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__NOTOC__
__NOTOC__
{{Liver mass}}
{{Liver mass}}
{{CMG}} ; {{AE}} {{ADG}}
{{CMG}}; {{AE}} {{ADG}}


==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.
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.


Line 14: Line 13:
**Portal venous phase  
**Portal venous phase  


*On CT, characteristic findings 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>
*On CT, characteristic findings 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>
**Solitary or multiple lesion
**Solitary or multiple lesion
**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.
**'''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"
{|
!Hepatic diseases
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hepatic Diseases
!CT scan Findings
! align="center" style="background:#4479BA; color: #FFFFFF;" + |CT Scan Findings
|-
|-
|[[Hepatocellular carcinoma]]
! align="center" style="background:#DCDCDC;" + |[[Hepatocellular carcinoma]]
|
| align="left" style="background:#F5F5F5;" + |
*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
Line 36: Line 35:
**Infiltrative (diffuse)  
**Infiltrative (diffuse)  
|-
|-
|[[Hemangioma]]
! align="center" style="background:#DCDCDC;" + |[[Hemangioma]]
|
| align="left" style="background:#F5F5F5;" + |
*Discontinuous, nodular, peripheral enhancement starting in arterial phase[[Image:Liver-haemangioma-bright-dot-sign.PNG|thumb|'''Liver hemangioma''': discontinuous, nodular, peripheral enhancement starting in arterial phase]]
[[Image:Liver-haemangioma-bright-dot-sign.PNG|thumb|'''Liver hemangioma''': discontinuous, nodular, peripheral enhancement starting in arterial phase]]
*Discontinuous, nodular, peripheral enhancement starting in arterial phase
*Gradual central filling  
*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)
*Enhancement must match blood pool in each phase, or not a hemangioma (i.e. similar to the 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)
*Small hemangiomas (< ~1.5 cm) may demonstrate "flash filling" - complete homogenous enhancement in arterial phase (no gradual filling in)
|-
|-
|[[Focal nodular hyperplasia]]
! align="center" style="background:#DCDCDC;" + |[[Focal nodular hyperplasia]]
|
| align="left" style="background:#F5F5F5;" + |
*Bright arterial phase enhancement except central scar
*Bright arterial phase enhancement except for central scar
*Isodense/isointense to liver on portal venous phase
*Isodense/isointense to liver on portal venous phase
*Central scar enhancement on delayed phase
*Central scar enhancement on delayed phase
|-
|-
|[[Hepatic adenoma]]
! align="center" style="background:#DCDCDC;" + |[[Hepatic adenoma]]
|
| align="left" style="background:#F5F5F5;" + |
*Large, well circumscribed encapsulated tumors
*Large, well circumscribed encapsulated tumors
*The distribution of hepatic adenoma
*The distribution of hepatic adenoma
**80% solitary
**80% solitary
**20% multiple
**20% multiple
*Arterial phase: transient homogenous enhancement
*Arterial phase: transient homogenous enhancement
*Returns to near isodensity on portal venous and delayed phase image
*Returns to near isodensity on portal venous and delayed phase image
|-
|-
|[[Metastases|Liver metastases]]
! align="center" style="background:#DCDCDC;" + |[[Metastases|Liver metastases]]
|
| align="left" style="background:#F5F5F5;" + |
*Hypodense and enhance less than the surrounding liver
*Hypodense and enhance less than the surrounding liver
*Metastases from certain primaries demonstrate an increase in the number of vessels
*Metastases from certain primaries demonstrate an increase in the number of vessels
*Rim enhancement is a feature of malignant lesions, especially metastases.
*Rim enhancement as a feature of malignant lesions especially metastases
|}
|}
==Gallery==
==References==
==References==
{{reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Hepatology]]
[[Category:Gastroenterology]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Primary care]]
[[Category:Surgery]]
[[Category:Surgery]]

Revision as of 22:18, 29 November 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [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
Liver hemangioma: discontinuous, nodular, peripheral enhancement starting in arterial phase
  • 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 the 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 for 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 as 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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