Evaluation for Hepatic Tumors by CT Scan Obtained during Arterial Portography, CT Scan during Hepatic Arteriography, and Simultaneous Use of Both Techniques

Fifty candidates for liver resection, who underwent CT obtained during arterial portography (CTAP), CT during hepatic arteriography (CTHA), and combined use of both techniques, were studied. Histopathologic study confirmed 96 tumors, consisting of 69 malignant tumors (hepatocellular carcinoma: [HCC] 28, metatasis 41), 17 borderline lesions of HCC, and 10 benign tumors. There were 45 tumors 1.5 cm or smaller in diameter, consisting of 17 borderline lesions of HCC and 28 other lesions. Eighty-six tumors (89.6%) were detected with CTAP, 74 (77%) with CTHA, and 87 (90.6%) with combined scaning. The detection rates for borderline lesions were 76.5% with CTAP and 35.5% with CTHA. These findings suggested that small tumors in patients with viral hepatitis or liver cirrhosis, detected with CTAP but not with CTHA, might be borderline lesions of HCC. Of 28 small tumors 19 (69%), excluding borderline lesions of HCC, were detected with CTHA. Of these, 9 malignant tumors and only 1 benign tumor had rim enhancement. Use of rim enhancement as the criterion for malignancy of these small tumors gave an accuracy rate of 84%. The above data suggest that CTAP alone can be used to detect hepatic tumors and that CTHA is of value not only in diagnosing borderline lesions, but also in differentiating malignant small tumors from benign ones.