Liver mass CT scan

Jump to navigation Jump to search

Liver Mass Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differential Diagnosis

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

Evaluation of Liver Mass

Staging

History and Symptoms

Physical Examination

Laboratory Studies

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Case Studies

Case #1

Liver mass CT scan On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Liver mass CT scan

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Liver mass CT scan

CDC on Liver mass CT scan

Liver mass CT scan in the news

Blogs on Liver mass CT scan

Directions to Hospitals Treating bone or soft tissue mass

Risk calculators and risk factors for Liver mass CT scan

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.