Volume 15 Supplement 1

Proceedings of the International Cancer Imaging Society (ICIS) 15th Annual Teaching Course

Open Access

Hepatic lesions

  • Wolfgang Schima1 and
  • Kartik S Jhaveri2
Cancer Imaging201515(Suppl 1):O28

https://doi.org/10.1186/1470-7330-15-S1-O28

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 [3]. Uncommon occurrence of hepatic peliosis and sinusoidal obstruction syndrome also needs to be kept in mind in patients with cancer [4].

In patients with chronic liver disease, ultrasound surveillance is the method of choice for the early detection of HCC in cirrhosis [5]. 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 [6]. 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 [7]. 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.

Authors’ Affiliations

(1)
Department of Diagnostic and Interventional Radiology, KH Göttlicher Heiland, KH der Barmherzigen Schwestern and Sankt Josef-Krankenhaus
(2)
Abdominal Imaging, University Health Network

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Copyright

© Schima and Jhaveri 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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