That liver lesion on MDCT in the oncology patient: is it important?

Abstract

Multidetector-row computed tomography (MDCT) has become the primary imaging test for the staging and follow-up of most malignancies that originate outside of the central nervous system. Technical advances in this imaging technique have led to significant improvement in the detection of metastatic disease to the liver. An unintended by-product of this improving diagnostic acumen is the discovery of incidental hepatic lesions in oncology patients that in the past remained undetected. These ubiquitous, incidentally identified hepatic lesions have created a management dilemma for both clinicians and radiologists: are these lesions benign or do they represent metastases? Naturally, the answer to this question has profound prognostic and therapeutic implications. In this review, guidelines concerning the diagnosis and management of some of the more common hepatic incidental lesions detected in patients with extrahepatic malignancies are presented.

The visualisation of focal liver lesions on ultrasound: A review of 300 liver ultrasounds with CT or MRI correlation

“…Despite improvements in US technology, the identification of FLLs remains a diagnostic challenge. The visualisation and characterisation of small FLLs by any form of current imaging are subject to spatial and contrast limitations leading to diagnostic uncertainty and management dilemmas particularly in smaller lesions . Additional considerations with regard to US include variable ability to visualise an FLL in different locations, in different patient types, and by operators of varying experience.…”

Focal masses in a non-cirrhotic liver: The additional benefit of CEUS over baseline imaging

“…MDCT affords better longitudinal spatial resolution due to thin slice acquisition and consequently, allows for high-quality multiplanar reconstructions. Detection rates of 96% are reported for FLLs <11 mm when using 2 and 4 mm slice reconstruction, as compared to the reported detection rates of 84%, 75%, and 70%, respectively, when using larger sections of 6, 8, and 10 mm [28,30].…”

“…The main diagnostic value of CECT is for detection and staging purposes in patients with (suspected) malignancy [17,18,28,29] (Fig. 1).…”

“…• CT is the imaging method of choice for staging purposes (thorax and abdomen) in patients with suspected/known malignancies [17,18,28,29], but will miss a substantial portion of liver metastases. • CT has limited diagnostic value for sub-centimetric FLLs unless thin slice technique is used.…”

EUS-derived criteria for distinguishing benign from malignant metastatic solid hepatic masses

“…1,2 The resulting impact on prognosis, selection of therapy, and patient outcome is substantially altered in the majority of patients with hepatic metastases. 3,4 For most cancers, the finding of hepatic metastasis indicates a noncurative status and poor prognosis with shortened survival. 3–7 The liver is most often assessed for metastases by CT or magnetic resonance imaging (MRI).…”