Table 2.
Accuracy and key features of imaging techniques in the diagnosis of most common liver masses
| US-US doppler, contrast ultrasound | Triphasic CT | MRI | PET SCAN | CT-angiography | |
| Hemangioma (1-10 cm) | ++ | +++ | ++++ | +++ | |
| Hyperechoic Doppler: low flow, low index, absence of spectral broadening | Peripheral puddles, fill in from periphery, enhancement on delayed scan | Peripheral enhancement centripetal progression Hyperintense on T2, hypo intense on T1 SS > 95%, SP 95% | No uptake | Cotton wool pooling of contrast, normal vessels without AV shunt, persistent enhancement | |
| Focal fatty liver | + | ++ | +++ | Normal finding | |
| Hyper echoic, no mass effect, no vessel displacement | Sharp interface Low density (< 40 u) | No uptake | |||
| FNH (< 3 cm) | + | ++ | ++++ | +++ | |
| Homogenous iso, hypo, or hyper echoic, central hyper echoic area Central arterial signal Doppler: high flow, spectral broadening | Homogeneous enhance strongly with hepatic arterial phase Isodense with liver; Central low density scar | Hyper vascular +Gd Isodense T1 Hyper intense scar T2 SS > 95%; SP > 95% | No uptake | Hyper vascular 70% centrifugal supply | |
| Adenoma (5-10 cm) | + | ++ | ++ | ++ | |
| Heterogeneous Hyper echoic If haemorrhage: anechoic center In doppler: variable flow, spectral broadening | Homogenous > Heterogeneous, Peripheral feeders filling in from periphery | Capsule, Hyper intense in T1 (intra lesional fat) | No uptake uptake if degenera-tion to HCC | Hyper vascular Large peripheral Vessel Central scar if haemorrhage | |
| HCC | + | +++ | +++ | + | ++++ |
| Hypo or hyper echoic Doppler: hyper vascular Doppler: index and flow high, spectral broadening | Hyper vascular, often irregular borders Heterogeneous > Homogeneous abnormal internal vessel Hallmark is venous washout SS 52%-54% | Hyper vascular Poor different: Hypo intense T-1, Hyper intense T2 Well different: Hyper intense T-1, Iso intense T-2 SS 53%-78% | Increased uptake, but many HCCs show no uptake at PET | Hyper vascular Av shunting Angiogenesis | |
| Cholangio-carcinoma | Bile duct dilatation if major ducts are involved. Intra-hepatic CCC: no bile dilatation | Hypo dense lesion. Delayed enhancement | Hypo intense T1 Hyper intense T2 MRCP is useful | Uptake ++ SS 93% | Hypervascular |
| Metastasis | +1 | +++ | +++ | +++++ | ++++ |
| SS 40%-70% hypo to hyper echoic; doppler; low index and flow; presence of spectral broadening | SS 49%-74 % complete ring enhancement | SS 68%-90 % Low intensity T-1 High intensity T-2 | SS 90%-100% | SS 88%-95% hyper vascular |
1
Intraoperative ultrasound, contrast ultrasound and EUS are highly sensitive to detect liver mass; +: Degree of accuracy; SS: Sensitivity; SP: Specificity; MRI: Magnetic resonance imaging; CT: Computed tomography; HCC: Hepatocellular carcinoma.