A prospective evaluation of 185 consecutive patients with abdominal pain or suspected hepatic malignancy was performed to compare the diagnostic accuracy of contrast material-enhanced incremental dynamic computed tomography (IDCT) scans with plain CT scans for detection of hepatic masses and fatty infiltration of the liver. After a series of nondynamic plain CT scans, patients were examined at 7.5 scans/min during intravenous injection of 50 g of iodinated contrast material. Enhanced IDCT study was found to be an accurate, reproducible technique for liver evaluation. Of 155 neoplasms measured in 59 patients, liver-to-lesion differences of less than 10 HU were seen in only two tumors in IDCT scans as compared with 31 in plain CT scans. These differences were not significantly affected by lesion size for neoplasms greater than 6 mm in diameter. A confident diagnosis of fatty infiltration (23 patients) could be made when the spleen-minus-liver difference was 25 HU on enhanced IDCT scans and 10 HU on plain CT scans. In eight patients with liver metastases, there was little variation in the attenuation values of normal-appearing liver between serial examination studies (8 HU average).