Journal of Digital Imaging

, Volume 28, Issue 2, pp 213–223 | Cite as

Classification of Hypervascular Liver Lesions Based on Hepatic Artery and Portal Vein Blood Supply Coefficients Calculated from Triphasic CT Scans

  • F. Edward BoasEmail author
  • Aya Kamaya
  • Bao Do
  • Terry S. Desser
  • Christopher F. Beaulieu
  • Shreyas S. Vasanawala
  • Gloria L. Hwang
  • Daniel Y. Sze


Perfusion CT of the liver typically involves scanning the liver at least 20 times, resulting in a large radiation dose. We developed and validated a simplified model of tumor blood supply that can be applied to standard triphasic scans and evaluated whether this can be used to distinguish benign and malignant liver lesions. Triphasic CTs of 46 malignant and 32 benign liver lesions were analyzed. For each phase, regions of interest were drawn in the arterially enhancing portion of each lesion, as well as the background liver, aorta, and portal vein. Hepatic artery and portal vein blood supply coefficients for each lesion were then calculated by expressing the enhancement curve of the lesion as a linear combination of the enhancement curves of the aorta and portal vein. Hepatocellular carcinoma (HCC) and hypervascular metastases, on average, both had increased hepatic artery coefficients compared to the background liver. Compared to HCC, benign lesions, on average, had either a greater hepatic artery coefficient (hemangioma) or a greater portal vein coefficient (focal nodular hyperplasia or transient hepatic attenuation difference). Hypervascularity with washout is a key diagnostic criterion for HCC, but it had a sensitivity of 72 % and specificity of 81 % for diagnosing malignancy in our diverse set of liver lesions. The sensitivity for malignancy was increased to 89 % by including enhancing lesions that were hypodense on all phases. The specificity for malignancy was increased to 97 % (p = 0.039) by also examining hepatic artery and portal vein blood supply coefficients, while maintaining a sensitivity of 76 %.


Triphasic CT Enhancement Washout Hepatocellular carcinoma Liver lesions Computer-aided diagnosis 



American Association for the Study of Liver Diseases


European Association for the Study of the Liver


Focal nodular hyperplasia


Hepatic artery coefficient or hepatic artery blood supply coefficient


Hepatocellular carcinoma


Hounsfield units


Portal vein coefficient or portal vein blood supply coefficient


Radiofrequency ablation


Region of interest


Transarterial chemoembolization


Transient hepatic attenuation difference







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Copyright information

© Society for Imaging Informatics in Medicine 2014

Authors and Affiliations

  • F. Edward Boas
    • 1
    Email author
  • Aya Kamaya
    • 2
  • Bao Do
    • 3
  • Terry S. Desser
    • 2
  • Christopher F. Beaulieu
    • 2
  • Shreyas S. Vasanawala
    • 2
  • Gloria L. Hwang
    • 2
  • Daniel Y. Sze
    • 2
  1. 1.Interventional RadiologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of RadiologyStanford University Medical CenterStanfordUSA
  3. 3.VA Palo Alto Health Care SystemPalo AltoUSA

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