Researchers have found that using precontrast low attenuation on CT scans helps identify more liver cancers and improves the accuracy of current diagnostic systems. This finding comes from a study led by Dr. Rohee Park of Asan Medical Center in Seoul, South Korea.
Current CT imaging features have limits because some signs of liver cancer show up more clearly on MRI. Precontrast low attenuation appears as a darker area on CT images because fewer X-rays are absorbed. This feature may help spot liver cancer and distinguish it from other liver conditions.
Study Details and Findings
The research included 194 adults at risk for liver cancer who had multiphase liver CT scans before liver surgery or transplant in 2022. In total, 328 liver lesions were examined: 187 (57%) were liver cancers, 26 (8%) were other cancers, and 115 (35%) were benign growths.
Two expert radiologists reviewed each lesion twice: once using established imaging features, and again including precontrast low attenuation as an extra diagnostic sign. Liver lesions were rated using LI-RADS categories:
- LR-3: Intermediate chance of cancer
- LR-4: Probably cancer
- LR-5: Definitely cancer
Key results included:
Precontrast low attenuation was strongly linked to liver malignancies, with a diagnostic odds ratio of 9.1.
Adding this feature upgraded 20 lesions from LR-3 to LR-4, increasing the estimated malignancy rate in LR-4 lesions from 64.7% to 72.2%.
Including precontrast low attenuation enhanced the test’s sensitivity to detect liver cancer without lowering its specificity.
The researchers concluded that precontrast low attenuation is a useful additional feature to better classify liver lesions and identify higher-risk cases.
Conclusion
A CT image example showed a 67-year-old man with hepatitis B-related cirrhosis. A liver lesion considered LR-3 on regular scans was upgraded to LR-4 after seeing low attenuation on precontrast images. Surgery confirmed the lesion was liver cancer.
The team recommends future studies on patients with different liver diseases and treatments, like ablation or chemoembolization. This will help clarify the diagnostic value of precontrast low attenuation CT and improve clinical decision-making.
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