Differentiation of hepatic abscess from metastasis on contrast-enhanced dynamic computed tomography in patients with a history of extrahepatic malignancy: emphasis on dynamic change of arterial rim enhancement

Abstract

Objectives

The objective of the study is to identify computed tomography (CT) findings that differentiate hepatic abscess from hepatic metastasis in a patient with a history of extrahepatic malignancy.

Materials and methods

This retrospective study included 30 patients with 93 hepatic abscesses and 40 patients with 125 hepatic metastases who had a history of extrahepatic malignancy and underwent contrast-enhanced dynamic CT with arterial phase (AP) and portal venous phase (PVP). The diagnosis of hepatic abscess and hepatic metastasis was made using pathological confirmation or clinical diagnosis. Margin, patchy parenchymal enhancement, arterial rim enhancement, dynamic change of arterial rim enhancement, size discrepancy of lesions between arterial and portal phases, bile duct dilatation, perilesional hyperemia, and perilesional low density were evaluated by two radiologists independently. Significant findings for differentiating two groups were identified at univariate and multivariate analysis with nomogram for predicting hepatic abscess. Interobserver agreement was also analyzed for each variable.

Results

Multivariate analysis revealed that patchy parenchymal enhancement (P < 0.001), arterial rim enhancement persistent through PVP (P < 0.001), and perilesional hyperemia (P = 0.013) were independent significant findings to predict hepatic abscess than metastasis. Among them, arterial rim enhancement persistent through PVP showed a highest odds ratio (OR 33.73) on multivariate analysis and a highest predictor point on a nomogram for predicting hepatic abscess. When two of these three criteria were combined, 80.7% (75/93) of hepatic abscess were correctly identified, with a specificity of 85.6% (107/125). When all three criteria were satisfied, specificity was up to 100% (125/125).

Conclusions

At contrast-enhanced dynamic CT, patchy parenchymal enhancement, arterial rim enhancement persistent through PVP, perilesional hyperemia, and their combinations may be reliable CT features for differentiating hepatic abscess from metastasis in patients with a history of primary extrahepatic malignancy.

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Abbreviations

CT:

Computed tomography

AP:

Arterial phase

PVP:

Portal venous phase

MRI:

Magnetic resonance imaging

HBPI:

Hepatobiliary phase image

TP:

Transitional phase

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Corresponding author

Correspondence to Seo-Youn Choi.

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2018R1C1B5030985). This work was supported by the Soonchunhyang University Research Fund.

Conflict of interest

J.G.O. declares that he has no conflict of interest. S.Y.C. declares that she has no conflict of interest. H.K.L. declares that she has no conflict of interest. M.H.L. declares that she has no conflict of interest. J.E.L. declares that she has no conflict of interest. B.H.Y. declares that she has no conflict of interest. S.S.K. declares that he has no conflict of interest. J.H.M. declares that she has no conflict of interest. B.L. declares that she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was waived for retrospective nature of clinical and imaging data collection in this study.

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Oh, J.G., Choi, SY., Lee, M.H. et al. Differentiation of hepatic abscess from metastasis on contrast-enhanced dynamic computed tomography in patients with a history of extrahepatic malignancy: emphasis on dynamic change of arterial rim enhancement. Abdom Radiol 44, 529–538 (2019). https://doi.org/10.1007/s00261-018-1766-y

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Keywords

  • Liver abscess
  • Metastasis
  • Computed tomography