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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).

View larger version (143K): [in a new window]   Figure 1a. CT images (window center, 70 HU; width, 200 HU) in a 58-year-old man with metastatic melanoma. (a) CT image obtained through the liver during the phase of peak hepatic arterial enhancement shows three enhanced lesions (arrows). The lesions were not present on previous images and are therefore considered to be malignant. (b) CT image obtained at the same level as a during the phase of peak portal venous enhancement shows that the three lesions are less conspicuous but are still visible.

View larger version (159K): [in a new window]   Figure 1b. CT images (window center, 70 HU; width, 200 HU) in a 58-year-old man with metastatic melanoma. (a) CT image obtained through the liver during the phase of peak hepatic arterial enhancement shows three enhanced lesions (arrows). The lesions were not present on previous images and are therefore considered to be malignant. (b) CT image obtained at the same level as a during the phase of peak portal venous enhancement shows that the three lesions are less conspicuous but are still visible.

View larger version (118K): [in a new window]   Figure 2a. CT images (window center, 70 HU; width, 200 HU) in a 51-year-old man with widely metastatic malignant melanoma. (a, b) CT images were obtained through the level of the hepatic veins during the phases of (a) peak hepatic arterial and (b) peak portal venous enhancement. The true extent of disease is best appreciated in b, as indicated by the presence of multiple hypoattenuating nodules in the liver. (c, d) CT images were obtained just above the level of the porta hepatis during the phases of (c) peak hepatic arterial and (d) peak portal venous enhancement. Lesions are better demonstrated in d. Multiple splenic lesions (arrows) also are visible. This patient had multiple other sites of disease throughout the chest, abdomen, pelvis, and skeleton.

View larger version (120K): [in a new window]   Figure 2b. CT images (window center, 70 HU; width, 200 HU) in a 51-year-old man with widely metastatic malignant melanoma. (a, b) CT images were obtained through the level of the hepatic veins during the phases of (a) peak hepatic arterial and (b) peak portal venous enhancement. The true extent of disease is best appreciated in b, as indicated by the presence of multiple hypoattenuating nodules in the liver. (c, d) CT images were obtained just above the level of the porta hepatis during the phases of (c) peak hepatic arterial and (d) peak portal venous enhancement. Lesions are better demonstrated in d. Multiple splenic lesions (arrows) also are visible. This patient had multiple other sites of disease throughout the chest, abdomen, pelvis, and skeleton.

View larger version (135K): [in a new window]   Figure 2c. CT images (window center, 70 HU; width, 200 HU) in a 51-year-old man with widely metastatic malignant melanoma. (a, b) CT images were obtained through the level of the hepatic veins during the phases of (a) peak hepatic arterial and (b) peak portal venous enhancement. The true extent of disease is best appreciated in b, as indicated by the presence of multiple hypoattenuating nodules in the liver. (c, d) CT images were obtained just above the level of the porta hepatis during the phases of (c) peak hepatic arterial and (d) peak portal venous enhancement. Lesions are better demonstrated in d. Multiple splenic lesions (arrows) also are visible. This patient had multiple other sites of disease throughout the chest, abdomen, pelvis, and skeleton.

View larger version (135K): [in a new window]   Figure 2d. CT images (window center, 70 HU; width, 200 HU) in a 51-year-old man with widely metastatic malignant melanoma. (a, b) CT images were obtained through the level of the hepatic veins during the phases of (a) peak hepatic arterial and (b) peak portal venous enhancement. The true extent of disease is best appreciated in b, as indicated by the presence of multiple hypoattenuating nodules in the liver. (c, d) CT images were obtained just above the level of the porta hepatis during the phases of (c) peak hepatic arterial and (d) peak portal venous enhancement. Lesions are better demonstrated in d. Multiple splenic lesions (arrows) also are visible. This patient had multiple other sites of disease throughout the chest, abdomen, pelvis, and skeleton.