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Hepatic lesions

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.

References

  1. 1.

    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.

    PubMed  CAS  Article  Google Scholar 

  2. 2.

    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.

    PubMed  CAS  Article  Google Scholar 

  3. 3.

    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.

    PubMed  Article  Google Scholar 

  4. 4.

    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.

    PubMed  Article  Google Scholar 

  5. 5.

    Forner A, Llovet JM, Bruix J: Hepatocellular carcinoma. Lancet. 2012, 379: 1245-1255. 10.1016/S0140-6736(11)61347-0.

    PubMed  Article  Google Scholar 

  6. 6.

    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.

    Article  Google Scholar 

  7. 7.

    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.

    PubMed  Article  Google Scholar 

  8. 8.

    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.

    PubMed  Article  Google Scholar 

  9. 9.

    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.

    PubMed  Article  Google Scholar 

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Correspondence to Wolfgang Schima.

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Schima, W., Jhaveri, K.S. Hepatic lesions. Cancer Imaging 15, O28 (2015). https://doi.org/10.1186/1470-7330-15-S1-O28

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Keywords

  • Adenoma
  • Liver Metastasis
  • Hemangioma
  • Liver Lesion
  • Focal Lesion