Detection and characterization of benign focal liver lesions with multislice CT

Winterer, Jan Thorsten; Kotter, Elmar; Ghanem, Nadir; Langer, Mathias

doi:10.1007/s00330-006-0247-9

Cited by 49 publications

(26 citation statements)

References 65 publications

(64 reference statements)

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“…On the other hand, small hemangiomas may show arterio-venous shunting, and hemangiomas less than 1 cm can preferentially have a rapid filling. In these cases, primary or metastatic malignant tumors may be considered as a differential diagnosis (32). Perfusion CT is able to demonstrate segmental or lobar arterioportal shunt formation caused by the hemangiomas, perfusion defects or changes as a result of compressive effects of a hemangioma, or signs of vascular involvement (Fig.…”

Section: Perfusion Imaging For Detection Of Hemangiomamentioning

confidence: 99%

Perfusion CT imaging of the liver: review of clinical applications

Oğul

Kantarcı²,

Genç³

et al. 2014

Diagn Interv Radiol

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Perfusion computed tomography (CT) has a great potential for determining hepatic and portal blood flow; it offers the advantages of quantitative determination of lesion hemodynamics, distinguishing malignant and benign processes, as well as providing morphological data. Many studies have reported the use of this method in the assessment of hepatic tumors, hepatic fibrosis associated with chronic liver disease, treatment response following radiotherapy and chemotherapy, and hepatic perfusion changes after radiological or surgical interventions. The main goal of liver perfusion imaging is to improve the accuracy in the characterization of liver disorders. In this study, we reviewed the clinical application of perfusion CT in various hepatic diseases. The advent of multidetector CT has given rise to the acquisition of images with higher quality and accuracy. Multidetector CT has been developed as a noninvasive imaging modality for evaluation of vascular anatomy. It has also made it possible to perform CT angiography of the hepatic vessels. New generation CT systems with multidetector are capable of performing volumetric imaging. These systems provide a single rotational acquisition and almost the whole upper abdomen can be appraised by means of serial rotational acquisitions at a single location in the z-direction. Multidetector CT imaging is used extensively for the preoperative selection of living related liver donors, as well as evaluation of the vascular anatomy of the recipients (1). This imaging technique is also used for the initial evaluation and follow-up of most patients with hepatic metastases, providing valuable information about the number, size, and distribution of hepatic metastases and the presence and extent of extrahepatic disease (1).Perfusion CT imaging permits the qualitative and quantitative assessment of liver perfusion. In perfusion CT, a quantitative tissue perfusion map is obtained from dynamic CT data and displayed using a color scale permitting the quantification of tissue perfusion in absolute units at high spatial resolution (2). Perfusion CT efficiently locates abnormal tissue perfusion which is difficult to detect accurately with conventional CT (3). Functional assessment of the perfusion of normal and pathologic tissues is performed by means of quantitative or semiquantitative parameters, such as blood flow (BF), blood volume (BV), mean transit time (MTT), portal liver perfusion (PLP), arterial liver perfusion (ALP) and hepatic perfusion index (HPI). Perfusion CT measures the temporal changes in tissue density through a series of dynamically acquired CT images after intravenous injection of an iodinated contrast material (4, 5). Perfusion CT may be performed quickly and provide valuable data for diagnosis. However, there are some limitations of this method such as long breath-holding for portal flow measurement, separation of arterial and portal blood flow, additional radiation exposure, limited craniocaudal scan range, and standardization of analytic methods (2). In this a...

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Section: Perfusion Imaging For Detection Of Hemangiomamentioning

confidence: 99%

Perfusion CT imaging of the liver: review of clinical applications

Oğul

Kantarcı²,

Genç³

et al. 2014

Diagn Interv Radiol

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“…CT is recommended in patients with known malignancy for staging, and in patients with chronic liver disease or even in otherwise healthy persons for confirmation of a suspected liver tumor detected on US [14]. The limits of CT are represented by small hypovascular FLLs, such as small metastases, difficult to differentiate from simple liver cysts or from small hemangiomas.…”

Section: Introductionmentioning

confidence: 99%

Diffusion Weighted Magnetic Resonance Imaging for the Classification of Focal Liver Lesions as Benign or Malignant

Caraiani

Chiorean

Fenesan

et al. 2015

JGLD

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Background & Aims: To assess the role of diffusion weighted imaging sequence (DWI), routinely used in hepatic magnetic resonance imaging (MRI) for the differentiation of focal liver lesions (FLLs) as benign or malignant. Method: 99 FLLs assessed by liver MRI in 80 patients were included in the present study. All lesions were retrospectively analyzed by two experienced radiologists, independent from each other, who were not aware of the previous results obtained by using different imaging techniques. All included FLLs had a final histological diagnosis or a final diagnosis based on consensus reading by two experienced radiologists and follow-up at 6 months. The FLLs signal was qualitatively appreciated on the b-800 sequences and on the apparent diffusion coefficient (ADC) map. The ADC value of each FLL was measured and the ADC ratio between the ADC value of the assessed FLL and that of the surrounding liver parenchyma were calculated. Results: The mean ADC value for benign FLLs as assessed by the two independent readers was 1.78 x 10¯³ and 1.72 x 10¯³, respectively. The mean ADC value for malignant FLLs was 0.92 x 10¯³ for the first reader and 0.95 x 10¯³ for the second reader. The mean ADC ratio for benign FLLs was 1.91 and 1.85 for the two readers and for malignant FLLs was 0.91 and 0.94, respectively. Using an ADC value lower than 1.024 x 10¯³ offers a specificity of 100% and a sensitivity of 62.5% for the diagnosis of malignant FLLs. The ADC value is an indicator which is less prone to interobserver variability (correlation of 0.919→1). The ADC ratio has, as the analysis of the ROC curve shows, the best predictive value for differentiation between benign and malignant FLLs. Analysis of the signal intensity on the DWI b-800 image alone is of no significance in differentiating benign from malignant FLLs (p>0.05). Conclusions: The ADC value and the ADC ratio assessed on liver DWI are useful diagnostic tools in the differential diagnosis of benign vs. malignant FLLs. Quantitative methods such as calculating the ADC value or ADC ratio have better diagnostic value than the qualitative techniques.

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“…In the portal venous and delayed phase, the FNH becomes isodense and may be difficult to detect. The central scar and septations typically show late enhancement due to diffusion of the contrast material into the stroma of the lesion [4,27,28,30,32,33,34,35,36,37]. A central scar is seen on CT in approximately 50% of the lesions.…”

Section: Resultsmentioning

confidence: 99%

Imaging Modalities for Focal Nodular Hyperplasia and Hepatocellular Adenoma

Esschert¹,

Gulik²,

Phoa

2010

Dig Surg

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Background/Aims: There are several imaging modalities available for the detection of focal liver lesions. Differentiation between focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) is important because of the consequences for management. However, differentiation based on imaging alone still shows limitations. Methods: We reviewed the literature for typical features of FNH and HCA on radiologic and nuclear imaging with emphasis on differentiation of both lesions. Results: Seven articles describe the performance of an imaging modality for the differentiation between FNH and HCA. Limitations of these studies are the small sample size and/or the lack of comparison with the ‘gold standard’, i.e. histological diagnosis. No studies are available that compare the accuracy of several imaging modalities in the differentiation of FNH and HCA. Conventional ultrasound (US) is not useful in the differentiation because of the non-specific features. On contrast-enhanced US, the arterial filling direction of FNH is centrifugal and centripetal in case of HCA. The parenchymal enhancement of FNH is sustained in the portal venous and delayed phases, but shows rapid washout in case of HCA. Multiphase CT scan can differentiate FNH from HCA when there is a central scar. FNH may have a slightly higher relative enhancement in the arterial phase. On MRI with hepatocyte-specific contrast agents, HCA does not show contrast uptake in the hepatobiliary phase in contrast to FNH. Conclusion: We conclude that there is limited evidence of the diagnostic performance of currently used imaging modalities for the differentiation of FNH and HCA. We therefore propose a prospective study (DiFA trial) to determine the accuracy of several radiologic and nuclear imaging studies in differentiating FNH and HCA.

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Detection and characterization of benign focal liver lesions with multislice CT

Cited by 49 publications

References 65 publications

Perfusion CT imaging of the liver: review of clinical applications

Perfusion CT imaging of the liver: review of clinical applications

Diffusion Weighted Magnetic Resonance Imaging for the Classification of Focal Liver Lesions as Benign or Malignant

Imaging Modalities for Focal Nodular Hyperplasia and Hepatocellular Adenoma

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