Optimization of the Timing of the Portal Venous Phase in Preoperative 3DCT for Malignant Liver Tumors.

Preoperative three-dimensional computed tomography (3DCT) of the liver is the most important examination in performing preoperative simulation. Detailed visualization of the portal vein using the workstation is critical to enable accurate liver segmentation. However, the timing of imaging in the portal venous phase has mostly been reported equivalent to that of the liver screening examinations commonly performed. The purpose of this study was to examine the optimal timing of image capture to create the best portal vein visualization in preoperative 3DCT of the liver. Seventy-nine patients who underwent hepatectomy for malignant liver tumors were enrolled in this study. All patients were preoperatively examined using protocol A (imaging method separated into a portal venous phase and a hepatic venous phase) and then examined 1 week after surgery using protocol B (normal liver screening protocol). We first established the regions of interest in the portal vein and the hepatic vein and then compared CT values for these regions under protocol A and protocol B. The average CT value of the portal vein in protocol A and B was 239.8±28.1 HU and 202.2±18.5 HU, respectively. The average CT value of the portal vein in protocol A was significantly higher compared with protocol B (p<0.01). By introducing separate timing for portal venous phase imaging before preoperative 3DCT (protocol A), it is possible to satisfactorily depict the portal vein.