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Liver Metastases from Melanoma: Detection with Multiphasic Contrast-enhanced CT¹

¹ From the Departments of Radiology (S.P.B., K.W., V.R.) and Medicine (M.B.A.) and the Cutaneous Oncology Program (S.P.B., M.B.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215. From the 1998 RSNA scientific assembly. Received September 11, 1998; revision requested October 15; revision received December 18; accepted April 30, 1999. Address reprint requests to V.R. (e-mail: vraptopo @caregroup.harvard.edu).

PURPOSE: To assess the clinical utility of multiphasic computed tomography (CT) of the liver in patients with metastatic melanoma.

MATERIALS AND METHODS: Nonenhanced and biphasic hepatic CT examinations were performed in 28 patients with metastatic melanoma, and liver lesion conspicuity was graded. CT studies in 20 patients met the eligibility criteria, and 13 patients had liver lesions.

RESULTS: A total of 57 liver lesions were seen on CT studies: 48 on hepatic arterial phase images, 49 on portal venous phase phase images, and 30 on delayed phase images. Of eight lesions overlooked on portal venous phase images, six were seen on nonenhanced images, and six were seen on arterial phase images. Twenty-eight lesions were graded as more conspicuous on portal venous phase images; 10 were graded as more conspicuous on arterial phase images.

CONCLUSION: CT images obtained only during the portal venous phase would have resulted in eight (14%) overlooked lesions, which implies that more than one phase is needed for hepatic CT in patients with malignant melanoma. The combination of nonenhanced and portal venous phase CT was as effective as the combination of arterial and portal venous phase CT in these patients. Delayed phase CT did not improve lesion detection either alone or in combination with CT at other phases.

Index terms: Computed tomography, technology, 761.1211 • Liver neoplasms, CT, 761.12111, 761.12112, 761.12114, 761.12115 • Liver neoplasms, secondary, 761.332 • Melanoma

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