Hypervascular Benign and Malignant Liver Tumors That Require Differentiation from Hepatocellular Carcinoma: Key Points of Imaging Diagnosis

Abstract

Most liver tumors are benign and hypervascular, and it is important to avoid unnecessary interventions for benign lesions. This review describes the typical and atypical imaging features of common hypervascular benign liver tumors and outlines a general approach to distinguishing between benign and malignant hepatic lesions. There are many types of benign liver tumors that need to be differentiated from hepatocellular carcinoma (HCC). Therefore, it is very important to know the imaging characteristics of benign tumors. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging is helpful in diagnosing hypervascular pseudotumors, focal nodular hyperplasia, and nodular lesions associated with alcohol-induced hepatitis. There are also some hypervascular malignant tumors, such as cholangiocarcinoma, cholangiolocellular carcinoma, mixed type tumors, and metastatic liver tumors, which also required differentiation from HCC.

Insufficient Ablative Margin Determined by Early Computed Tomography May Predict the Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation

“…Patients with a liver nodule detectable on ultrasonography underwent dynamic CT or magnetic resonance imaging (MRI) for a definitive diagnosis of HCC [13]. Arterial and portal phase dynamic CT images were obtained at approximately 35 and 70 s, respectively, after injecting iodinated contrast material.…”

Improved detection of metastases by color Doppler ultrasonography

“…The most common benign hypervascular liver tumor requiring differential diagnosis is hemangioma [13]. From a clinical perspective, it is important to differentiate haemangiomas from hepatic neoplasms.…”

Current Trends and Recent Advances in Diagnosis, Therapy, and Prevention of Hepatocellular Carcinoma

“…Dynamic MRI with gadolinium diethyl-enetriamine pentaacetic acid (Gd-EOB-DTPA), a hepatocyte-specific contrast agent, is commonly used on dynamic MRI because Gd-EOB-DTPA-enhanced MRI has been reported to considerably improve diagnostic accuracy of HCC and has a sensitivity of 91-93% for small HCC of less than 2 cm in size Ichikawa et al, 2014). Gd-EOB-DTPA-enhanced MRI is helpful in diagnosing benign tumors, such as hypervascular pseudotumors, focal nodular hyperplasia, and nodular lesions associated with alcohol-induced hepatitis, as well as some hypervascular malignant tumors, such as cholangiolocellular carcinoma, mixed type tumors, and metastatic liver tumors, which all required differentiation from HCC (Murakami and Tsurusaki, 2014). However, if there are still uncertainties on imaging diagnosis of HCC, biopsy may be able to resolve doubts about the diagnosis.…”