FDG-PET/CT Skull Base to Mid-Thigh In patients with a history of primary malignancy, FDG-PET/CT may be indicated to evaluate for presence of metastases beyond the liver. Current literature does not support the use of FGD-PET/CT specifically to characterize subcentimeter liver lesions due to its limited sensitivity for lesions <1 cm. DOTATATE PET/CT Skull Base to Mid-Thigh Ga-68-DOTATATE PET/CT is sensitive for detection of metastases in patients with primary NET; however, there is no relevant literature on assessment of subcentimeter liver lesions. Octreotide Scan with SPECT or SPECT/CT Chest and Abdomen In patients with a history of primary NET, In-111 somatostatin receptor scan with SPECT or SPECT/CT can detect liver metastases; however, there is no relevant literature to support the use of this procedure in characterization of subcentimeter liver lesions. MRI Abdomen On MRI with gadoxetate, the combination of HBP and DWI has the highest accuracy for detection of subcentimeter liver lesions [15]. ADC values can help differentiate benign versus malignant subcentimeter liver lesions with 92% to 93% accuracy [84]. There is no relevant literature that has assessed the performance of MRI without IV contrast specifically for this clinical scenario. Therefore, the committee recommendations on the use of MRI without IV contrast are based primarily on expert opinion. In some cases, MRI without IV contrast may be appropriate as it can differentiate between small cysts and solid lesions. Image-Guided Biopsy Liver Tissue sampling may be necessary to establish the definitive diagnosis in patients with a history of primary malignancy and indeterminate subcentimeter liver lesions. However, the role of percutaneous biopsy is limited in the evaluation of subcentimeter liver lesions because such lesions are typically difficult to target under image guidance. Furthermore, there is no relevant literature to assess performance of percutaneous biopsy techniques for subcentimeter liver lesions.
Liver Lesion Initial Characterization. FDG-PET/CT Skull Base to Mid-Thigh In patients with a history of primary malignancy, FDG-PET/CT may be indicated to evaluate for presence of metastases beyond the liver. Current literature does not support the use of FGD-PET/CT specifically to characterize subcentimeter liver lesions due to its limited sensitivity for lesions <1 cm. DOTATATE PET/CT Skull Base to Mid-Thigh Ga-68-DOTATATE PET/CT is sensitive for detection of metastases in patients with primary NET; however, there is no relevant literature on assessment of subcentimeter liver lesions. Octreotide Scan with SPECT or SPECT/CT Chest and Abdomen In patients with a history of primary NET, In-111 somatostatin receptor scan with SPECT or SPECT/CT can detect liver metastases; however, there is no relevant literature to support the use of this procedure in characterization of subcentimeter liver lesions. MRI Abdomen On MRI with gadoxetate, the combination of HBP and DWI has the highest accuracy for detection of subcentimeter liver lesions [15]. ADC values can help differentiate benign versus malignant subcentimeter liver lesions with 92% to 93% accuracy [84]. There is no relevant literature that has assessed the performance of MRI without IV contrast specifically for this clinical scenario. Therefore, the committee recommendations on the use of MRI without IV contrast are based primarily on expert opinion. In some cases, MRI without IV contrast may be appropriate as it can differentiate between small cysts and solid lesions. Image-Guided Biopsy Liver Tissue sampling may be necessary to establish the definitive diagnosis in patients with a history of primary malignancy and indeterminate subcentimeter liver lesions. However, the role of percutaneous biopsy is limited in the evaluation of subcentimeter liver lesions because such lesions are typically difficult to target under image guidance. Furthermore, there is no relevant literature to assess performance of percutaneous biopsy techniques for subcentimeter liver lesions.