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. MRI with extracellular agents has a sensitivity of 78% to 83% and specificity of 100% [35,61]. Addition of HBP improves sensitivity and accuracy for nodules <2 cm [62]. The sensitivity of MRI with gadoxetate for diagnosing a small HCC (<2 cm) is 76% to 97% [56,63]. Addition of HBP improves detection of HCC and differentiation between HCC and dysplastic nodules [64,65]. Furthermore, addition of HBP improves sensitivity and accuracy for diagnosis of HCC, compared with the dynamic images alone [66,67]. Gadoxetate-enhanced MRI allows for correct characterization of liver lesions in 87% to 91% of cases [63]. However, the HBP on gadoxetate-enhanced MRI can be limited in the setting of poor liver function, and transient hepatic enhancement differences can cause artifacts in the HBP in cirrhotic patients [68,69]. In patients with chronic liver disease, the mean ADC values in benign solid lesions are higher than those in malignant lesions [70]. In small (<3 cm) lesions, presence of high signal intensity on both T2-weighted imaging and DWI helps differentiate atypical HCCs from dysplastic nodules, with the resultant sensitivity of 80%, specificity of 100%, PPV of 100%, and NPV of 78.3% [71]. For lesions <3 cm in patients with cirrhosis, the sensitivity and accuracy to differentiate the dysplastic nodule from HCC are 46% to 82% and 57% to 75%, respectively [72,73]. The addition of DWI to dynamic sequences improved its ability to distinguish between HCC and dysplastic nodules compared with dynamic sequences alone, with a resultant accuracy of 93% and sensitivity of 97% [73].
Liver Lesion Initial Characterization. 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. MRI with extracellular agents has a sensitivity of 78% to 83% and specificity of 100% [35,61]. Addition of HBP improves sensitivity and accuracy for nodules <2 cm [62]. The sensitivity of MRI with gadoxetate for diagnosing a small HCC (<2 cm) is 76% to 97% [56,63]. Addition of HBP improves detection of HCC and differentiation between HCC and dysplastic nodules [64,65]. Furthermore, addition of HBP improves sensitivity and accuracy for diagnosis of HCC, compared with the dynamic images alone [66,67]. Gadoxetate-enhanced MRI allows for correct characterization of liver lesions in 87% to 91% of cases [63]. However, the HBP on gadoxetate-enhanced MRI can be limited in the setting of poor liver function, and transient hepatic enhancement differences can cause artifacts in the HBP in cirrhotic patients [68,69]. In patients with chronic liver disease, the mean ADC values in benign solid lesions are higher than those in malignant lesions [70]. In small (<3 cm) lesions, presence of high signal intensity on both T2-weighted imaging and DWI helps differentiate atypical HCCs from dysplastic nodules, with the resultant sensitivity of 80%, specificity of 100%, PPV of 100%, and NPV of 78.3% [71]. For lesions <3 cm in patients with cirrhosis, the sensitivity and accuracy to differentiate the dysplastic nodule from HCC are 46% to 82% and 57% to 75%, respectively [72,73]. The addition of DWI to dynamic sequences improved its ability to distinguish between HCC and dysplastic nodules compared with dynamic sequences alone, with a resultant accuracy of 93% and sensitivity of 97% [73].