ROLE OF MULTIPHASE STUDY OF LIVER LESIONS ON 128 SLICE DUAL SOURCE COMPUTED TOMOGRAPHY WITH CYTOLOGY OR HISTOPATHOLOGICAL CORRELATION

Abstract

Introduction: Dual source Multidetector Computed Tomography (MDCT) provides
multiphase study of various liver lesions for better detection and characterization. This study
aims to detect and characterize the liver lesions in multiphase Computed Tomography (CT)
with cytological and histopathological correlation to confirm the diagnosis.
Material and Methods: This cross-sectional study included 65 patients who were referred to
the Radiology Department of Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly,
Uttar Pradesh, India with clinical features jaundice, pain in abdomen, nausea and vomiting. All
patients were evaluated by five phase CT (unenhanced, early and late arterial, portal venous and
delayed scan)of liver with Siemens128 slice dual source spiral CT. Protocols with a scan delay
of 06 seconds, 09 seconds, 45 seconds and 180-300 secondsfrom contrast bolus was preselected
for early and late arterial, portovenous and delayed scans.
Results: Sixty five (age 10yrs- 90yrs) patients were included in the study. Most common
neoplasm was metastases 33(51%).Hepatocellular carcinoma (HCC) were 18(28%),
hemangioma 10(15%), peripheral intrahepatic cholangiocarcinoma 1and 3 were nonneoplastic
which included hepatic abscesses and hydatid cyst.Most common pattern of
enhancement of metastasis in arterial phase was hypodense with peripheral enhancement and
most were hypodense in portal venous phase. Portal venous phase had highest grade for
hypovascular metastases and arterial phase had high grade to detect hypervascular metastasis.
Delayed scan was better for smaller lesions less than 1cm.The sensitivity to detect metastases
was 94%. Most common pattern of enhancement in HCC (variegated or heterogeneous
enhancementin arterial phase with rapid washout in the portal venous phase. Total sensitivity
to detect HCC was 83.3%. Hemangioma showed peripheral globular enhancement in arterial
phase. In portal venous and delayed phase showed progressive enhancement with more
centripetal filling. Sensitivity was 90% in case of hemangiomas.
Conclusion: Multiphasic CT scan is a good non-invasive tool and can be used as first line
imaging modality for differentiating benign and malignant liver lesions.