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.
• 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:

• Solitary or multiple lesion
• Solid or cystic
• Rounded lesion

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

• 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

On CT, radiological signs of liver mass, include:

• 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

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  Liver hemangioma: discontinuous, nodular, peripheral enhancement starting in arterial phase