Hepatic Enhancement in Multiphasic Contrast-Enhanced MDCT: Comparison of High- and Low-Iodine-Concentration Contrast Medium in Same Patients with Chronic Liver Disease

OBJECTIVE: The aim of this study was to evaluate the degree of hepatic enhancement and image quality in patients with cirrhosis or chronic hepatitis who underwent multiphasic contrast-enhanced dynamic imaging on MDCT at least twice using standard (300 mg I/mL) and higher (370 mg I/mL) iodine concentrations in contrast medium during follow-up periods. MATERIALS AND METHODS: This study included 20 patients with chronic liver diseases who underwent at least two multiphasic contrast-enhanced dynamic MDCT examinations using 100 mL of standard (300 mg I/mL = group A) and higher (370 mg I/mL = group B) iodine concentrations in contrast medium. After we obtained unenhanced CT scans, we performed multiphasic scanning at 30 sec (arterial phase), 60 sec (portal phase), and 180 sec (late phase) after the start of contrast medium injection. The CT values of hepatic parenchyma, abdominal aorta, and portal vein were measured. The mean enhancement value was defined as the difference in CT values between unenhanced and contrast-enhanced images. Visual image quality was also assessed on the basis of the degree of hepatic and vascular enhancement, rated on a 4-point scale. RESULTS: The mean hepatic parenchyma enhancement values in group B was significantly greater (p < 0.001) than those in group A during the portal phase (43.8 +/- 8.2 H vs 36.2 +/- 7.3 H) and the late phase (33.7 +/- 7.0 H vs 27.3 +/- 3.9 H), but the difference on the arterial phase images between the two groups (9.4 +/- 3.2 H vs 8.3 +/- 2.5 H) was not significant. The mean aorta-to-liver contrast during the arterial phase in group B was significantly higher (p < 0.001) than that in group A (236 +/- 40 H vs 193 +/- 32 H). For qualitative analysis, the mean visual scores for hepatic parenchyma and vasculature enhancement in group B were significantly higher than those in group A in arterial phase (p < 0.018), portal phase (p < 0.0001), and late phase (p < 0.0001). CONCLUSION: In the same patients with chronic liver diseases, a higher iodine concentration (370 mg I/mL) in the contrast medium improves contrast enhancement of liver parenchyma in the portal phase and late phase images, improves overall image quality, and helps improve diagnostic accuracy for liver diseases on multiphasic contrast-enhanced dynamic MDCT.