Abstract
Background: Hepatocellular carcinoma (HCC) is one of the most lethal cancers globally, making early, accurate detection a primary determinant of survival. Triphasic contrast-enhanced computed tomography (CT) serves as a cornerstone diagnostic technique, with technical refinements such as a dedicated late arterial phase showing promise in improving diagnostic confidence by optimizing tumor-to-parenchyma contrast. Objective: This study aimed to evaluate the diagnostic accuracy of triphasic CT scans featuring a dedicated late arterial phase for identifying HCC in patients with chronic liver disease (CLD), using histopathological confirmation as the diagnostic gold standard. Materials and Methods: A prospective cross-sectional diagnostic accuracy study was conducted over a 4-month period in the Radiology Department of Mayo Hospital. The study enrolled 85 consecutive patients (≥40 years old) presenting with chronic liver disease risk factors and focal liver lesions suspected of being HCC on screening ultrasound. Triphasic liver CT scanning protocols were standardized to include a late arterial phase (35–40 seconds), a portal venous phase (60–70 seconds), and a delayed phase (5 minutes) using multidetector CT equipment (≤5 mm slice thickness). Imaging findings were correlated with histopathological results and analyzed using SPSS software. Results: The study population was predominantly male (76.5%) with a mean age of 58.87±10.10 years. The primary etiological factor was Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) co-infection (27.1%), followed by isolated HCV (22.4%) and isolated HBV (20.0%). The mean diameter of the index lesions was 6.06±3.43 cm, with 87.1% measuring ≥2 cm. Positive late arterial phase hyperenhancement was observed in 74.1% of patients, while positive portal venous phase washout was identified in 64.7%. Chi-square analysis demonstrated a highly significant statistical association between late arterial enhancement and final histopathological diagnosis of HCC (χ2(1)=40.012, p<.001), as well as between portal venous washout and final HCC diagnosis (χ2(1)=19.443, p<.001). Complementary findings across all dynamic phases occurred in 83.5% of cases. Conclusion: Triphasic CT with a dedicated late arterial phase demonstrates strong diagnostic correlation and exceptional clinical utility for evaluating HCC within a chronic liver disease framework. The combination of late arterial hyperenhancement and subsequent venous/delayed phase washout enables strong non-invasive diagnostic confidence