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Abstract

State-of-the-art multidetector computed tomography (MDCT) and magnetic resonance (MR) imaging technologies offer detailed insights into the liver’s anatomy and the pathophysiology of liver disease, such that imaging has become the pacemaker in the development of new therapeutic techniques. Understanding different imaging techniques and the diagnostic potential of different modalities, including contrast utilization, is essential to optimize patient diagnoses. In the current environment of cost containment, the most appropriate modality should be chosen to answer the clinical question. Ultrasonography (US) is widely available, non-invasive, and the least expensive, but it is limited by low sensitivity and specificity unless US contrast agents are used. Instead, contrastenhanced CT has emerged as the modality of choice for routine liver imaging while MR imaging is used primarily as a problem-solving technique for liver evaluation when CT or US results are equivocal or if high concern exists for malignancy in certain high-risk populations. This chapter highlights the imaging of hepatic focal liver lesions, focusing on MDCT and MR imaging, but including ultrasonography in selected cases.

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References

  1. Laghi A (2007) Multidetector CT (64 Slices) of the liver: examination techniques. Eur Radiol 17:675–683

    Article  PubMed  Google Scholar 

  2. Weg N, Scheer MR, Gabor MP (1998) Liver lesions: improved detection with dual-detector-array CT and routine 2.5-mm thin collimation. Radiology 209:417–426

    CAS  PubMed  Google Scholar 

  3. Ichikawa T, Nakajima H, Nanbu A et al (2006) Effect of injection rate of contrast material on CT of hepatocellular carcinoma. AJR Am J Roentgenol 186:1413–1418

    Article  PubMed  Google Scholar 

  4. Foley WD, Hoffmann RG, Quiroz FA et al (1994) Hepatic helical CT: contrast material injection protocol. Radiology 192:367–371

    CAS  PubMed  Google Scholar 

  5. Kim T, Murakami T, Takahashi S et al (1998) Effects of injection rates of contrast material on arterial phase hepatic CT. AJR Am J Roentgenol 171:429–432

    CAS  PubMed  Google Scholar 

  6. Schima W, Hammerstingl R, Catalano C et al (2006) Quadruple-phase MDCT of the liver in patients with suspected hepatocellular carcinoma: effect of contrast material flow rate. AJR Am J Roentgenol 186:1571–1579

    Article  PubMed  Google Scholar 

  7. Sultana S, Awai K, Nakayama Y et al (2007) Hypervascular hepatocellular carcinomas: bolus tracking with a 40-detector CT scanner to time arterial phase imaging. Radiology 243:140–147

    Article  PubMed  Google Scholar 

  8. Oliver JH, Baron RL (1996) Helical biphasic contrast-enhanced CT of the liver: technique, indications, interpretations, and pitfalls. Radiology 201:1–14

    PubMed  Google Scholar 

  9. Mehnert F, Pereira PL, Trubenbach J et al (2001) Biphasic spiral CT of the liver: automatic bolus tracking or time delay? Eur Radiol 11:427–431

    Article  CAS  PubMed  Google Scholar 

  10. Oudkerk M, Torres CG, Song B et al (2002) Characterization of liver lesions with mangafodipir trisodium-enhanced MR imaging: multicenter study comparing MR and dual-phase spiral CT. Radiology 223:517–524

    Article  PubMed  Google Scholar 

  11. Scharitzer M, Schima W, Schober E et al (2005) Characterization of hepatocellular tumors: value of mangafodipirenhanced magnetic resonance imaging. J Comput Assist Tomogr 29:181–190

    Article  PubMed  Google Scholar 

  12. Ward J, Robinson PJ, Guthrie JA et al (2005) Liver metastases in candidates for hepatic resection: comparison of helical CT and gadolinium-and SPIO-enhanced imaging. Radiology 237:170–180

    Article  PubMed  Google Scholar 

  13. Hammerstingl R, Huppertz A, Breuer J et al (2008) Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intra-operative and histopathologic findings in focal liver lesions. Eur Radiol 18:457–467

    Article  PubMed  Google Scholar 

  14. Schima W, Saini S, Echeverri JA et al (1997) T2-weighted MR imaging for characterization of focal liver lesions: conventional spin-echo vs fast spin-echo. Radiology 202:389–393

    CAS  PubMed  Google Scholar 

  15. Farraher SW, Jara H, Chang KJ et al (2006) Differentiation of hepatocellular carcinoma and hepatic metastasis from cysts and hemangiomas with calculated T2 relaxation times and the T1/T2 relaxation times ratio. J Magn Reson Imaging 24:1333–1341

    Article  PubMed  Google Scholar 

  16. Semelka RC, Brown ED, Ascher SM et al (1994) Hepatic hemangiomas: a multi-institutional study of appearance on T2-weighted and serial gadolinium-enhanced gradient-echo MR images. Radiology 192:401–406

    CAS  PubMed  Google Scholar 

  17. Kim T, Federle MP, Baron RL et al (2001) Discrimination of small hepatic hemangiomas from hypervascular malignant tumors smaller than 3 cm with three-phase helical CT. Radiology 219:699–706

    CAS  PubMed  Google Scholar 

  18. Ba-Ssalamah A, Uffmann M, Saini S et al (2009) Clinical value of MRI liver-specific contrast agents: a tailored examination for a confident non-invasive diagnosis of focal liver lesions. Eur Radiol 19:342–357

    Article  PubMed  Google Scholar 

  19. Grangier C, Tourniaire J, Mentha G et al (1994) Enhancement of liver hemangiomas on T1-weighted MR SE images by superparamagnetic iron oxide particles. J Comput Assist Tomogr 18:888–896

    Article  CAS  PubMed  Google Scholar 

  20. Vossen JA, Buijs M, Liapi E et al (2008) Receiver operating characteristic analysis of diffusion-weighted magnetic resonance imaging in differentiating hepatic hemangioma from other hyper-vascular liver lesions. J Comput Assist Tomogr 32:750–756

    Article  PubMed  Google Scholar 

  21. Kehagias D, Moulopoulos L, Antoniou A et al (2001) Focal nodular hyperplasia: imaging findings. Eur Radiol 11:202–212

    Article  CAS  PubMed  Google Scholar 

  22. Brancatelli G, Federle MP, Grazioli L et al (2001) Focal nodular hyperplasia: CT findings with emphasis on multiphasic helical CT in 78 patients. Radiology 219:61–68

    CAS  PubMed  Google Scholar 

  23. Uggowitzer MM, Kugler C, Mischinger HJ et al (1999) Echoenhanced Doppler sonography of focal nodular hyperplasia of the liver. J Ultrasound Med 18:445–451; quiz 453–444

    CAS  PubMed  Google Scholar 

  24. Ba-Ssalamah A, Schima W, Schmook MT et al (2002) Atypical focal nodular hyperplasia of the liver: imaging features of nonspecific and liver-specific MR contrast agents. AJR Am J Roentgenol 179:1447–1456

    PubMed  Google Scholar 

  25. Leconte I, Van Beers BE, Lacrosse M et al (2000) Focal nodular hyperplasia: natural course observed with CT and MRI. J Comput Assist Tomogr 24:61–66

    Article  CAS  PubMed  Google Scholar 

  26. Mathieu D, Kobeiter H, Maison P et al (2000) Oral contraceptive use and focal nodular hyperplasia of the liver. Gastroenterology 118:560–564

    Article  CAS  PubMed  Google Scholar 

  27. Prasad SR, Sahani DV, Mino-Kenudson M et al (2008) Benign hepatic neoplasms: an update on cross-sectional imaging spectrum. J Computer Assist Tomogr 32:829–840

    Article  Google Scholar 

  28. Grazioli L, Morana G, Kirchin MA, Schneider G (2005) Accurate differentiation of focal nodular hyperplasia from hepatic adenoma at gadobenate dimeglumine-enhanced MR imaging: prospective study. Radiology 236:166–177

    Article  PubMed  Google Scholar 

  29. Jeffrey RB, Jr, Tolentino CS, Chang FC, Federle MP (1988) CT of small pyogenic hepatic abscesses: the cluster sign. AJR Am J Roentgenol 151:487–489

    PubMed  Google Scholar 

  30. Barreda R, Ros PR (1992) Diagnostic imaging of liver abscess. Crit Rev Diagn Imaging 33:29–58

    CAS  PubMed  Google Scholar 

  31. Laghi A, Iannaccone R, Rossi P et al (2003) Hepatocellular carcinoma: detection with triple-phase multi-detector row helical CT in patients with chronic hepatitis. Radiology 226:543–549

    Article  PubMed  Google Scholar 

  32. Ichikawa T, Kitamura T, Nakajima H et al (2002) Hypervascular hepatocellular carcinoma: can double arterial phase imaging with multidetector CT improve tumor depiction in the cirrhotic liver? AJR Am J Roentgenol 179:751–758

    PubMed  Google Scholar 

  33. Monzawa S, Ichikawa T, Nakajima H et al (2007) Dynamic CT for detecting small hepatocellular carcinoma: usefulness of delayed phase imaging. AJR Am J Roentgenol 188:147–153

    Article  PubMed  Google Scholar 

  34. Iannacone R, Laghi A, Catalano C et al (2005) Hepatocellular carcinoma: Role of unenhanced and delayed-phase multi-detector row helical CT in patients with cirrhosis. Radiology 234:460–467

    Article  Google Scholar 

  35. Baron RL, Brancatelli G (2004) Computed tomographic imaging of hepatocellular carcinoma. Gastroenterology 127:s133–143

    Article  Google Scholar 

  36. Forner A, Vilana R, Ayuso C et al (2008) Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: Prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology (Baltimore, Md) 47:97–104

    Google Scholar 

  37. Tublin ME, Dodd GD, Baron RL (1997) Benign and malignant portal vein thrombosis: differentiation by CT characteristics. AJR Am J Roentgenol 168:719–723

    CAS  PubMed  Google Scholar 

  38. Stevens WR, Gulino SP, Batts KP et al (1996) Mosaic pattern of hepatocellular carcinoma: histologic basis for a characteristic CT appearance. J Comput Assist Tomogr 20:337–342

    Article  CAS  PubMed  Google Scholar 

  39. Pauleit D, Textor J, Bachmann R et al (2001) Hepatocellular carcinoma: detection with gadolinium-and ferumoxidesenhanced MR imaging of the liver. Radiology 222:73–80

    Article  Google Scholar 

  40. Tang Y, Yamashita Y, Arakawa A et al (1999) Detection of hepatocellular carcinoma arising in cirrhotic livers: Comparison of gadolinium-and ferumoxides-enhanced MR imaging. AJR Am J Roentgenol 172:1547–1554

    CAS  PubMed  Google Scholar 

  41. Kitao A, Zen Y, Matsui O et al (2009) Hepatocarcinogenesis: multistep changes of drainage vessels at CT during arterial portography and hepatic arteriography-radiologic-pathologic correlation. Radiology 252:605–614

    Article  PubMed  Google Scholar 

  42. Ward J, Guthrie JA, Scott DJ et al (2000) Hepatocellular carcinoma in the cirrhotic liver: double-contrast MR imaging for diagnosis. Radiology 216:154–162

    CAS  PubMed  Google Scholar 

  43. Lee DH, Kim SH, Lee JM et al (2009) Diagnostic performance of multidetector row computed tomography, superparamagnetic iron oxide-enhanced magnetic resonance imaging, and dualcontrast magnetic resonance imaging in predicting the appropriateness of a transplant recipient based on milan criteria: correlation with histopathological findings. Invest Radiol 44:311–321

    Article  PubMed  Google Scholar 

  44. Ichikawa T, Federle MP, Grazioli L et al (1999) Fibrolamellar hepatocellular carcinoma: imaging and pathologic findings in 31 recent cases. Radiology 213:352–361

    CAS  PubMed  Google Scholar 

  45. Ichikawa T, Federle MP, Grazioli L, Marsh W (2000) Fibrolamellar hepatocellular carcinoma: pre-and posttherapy evaluation with CT and MR imaging. Radiology 217:145–151

    CAS  PubMed  Google Scholar 

  46. Lim JH (2003) Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. AJR Am J Roentgenol 181:819–827

    PubMed  Google Scholar 

  47. Han JK, Choi BI, Kim AY et al (2002) Cholangiocarcinoma: pictorial essay of CT and cholangiographic findings. Radio-graphics 22:173–187

    Google Scholar 

  48. Lee WJ, Lim HK, Jang KM et al (2001) Radiologic spectrum of cholangiocarcinoma: emphasis on unusual manifestations and differential diagnoses. Radiographics 21 Spec No:S97–S116

    Google Scholar 

  49. Buetow PC, Buck JL, Pantongrag-Brown L et al (1995) Biliary cystadenoma and cystadenocarcinoma: clinical-imagingpathologic correlations with emphasis on the importance of ovarian stroma. Radiology 196:805–810

    CAS  PubMed  Google Scholar 

  50. Peterson MS, Baron RL, Rankin SC (2000) Hepatic angiosarcoma: findings on multiphasic contrast-enhanced helical CT do not mimic hepatic hemangioma. AJR Am J Roentgenol 175:165–170

    CAS  PubMed  Google Scholar 

  51. Koyama T, Fletcher JG, Johnson CD et al (2002) Primary hepatic angiosarcoma: findings at CT and MR imaging. Radiology 222:667–673

    Article  PubMed  Google Scholar 

  52. Miller WJ, Dodd GD 3rd, Federle MP, Baron RL (1992) Epithelioid hemangioendothelioma of the liver: imaging findings with pathologic correlation. AJR Am J Roentgenol 159:53–57

    Google Scholar 

  53. Schima W, Kulinna C, Langenberger H, Ba-Ssalamah A (2005) Liver metastases of colorectal cancer: US, CT or MR? Cancer Imaging 5 Spec No A:S149–156

    Google Scholar 

  54. Lee MJ, Saini S, Compton CC, Malt RA (1991) MR demonstration of edema adjacent to a liver metastasis: pathologic correlation. AJR Am J Roentgenol 157:499–501

    CAS  PubMed  Google Scholar 

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Schima, W., Baron, R. (2010). Focal Liver Lesions. In: Hodler, J., Zollikofer, C.L., Von Schulthess, G.K. (eds) Diseases of the Abdomen and Pelvis 2010–2013. Springer, Milano. https://doi.org/10.1007/978-88-470-1637-8_9

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  • DOI: https://doi.org/10.1007/978-88-470-1637-8_9

  • Publisher Name: Springer, Milano

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