ROLE OF TRIPHASIC COMPUTED TOMOGRAPHYIN THE EVALUATION OF FOCAL LIVER LESIONS: A CROSS – SECTIONAL STUDY
DOI:
https://doi.org/10.71000/kh68jc80Keywords:
Contrast Media, Diagnostic Imaging, Hepatocellular Carcinoma, Liver Neoplasms, Multidetector Computed Tomography, Sensitivity and Specificity, Triphasic CT Scan.Abstract
Background: Liver cancer remains one of the leading causes of cancer-related morbidity and mortality worldwide, with a steadily increasing incidence over the past several decades. Early detection and accurate characterization of focal liver lesions are critical for effective patient management and prognosis. Triphasic computed tomography (CT) has emerged as a highly sensitive and specific imaging modality for differentiating benign from malignant hepatic lesions through dynamic contrast enhancement across multiple vascular phases.
Objective: To determine the diagnostic role and frequency distribution of benign and malignant focal liver lesions using triphasic computed tomography.
Methods: A descriptive cross-sectional study was conducted over four months at two diagnostic centers in Peshawar—Real Imaging Center, Hayatabad, and Real Imaging Center, Dabgari Garden. A total of 150 patients with suspected or confirmed focal liver lesions were included through non-probability consecutive sampling. Triphasic CT scans were performed using a 64-slice multidetector scanner following intravenous administration of non-ionic iodinated contrast. Images were obtained in arterial, portal venous, and delayed phases. Lesions were evaluated based on enhancement pattern, margins, and morphology, and classified as benign or malignant. Data were analyzed using SPSS version 26.0, applying descriptive statistics and chi-square tests, with a p-value <0.05 considered significant.
Results: Among 150 patients, 86 (57.3%) were male and 64 (42.7%) were female, indicating male predominance. The age group 51–70 years constituted the largest proportion with 87 (58.0%) patients, followed by 30–50 years with 54 (36.0%), and ≥71 years with 9 (6.0%). Triphasic CT revealed benign lesions in 89 (59.3%) cases and malignant lesions in 61 (40.7%). Hemangioma was the most common benign lesion, while hepatocellular carcinoma predominated among malignant findings.
Conclusion: Triphasic CT proved to be a reliable and non-invasive modality for differentiating benign from malignant focal liver lesions, demonstrating high diagnostic accuracy and clinical relevance. The study revealed a predominance of benign lesions, with male patients and individuals aged 51–70 years being most frequently affected.
References
Minamiguchi K, Maki H, Haddad A, Cortes AC, Lendoire M, Tanaka T, et al. Synthetic tumor extracellular volume as a predictive biomarker for colorectal liver metastasis patients prior to curative hepatectomy. Eur Radiol. 2025;35(9):5348-59.
Choi WS, Chang W, Lee M, Hur S, Kim HC, Jae HJ, et al. Spectral CT-Based Iodized Oil Quantification to Predict Tumor Response Following Chemoembolization of Hepatocellular Carcinoma. J Vasc Interv Radiol. 2021;32(1):16-22.
Huang H, He DN, Lu RF, Tong WJ, Wang Y, Qin S, et al. The role of contrast-enhanced ultrasound in the radiological classification of liver observations identified by CT and MRI. Radiol Med. 2025;130(6):805-16.
Gong H, Yu L, Leng S, Fletcher JG, McCollough CH. Reader Performance as a Function of Patient Size for the Detection of Hepatic Metastases. J Comput Assist Tomogr. 2021;45(6):812-9.
Franzè MS, Bottari A, Caloggero S, Pitrone A, Barbera A, Lembo T, et al. Rate of hepatocellular carcinoma diagnosis in cirrhotic patients with ultrasound-detected liver nodules. Intern Emerg Med. 2021;16(4):949-55.
Li J, Chen Z, Wang Q, Du X, Zhang J. Radiomics Model Based on Preoperative Contrast-enhanced CT and Clinical Features for Predicting Early Recurrence of Hepatocellular Carcinoma. Ann Ital Chir. 2025;96(6):771-82.
Shahbazian H, Birnbaum J, Burns PJ, Shabanan SH, Kanmaniraja D, Reinus J, et al. Prevalence of different LI-RADS v2018 categories in high-risk patients undergoing CT- or MRI-based screening for hepatocellular carcinoma. Abdom Radiol (NY). 2023;48(12):3696-702.
Wu CH, Lee YH, Liang PC, Hu RH, Shih TT, Ho MC. Predictors of changes in preoperative tumor stage between dynamic computed tomography and gadoxetate disodium-enhanced magnetic resonance imaging for hepatocellular carcinoma. J Formos Med Assoc. 2022;121(8):1550-9.
Nakharutai N, Chitapanarux I, Traisathit P, Srikummoon P, Pojchamarnwiputh S, Inmutto N, et al. Prediction of survival and analysis of prognostic factors for hepatocellular carcinoma: a 20-year of imaging diagnosis in Upper Northern Thailand. BMC Cancer. 2023;23(1):1063.
Ota T, Onishi H, Fukui H, Tsuboyama T, Nakamoto A, Honda T, et al. Prediction models for differentiating benign from malignant liver lesions based on multiparametric dual-energy non-contrast CT. Eur Radiol. 2025;35(3):1361-77.
Ruan L, Yu J, Lu X, Numata K, Zhang D, Liu X, et al. A Nomogram Based on Features of Ultrasonography and Contrast-Enhanced CT to Predict Vessels Encapsulating Tumor Clusters Pattern of Hepatocellular Carcinoma. Ultrasound Med Biol. 2024;50(12):1919-29.
Sato A, Okada M, Tago K, Nakazawa Y, Mizuno M, Miyauchi T, et al. Multiparametric gadoxetic acid-enhanced MR versus dual-layer spectral detector CT for differentiating hepatocellular carcinoma from hypervascular pseudolesions. Acta Radiol. 2025;66(7):712-21.
Hong CW, Chernyak V, Choi JY, Lee S, Potu C, Delgado T, et al. A Multicenter Assessment of Interreader Reliability of LI-RADS Version 2018 for MRI and CT. Radiology. 2023;307(5):e222855.
Pan J, Huang H, Zhang S, Zhu Y, Zhang Y, Wang M, et al. Intraindividual comparison of CT and MRI for predicting vessels encapsulating tumor clusters in hepatocellular carcinoma. Eur Radiol. 2025;35(1):61-72.
Li L, Mao S, Wang J, Zheng W, Shen J, Clevert DA, et al. Intraindividual Comparison of Contrast-Enhanced Ultrasound Using Perfluorobutane With Modified Criteria Versus CT/MRI LI-RADS Version 2018 for Diagnosing HCC in High-Risk Patients. AJR Am J Roentgenol. 2023;220(5):682-91.
Yang CC, Lin KW. Improving the detection of hypo-vascular liver metastases in multiphase contrast-enhanced CT with slice thickness less than 5 mm using DenseNet. Radiography (Lond). 2024;30(3):759-69.
Xie T, Liu W, Chen L, Zhang Z, Chen Y, Wang Y, et al. Head-to-head comparison of contrast-enhanced CT, dual-layer spectral-detector CT, and Gd-EOB-DTPA-enhanced MR in detecting neuroendocrine tumor liver metastases. Eur J Radiol. 2024;181:111710.
Zhu M, Li H, Wang C, Yang B, Wang X, Hou F, et al. Focal nodular hyperplasia mimicking hepatocellular adenoma and carcinoma in two cases. Drug Discov Ther. 2021;15(2):112-7.
Kitao A, Matsui O, Zhang Y, Ogi T, Nakada S, Sato Y, et al. Dynamic CT and Gadoxetic Acid-enhanced MRI Characteristics of P53-mutated Hepatocellular Carcinoma. Radiology. 2023;306(2):e220531.
Jia W, Li F, Cui Y, Wang Y, Dai Z, Yan Q, et al. Deep Learning Radiomics Model of Contrast-Enhanced CT for Differentiating the Primary Source of Liver Metastases. Acad Radiol. 2024;31(10):4057-67.
Odedra D, Jandaghi AB, Bhayana R, Elbanna KY, Espin-Garcia O, Fischer SE, et al. Comparison of international guidelines for diagnosis of hepatocellular carcinoma and implications for transplant allocation in liver transplantation candidates with gadoxetic acid enhanced liver MRI versus contrast enhanced CT: a prospective study with liver explant histopathological correlation. Cancer Imaging. 2022;22(1):55.
Lloret MR, Pisoni S, Armiñana A, Mora DF, Picado A, Martínez JJ, et al. Comparison of Cone-Beam CT Angiography and Contrast-Enhanced CT Guidance Using Electromagnetic Navigation for Percutaneous Liver Microwave Ablation: A Retrospective Nonrandomized Observational Study. J Vasc Interv Radiol. 2025;36(11):1696-704.
Siu Xiao T, Kuon Yeng Escalante CM, Tahmasebi A, Kono Y, Piscaglia F, Wilson SR, et al. Combining CEUS and CT/MRI LI-RADS major imaging features: diagnostic accuracy for classification of indeterminate liver observations in patients at risk for HCC. Abdom Radiol (NY). 2025;50(5):2066-77.
Kristiansen MK, Larsen LP, Villadsen GE, Sørensen M. Clinical impact of MRI on indeterminate findings on contrast-enhanced CT suspicious of HCC. Scand J Gastroenterol. 2024;59(9):1075-80.
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Copyright (c) 2025 Wajid Rehman, Umar Sadiq, Sobia Wali Muhammad, Abdul Salam, Ayesha Malik, Abdul Wadood, Alia Wazir (Author)
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