Quadruple-phase MDCT of the liver in patients with suspected hepatocellular carcinoma: Effect of contrast material flow rate

Wolfgang Schima, Renate Hammerstingl, Carlo Catalano, Luis Marti-Bonmati, Ernst J. Rummeny, Francisco Tardáguila Montero, Albert Dirisamer, Bernd Westermayer, Massimo Bellomi, Denis Brisbois, Patrick Chevallier, Martin Dobritz, Jacques Drouillard, Francesco Fraioli, Maria Jesus Martinez, Sandro Morassut, Thomas J. Vogl

Research output: Contribution to journalArticlepeer-review


OBJECTIVE. The purposes of this study were to evaluate the effect of contrast material flow rate (3 mL/sec vs 5 mL/sec) on the detection and visualization of hepatocellular carcinoma (HCC) with MDCT and the safety profile of iodixanol at different injection rates. SUBJECTS AND METHODS. In a prospective, randomized multicenter trial, 97 patients (83 men and 14 women, with a mean age of 64 years) suspected of having HCC underwent quadruple-phase (double arterial, portal venous, delayed phase) 4- 16-MDCT. Patients were randomized to receive iodixanol, 320 mg I/mL (1.5 mL/kg body weight), at a flow rate of 3 mL/sec (48 patients) or 5 mL/sec (49 patients). Qualitative (lesion detection, image quality) and quantitative (liver and aortic enhancement, tumor-liver contrast) analyses and safety assessment were performed. RESULTS. Overall, 145 HCCs were detected in the 5 mL/sec group and 100 HCCs in the 3 mL/sec group (p <0.05). More lesions equal to or less than 1 cm were detected at 5 mL/sec (33 vs 16 lesions). The late arterial phase showed significantly more lesions than the early, arterial phase (133 vs 100 and 96 vs 67 lesions, respectively, p <0.0001). Hyperattenuating HCCs were better visualized in the late arterial phase at 5 mL/sec (excellent visualization: 54% vs 27%). Using a flow of 5 mL/sec did not increase the rate of patient discomfort or contrast media-related adverse events. Most discomfort in both groups was of mild intensity and there was no severe discomfort. CONCLUSION. For detection of HCC with MDCT, a higher flow rate of 5 mL/sec is recommended. Visualization of hyperattenuating HCC is improved with no greater discomfort or adverse events.

Original languageEnglish
Pages (from-to)1571-1579
Number of pages9
JournalAmerican Journal of Roentgenology
Issue number6
Publication statusPublished - Jun 2006


  • Contrast media
  • CT
  • Liver disease
  • MDCT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology


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