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Gastrointestinal Imaging |
1 From the Department of Radiology, Stanford University Medical Center, Stanford, Calif (M.N.M., E.W.O., R.B.J., R.L.L., C.F.B.); the Radiology Service (114), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304 (M.N.M., E.W.O.); and the Department of Radiology, University of California Davis, Sacramento (K.A.J.). Received November 9, 1998; revision requested January 5, 1999; final revision received August 31; accepted September 15. Address correspondence to M.N.M. (e-mail: ninomurcia@forsythe.stanford.edu).
PURPOSE: To present our early experience with a classification scheme for categorizing focal liver lesions on the basis of the enhancement patterns that they exhibit in the arterial phase of computed tomography (CT) and to determine whether particular enhancement patterns suggest particular diagnoses.
MATERIALS AND METHODS: The authors reviewed arterial phase CT images in 100 consecutive patients with focal liver lesions, excluding simple cysts. The enhancement pattern of the dominant or representative lesion in each patient was classified into one of five categories—homogeneous, abnormal internal vessels or variegated, peripheral puddles, complete ring, or incomplete ring—by three radiologists blinded to the proved diagnosis. Lesions without enhancement were recorded separately. Agreement was reached by consensus in all cases. Standards of reference included findings at histologic examination, correlative imaging, or clinical and imaging follow-up.
RESULTS: Ninety-two percent of the 100 lesions demonstrated arterial phase enhancement. Patterns associated with positive predictive values of 82% or greater and specificity of 80% or greater included abnormal internal vessels or variegated (hepatocellular carcinoma), peripheral puddles (hemangioma), and complete ring (metastasis).
CONCLUSION: The appearance of hepatic lesions in the arterial phase of enhancement has potential use in the determination of specific diagnoses. The classification scheme used in this study may be a useful tool for the interpretation of arterial phase CT studies.
Index terms: Angioma, 761.3194 • Liver, focal nodular hyperplasia, 761.3198 • Liver neoplasms, CT, 761.12112, 761.12114, 761.12115 • Liver neoplasms, diagnosis, 761.32, 761.33 • Liver neoplasms, secondary, 761.33
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