Authors (including presenting author) :
Lam PL (1), Lee KH (1), Chu MK (1), Lee L (1), Cheung TY (1), Cho DHY (1)
Affiliation :
(1) Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital
Introduction :
Liver cancer is the third leading cause of cancer deaths in Hong Kong. Contrast-enhanced triphasic computed tomography (CT) enables early detection of hepatocellular carcinoma. It is crucial in pre-operative planning and post-procedural surveillance for liver interventions, including ablation and embolization. International standards for triphasic CT liver, including American College of Radiology (ACR) Liver Imaging Reporting and Data System (LI-RADS), have been published to ensure diagnostic quality.
Phase 1 Redevelopment of Kwong Wah Hospital was completed in 2023, and a new CT machine has been installed. Modifications of the existing triphasic CT liver protocol has therefore been implemented after multi-disciplinary collaboration between radiologists, radiographers and nurses to improve image quality, which included adjustments in contrast injection rate and volume, as well as timing of image capture.
Objectives :
This study aims to evaluate the quality of triphasic CT liver before and after protocol modifications according to internationally established standards.
Methodology :
Consecutive triphasic CT liver performed in July 2023 when Kwong Wah Hospital Phase 1 Redevelopment was completed and in April 2024 when the modified CT protocol had been adopted were retrospectively audited. CT parameters, such as kV, timing of images taken and contrast administered, were recorded. Patient details, such as age and weight, were documented. CT image quality, including liver parenchymal, aortic, portal vein and hepatic vein attenuation in pre-contrast, arterial, portovenous and delayed phases, were assessed by radiologists. Statistical analysis was performed using Mann-Whitney U test for comparison between non-gaussian continuous variables and Fisher’s exact test for categorical variables.
Result & Outcome :
A total of 100 triphasic CT liver studies were audited, 50 performed in July 2023 before protocol modification and 50 in April 2024 after implementation (median age: 65.0 years; male:female = 63:37). There were significant improvements in peak aortic attenuation (p=0.049), portal vein enhancement in arterial phase (p=0.003), liver parenchymal enhancement in portovenous phase (p< 0.001) and differentiation of liver parenchyma with vasculature in delayed phase (p< 0.001). All (100.0%) triphasic CT met ACR LI-RADS standards after the modified CT protocol was adopted.
