Characteristics of common solid liver lesions and recommendations for diagnostic workup

Abstract

Due to the widespread clinical use of imaging modalities such as ultrasonography, computed tomography and magnetic resonance imaging (MRI), previously unsuspected liver masses are increasingly being found in asymptomatic patients. This review discusses the various characteristics of the most common solid liver lesions and recommends a practical approach for diagnostic workup. Likely diagnoses include hepatocellular carcinoma (the most likely; a solid liver lesion in a cirrhotic liver) and hemangioma (generally presenting as a mass in a non-cirrhotic liver). Focal nodular hyperplasia and hepatic adenoma should be ruled out in young women. In 70% of cases, MRI with gadolinium differentiates between these lesions. Fine needle core biopsy or aspiration, or both, might be required in doubtful cases. If uncertainty persists as to the nature of the lesion, surgical resection is recommended. If the patient is known to have a primary malignancy and the lesion was found at tumor staging or follow up, histology is required only when the nature of the liver lesion is doubtful.

Contrast-enhanced ultrasound in diagnosis and characterization of focal hepatic lesions

“…Labeled red blood cell scintigraphy is the best and least expensive modality for lesions over 2.5 cm in diameter and MRI for lesions under 2 cm in diameter [1] . Asymptomatic patients with hepatic hemangiomas do not need follow-up as there is no risk of malignant transformation, but when a homogeneous hyperechoic lesion is discovered in a patient with a history of cirrhosis 457 December 28, 2010|Volume 2|Issue 12| WJR|www.wjgnet.com Patients for whom the ultrasonography without contrast, computed tomography, magnetic resonance imaging or cytology is not conclusive Evaluation of lesions before percutaneous treatment to have a first image to compare after the procedure if necessary Guidance of the needle or the probe during percutaneous treatment Immediate evaluation of the lesion after percutaneous treatment to detect viable areas [24] Follow-up of patients with liver lesions treated by percutaneous ethanol injection or radiofrequency ablation Detection of liver tumors and study of its microcirculation Evaluation of organ perfusion Study of macrocirculation Improvement of sensibility and specificity during intraoperative sonography or known malignancy, further characterization is recommended [4] .…”

“…The management is surgical due to its high bleeding risk and potential malignant degeneration [5% of hepatic adenomas transform to hepatocellular carcinoma (HCC)] [1] .…”

“…About 80% of HCCs appear in cirrhotic population. A liver mass in a cirrhotic patient should be considered a HCC until proven otherwise [1] . Screening of HCC is recommended in these patients through the determination of AFP and a conventional ultrasound every 6 mo.…”

“…The widespread availability of imaging modalities such as ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI), to screen for liver lesions and in the study of nonspecific abdominal complaints, has greatly increased the diagnosis of liver lesions in asymptomatic patients [1] . The precise diagnosis of liver lesions should not only…”

“…In nodules between 1 and 2 cm in diameter, two techniques showing typical imaging criteria are needed for the diagnosis. Follow-up every 3 mo is recommended for masses less than 1 cm in diameter [1] .…”