© Schima and Jhaveri 2015
Published: 2 October 2015
The liver presents with a variety of lesions for evaluation and appropriate triage with imaging. Ultrasound, MDCT and particularly MRI play a significant role in this objective. In patients without a known malignancy the vast majority of non-cystic lesions are benign (hemangioma, FNH, adenoma, focal fat, etc.), while a few are malignant. However, common benign hepatic lesions may pose a dilemma, if their imaging features are atypical. Although patients with a known malignancy are more likely to have a diagnosis of metastasis for a liver lesion, some studies have shown that small (<1cm) hepatic lesions are more likely to be benign even in patients with a cancer diagnosis [1, 2]. While metastases may be a common diagnosis in cancer, it is important to recognise varied patterns of liver metastases after chemotherapy or after surgery. Chemotherapy-related focal or nodular fat deposition can also lead to variety of pseudolesions and one needs to be aware of these appearances and distinguish them from fat-containing hepatic tumors . Uncommon occurrence of hepatic peliosis and sinusoidal obstruction syndrome also needs to be kept in mind in patients with cancer .
In patients with chronic liver disease, ultrasound surveillance is the method of choice for the early detection of HCC in cirrhosis . For characterization of focal lesions in cirrhosis, EASL-EORTC and AASLD recommend multi-phasic contrast-enhanced MDCT or MRI. Imaging features typical for HCC is arterial phase hypervascularity and wash-out to hypoattenuation/hypointensity in the venous and/or equilibrium phase, which allows non-invasive diagnosis of HCC . Recently diffusion-weighted imaging (DWI) and liver-specific MR contrast agent have been introduced in the clinical routine for detection and lesion characterization. The combination of DWI and liver-specific contrast agents yields the bests results in the detection liver metastases . For characterization of focal lesions in cirrhosis, administration of liver-specific MR contrast agents may help a make a confident diagnosis [8, 9].
In this workshop the work-up of focal liver lesions will be discussed and the varied imaging features of common and less common focal lesions will be presented.
- Schwartz LH, Gandras EJ, Colangelo SM, et al: Prevalence and importance of small hepatic lesions found at CT in patients with cancer. Radiology. 1999, 210: 71-74. 10.1148/radiology.210.1.r99ja0371.PubMedView ArticleGoogle Scholar
- Noone TC, Semelka RC, Cem Balci N, Graham ML: Common occurrence of benign liver lesions inpatients with newly diagnosed breast cancer investigated by MRI for suspected liver metastases. J Magn Reson Imaging. 1999, 10: 165-169. 10.1002/(SICI)1522-2586(199908)10:2<165::AID-JMRI9>3.0.CO;2-Z.PubMedView ArticleGoogle Scholar
- Valls C, Iannacconne R, Alba E, et al: Fat in the liver: diagnosis and characterization. Eur Radiol. 2006, 16: 2292-308. 10.1007/s00330-006-0146-0.PubMedView ArticleGoogle Scholar
- Iannaccone R, Federle MP, Brancatelli G, et al: Peliosis hepatis: spectrum of imaging findings. AJR Am J Roentgenol. 2006, 187: W43-52. 10.2214/AJR.05.0167.PubMedView ArticleGoogle Scholar
- Forner A, Llovet JM, Bruix J: Hepatocellular carcinoma. Lancet. 2012, 379: 1245-1255. 10.1016/S0140-6736(11)61347-0.PubMedView ArticleGoogle Scholar
- European Association For The Study Of The Liver, European Organisation For Research And Treatment Of Cancer: EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012, 56: 908-943.View ArticleGoogle Scholar
- Löwenthal D, Zeile M, Lim WY, et al: Detection and characterisation of focal liver lesions in colorectal carcinoma patients: comparison of diffusion-weighted and Gd-EOB-DTPA enhanced MR imaging. Eur Radiol. 2011, 21: 832-840. 10.1007/s00330-010-1977-2.PubMedView ArticleGoogle Scholar
- Kwon HJ, Byun JH, Kim JY, et al: Differentiation of small (≤2 cm) hepatocellular carcinomas from small benign nodules in cirrhotic liver on gadoxetic acid-enhanced and diffusion-weighted magnetic resonance images. Abdom Imaging. 2015, 40: 64-75. 10.1007/s00261-014-0188-8.PubMedView ArticleGoogle Scholar
- Lee MH, Kim SH, Park MJ, Park CK, Rhim H: Gadoxetic acid-enhanced hepatobiliary phase MRI and high-b-value diffusion-weighted imaging to distinguish well-differentiated hepatocellular carcinomas from benign nodules in patients with chronic liver disease. AJR Am J Roentgenol. 2011, 197: W868-875. 10.2214/AJR.10.6237.PubMedView ArticleGoogle Scholar
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