Medical Imaging and Radiotherapy Journal (MIRTJ) 39 (Suppl. 1) 9
Medical Imaging and Radiotherapy Journal (MIRTJ) 39 (Suppl. 1)
PROTOKOLI ZA SLIKANJE JETER Z RAČUNALNIŠKO 
TOMOGRAFIJO
LIVER COMPUTED TOMOGRAPHY IMAGING PROTOCOLS
Benjamin Duh, Jure Mišič, Irena Lopatič
Univerzitetni klinični center Ljubljana, Klinični inštitut za radiologijo, Zaloška cesta 7, 1000 Ljubljana, Slovenija / 
University medical centre Ljubljana, Institute of Radiology, Zaloška cesta 7, 1000 Ljubljana, Slovenia
Korespondenca / Corresponding author: benni.duh@gmail.com
Prejeto/Recived: 5. 11. 2019
Sprejeto/Accepted: 8. 3. 2022
IZVLEČEK 
Uvod: Računalniška tomografi ja (CT) ima ključno vlogo 
pri določanju diagnoze, stopnje bolezni, načrtovanju in 
vrednotenju zdravljenja kot tudi pri spremljanju bolnikov 
z znanimi boleznimi jeter ali s sumom na bolezni jeter. 
Za kakovostno slikanje patologij v jetrih in s tem njihovo 
karakterizacijo se uporabljajo različne faze slikanja. Jetra 
lahko slikamo z ali brez uporabe kontrastnega sredstva (KS), 
v različnih časovnih obdobjih po aplikaciji KS. Različne faze 
slikanja nam služijo za identifi kacijo patologij v jetrih. 
Namen: Namen prispevka je predstavitev pomembnosti 
izbire pravilnega protokola za CT slikanje jeter.
Metode: Uporabili smo kvalitativno raziskovalno metodologijo 
s pregledom literature in pregledom obstoječih protokolov 
na Kliničnem inštitutu za radiologijo (KIR) UKC Ljubljana. V 
teoretičnem delu je bila uporabljena deskriptivna metoda 
dela, opravili smo pregled strokovne literature in znanstvenih 
člankov s pomočjo podatkovnih baz COBISS, MEDLINE, CHINAL. 
Rezultati in razprava: Po pregledu obstoječe literature 
smo z zdravniki radiologi optimizirali protokol za CT slikanje 
jeter na KIR UKC Ljubljana. Pri omenjenem protokolu smo 
prilagodili hitrost aplikacije KS in količino KS ter s tem izboljšali 
kontrastnost jetrnih patologij. Uporaba pravilnih protokolov za 
CT slikanje jeter, optimizacija količine in hitrosti aplikacije KS in 
izbira ustrezne faze slikanja so ključni za kakovostno CT slikanje 
jeter, ki ne omogoča le odkrivaje lezij, temveč tudi njihovo 
karakterizacijo. Metoda je zlasti pomembna za zanesljivo 
ugotavljanje, ali so majhne lezije benigne ali maligne.
Zaključek: Pri pregledu obstoječih protokolov za slikanje 
abdomna na Kliničnem inštitutu za radiologijo UKC Ljubljana 
smo ugotovili, da je pravilna izvedba ključna za pravilen 
prikaz jetrnih patologij. Protokoli za slikanje jeter bi morali 
biti standardizirani med posameznimi ustanovami. Na ta 
način bi dosegli primerljivost preiskav med ustanovami, saj bi 
bile patologije jeter vedno prikazane na enak način. S tem bi 
se izognili centralizaciji CT slikanj jeter ter ponovni dozni in 
kontrastni obremenitvi pacienta. Radiološki inženirji morajo 
poznati pomen izbire primernega protokola za slikanje jeter 
pri posamezni diagnozi in sodelovati z radiologi pri izbiri 
primernega protokola za slikanje. 
Ključne besede: računalniška tomografi ja, jetra, kontrastno 
sredstvo
ABSTRACT
Introduction: Computed tomography (CT) plays an important 
role in diagnosis, disease staging, treatment planning and 
evaluation, and monitoring of patients with known or suspected 
liver disease. Diff erent phases of imaging are used to provide 
the high-quality visualization of pathology in the liver and 
thus to characterize it. The liver can be imaged with or without 
the use of a contrast agent (CA) at diff erent time periods after 
CA application. Diff erent phases of imaging help us to identify 
pathologies in the liver.
Purpose: The purpose of this paper is to present the importance 
of choosing the right protocol for the CT imaging of the liver.
Methods: We used a qualitative research methodology with 
a review of literature and a review of existing protocols at the 
Clinical Institute of Radiology (KIR) at the UKC Ljubljana. In the 
theoretical part, the descriptive working method was used. We 
reviewed professional literature and scientifi c articles using the 
COBISS, MEDLINE, CHINAL databases.
Results and discussion: After reviewing existing literature, we 
optimized the protocol for the CT imaging of the liver at KIR UKC 
Ljubljana with the help of radiologists. In the aforementioned 
protocol, we adjusted the rate of CA application and the amount 
of CA, and thus improved the contrast of liver pathologies. Using 
the right protocols for the CT imaging of the liver, optimizing the 
amount and rate of CA application, and selecting the appropriate 
phase of imaging are key to the high-quality CT imaging of the 
liver, which allows not only the detection of lesions but also their 
characterization. The method is particularly important for reliably 
determining whether small lesions are benign or malignant.
Conclusion: After reviewing the existing protocols for CT 
abdominal imaging at the Clinical Institute of Radiology, University 
Medical Centre Ljubljana, we found that proper implementation 
is critical for the correct presentation of liver pathologies. Liver 
imaging protocols should be standardized between institutions. 
In this way, comparability between institutions would be 
achieved, as liver pathologies would always be presented in the 
same way. This would avoid the centralization of CT scans of the 
liver and the re-dosing and contrast exposure of the patient. 
Radiographers should be aware of the importance of selecting 
an appropriate liver imaging protocol for each diagnosis and 
work with radiologists to select an appropriate imaging protocol.
Keywords: computed tomography, liver, contrast medium
10 Medical Imaging and Radiotherapy Journal (MIRTJ) 39 (Suppl. 1)
Medical Imaging and Radiotherapy Journal (MIRTJ) 39 (Suppl. 1)
LITERATURA / REFERENCES
Bae, K. (2010).  Intravenous contrast medium administration 
and scan timing in CT: Considerations and approaches. 
Radiology, 256: 32–61.
Feng, ST., Zhu, H., Peng, Z., Huang, L., Dong, Z., Xu, L.,Huang, 
K., Yang, X., Lin,Z., Li, ZP. (2017). An individually optimized 
protocol of contrast medium injecion in enhanced CT scan 
for liver imaging, Contrast media mol imaging 2017 Jul 10; 
7350429.
http://www.radiologyassistant.nl/en/p446f010d8f420/liver-
masses-i-characterisation.html  (dostopno 15. 5. 2019).
Jo, B.G., Song, Y.G., Shim, S.G., Kim, Y.W. (2016). Comparison 
of enhancement and image quality: diff erent iodine 
concentartions for liver on 128-slice multidetector 
computed tomograpy in the same chronic liver disease 
patrients, Korean J Intern Med, 31:461-9.
Kartalis, N., Brehmer, K., Loizou, L. (2017). Multi-detector CT: 
Liver protocol and recent developments, Eur J Radio. 97, 
101–9.
Masuda, T., Nakaura, T., Funama, Y., Sato, T., Higaki, T., 
Matsumoto, Y., Yamashita, Y., Imada, N., Kiguchi, M., Baba, 
Y., Yamashita, Y., Awai, K. (2019) Contrast enhancement 
on 100- and 120 kVp hepatic CT scans at thin adults in 
a retrospective cohort study: Bayesian inference of the 
optimal enhancement probability. Medicine 98 (47), 
e17902.