Should Unenhanced Phase of the Liver Be Included in the Scanning Protocol of Metastatic Breast Cancer?: Implications for Sensitivity, Response Evaluation and Size Measurement.

Abstract

Purpose

To analyze if performing unenhanced CT of the liver aids in the evaluation of metastatic lesions, response assessment or alter the size of the lesions, compared with portal phase alone, in patients with hepatic metastases from breast carcinoma.

Methods

One-hundred and fifty-three CT scans of 36 women were included. Scans consisted of unenhanced, arterial and portal delayed phases of the liver. Two readers sorted which phase was the best for visualization of metastases, evaluated the number of lesions detected by each phase, selected the best phase for assessment of response in two consecutive scans, and measured one target lesion at all the phases. Χ² was used to compare differences among phases and paired t test for size differences.

Results

Unenhanced, arterial and portal phases were considered better phases by readers 1/2 in 68/67%, 27/28% and 69/70%, and some lesions were missed in 2%, 11% and 7%, respectively. Sensitivity was significantly better for unenhanced and portal phases compared to arterial phase. Comparison between consecutive scans was considered better in unenhanced (80/79%), followed by portal (70/69%) and arterial phases (31/31%). Maximum diameter of target lesions was 15% greater in unenhanced phase (p<0.001).

Conclusions

Portal and unenhanced phases of the liver allow better detection and delineation of metastatic hepatic lesions from breast carcinoma. Unenhanced CT in most cases is the best phase to to assess response and provides the larger diameter. So, we recommend the use of unenhanced CT when evaluating patients with breast carcinoma and suspected or known hepatic metastatic disease.