Liver mass CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

Computed tomography may be useful for the evaluation and diagnosis of liver masses. The evaluation of liver mass should be performed with a triphasic CT, this modality includes 3 phases: non-contrast, arterial phase, and portal venous phase. On CT, characteristic findings of liver mass, may include: solitary or multiple lesion, solid or cystic consistency, and normally a rounded lesion. The evaluation of liver mass will depend on several characteristics, such as: vascular pattern, size, location, size, distribution, margins, attenuation, and contrast enhancement.

CT

Computed tomography may be useful for the evaluation and diagnosis of liver masses.[1][2]

  • The evaluation of liver mass should be performed with a triphasic CT, this modality includes 3 phases:
    • Non-contrast
    • Arterial phase
    • Portal venous phase
  • On CT, characteristic findings of liver mass, include:[1]
    • Solitary or multiple lesion
    • Solid or cystic
    • Rounded lesion
    • Bright dot sign: Presence of a bright dot within a lesion which remains hyper-attenuating on arterial and portal venous phase CT, corresponding to early nodular enhancement seen on liver hemangioma.
Hepatic diseases CT scan Findings
Hepatocellular carcinoma
  • Early arterial phase enhancement and then rapid wash out
  • Rim enhancement of capsule may persist
  • Malignant liver mass, particularly hepatocellular carcinoma, can have a variety of appearances, such as:
    • Massive (focal)
      • Large mass
      • May have necrosis, fat and /or calcification
    • Nodular (multifocal)
      • Multiple masses of variable attenuation
      • May also have central necrosis
    • Infiltrative (diffuse)
Hemangioma
  • Discontinuous, nodular, peripheral enhancement starting in arterial phase
  • Gradual central filling
  • Enhancement must match blood pool in each phase, or not a hemangioma (i.e. similar to aorta in arterial, portal vein in portal phase, etc)
  • Small hemangiomas (< ~1.5 cm) may demonstrate "flash filling" - complete homogenous enhancement in arterial phase (no gradual filling in)
Focal nodular hyperplasia
  • Bright arterial phase enhancement except central scar
  • Isodense/isointense to liver on portal venous phase
  • Central scar enhancement on delayed phase
Hepatic adenoma
  • Large, well circumscribed encapsulated tumors
  • The distribution of hepatic adenoma
    • 80% solitary
    • 20% multiple
  • Arterial phase: transient homogenous enhancement
  • Returns to near isodensity on portal venous and delayed phase image
Liver metastases
  • Hypodense and enhance less than the surrounding liver
  • Metastases from certain primaries demonstrate an increase in the number of vessels
  • Rim enhancement is a feature of malignant lesions, especially metastases.


References

  1. 1.0 1.1 Oliver JH, Baron RL: State of the art, helical biphasic contrast enhanced CT of the liver: Technique, indications, interpretation, and pitfalls. Radiology 1996; 201:1-14.
  2. Bonder A, Afdhal N (2012). "Evaluation of liver lesions". Clin Liver Dis. 16 (2): 271–83. doi:10.1016/j.cld.2012.03.001. PMID 22541698.

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