Management recommendations of incidental liver lesions were addressed in a recent white paper by the ACR Incidental Findings Committee (Management of Incidental Liver Lesions on CT: A White Paper of the ACR Incidental Findings Committee) [4]. The document addressed management guidance for incidental liver lesions detected on CT only. In contrast, this document addresses approaches to characterization of hepatic lesions detected with various modalities and in various clinical scenarios. For purposes of increased clarity in this document, we combined the low-risk and average-risk individual into one category using the definitions as stated in the white paper (any age with no known malignancies, hepatic dysfunction, risk factors for HCC, or symptoms attributable to the liver). The definition of a high-risk individual in this document differs from that in the white paper in that we separate those individuals with pre-existing liver disease (cirrhosis and chronic hepatitis B without cirrhosis) from those with a known primary malignancy. Special Imaging Considerations When considering a definitive diagnosis of liver lesions, the dynamic pattern of lesion enhancement can guide the final diagnosis. Therefore, at least two dynamic imaging phases (ie, dual-phase) are required for characterization of most liver lesions. These phases include hepatic arterial phase and portal venous phase and are applicable to CT, aMontefiore Medical Center, Bronx, New York. bPanel Vice-Chair, Northwestern University, Chicago, Illinois. cPanel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland. dUniversity of Arizona, Banner University Medical Center, Tucson, Arizona. eDuke University Medical Center, Durham, North Carolina. fUniversity of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association. gInterventional Endoscopy and Pancreatic Diseases, New Haven, Connecticut; American Gastroenterological Association.
Liver Lesion Initial Characterization. Management recommendations of incidental liver lesions were addressed in a recent white paper by the ACR Incidental Findings Committee (Management of Incidental Liver Lesions on CT: A White Paper of the ACR Incidental Findings Committee) [4]. The document addressed management guidance for incidental liver lesions detected on CT only. In contrast, this document addresses approaches to characterization of hepatic lesions detected with various modalities and in various clinical scenarios. For purposes of increased clarity in this document, we combined the low-risk and average-risk individual into one category using the definitions as stated in the white paper (any age with no known malignancies, hepatic dysfunction, risk factors for HCC, or symptoms attributable to the liver). The definition of a high-risk individual in this document differs from that in the white paper in that we separate those individuals with pre-existing liver disease (cirrhosis and chronic hepatitis B without cirrhosis) from those with a known primary malignancy. Special Imaging Considerations When considering a definitive diagnosis of liver lesions, the dynamic pattern of lesion enhancement can guide the final diagnosis. Therefore, at least two dynamic imaging phases (ie, dual-phase) are required for characterization of most liver lesions. These phases include hepatic arterial phase and portal venous phase and are applicable to CT, aMontefiore Medical Center, Bronx, New York. bPanel Vice-Chair, Northwestern University, Chicago, Illinois. cPanel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland. dUniversity of Arizona, Banner University Medical Center, Tucson, Arizona. eDuke University Medical Center, Durham, North Carolina. fUniversity of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association. gInterventional Endoscopy and Pancreatic Diseases, New Haven, Connecticut; American Gastroenterological Association.