Liver Lesion-Initial Characterization RBC Scan Abdomen and Pelvis There is no relevant literature to support the use of a Tc-99m RBC scan in this clinical scenario. Liver Spleen Scan There is no relevant literature to support the use of a Tc-99m sulfur colloid scan in this clinical scenario. US Abdomen with Contrast Compared with a baseline grayscale US, CEUS can detect 6.5 times more subcentimeter metastases [9]. For indeterminate liver lesions discovered on grayscale US, CEUS reached a specific diagnosis in 83% of cases and distinguished benign versus malignant in 90% of cases [30]. For the benign diagnoses, CEUS correctly characterized 89% of areas of focal fat, 90% of hemangiomas, 87% of complex cysts, 78% of hepatic adenomas, 90% of FNHs, 86% of abscesses, and 60% of hematomas [30]. CEUS correctly characterized 86% of metastases [30]. Variant 7: Indeterminate, less than 1 cm liver lesion on initial imaging with CT (noncontrast or single-phase) or noncontrast MRI. Known history of an extrahepatic malignancy. CT Abdomen Subcentimeter liver lesions in patients with primary malignancy are seen on contrast-enhanced CT in 13% of patients, and of these, 12% are metastases [82]. Among patients with a history of colorectal and breast cancers, small hepatic lesions were metastatic in 14% and 22% of cases, respectively [82]. Subcentimeter liver lesions in women with breast cancer can be found in 29%, and if no obvious liver metastases are present, 93% to 97% of these subcentimeter liver lesions are benign [85]. 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 In patients with a history of primary malignancy, FDG-PET/CT may be indicated to evaluate for the presence of metastases beyond the liver.
Liver Lesion Initial Characterization. Liver Lesion-Initial Characterization RBC Scan Abdomen and Pelvis There is no relevant literature to support the use of a Tc-99m RBC scan in this clinical scenario. Liver Spleen Scan There is no relevant literature to support the use of a Tc-99m sulfur colloid scan in this clinical scenario. US Abdomen with Contrast Compared with a baseline grayscale US, CEUS can detect 6.5 times more subcentimeter metastases [9]. For indeterminate liver lesions discovered on grayscale US, CEUS reached a specific diagnosis in 83% of cases and distinguished benign versus malignant in 90% of cases [30]. For the benign diagnoses, CEUS correctly characterized 89% of areas of focal fat, 90% of hemangiomas, 87% of complex cysts, 78% of hepatic adenomas, 90% of FNHs, 86% of abscesses, and 60% of hematomas [30]. CEUS correctly characterized 86% of metastases [30]. Variant 7: Indeterminate, less than 1 cm liver lesion on initial imaging with CT (noncontrast or single-phase) or noncontrast MRI. Known history of an extrahepatic malignancy. CT Abdomen Subcentimeter liver lesions in patients with primary malignancy are seen on contrast-enhanced CT in 13% of patients, and of these, 12% are metastases [82]. Among patients with a history of colorectal and breast cancers, small hepatic lesions were metastatic in 14% and 22% of cases, respectively [82]. Subcentimeter liver lesions in women with breast cancer can be found in 29%, and if no obvious liver metastases are present, 93% to 97% of these subcentimeter liver lesions are benign [85]. 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 In patients with a history of primary malignancy, FDG-PET/CT may be indicated to evaluate for the presence of metastases beyond the liver.