CT shows poor sensitivity for the diagnosis of lesions of<10mm, although its sensitivity increases with the size of the nodules16. Chen L, Zhang L, Bao J, et al. We often can not tell with confidence what they are. Small lesions (up to ~2 cm) may show immediate and complete enhancement in the arterial phase, with sustained enhancement in the venous and delayed phases (type I, flash filling) [31] (Fig. AJR Am J Roentgenol. Diffusion-weighted MRI provides additional value to conventional dynamic contrast-enhanced MRI for detection of hepatocellular carcinoma. Eur Radiol. If the lesion shows near water density, is homogenous in character, and has sharp margins, then a cyst should be considered and can be confirmed with US, equilibrium-phase CT, or even MR imaging (T2 bright and non-enhancing post-gadolinium), which can ensure there are no solid components or mural wall lesions. Web2. Management of indeterminate hepatic nodules and evaluation of Theyre found in as many as 30 percent of people over the age of 40. On CT, hepatic cysts are well circumscribed and typically show attenuation values similar to water (015 HU), although smaller cysts may show higher attenuation values due to partial volume effects. Hepatocellular adenoma (HCA) is uncommon, but has an association with oral contraceptive and anabolic steroid usage. Two of these patients underwent repeat surgery for the recurrence, of which one had benign nodules. ; 15 and 10 years of ex- ence in intensity between the lesion and the lesion database, the similarity ref- perience in abdominal imaging, respec- the surrounding liver and the sharpness erence standard, our evaluation mea- tively) viewed each pair of images twice of the margin to characterize each profile. Focal nodular hyperplasia: CT findings with emphasis on multiphasic helical CT in 78 patients. Clin. The presence of subcentimeter liver lesions at diagnosis was significantly associated with reduced overall survival (hazard ratio 1.65; 95% confidence interval 1.03-2.64, P = .036). https://doi.org/10.1186/s12876-019-1036-7 (2019). Holzapfel K, Reiser-Erkan C, Fingerle AA, et al. Focal nodular hyperplasia (FNH) is the second most common benign lesion of the liver most frequently occurring in healthy, young and middle-aged women [ 1 3 ]. Res. Magnetic resonance with diffusion-weighted imaging improves assessment of focal liver lesions in patients with potentially resectable pancreatic cancer on CT. P50 CA127003/CA/NCI NIH HHS/United States. Subcapsular lesions that do not exhibit mass effect or a round nature should be carefully evaluated before suggesting the diagnosis of HCC. On dynamic contrast-enhanced MR imaging, metastases demonstrate enhancement characteristics similar to those described for CT. Metastases may demonstrate a hypointense rim compared with the center of the lesion on delayed images (peripheral washout sign), which is highly specific for malignancy. Survival was calculated from the date of resection to the date of last follow-up or death. These symptoms tend to first occur in people who are aged 60 years or older. FOIA Larger lesions (>5 cm) or lesions with central thrombosis/fibrosis may lack central fill-in (type III) (Fig. The oncosurgery approach to managing liver metastases from colorectal cancer: A multidisciplinary international consensus. This is in contrast to the scar of FNH, which is most often hyperintense on T2-weighted images. In addition, subcentimeter lesions detected by gadoxetic acid-enhanced MRI are likely to be or can transform to become HCC within a short interval [59]. PubMed (a) Normal dose MDCT in the venous phase (120 kVp, ref. https://doi.org/10.1038/sj.bjc.6605049 (2009). On MRI, biliary hamartomas appear low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging (Fig. Biliary hamartomas: solitary and multiple lesions shown on current MR techniques including gadolinium enhancement. Materials and methods: Barreda R, Ros PR. A visible branch of the portal or hepatic vein terminating at the periphery of these lesions t (lollipop sign) has also been described, although this is not pathognomonic of the disease [74]. Another key feature is that other than the scar, FNH are usually homogeneous in appearance compared with the heterogeneous appearance encountered in fibrolamellar HCC. Monzawa S, Ichikawa T, Nakajima H, et al. 8600 Rockville Pike The differential diagnosis of CRLM may include primary intrahepatic cholangiocarcinoma, primarily because CRC is usually an adenocarcinoma4. Accessibility Note that the free-breathing acquisition in this patient resulted in better delineation of the smaller liver metastases as T1 hypointense lesions against the enhancing liver parenchyma (arrows). To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. You can scrub and scrub and this wont remove the aroma. This site needs JavaScript to work properly. Most lesions can be diagnosed without the need for a tissue sample called a biopsy. https://doi.org/10.1007/s00432-020-03233-7 (2020). Liver-specific MR contrast has been shown to improve the characterization of FNH and HCA, increase the detection of suspicious focal lesions in patients with liver cirrhosis, as well as the identification of small focal liver lesions. Peterson MS, Baron RL, Rankin SC. Liver lesions: Types, risk factors, investigations and treatment. liver Size Most incidental liver lesions <1 cm are benign, while some small lesions may be difficult to definitively characterize by imaging methods . The positive predictive value was 96.6%. Jeon SK, Lee JM, Joo I, Lee DH, Ahn SJ, Woo H, Lee MS, Jang JY, Han JK. Gadoxetic acid-enhanced hepatobiliary phase MRI and high-b-value diffusion-weighted imaging to distinguish well-differentiated hepatocellular carcinomas from benign nodules in patients with chronic liver disease. Oncologist 17, 12251239. Small benign lesions often dont cause symptoms and dont require treatment. Using Cox regression, we calculated adjusted hazard ratios to determine the association between presence of liver lesions and overall survival. Surg. liver Baron RL, Brancatelli G. Computed tomographic imaging of hepatocellular carcinoma. Limited detection of small ( 10 mm) colorectal liver metastasis at preoperative CT in patients undergoing liver resection. T1-weighted chemical shift or DIXON imaging is useful for detecting intratumoral fat, while the presence of high T1-signal before contrast administration will raise the suspicion of spontaneous hemorrhage. On ultrasound, the lesion is usually isoechoic or slightly hypoechoic [33] to liver, but appears hypoechoic in patients with diffuse hepatic steatosis. The resultant water-only images have been shown to improve the uniformity of fat suppression at 3 T, compared with conventional spectral fat suppression technique [16]. The presence of indeterminate liver lesions may be associated with reduced overall survival. Eur Radiol. In addition, some well-differentiated or moderately differentiated HCC may appear isointense or hyperintense on delayed images due to higher levels of OATP1B3 and MRP3 receptor expression.
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