japanese series (>50%). Portal vein involvement was present in 38/81 (47%), but only 24/38 (63%) showed caliber expansion, a reliable discriminator of thrombus from tumor

[en] Computed tomographic arteriography (CTA) is one method of evaluating hepatic masses. It consists of simultaneous infusion of 30% iodinated contrast medium into the hepatic artery during computed tomography (CT). Twenty-two patients with suspected resectable hepatic tumors were evaluated prior to surgery. Initial imaging procedures included conventional CT, ultrasonography, scintigraphy, and selective angiography. CTA identified additional tumor nodules in 12 out of 22 patients (55%), rendering the initially detected neoplasms unresectable. However, 2 other patients were found to have a normal liver and thus were spared unnecessary laparotomy

[en] Dynamic bolus CT (154 cases) and angiography (40 cases) were used as the basis for diagnosis and staging of ductal pancreatic carcinomas. The CT-based diagnosis was correct in 152 of 154 (98.7%) cases. Ten CT criteria of tumor unresectability were evaluated for staging. Tumors were unresectable in 136 (88%) patients and resectable in 18 (12%). Angiography provided useful staging information in only two (5%) cases; CT was equal to or superior to angiography in 38 (95%) cases. Forty patients underwent surgery; in none was the tumor found to be incorrectly staged as unresectable using CT criteria. Six patients who met no CT criteria of tumor unresectability were found to have unresectable tumors at surgery. The 142 patients who did not undergo surgical resection had an average survival of 3.9 months (range, 0.5-15 months). Twelve patients who underwent surgical resection of tumor survived an average of 12.4 months (range, 6-27 months)

[en] In order to analyze the usefulness of dynamic contrast-enhanced CT, 84 patients who had hepatocellular carcinoma or suspected hypervascular metastases were studied with conventional incremental dynamic CT (CID-CT) or double helical CT (DH-CT). Delayed phase contrast-enhanced CT studies were consecutively performed in all patients. Thirty-six of 84 patients had malignant hepatic neoplasms; six had hepatocellular carcinoma and 30 had metastatic tumors. At first, the detectability of hepatic lesions was evaluated with bolus dynamic CT and delayed phase CT. Dynamic CT has detected more lesions than delayed CT. Some hepatic lesions described as isodensity were missed on CID-CT. Therefore, delayed phase CT cannot be eliminated when CID-CT is performed. Secondly, hepatic lesion detectability with CID-CT was compared with that of DH-CT. DH-CT did not miss the hepatic lesions picked up by delayed phase CT and was expected to provide excellent detectability of hypervascular hepatic neoplasms. In addition, first helical CT showed most hepatic lesions as areas of obvious hyperdensity, while CID-CT did not show their correct vascularities. So-called hypervascular hepatic tumors, however, were not always hypervascular and were demonstrated as areas of iso-hypodensity even on initial helical scanning. Second helical CT was useful to detect these so-called hypervascular, but actually hypovascular lesions. In conclusion, dynamic CT was helpful in detecting hypervascular hepatic malignant neoplasms, and DH-CT was more accurate than-CID-CT for the detection of hepatic lesions and the evaluation of vascular lesion. (author)

[en] To evaluate the ability of CT to detect findings indicative of primary sclerosing cholangitis (PSC) in the intrahepatic and extrahepatic biliary system, CT scans in 20 cases of PSC were compared with cholangiographic findings. Of 19 cases with extrahepatic duct disease demonstrated at cholangiography, CT detected abnormalities in the common hepatic or bile duct in 16 cases, including duct stenosis (n = 10), mural nodularity (n = 3), duct dilatation (n = 7), wall thickening (n = 6), and mural enhancement (n = 11). CT detected intrahepatic disease in all 20 cases with cholangiographic findings of PSC. CT abnormalities in the intrahepatic duct system included duct dilation (n = 19), duct stenosis (n = 15), pruning (n = 11), and beading (n = 7). CT was superior to cholangiography in characterizing the status of the intrahepatic duct system in 11 of 20 cases. In addition, CT was able to demonstrate signs of superimposed cholangiocarcinoma in three cases and to illustrate extrabiliary complications of PSC in 12 cases. This study showed that CT can detect abnormalities of the extrahepatic duct in the majority of patients with PSC and can more optimally characterize the status of the intrahepatic ducts

[en] 33 patients were studied with double helical CT after bolus injection to evaluate the detectability for malignant hepatic tumors. 28 patients actually had malignant hepatic lesions ; 8 had hepatocellular carcinomas, one had cholangiocarcinoma, and 19 had metastatic tumors. According to the comparison of the detectabilities between the first and the second helical CT, 32% of all cases showed the superiority of the first helical CT, while 54% showed that of the second helical CT. 9 in 23 cases with so-called hypervascular hepatic tumors showed the superiority of the first helical CT which described hepatic tumors as obvious hyperdensities, although the second helical CT had the better detectabilities in 11 cases. 4 in 5 cases with so-called hypovascular hepatic tumors showed the better detectabilities on the second helical CT. Double helical CT, obtained during arterial and portal phase, seems to be required for the detection of both hypervascular and hypovascular hepatic malignancies. (author)