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Multiphase Multi–Detector Row Computed Tomography in the Setting of Chronic Liver Disease and Orthotopic Liver Transplantation: Can a Series Be Eliminated in Order to Reduce Radiation Dose?

Luke, Frank E. MD; Allen, Brian C. MD; Moshiri, Sara T. MD; Ho, Lisa M. MD; Massey, Christopher M. MD; Stinnett, Sandra S. Dr PH; Muir, Andrew J. MD; Jaffe, Tracy A. MD

Journal of Computer Assisted Tomography: May/June 2013 - Volume 37 - Issue 3 - p 408–414
doi: 10.1097/RCT.0b013e3182838680
Cardiovascular Imaging

Objective The objectives of this study were to explore utilization of multi–detector row computed tomography (MDCT) in screening for hepatocellular carcinoma (HCC) and to modify a liver CT protocol with a goal of dose reduction.

Methods An electronic mail survey querying HCC surveillance practices was sent. One hundred forty consecutive patients referred for HCC indications underwent 4-phase MDCT of the liver. The unenhanced and delayed phases were evaluated by 3 readers for identification of HCC and reader confidence. The estimated effective dose (ED) was calculated.

Results Computed tomography is primarily used to screen for HCC. Average estimated ED was 35.5 mSv. Unenhanced phase did not add to reader confidence; delayed phase increased confidence in 47% of cases. Thirty-two percent of the screening population had cumulative ED of greater than 200 mSv.

Conclusions Multi–detector row CT of the liver is used frequently in screening for HCC. Unenhanced phase imaging does not add to HCC detection and may be eliminated to reduce radiation dose.

From the *Department of Radiology, Duke University Medical Center, Durham, NC; †Department of Radiology, Penn State University, Hershey, PA; ‡Department of Radiology, Wake Forest Baptist Medical Center, Winston-Salem, NC; §GMC General Diagnostic Radiology, Danville, PA; ∥DXP Imaging, Shively, KY; and Departments of ¶Biostatistics and Medicine, Duke University Medical Center, Durham, NC.

Received for publication August 20, 2012; accepted December 17, 2012.

Reprints: Brian C. Allen, MD, Department of Radiology, Wake Forest Baptist Medical Center, Medical Center Blvd, 3rd Floor MRI, Winston-Salem, NC 27157 (e-mail:

The authors have no disclosures or conflicts of interest to report.

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