Learning objectives
The objectives of this presentation are:
to review the imaging findings of the most frequent benign hepatic tumors;
to emphasize the importance of contrast enhanced CT and MRI (including hepatobiliary-specific contrast agents) in the diagnostic process;
to conceive a correct approach for the diagnosis of the most frequent lesions;
to present an algorithm for the diagnosis of these tumors.
Background
The exponential increase in the number of diagnostic imaging procedures in the last two or three decades revealed a vast number of incidental benign hepatic lesions that probably would remain assymptomatic and unknown during the rest of the individuals life.
In fact,
benign liver tumors are very frequent,
some studies indicating a possible prevalence of 20-50% in general population.
The imagiological recognition of the benign character of a lesion is an important part in the work-up of these patients.
HOW CAN THESE LESIONS BE CLASSIFIED?...
Imaging findings OR Procedure details
WHICH IMAGING FINDINGS SUGGEST THE BENIGN CHARACTER OF A LIVER LESION?
US
The greatest utility of US is the capacity of distinguishing cystic from solid lesions.
Benign features of hepatic cysts:
-well defined,
homogeneous,
anechoic structure;
-unperceived walls;
-posterior acoustic enhancement;
-ocasionally thin septa may be seen;
-no Doppler sign.
Complex cysts (those who present thick septa,
internal debris or echogenic foci and mural or septal nodularity) usually require the realization of a contrast enhanced study,
although they are most frequently benign.
Solid focal lesions...
Conclusion
The vast majority of the benign hepatic tumors can be diagnosed with ultrasound,
CT and MRI; even when a specific diagnosis cannot be provided,
the benign nature of the tumor can be confidently suggested,
avoiding more aggressive diagnostic approaches such as biopsy or surgical excision.
In our opinion,
MRI should have a more preponderant role in the evaluation of focal hepatic lesions,
due to the aspects previously described.
Nevertheless,
we understand that the use of this technique is limited in many imaging departments,
making this...
Personal Information
João Ressurreição (
[email protected])
Department of Imagiology of Centro Hospitalar de Vila Nova de Gaia/Espinho - Vila Nova de Gaia,
Portugal
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