In a small retrospective study of patients with primary pancreatic adenocarcinoma, CT and CEUS have similar sensitivities for detection of metastases (73% versus 80%, respectively) [2]. However, CEUS is able to more accurately differentiate between an incidental benign lesion (eg, cysts, vascular shunts) from metastases, resulting in fewer false-positive diagnoses and therefore higher PPV (60% versus 92%) [2]. The accuracy of CEUS for diagnosis of metastases is 76% [35]. Liver Lesion-Initial Characterization Variant 5: Incidental liver lesion, greater than 1 cm on US, noncontrast or single-phase CT, or noncontrast MRI. Known chronic liver disease. Evaluation of liver lesions detected in a patient with chronic liver disease should be performed based on the algorithm set forth by the most recent version of LI-RADS [6,55]. CT Abdomen The sensitivity of a dual-phase contrast-enhanced CT for diagnosing a small HCC (<2 cm) is 53% [56]. In patients with chronic liver disease, triple-phase contrast-enhanced CT correctly characterizes lesions in 49% to 68% of cases and has a sensitivity of 61% to 73% for lesion detection [57]. Delayed phase wash-out on CT is important in HCC diagnosis [58]. For 1- to 2-cm lesions in patients with cirrhosis detected on screening US, the addition of noncontrast CT to dynamic postcontrast phases (CT without and with IV contrast) does not increase sensitivity or accuracy for HCC [59]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT has a limited role in characterization of liver lesions in patients with parenchymal liver disease [6]. Once the diagnosis of HCC is established, tumor FDG activity may predict microvascular invasion [60]. 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.
Liver Lesion Initial Characterization. In a small retrospective study of patients with primary pancreatic adenocarcinoma, CT and CEUS have similar sensitivities for detection of metastases (73% versus 80%, respectively) [2]. However, CEUS is able to more accurately differentiate between an incidental benign lesion (eg, cysts, vascular shunts) from metastases, resulting in fewer false-positive diagnoses and therefore higher PPV (60% versus 92%) [2]. The accuracy of CEUS for diagnosis of metastases is 76% [35]. Liver Lesion-Initial Characterization Variant 5: Incidental liver lesion, greater than 1 cm on US, noncontrast or single-phase CT, or noncontrast MRI. Known chronic liver disease. Evaluation of liver lesions detected in a patient with chronic liver disease should be performed based on the algorithm set forth by the most recent version of LI-RADS [6,55]. CT Abdomen The sensitivity of a dual-phase contrast-enhanced CT for diagnosing a small HCC (<2 cm) is 53% [56]. In patients with chronic liver disease, triple-phase contrast-enhanced CT correctly characterizes lesions in 49% to 68% of cases and has a sensitivity of 61% to 73% for lesion detection [57]. Delayed phase wash-out on CT is important in HCC diagnosis [58]. For 1- to 2-cm lesions in patients with cirrhosis detected on screening US, the addition of noncontrast CT to dynamic postcontrast phases (CT without and with IV contrast) does not increase sensitivity or accuracy for HCC [59]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT has a limited role in characterization of liver lesions in patients with parenchymal liver disease [6]. Once the diagnosis of HCC is established, tumor FDG activity may predict microvascular invasion [60]. 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.