Focal Liver Lesions: One More Example of Discordance Between Contrast-Enhanced Sonography and CT Pattern of Enhancement

Abstract

We would like to comment on the recent article by Dr. Wilson and colleagues [1] about discordance between contrast-enhanced sonography and CT and MRI as to patterns of enhancement of focal liver lesions. The authors should be commended on their effort to clarify this topic: albeit representing a small percentage of cases, patients with space-occupying liver lesions and discordant results between the contrast-based imaging techniques constitute a diagnostic challenge to their physicians.However, we have several questions. First, it is unclear from the Materials and Methods section what was the pathologic method of reference: percutaneous biopsy or histology on a surgical specimen? For example, in some cases of atypical liver adenoma, only surgery can definitely exclude liver malignancy [2].Second, did the authors evaluate whether discordant results occurred more often when older sonography, CT, or MRI machines were used? In other words, could the use of different equipment have influenced their results?Third, did the authors verify whether different histomorphology, vascular architecture, or both could explain why the same category of lesions (e.g., adenoma) behaved differently after the administration of contrast agents? Could lesion size affect the results as well?

Performance of imaging modalities in diagnosis of liver metastases from colorectal cancer: A systematic review and meta‐analysis

“…After cross‐referencing the references, 11 extra studies were included, thus reaching a total number of 76. After revision, 51 studies were excluded for the following reasons: 23 because including mixed samples (i.e., including also patients with metastases from tumors other than CRC) (16–38), 12 because not comparative or assessing less than two eligible modalities (39–50), 5 because not having an adequate reference standard (51–55), 4 because review (56–59), 6 because with a different aim (60–65), and 1 because on duplicated patients in other included study (66). Therefore, 25 (5, 67–90) studies fulfilled eligibility criteria and were, therefore, selected for data extraction and analysis.…”

A case of primary hepatic extranodal marginal zone B-cell mucosa-associated lymphoid tissue (MALT) lymphoma treated by radiofrequency ablation (RFA), and a literature review

“…To the best of our knowledge, 113 cases of primary hepatic MALT lymphoma have been reported in 71 articles to date, 7 – 37 of which 80 cases (including our case) had relatively detailed clinical data ( Table 1 ). Among the patients in these 113 cases, 43 patients were men (38%) and 48 were women (42%) (the sex was not indicated in the remaining cases), with an age range of 30 to 89 years and a median age of 63.5 years.…”

“…The other two cases showed uniform wash-in and wash-out in the arterial and portal phases, respectively, suggesting susceptibility to HCC. 14 , 49 It is atypical to see uneven enhancement in the arterial phase of HCC. Therefore, when the tumor shows uneven wash-in and wash-out during enhanced imaging, hepatic MALT lymphoma should be included in the differential diagnosis.…”

A Case of Primary Hepatic Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue (MALT) type Treated by Radiofrequency Ablation (RFA) and Literature Review.

“…The other 2 cases showed uniform wash-in and wash-out in the arterial and portal phase respectively, showing more prone to hepatocellular carcinoma. 23,59 However, it is not very typical to see uneven enhancement in the arterial phase of hepatocellular carcinoma. Therefore, when the tumor shows uneven wash-in and wash-out in the arterial and portal phase, we should include hepatic MALT lymphoma among the diseases that require differential diagnosis.…”