Correlate imaging findings with histology to identify specific radiological features that can aid in the differentiation between “neoplastic vs non-neoplastic” liver cysts. Discuss the key diagnostic imaging features of complex liver cysts

Liver cysts are typically identified in routine imaging with the prevalence ranging from 20% - 34%. They are broadly classified as developmental, neoplastic, inflammatory and miscellaneous. Most liver cysts do not need treatment as they are purely benign lesions. However complex liver cysts may represent malignant or premalignant lesions. Hence it is important to identify the specific imaging features to differentiate complex vs simple cysts and malignant vs benign cysts to guide management.

Patients that underwent surgery for noninfective liver cysts from January 2003 to July 2017 were identified from our tertiary liver unit database The primary diagnostic imaging was retrospectively reviewed, and key diagnostic features were identified and correlated with histological findings. Cysts were specifically evaluated for enhancing thick septations, intra-cystic nodules, calcification, solid elements, intra-cystic debris and biliary dilatation. The study included 51 patients who underwent surgery. There were 44 females and 7 males with Female to male ratio 6:1( Figure 1). The mean age was...

The presence of intra-cystic nodules and solid elements proved to be the most reliable criteria in the assessment of complex cysts that require surgical resection. However other imaging features such as presence of enhancing thick septations, calcification, intra-cystic debris, biliary dilatation are important. In addition, clinical information such as age, gender, history and symptoms remain extremely important in diagnosing and managing liver cysts. Enhanced MRI is deemed to be the most informative technique for complex hepatic cyst evaluation

Contact details: Dr Sripali Kotugodella, Department of radiology, University Hospital of Wales, Cardiff, CF14 4XW . Email: [email protected] Dr Craig R Parry, Department of Radiology, University Hospital of Wales, Cardiff, CF14 4XW. Email: [email protected] Dr Ashish Gupta, Department of surgery, University Hospital of Wales, Cardiff, CF14 4XW, Email: [email protected] Dr Nagappan Kumar, Department of surgery, University Hospital of Wales, Cardiff, CF14 4XW, Email : [email protected]

Koenraad J. Mortele, Pablo R. Ros, et al. Cystic Focal Liver Lesions in the Adult: Differential CT and MR Imaging Features. Radiographics 2001; 21:895-910 Amir A. Borhani, Amanda Wiant, Matthew T. Heller et al. Cystic Hepatic Lesions: A Review and an Algorithmic Approach. AJR 2014; 203:1192–1204 Murphy BJ, Casillas J, Ros PR, et al. The CT appearance of cystic masses of the liver. RadioGraphics 1989; 9:307–322 Singh Y, Winick AB, Tabbara SO. Multiloculated cystic liver lesions: radiologic-pathologic differential diagnosis. RadioGraphics 1997; 17:219–224 Mergo PJ, Ros...