Focal liver lesions: characterization with triphasic spiral CT.

PURPOSE: To assess whether triphasic spiral CT enables characterization of a wide range of focal liver lesions. MATERIALS AND METHODS: One hundred five patients with suspected focal liver disease underwent triphasic liver CT. After injection of contrast material, the liver was scanned in arterial (scanning delay, 22-27 seconds), portal (scanning delay, 49-73 seconds), and equilibrium (scanning delay, 8-10 minutes) phases. Enhancement of each lesion in each phase was evaluated, and the lesions were tabulated according to one of 11 enhancement patterns. RESULTS: In 94 patients, 375 liver lesions were detected. The nature of the lesion was confirmed in 326 lesions (87%). Six of 11 enhancement patterns were always due to benign disease and caused by areas with hyper- or hypoperfusion, hemangiomas, cysts, focal nodular hyperplasias, or benign but nonspecified lesions. Two of 11 patterns were always due to malignant disease, and one pattern was due to malignant disease in 38 (97%) of 39 patients with known malignancy elsewhere or with chronic liver disease. The other two patterns were seen in metastases and partly fibrosed hemangiomas. CONCLUSION: Triphasic liver CT enables characterization of a wide range of focal liver lesions, including the benign liver lesions that occur most frequently.

3-D reconstruction of hepatic neoplasms: a preoperative planning procedure.

Three-dimensional display of intrahepatic vascular structures, tumour(s) and liver surface offers the possibility of perceiving the complex individual anatomy in a coherent fashion. Since this presentation of anatomical structures can be varied at will, the resulting interactive dynamic display of the 3-D data sets can be considered an example of Virtual Reality; the surgeon experiences the interactive 3-D display as a realistic presentation of the patient's surgical anatomy. Three-dimensional display offers the possibility of planning a specific resection in detail, tailored to the individual anatomy. The benefits and problems of various surgical approaches can be worked out in detail, and potential hazardous phases in the operation can be anticipated, thus minimizing unexpected complications. However, because the generation of detailed 3-D renderings takes considerable time investment by an experienced operator it is important to select patients, in whom such an effort is warranted. In our experience, 3-D display of the liver is most likely to be of benefit in the presence of central tumours, or if segmental resections are considered.