Differentiation Between Biliary Cystic Neoplasms and Simple Cysts of the Liver: Accuracy of CT

Abstract

Upstream bile duct dilatation, lesion location at the left hepatic lobe, fewer than three coexistent cysts, and THAD were found to be highly suggestive CT findings for the differentiation of biliary cystic neoplasms from simple hepatic cysts. Radiologists' performance was significantly improved with the knowledge of these highly suggestive CT criteria.

Surgical Management of Simple Liver Cysts: A 10-Year Single-Center Experience

“…However, it can be challenging to differentiate SLC from cystadenoma and cystadenocarcinoma on imaging alone, as they can exhibit joint radiographic features [3,4,7,12,19]. In our study too, imaging failed to differentiate adequately between simple and complex cysts or between benign and malignant cystic lesions.…”

“…In most series, cystadenocarcinomas and cystadenomas represent less than 5% of cystic liver lesions [1,19]. However, in this center, they accounted for 17.8% of the total number of lesions thought to be SLC.…”

“…A number of identifying characteristics found on US and CT investigation make it possible to distinguish SLC from most other lesions [19]. However, it can be challenging to differentiate SLC from cystadenoma and cystadenocarcinoma on imaging alone, as they can exhibit joint radiographic features [3,4,7,12,19].…”

“…Kim et al compared the CT features of cystadenoma and cystadenocarcinoma to CT features of atypical SLC that showed septation and calcification [19]. It was observed that a left lobe cyst, upstream biliary dilatation, number of cysts < 3 and a positive perilesional transhepatic attenuation difference (THAD) were predictors of malignancy [19,20]. The atypical appearance of SLC on cross-sectional images is also attributable to previous complications such as cyst rupture, hemorrhage or infection [4,10].…”

A rare large symptomatic simple hepatic cyst

“…There is contrast-induced enhancement of the wall and septa. Furthermore, in contrast to simple hepatic cyst, these lesions can be associated with upstream bile duct dilation and arterial phase high attenuation of perilesional hepatic tissue 6. Serum or cyst fluid CA 19–9 levels may be raised though this is not entirely a specific feature.…”