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==Overview==
==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.<ref name="pmid22541698">{{cite journal |vauthors=Bonder A, Afdhal N |title=Evaluation of liver lesions |journal=Clin Liver Dis |volume=16 |issue=2 |pages=271–83 |year=2012 |pmid=22541698 |doi=10.1016/j.cld.2012.03.001 |url=}}</ref>
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==
==CT==
Computed tomography may be useful for the evaluation and diagnosis of liver masses.
Computed tomography may be useful for the evaluation and diagnosis of liver masses.<ref name="radioas" /><ref name="pmid22541698">{{cite journal |vauthors=Bonder A, Afdhal N |title=Evaluation of liver lesions |journal=Clin Liver Dis |volume=16 |issue=2 |pages=271–83 |year=2012 |pmid=22541698 |doi=10.1016/j.cld.2012.03.001 |url=}}</ref>
*The evaluation of liver mass should be performed with a triphasic CT, this modality includes 3 phases:
*The evaluation of liver mass should be performed with a triphasic CT, this modality includes 3 phases:
**Non-contrast  
**Non-contrast  
Line 18: Line 18:
**Solid or cystic
**Solid or cystic
**Rounded lesion
**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.
{| class="wikitable"
{| class="wikitable"
!
!Common Liver masses
!
!CT scan Findings
!CT scan Findings
|-
|-
| rowspan="3" |[[Hepatocellular carcinoma]]
|[[Hepatocellular carcinoma]]
|
*Early arterial phase enhancement and then rapid wash out
*Early arterial phase enhancement and then rapid wash out
*Rim enhancement of capsule may persist
*Rim enhancement of capsule may persist
|Massive (focal)
*Malignant liver mass, particularly hepatocellular carcinoma, can have a variety of appearances, such as:
|
**Massive (focal)
*Large mass
***Large mass  
*May have necrosis, fat and /or calcification
***May have necrosis, fat and /or calcification
**Nodular (multifocal)
***Multiple masses of variable attenuation
***May also have central necrosis
**Infiltrative (diffuse)
|-
|-
|Nodular (multifocal)
|[[Hemangioma]]
|
*Multiple masses of variable attenuation
*May also have central necrosis
|-
|Infiltrative (diffuse)
|
|-
| colspan="2" |[[Hemangioma]]
|
|
*Discontinuous, nodular, peripheral enhancement starting in arterial phase
*Discontinuous, nodular, peripheral enhancement starting in arterial phase
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*Small hemangiomas (< ~1.5 cm) may demonstrate "flash filling" - complete homogenous enhancement in arterial phase (no gradual filling in)
*Small hemangiomas (< ~1.5 cm) may demonstrate "flash filling" - complete homogenous enhancement in arterial phase (no gradual filling in)
|-
|-
| colspan="2" |[[Focal nodular hyperplasia]]
|[[Focal nodular hyperplasia]]
|
|
*Bright arterial phase enhancement except central scar
*Bright arterial phase enhancement except central scar
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*Central scar enhancement on delayed phase
*Central scar enhancement on delayed phase
|-
|-
| colspan="2" |[[Hepatic adenoma]]
|[[Hepatic adenoma]]
|
|
*Large, well circumscribed encapsulated tumors
*Large, well circumscribed encapsulated tumors
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*Returns to near isodensity on portal venous and delayed phase image
*Returns to near isodensity on portal venous and delayed phase image
|-
|-
| colspan="2" |[[Metastases|Liver metastases]]
|[[Metastases|Liver metastases]]
|
|
*Hypodense and enhance less than the surrounding liver
*Hypodense and enhance less than the surrounding liver
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*Rim enhancement is a feature of malignant lesions, especially metastases.
*Rim enhancement is a feature of malignant lesions, especially metastases.
|}
|}
[[Hepatocellular carcinoma]]
:*Most common hypervascular primary liver malignancy
:*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)
:*May be difficult to distinguish from associated cirrhosis
[[Hemangioma]]
:*Benign; most common liver tumor overall
:*Discontinuous, nodular, peripheral enhancement starting in arterial phase
:*Gradual central filling in
:*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
[[Metastases|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.
On CT, radiological signs of liver mass, include:<ref name="radioas">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. </ref>
*'''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.


==Gallery==
==Gallery==

Revision as of 20:25, 29 January 2018

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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.
Common Liver masses 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.

Gallery

  • Liver hemangioma: discontinuous, nodular, peripheral enhancement starting in arterial phase
    Liver hemangioma: discontinuous, nodular, peripheral enhancement starting in arterial phase
  • Bright dot sign: 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
    Bright dot sign: 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
  • Focal nodular hyperplasia: bright arterial contrast enhancement except for the central scar which remains hypoattenuating
    Focal nodular hyperplasia: bright arterial contrast enhancement except for the central scar which remains hypoattenuating
  • Hepatic abscess: peripheral enhancement, centrally hypoattenuating lesions. Occasionally they appear solid, or contain gas. Segmental perfusion abnormalities, with early enhancement, may be seen.
    Hepatic abscess: peripheral enhancement, centrally hypoattenuating lesions. Occasionally they appear solid, or contain gas. Segmental perfusion abnormalities, with early enhancement, may be seen.


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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