Liver Lesion-Initial Characterization Variant 2: Indeterminate, greater than 1 cm liver lesion on initial imaging with CT (noncontrast or single- phase) or noncontrast MRI. Normal liver. No suspicion or evidence of extrahepatic malignancy or underlying liver disease. CT Abdomen Contrast-enhanced CT correctly differentiates between malignant and benign lesions in 74% to 95% of lesions [9,10]. For patients with incidental liver lesions, multiphase contrast-enhanced CT has 91% to 95% accuracy for diagnosis of hemangioma, 85% to 93% accuracy for the diagnosis of FNH, and 96% to 99% accuracy for diagnosis of HCC [10,12]. CT of the abdomen with and without IV contrast is not recommended for this clinical scenario because there is no added value for unenhanced images. FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of FDG-PET/CT in this clinical scenario. DOTATATE PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of Ga-68-DOTATATE PET/CT in this clinical scenario. Octreotide Scan with SPECT or SPECT/CT Chest and Abdomen There is no relevant literature to support the use of In-111 somatostatin receptor scan with SPECT or SPECT/CT in this clinical scenario. Image-Guided Biopsy Liver Percutaneous image-guided biopsy may be necessary to establish the diagnosis, particularly when the imaging features on a CT or MRI examination indicate possibility of malignancy. In some liver lesions, such as lymphoma, histopathologic analysis is the only technique that can make a definitive diagnosis [20]. Various techniques exist for guidance of the biopsy, and US and CT are the most commonly utilized modalities for biopsy guidance. When a biopsy is performed to diagnose or rule out malignancy in indeterminate lesions, the overall technical success rate under grayscale US guidance is 74%, which can be increased to 100% under CEUS guidance [21,22].
Liver Lesion Initial Characterization. Liver Lesion-Initial Characterization Variant 2: Indeterminate, greater than 1 cm liver lesion on initial imaging with CT (noncontrast or single- phase) or noncontrast MRI. Normal liver. No suspicion or evidence of extrahepatic malignancy or underlying liver disease. CT Abdomen Contrast-enhanced CT correctly differentiates between malignant and benign lesions in 74% to 95% of lesions [9,10]. For patients with incidental liver lesions, multiphase contrast-enhanced CT has 91% to 95% accuracy for diagnosis of hemangioma, 85% to 93% accuracy for the diagnosis of FNH, and 96% to 99% accuracy for diagnosis of HCC [10,12]. CT of the abdomen with and without IV contrast is not recommended for this clinical scenario because there is no added value for unenhanced images. FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of FDG-PET/CT in this clinical scenario. DOTATATE PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of Ga-68-DOTATATE PET/CT in this clinical scenario. Octreotide Scan with SPECT or SPECT/CT Chest and Abdomen There is no relevant literature to support the use of In-111 somatostatin receptor scan with SPECT or SPECT/CT in this clinical scenario. Image-Guided Biopsy Liver Percutaneous image-guided biopsy may be necessary to establish the diagnosis, particularly when the imaging features on a CT or MRI examination indicate possibility of malignancy. In some liver lesions, such as lymphoma, histopathologic analysis is the only technique that can make a definitive diagnosis [20]. Various techniques exist for guidance of the biopsy, and US and CT are the most commonly utilized modalities for biopsy guidance. When a biopsy is performed to diagnose or rule out malignancy in indeterminate lesions, the overall technical success rate under grayscale US guidance is 74%, which can be increased to 100% under CEUS guidance [21,22].