Two-hundred and forty-two (242) patients underwent liver biopsy during the study time period.
Of these,
64 had no prior imaging available at our institution.
Many of these patients likely had outside imaging performed,
and were referred for liver biopsy.
A majority (45.3%) were found to have hepatitis.
23.4% had malignancy lesions,
such as metastases,
hepatocellular carcinoma (HCC) and lymphoma.
These patients were excluded from further data analysis.
The remaining patients (180) have had at least one imaging study of the liver performed at our institution,
prior to biopsy.
Two patients had positron emission tomography (PET) scans,
and both scans were correctly interpreted as metastatic disease.
Four patients had ultrasonography of the liver,
without comparison cross-sectional imaging available.
In all cases,
radiologic interpretation was concordant with pathology results.
In 75%,
a lesion of described as suspicious,
and biopsy yielded findings of malignancy (two cases of metastatic disease and one case of HCC).
Eight patients had contrast-enhanced magnetic resonance imaging (MRI) of the abdomen,
without prior CT scan.
In all cases,
imaging was concordant with biopsy: two of the eight patients (25%) had suspicious MRI findings,
and pathology resulted in neoplasm.
The remaining six lesions were described as benign (e.g. focal nodular hyperplasia,
steatosis,
etc.),
and pathology was concordant.
One-hundred and sixty-six (166) patients had undergone CT,
with 6 then preceding to MRI.
In all cases when MRI followed CT,
concordance was 100%; three lesions were correctly described as benign,
whereas the other three as malignant.
The remaining 160 patients had CT alone,
prior to biopsy; 145 scans were contrast-enhanced,
and the other 15 were performed without the use of an intravenous contrast agent.
On contrast-enhanced CT,
87 scans (60%) were interpreted as clearly suspicious,
46 (31.7%) were clearly interpreted as benign,
and the other 12 (8.3%) were reported as indeterminate (that is,
could be benign or malignant).
In cases where the lesion was clearly categorized as benign or malignant,
concordance was 100%.
In the 12 indeterminate lesions,
malignancy rate on biopsy was 25%.
For the 15 patients who underwent non-contrast enhanced CT,
10 lesions were classified as benign,
and 5 as malignant.
All lesions interpreted as malignant had concordant pathology findings.
However,
of the lesions classified as benign,
only 7 out of 10 truly were benign,
with the other three being pathologically-proven neoplasms (B cell lymphoma and two cases of metastatic lesions).
Fig. 1: Percent concordance of radiology interpretation with pathology findings, based on imaging modality. CECT = contrast-enhanced CT; NECT = non-enhanced CT; MRI = magnetic resonance imaging; US = ultrasound; PET = positron emission tomography.
Fig. 2: Number of biopsied liver lesions, which were pathologically benign, and interpreted as such, based on imaging modality.