Intriguingly, among patients in whom nodules were detected by IOUS, 96% of patients had malignant nodules, which explained the high specificity and positive predictive value of IOUS for detecting indeterminate nodules (93.75% and 96.6%, respectively). Part of Springer Nature. Periductal infiltrative CCC causes early segmental dilatation of bile ducts in a stage when the tumor itself may be difficult to discern [67]. Brancatelli G, Federle MP, Grazioli L, et al. Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. In addition it was found that left-sided primary tumors were associated with improved median OS after resection of CRLM7. To explore the history and philosophy of the family practice movement. WebMany of the liver parenchyma cells are necrotic; in other areas the cells are grossly swollen. Schima W, Hammerstingl R, Catalano C, et al. Although the sensitivity and specificity of IOUS were reported to be as high as 99.1% and 98.5%, respectively, in prior studies19,20, there are no reports of its clinical value for detecting small indeterminate lesions. There is inhomogeneous enhancement of the right lobe, but no definite tumor is seen. Only total avoidance would work. The size, margin, shape, attenuation, and enhancement features of the lesions were evaluated. Vossen JA, Buijs M, Liapi E, et al. High signal intensity on T1-weighted sequences is typical for melanoma metastases due to the paramagnetic nature of melanin. 17.18). In general, DWI depends upon the microscopic mobility of water, called Brownian motion, in tissue. Google Scholar. National Library of Medicine False negatives and false positives were taken as patients where the IOUS findings and pathological findings differed. Mutations of catenin b1 (CTNNB1) in exon 3 (coding for b-catenin) are seen in 1015% of HCA. These liver-specific agents are taken up into hepatocytes to varying extent (gadobenate dimeglumine 45%; gadoxetic acid ~50%), resulting in avid T1 enhancement of the liver parenchyma in the hepatobiliary phase, which is performed at 20 min for gadoxetic acid and about 12 h for gadobenate dimeglumine after contrast administration. ; 15 and 10 years of ex- ence in intensity between the lesion and the lesion database, the similarity ref- perience in abdominal imaging, respec- the surrounding liver and the sharpness erence standard, our evaluation mea- tively) viewed each pair of images twice of the margin to characterize each profile. Conclusions: Peritumoral edema makes lesions appear larger on T2-weighted images and is highly suggestive of a malignant mass [76]. These are commonly benign cysts or other benign tumors in patients who do not have cancer. MRI has many advantages over computed tomography (CT), mainly lack of ionizing radiation and generally higher accuracy for lesion detection and characterization, especially for small lesions. IR uses loop-wise raw data correction to reduce image noise, thus allowing imaging to be performed at reduced kVp or mAs, with lower radiation dose but comparable image quality. https://doi.org/10.1007/s002689910009 (2000). Ba-Ssalamah A, Uffmann M, Saini S, et al. Eur Radiol. Liver-specific contrast agents have been shown to improve the detection of liver metastases [23,24,25,26], especially when used in combination with diffusion-weighted MR imaging. CAS Hepatic lesions deemed too small to characterize at CT - PubMed Inactivating mutations of hepatocyte nuclear factor 1 alpha (HNF1A) are observed in 4050% of HCA. Article 17.2), especially during dynamic contrast-enhanced acquisitions [17]. (a) Unenhanced CT shows a siderotic (hyperattenuating) large nodule, which contains a low-density (non-siderotic) focus (arrow). J Magn Reson Imaging. Diffusion-weighted MRI provides additional value to conventional dynamic contrast-enhanced MRI for detection of hepatocellular carcinoma. Jai Young Cho. may email you for journal alerts and information, but is committed Its increased from 3 percent to over 20 percent in the past 40 years, according to the American Society of Clinical Oncology. the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in MR demonstration of edema adjacent to a liver metastasis: pathologic correlation. 1996;20:33742. Chernyak V, Flusberg M, Haramati LB, Rozenblit AM, Bellin E. Radiology. Y.Y. Cho, J. Y. et al. 3 views. Disclaimer. However, in the majority, the tumor is idiopathic. Liver-specific MR contrast agents (gadoxetic acid or gadobenate dimeglumine) can be administered to provide arterial, portal venous, and equilibrium-phase imaging but has the added advantage of revealing additional characteristics at the delayed hepatobiliary phase of contrast enhancement. Prevalence and importance of small hepatic lesions found at CT in patients with cancer. Nault JC, Paradis V, Cherqui D, Vilgrain V, Zucman-Rossi J. Molecular classification of hepatocellular adenoma in clinical practice. 1992;33:2958. PubMed Central 1998;171:42932. 2003;181:81927. (a) T2-weighted TSE shows a large lobulated lesion of very high signal intensity. Too small to characterize liver lesions These are usually lesions under a centimeter. The Eastern Cooperative Oncology Group (ECOG) scale was used to evaluate performance status (PS) of patients. MR examination of the liver should include unenhanced T1-weighted and T2-weighted sequences, as well as contrast-enhanced sequences. Small Semelka RC, Brown ED, Ascher SM, et al. 22, 225232. Your doctor can diagnose liver lesions with a combination of imaging, blood tests, and sometimes a small tissue sample. Stepwise IR reduces CT noise levels. Contrast CT (portal venous phase) shows multiple predominantly peripheral-based hypodense lesions. It's usually caused by certain medical conditions, medications, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. For comparison measured iodine uptake in background liver (red ROI) is about 1.1 mg/mL. The positive predictive value was 96.6%. Tublin ME, Dodd GD, Baron RL. Ann. It has been reported that small, indeterminate liver lesions may occur in up to 16.7% of patients with CRC 11. Two of these patients underwent repeat surgery for the recurrence, of which one had benign nodules. You can scrub and scrub and this wont remove the aroma. Wolters Kluwer Health, Inc. and/or its subsidiaries. Healthcare providers may treat liver cysts by monitoring the cysts. Whereas most large HCC are hyperintense on T2-weighted images, smaller lesions, measuring even 34 cm, can appear isointense or hypointense. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. A visible branch of the portal or hepatic vein terminating at the periphery of these lesions t (lollipop sign) has also been described, although this is not pathognomonic of the disease [74]. There is wide varying appearances of HCC on imaging. Role of gadoxetic acid-enhanced magnetic resonance imaging in the preoperative evaluation of small hepatic lesions in patients with colorectal cancer. A substantial dose reduction of 3855% is possible with IR without compromising image quality [11,12,13] (Fig. https://doi.org/10.1016/j.suronc.2018.05.012 (2018). Surg. 1997;202:38993. Inflammatory HCA appear strongly hyperintense on T2-weighted MRI, which may be diffuse or rim-like in the periphery of the lesion (Atoll sign). Biliary hamartomas (von Meyenburg complex). Occasionally, bile duct hamartomas can be very large, up to 20 cm, and be symptomatic from internal hemorrhage or pressure on adjacent structures [46]. Characterization of hepatocellular tumors: value of mangafodipir-enhanced magnetic resonance imaging. Lee, D. H. et al. (b) Arterial phase T1-weighted contrast-enhanced image shows hypervascularity of the lesion. is responsible for the concept and design of work, critical revision of the manuscript, material support, final approval of the version to be published and is accountable for all aspects of the work. Of 33 patients with visible nodules on IOUS, 25 (75.8%) underwent surgical resection and four (12.1%) underwent radiofrequency ablation. WebWe will now describe (C.F.B., D.L.R. Although most lesions arent harmful, its still critical to receive a proper diagnosis. (a) T1-weighted in-phase GRE image demonstrates a very large mass in a young woman. The liver is an essential organ that plays a key role in your health. The Radiology Assistant : Incidentalomas 1995;196:80510. Conversion surgery after cetuximab or bevacizumab plus FOLFIRI chemotherapy in colorectal cancer patients with liver- and/or lung-limited metastases. 2010;254:4766. Scientific Reports (Sci Rep) For patients with a history of extrahepatic malignancy, liver metastases are a potential cause of solid liver lesions. In such patients, the evaluation begins with a search for metastatic disease in other organs (eg, CT of the abdomen and pelvis as well as chest imaging). Management of incidental liver lesions on CT: A white paper of the ACR Incidental Findings Committee. Hepatol. Diffusion-weighted imaging (DWI) has become a standard technique in liver imaging, and it is now available on all scanners. As a tumor grows larger, it can cause liver dysfunction or problems by pushing on other tissues. liver Liver function tests help determine the health of your liver. Lee WJ, Lim HK, Jang KM, et al. They return variable T2 signal. Altenbernd J, Heusner TA, Ringelstein A, Ladd SC, Forsting M, Antoch G. Dual-energy-CT of hypervascular liver lesions in patients with HCC: investigation of image quality and sensitivity. Clin. 2005 Jun;235(3):872-8. doi: 10.1148/radiol.2353041099. modify the keyword list to augment your search. Barreda R, Ros PR. Radiology. In addition, there are morphologic features that can suggest the diagnosis of CCC. Correspondence to 1994;192:4016. Among the three most common WebOn conventional CT, small hepatic lesions smaller than 15 to 20 mm were considered difficult to characterize with CT findings alone. There is a subtle hypointensity in the right lobe in a subcapsular location. Categorical data were expressed as numbers and percentages. This accounts for the high positive predictive value and specificity of IOUS (Fig. Laing RW, et al. IDKD Springer Series. There are multiple foci of high T2-weighted signal within the liver, suggestive of biliary hamartomas. What is important for radiologists? Approach to the Solitary Liver Lesion: Imaging and However, imaging is also performed at a delayed liver-specific or hepatobiliary phase, the timing of this differs according to the contrast agent. Clinical value of MRI liver-specific contrast agents: a tailored examination for a confident noninvasive diagnosis of focal liver lesions. At contrast-enhanced T1-weighted MRI, they are hypervascular, often with contrast washout in the portal venous or delayed phase. 2010;257:37383. Giant and complicated variants of cystic bile duct hamartomas of the liver: MRI findings and pathological correlations. WebLiver Cysts. 27, 280288. https://doi.org/10.1016/J.EJRAD.2017.10.016 (2017). 2004;127:S13343. Immunohistochemical evaluation of hepatic progenitor Surg. What Does Jaundice Look Like in Black People? 14-2018-032 from SNUBH Research Fund. Nonetheless, a recent meta-analysis showed that the lesion T1 isointensity or hyperintensity at delayed hepatobiliary phase MRI has a high sensitivity (91100%) and specificity (87100%) for diagnosing FNH [36]. Using a 64-plus-detector-row system, the entire liver can be scanned within 14 s using a submillimeter detector configuration allowing for high-quality multiplanar reconstructions (MPR) [1]. Small cysts (3 mm in size) may pose a diagnostic challenge in the cancer patient on CT as they are too small to fully characterize and stability on follow-up imaging is important to reassure. To provide a data base which can serve as a day-by-day reference source for the resident physician and clinician. PURPOSE: To retrospectively evaluate the prevalence and clinical importance of hepatic lesions considered too small to characterize (TSTC) at initial computed You may search for similar articles that contain these same keywords or you may Small lesions (up to ~2 cm) may show immediate and complete enhancement in the arterial phase, with sustained enhancement in the venous and delayed phases (type I, flash filling) [31] (Fig. Most lesions are noncancerous and dont require treatment if theyre small and dont cause symptoms. AJR Am J Roentgenol. To describe the approach of the family physician to clinical problems. Eur Radiol. This site needs JavaScript to work properly. 2000;24:616. Intrahepatic CCC often presents late as a large mass [66]. Small Using liver-specific MR contrast agents, FNH frequently shows enhancement on delayed images after administration of hepatobiliary contrast agents (such as gadoxetic acid or gadobenate dimeglumine) because of the presence of normal biliary ductules within the lesion and the expression of OATP receptors (Fig. PubMed A total of 31 patients (30.7%) had subcentimeter hepatic lesions on staging scans. A 45-year-old woman with incident lesion (arrows) in the right lobe of the liver. Epithelioid hemangioendothelioma (EHE) is a rare tumor of vascular origin, not to be confused with infantile hemangioendothelioma, which is a very different tumor. https://doi.org/10.1186/s12876-019-1036-7 (2019). WebHepatic lesions too small to characterize are a common finding on CT in women with newly diagnosed breast cancer. Adenoma: inflammatory type. All rights reserved. (b) T2-weighted MRI shows large left lobe mass (arrows) with heterogeneous appearance and mild to moderately increased signal intensity. These include gadobenate dimeglumine (MultiHance, Bracco) and gadoxetic acid (Primovist or Eovist, Bayer Healthcare). Sultana S, Awai K, Nakayama Y, et al. Hepatocellular carcinoma: role of unenhanced and delayed-phase multi-detector row helical CT in patients with cirrhosis. DSilva, M., Cho, J.Y., Han, HS. Copyright 2012 American Society for Radiation Oncology. 2006;24:133341. About 7% of HCA remains unclassified. Receiver operating characteristic analysis of diffusion-weighted magnetic resonance imaging in differentiating hepatic hemangioma from other hypervascular liver lesions. Characterisation of liver masses From a practical point of view, the approach to characterizing a focal liver lesion seen on CT begins with the determination of its density. If the lesion is of near water density, homogeneous, has sharp margins and shows no enhancement, then it is a cyst. D: Corresponding microangiography shows lesions as filling defects suggestive of necrosis (arrows). 24, 4348. Continuous data were expressed as meanStandard deviation. In addition to the unusual peripheral liver distribution, a key characteristic feature is the presence of overlying capsular retraction, due to the presence of fibrosis and scarring [73]. FNH is isodense or minimally hypodense on unenhanced and equilibrium-phase post-contrast CT and may be only suspected because of the presence of mass effect on adjacent vessels. There, I too observed the young man to be in distress from pain. Conclusion: Patients with TDT had significantly higher mortality than the matched general population. findings: low-attenuation lesion in the left maxillary consistent with ovarian cyst? The most common enhancement pattern is peripheral nodular discontinuous enhancement, which progressively fill-in over time (type II). Diseases of the Abdomen and Pelvis 2018-2021, https://doi.org/10.1007/978-3-319-75019-4_17, Rights and Diagnostic imaging of liver abscess. The term means that we cant say for sure what the spot is because its too small. Radiology. On T1-weighted images, HCC shows variable signal intensity relative to hepatic parenchyma. In addition, subcentimeter lesions detected by gadoxetic acid-enhanced MRI are likely to be or can transform to become HCC within a short interval [59]. 17.8 and 17.9). Ann. As they are usually asymptomatic, they are detected incidentally on US, CT, or MR imaging. PubMedGoogle Scholar. HCA are often hypervascular and may appear heterogeneous due to the presence of fat, necrosis, or hemorrhage [39, 40]. The resultant water-only images have been shown to improve the uniformity of fat suppression at 3 T, compared with conventional spectral fat suppression technique [16]. Radial acquisition technique. J. Surg. The mean carcinoembryonic antigen level at diagnosis was 27.7ng/mL (range 1520ng/mL). Diffusion-weighted MR imaging of the liver. Hammerstingl R, Huppertz A, Breuer J, et al. Google Scholar. 2007;17:67583. 7. Chir. On MRI, biliary hamartomas appear low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging (Fig. 17.1). In the arterial phase, there is also associated increased parenchyma enhancement surrounding many of the lesions. There may be a large number of patients with benign indeterminate lesions who are not evaluated by hepatobiliary specialists. 2005;234:4607. AJR Am J Roentgenol. 2008;32:82940. However, the uptake of hepatobiliary contrast agents within FNH may be rarely heterogeneous or absent [36]. Patient dose is reduced by 36%. We routinelyperformed PET scan for all patients with colorectal cancer. FNH is most likely in young women with a non-cirrhotic liver and if the lesion is homogeneous and near-isodense/near-isointense on unenhanced CT/MR imaging with a central T2-weighted hyperintense scar. Radiology. Radiology. Eur Radiol. On dynamic contrast-enhanced MR imaging, metastases demonstrate enhancement characteristics similar to those described for CT. Metastases may demonstrate a hypointense rim compared with the center of the lesion on delayed images (peripheral washout sign), which is highly specific for malignancy. Liver cysts are fluid-filled sacs that appear on your liver. AJR Am J Roentgenol. JP2023052545A - Treatment of avascular or oligovascular However, only the ratio of positive lymph nodes to the total number of resected lymph nodes (pLNR) in the primary was significantly associated with the risk of malignant indeterminate nodules (P=0.006; Table 2). The enhancement pattern is typical for FNH. AJR Am J Roentgenol. Biliary hamartomas are typically small (510 mm in size) and usually widely distributed in both lobes of the liver. HCC: quadruple-phasic CT for detection and characterization. Fibrolamellar HCC. Granata, V. et al. https://doi.org/10.1038/sj.bjc.6605049 (2009). A middle-aged woman was referred to MRI following an ultrasound examination. 8, 55. https://doi.org/10.21037/cco.2019.08.11 (2019). Bioulac-Sage P, Sempoux C, Balabaud C. Hepatocellular adenoma: classification, variants and clinical relevance. 17.15) [57]. 2017;67:107483. At MR, metastases are usually hypointense on T1-weighted and hyperintense on T2-weighted images [75]. Li Destri, G. et al. It has been reported that small, indeterminate liver lesions may occur in up to 16.7% of patients with CRC 11. Prasad SR, Sahani DV, Mino-Kenudson M, et al. Diffuse HCC in the right lobe with tumor thrombus in the portal vein. In case of just a primary colorectal tumor, surgery was done and liver metastasis was detected on routine follow-up. MDCT allows imaging to be performed in multiple planes. AJR Am J Roentgenol. & Kim, M.-J. DWIs main clinical benefit is the detection of focal liver lesions, which may be missed on conventional and contrast-enhanced imaging sequences. Epithelioid hemangioendothelioma. In most cases these lesions represent cysts, hemangiomas, or biliary hamartomas. 2002;223:51724. 10, 20832094. Clin. Target-enhancement was far more frequent in metastases (64.4%) than benign SLAHs (1.2%;P < 0.001). 2006;186:15719. 17.4). Liver cysts are fluid-filled sacs that form in the liver. However, a biopsy may be needed in difficult cases. Therefore, the objective of this study was to observe the natural course of indeterminate hepatic nodules detected on MRI and evaluate appropriate management strategies for these lesions. 2009;19:245666. For the detection and characterization of focal liver lesions, late arterial phase imaging (with a delay of aortic transit time plus 1518 s) [6, 7] and a venous phase scan (2030 s interscan delay or with fixed delay of ~6070 s) are performed. You can learn more about how we ensure our content is accurate and current by reading our. Han JK, Choi BI, Kim AY, et al. 2000;217:14551. Hemangioma type 1. Subcentimeter HCC may be treated by locoregional therapy, thus avoiding the morbidity and mortality associated with radical surgery. Conventional CT: At 28.5 HU, this lesion is "too small to characterize". Although your liver itself doesn't feel pain, problems in your liver can cause pain or discomfort in other places, usually throughout your abdomen. On CT, they appear as small cystic lesions of round, oval, or irregular shape without contrast enhancement, although thin rim enhancement may sometimes be present, thus mimicking hypovascular liver metastases [40]. Permissions team. Multidetector computed tomography (MDCT) and magnetic resonance (MR) imaging provide noninvasive insights into liver anatomy and the pathophysiology of liver diseases, which allows for better disease diagnosis, monitoring of disease evolution and treatment response, as well as for guiding treatment decisions. 100, 15301533. Liver lesions: Types, risk factors, investigations and treatment. Scharitzer M, Schima W, Schober E, et al. Lymph node ratio and liver metachronous metastases in colorectal cancer. Correlations between pathogenic variants in DNA repair genes and Primary hepatic angiosarcoma: findings at CT and MR imaging. van Aalten SM, Thomeer MG, Terkivatan T, et al. C: Liver specimen containing a microrhabdomyosarcoma R1 tumor (arrow) too small to be superficially visible. CAS In- and opposed-phase (or out-of-phase) T1-weighted imaging is recommended for maximal tumor detection and for characterization of fat containing tumors and the presence of steatosis. Alomari AI. Hepatic helical CT: contrast material injection protocol. The washout of contrast in these tumors is a diagnostic characteristic of HCC (Fig. Theyre found in as many as 30 percent of people over the age of 40. Contrast-enhanced liver MDCT for detection and characterization of focal masses should be at least biphasic, with a quadruple-phasic protocol being recommended for HCC detection and characterization in cirrhotic patients. Benign lesions are noncancerous growths. Hepatocellular adenoma (HCA) is uncommon, but has an association with oral contraceptive and anabolic steroid usage. Although less common than leukocytosis, leukopenia is associated with a worse prognosis.7, 18, 19Increased serum activities of liver enzymes (ALT, ALP, aminotransferase, and gamma-glutamyl transpeptidase) and increased total bilirubin are commonly reported, and sometimes reflect concurrent lipidosis or cholangitis. The study was approved by the institutional review board at Seoul National University Bundang Hospital, Seongnam, South Korea. jacr.org/article/S1546-1440(17)30889-X/fulltext, wchh.onlinelibrary.wiley.com/doi/full/10.1002/tre.777, cancer.net/cancer-types/liver-cancer/statistics, 7 Ways to Improve the Health of Your Liver, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT. The lollipop sign: a new cross-sectional sign of hepatic epithelioid hemangioendothelioma. Hepatocellular adenomas: correlation of MR imaging findings with pathologic subtype classification. Incidental pancreatic cystic lesions: is there a relationship with the development of pancreatic adenocarcinoma and all-cause mortality? In most such cases, however, careful evaluation will show that the tumoral enhancement does not follow characteristics of blood pool at all phases or that there are other features, such as multiple lesions, that make the diagnosis of hemangioma unlikely [71, 72]. 90, 275280 (2019). Besides showing greater accuracy for the diagnosis of indeterminate nodules found on CT, MRI revealed new lesions in 138/389 patients (35.5%). On CT, FL-HCC appears as a large, well-defined vascular mass with lobulated surface and often a central scar and calcifications in up to 70% of cases [64, 65]. In addition the surgeons or radiologists who had full knowledge of the preoperative imaging findings performed intraoperative liver ultrasonography (SSD-3500, Aloka, Japan; MylLab 25 Gold, Esaote Biomedica, Italy; or iU22, Philips Medical Systems, The Netherlands) to detect new lesions and further characterization of small indeterminate nodules13. Nonetheless, quantitative ADC values may be useful to support lesion characterization and for identifying early tumor response to treatment, which is currently being investigated. Liver, Cysts, Liver neoplasms, Computed tomography (CT), Metastases. Ann. 2). You can read the full text of this article if you: Keywords PLoS ONE https://doi.org/10.1371/journal.pone.0189797 (2017). They are best observed on maximum intensity projections MRCP sequences as high signal intensity foci without connection to or associated abnormalities of the intrahepatic ducts. https://doi.org/10.1245/s10434-017-6264-x (2018). These symptoms tend to first occur in people who are aged 60 years or older. Martin DR, Kalb B, Sarmiento JM, et al. Koyama T, Fletcher JG, Johnson CD, et al. These are common everyday type findings that WebFish odour syndrome, sadly some people cant break down a certain compound in the liver, because they lack a enzymes to break it down. T1-weighted chemical shift or DIXON imaging is useful for detecting intratumoral fat, while the presence of high T1-signal before contrast administration will raise the suspicion of spontaneous hemorrhage. Gao, P. et al. Dis. Kehagias D, Moulopoulos L, Antoniou A, et al. Mosaic pattern of hepatocellular carcinoma: histologic basis for a characteristic CT appearance. Search for Similar Articles Google Scholar. 17.6) [33] because of its vascular component. From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (H-J. All patients underwent a routine CT scan for screening, and patients with CRLM detected by CT were further evaluated with a Gadoxetic acid MRI (Primovist, Germany). 2001;21:S97S116. All rights reserved. They are hypointense on T1-weighted and markedly hyperintense on T2-weighted imaging, sometimes with a lobular contour. The CT attenuation or MR signal intensity characteristics are nonspecific, although occasional tumoral calcifications may be seen. Dr. Gurmukh Singh answered Pathology 51 years experience On dynamic contrast-enhanced CT, most metastases appear hypovascular and hypodense relative to liver parenchyma on the portal venous phase (Fig. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Intraoperative ultrasound staging for colorectal liver metastases in the era of liver-specific magnetic resonance imaging: Is it still worthwhile?. Small cysts (3 mm in size) may pose a diagnostic challenge in the cancer patient on CT as they are too small to fully characterize and stability on follow-up imaging is important to reassure. Vilgrain V, Esvan M, Ronot M, Caumont-Prim A, Aub C, Chatellier G. A meta-analysis of diffusion-weighted and gadoxetic acid-enhanced MR imaging for the detection of liver metastases. Another key feature is that other than the scar, FNH are usually homogeneous in appearance compared with the heterogeneous appearance encountered in fibrolamellar HCC. In recent years, dual-energy and spectral CT technique has emerged, where the utilization of dual-source or polychromatic X-ray beams and the differential attenuation of such beams of different energies in tissues are applied to improve the detection of hypervascular hepatocellular carcinomas [14] or for the quantification of hepatic iron content [15]. Hemangioma is the most common benign liver tumor. Hepatobiliary phase imaging performed at 20 min after gadoxetate contrast administration using (a) free breathing radial acquisition fat-suppressed gradient echo and (b) breath-hold volume interpolated fat-suppressed gradient echo technique.