Normal liver. No suspicion or evidence of extrahepatic malignancy or underlying liver disease. CT Abdomen In some cases, establishing the benign nature of the lesion, rather than a definitive diagnosis is sufficient. In differentiation between malignant and benign lesions, contrast-enhanced CT is accurate in 74% to 95% of cases [9,10]. Definitive diagnosis can be established on contrast-enhanced CT in 71% of patients, with additional imaging recommended in 10% of patients [11]. 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]. For lesions detected on grayscale US, contrast-enhanced CT has sensitivity of 72% to 91%, specificity of 38% to 82%, positive predictive value (PPV) of 92%, negative predictive value (NPV) of 80%, and accuracy of 80% to 88% for establishing a definitive diagnosis [9,13]. 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 fluorine-18-2-fluoro-2-deoxy-D-glucose (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 single-photon emission computed tomography (SPECT) or SPECT/CT in this clinical scenario. MRI Abdomen In lesions detected on grayscale US, one study of MRI with and without intravenous (IV) contrast has sensitivity of 82% and specificity of 43% for establishing an exact diagnosis [14].
Liver Lesion Initial Characterization. Normal liver. No suspicion or evidence of extrahepatic malignancy or underlying liver disease. CT Abdomen In some cases, establishing the benign nature of the lesion, rather than a definitive diagnosis is sufficient. In differentiation between malignant and benign lesions, contrast-enhanced CT is accurate in 74% to 95% of cases [9,10]. Definitive diagnosis can be established on contrast-enhanced CT in 71% of patients, with additional imaging recommended in 10% of patients [11]. 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]. For lesions detected on grayscale US, contrast-enhanced CT has sensitivity of 72% to 91%, specificity of 38% to 82%, positive predictive value (PPV) of 92%, negative predictive value (NPV) of 80%, and accuracy of 80% to 88% for establishing a definitive diagnosis [9,13]. 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 fluorine-18-2-fluoro-2-deoxy-D-glucose (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 single-photon emission computed tomography (SPECT) or SPECT/CT in this clinical scenario. MRI Abdomen In lesions detected on grayscale US, one study of MRI with and without intravenous (IV) contrast has sensitivity of 82% and specificity of 43% for establishing an exact diagnosis [14].