*Helical Tri-phase Liver*
W. Dennis Foley, M.D. Professor of Radiology Director of Section of Digital Imaging Medical College of Wisconsin Milwaukee, Wisconsin
	GE Medical Systems Patient has chronic hepatitis and suspected hemochromatosis. CT study was performed to evaluate for possible hepatoma. The examination was performed using a triple pass technique as follows: First pass (image thickness/table speed) 2.5/15 mm Second pass (image thickness/table speed) 5/15 Q Third pass (image thickness/table speed) 5/22.5

	First pass is obtained at aortic peak plus 10 sec, second pass between 10 and 20 sec after aortic peak, and the third pass 60 sec after the beginning of the intravenous bolus injection. Aortic peak is determined from a preliminary mini bolus. Bolus contrast injection for the study is 5 cc/sec for 30 sec of 60% iodinated contrast material. First two passes are obtained during a single breath-hold and the third pass in a separate breath-hold.

This study demonstrates a large right hepatic lobe hepatoma 8 cm in craniocaudal dimension by 6 cm in cross-sectional diame-ter. There is early arterial enhancement that is documented on the second phase. Right posterior portal vein is occluded by tumor and associated tumor thrombus is present. Hepatic cirrhosis and ascites are noted. Hepatic veins, main portal vein, right anterior branch, and splenic vein are patent. Good example of detection of hypervas- cular primary hepatic neoplasm using the triple pass technique. The first pass is used for CT arteriography, while the second pass best delineates hypervascular neoplasm. The hypervascular neoplasm is isoattenuat-ing with liver on the conventional third pass. Perfusion abnormalities are not uncommon in patients with hepatoma as is illustrated in this case. Diagnosis of hepatoma was confirmed by guided biopsy.


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