Prevalence and Importance of Small Hepatic Lesions Found at CT in Patients with Cancer

Abstract

Although small hepatic lesions in patients with cancer more frequently are benign than malignant, these lesions represent metastases in 11.6% of patients.

Liver haemangioma: common and uncommon findings and how to improve the differential diagnosis

“…Among those, the majority correspond to cysts, haemangiomas, focal nodular hyperplasia, adenomas and pseudolesions, such as focal fatty infiltration and focal fatty sparing [2]. It has been demonstrated that the majority of incidental focal liver lesions discovered during any abdominal imaging work-up is, in fact, benign and devoided of particular clinical significance, even in oncologic patients [3,4].…”

Liver specific magnetic resonance imaging contrast medium for evaluation of focal liver lesions – Initial experience at a service hospital

“…12 In our study, only 68% of patients had benign lesions, primarily because of the exclusion criteria exercised in respect of simple cysts detected on USG/CT. While the most common malignant liver lesions are metastases, the common primary hepato-biliary malignant lesions are hepato-cellular carcinoma (HCC) and intra-hepatic cholangio-carcinoma.…”

Optimization of Computed Tomography Protocols: Limitations of a Methodology Employing a Phantom with Location-Known Opacities

“…A high level of observer uncertainty may account for the poor interobserver agreement for the 4.8-mm lesion under framed conditions: While the large opacity was clearly noticeable and the small opacity definitely invisible at most settings, the conspicuousness of the intermediate lesion was more ambiguous and some observers may have overestimated their confidence in perceiving this lesion because its location could be accurately determined by adjacent opacities that were plainly visible due to their larger size and/or greater density difference to the background. Hepatic lesions smaller than 10 mm in diameter are likely to be benign, particularly in patients with no history of malignancy [13,14,20]. Our results suggest that the use of a phantom with fixed lesion location may therefore be adequate for optimization of routine liver protocols when the detection of small lesions is not required.…”

“…Moreover, to our knowledge, the requirement for randomization of disease presence and/or location for CT dose optimization purposes has not been established. In the clinical setting, the diagnostic task of lesion detection usually involves visual search [18,19] and a predominance of normal cases [13,20], elements that are absent in a typical CT optimization methodology involving a phantom with fixed location of lesions. It has been shown that if an observer receives visual cues for the location or presence of an abnormality, sensitivity is increased [21,22].…”

“…The phantom consisted of a soft-tissue-equivalent disk containing spherical opacities of different sizes and densities, the focus here being the opacities of 9.5, 4.8, and 2.4 mm each with a density of 10 HU lower than the background. A diameter of 10 mm has been used as a size threshold for the investigation of liver lesions in a number of studies [13,14], and the 9.5 mm sphere was close to this size. The routine use of thinner collimation with multidetector CT has resulted in more frequent detection of very small lesions [15], and the detection and characterization of small lesions can be important for patients with history of malignancy [14], hence the inclusion of the two smaller opacity sizes in this study.…”