Gastrointestinal - Learning Modules - CTisus.com CT Scanning

CT Evaluation of Liver Masses: Key Differential Diagnosis Findings

Elliot K. Fishman M.D.
Johns Hopkins Hospital

Click here to view this module as a video lecture.

Goals of MDCT of the Liver1978-2022

Detection of the presence of disease
Define the extent of disease
Define the etiology of the disease process
Help in patient management decisions (ie further studies, biopsy, surgery, etc.)

Factoid: Increased lesion detection does not necessarily mean a more accurate study. Most mm-size lesions are benign cysts or hemangiomas

Study Protocols: Patient Prep

Oral contrast

Water as a neutral contrast agent
Oral iohexol (Omnipaque) for positive agent

IV contrast agents

100-120 mL of iohexol-350
100-120 mL of iodixanol-320

Study Protocols: Phases of Acquisition

Non-contrast scans
Arterial phase imaging
- Early phase (15 seconds)
- Late phase (25-30 seconds)
Venous phase imaging (60-70 seconds)
Late or excretory phase imaging (3-4 minutes post injection)

MDCT of the Liver: Applications

Benign and malignant liver tumors
Parenchymal liver disease
Infectious disease of the liver

Incidental Liver Mass on CT

Benign Hepatic Tumors

Hepatic cysts
Hemangiomas
Focal nodular hyperplasia
Hepatic adenoma

“We propose a practical algorithm that can simplify the approach for the diagnosis of these lesions. By applying these workup strategies, one can prevent unnecessary tests, avoid a delay in initiating the appropriate management, and improve the cost-effectiveness of diagnostic tests.”
Cystic hepatic lesions: a review and an algorithmic approach.
Borhani AA, Wiant A, Heller MT
AJR Am J Roentgenol. 2014 Dec;203(6):1192-204

Cystic Hepatic Lesions