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Radiologists’ Performance in the Diagnosis of Liver Tumors with Central Scars by Using Specific CT Criteria¹

¹ From the Departments of Radiology (A.B., M.P.F., J.V.F., J.M.L., J.S.W., D.R.A., G.C., O.A., E.B.) and Biostatistics (W.L.), University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213; and Department of Radiology, Spedali Civili Brescia, Italy (L.G.). Received April 17, 2001; revision requested June 5; revision received September 17; accepted October 10. Address correspondence to M.P.F. (e-mail: federle@pitt.edu).

View larger version (116K): [in a new window]   Figure 1a. Transverse CT scans obtained in a 41-year-old woman with FNH. (a) Section obtained during the hepatic arterial phase shows a round mass that demonstrates intense homogeneous enhancement with a smooth margin and a small central scar (arrow). (b) Section obtained during the portal venous phase at the same level. The mass (solid arrows) is isoattenuating with the normal hepatic parenchyma and can be identified by the scar (open arrow) that has decreased in size due to partial enhancement.

View larger version (117K): [in a new window]   Figure 1b. Transverse CT scans obtained in a 41-year-old woman with FNH. (a) Section obtained during the hepatic arterial phase shows a round mass that demonstrates intense homogeneous enhancement with a smooth margin and a small central scar (arrow). (b) Section obtained during the portal venous phase at the same level. The mass (solid arrows) is isoattenuating with the normal hepatic parenchyma and can be identified by the scar (open arrow) that has decreased in size due to partial enhancement.

View larger version (120K): [in a new window]   Figure 2a. Images obtained in an 18-year-old woman with fibrolamellar HCC. (a) Unenhanced transverse CT scan demonstrates a large, heterogeneous hypoattenuating mass that replaces most of the left hepatic lobe. The central scar is not well seen, but there are central coarse calcifications (arrow). (b) Hepatic arterial phase image obtained at the same level shows heterogeneous intense enhancement of the same mass (open arrows). There are two satellite lesions (solid white arrows), and the surface lobulation, central scar (solid black arrow), and calcifications within the scar are seen more clearly. (c) Photograph of the resected specimen. Note the central scar (arrow) and lobulated surface.

View larger version (123K): [in a new window]   Figure 2b. Images obtained in an 18-year-old woman with fibrolamellar HCC. (a) Unenhanced transverse CT scan demonstrates a large, heterogeneous hypoattenuating mass that replaces most of the left hepatic lobe. The central scar is not well seen, but there are central coarse calcifications (arrow). (b) Hepatic arterial phase image obtained at the same level shows heterogeneous intense enhancement of the same mass (open arrows). There are two satellite lesions (solid white arrows), and the surface lobulation, central scar (solid black arrow), and calcifications within the scar are seen more clearly. (c) Photograph of the resected specimen. Note the central scar (arrow) and lobulated surface.

View larger version (134K): [in a new window]   Figure 2c. Images obtained in an 18-year-old woman with fibrolamellar HCC. (a) Unenhanced transverse CT scan demonstrates a large, heterogeneous hypoattenuating mass that replaces most of the left hepatic lobe. The central scar is not well seen, but there are central coarse calcifications (arrow). (b) Hepatic arterial phase image obtained at the same level shows heterogeneous intense enhancement of the same mass (open arrows). There are two satellite lesions (solid white arrows), and the surface lobulation, central scar (solid black arrow), and calcifications within the scar are seen more clearly. (c) Photograph of the resected specimen. Note the central scar (arrow) and lobulated surface.

View larger version (151K): [in a new window]   Figure 3a. Transverse CT scans obtained in a 67-year-old man with a large hemangioma. (a) Section obtained during the hepatic arterial phase shows a large lobulated mass (solid arrows) that replaces the right hepatic lobe and demonstrates nodular enhancement (open arrows) that is isoattenuating with the aorta. There is an irregular, cleftlike, central hypoattenuating scar. (b) Section obtained during the portal venous phase at the same level shows more nodular enhancement of the mass, which is still isoattenuating with the aorta. The irregular, elongated, hypoattenuating central scar (arrow) is seen more clearly with the increase in lesion enhancement.

View larger version (140K): [in a new window]   Figure 3b. Transverse CT scans obtained in a 67-year-old man with a large hemangioma. (a) Section obtained during the hepatic arterial phase shows a large lobulated mass (solid arrows) that replaces the right hepatic lobe and demonstrates nodular enhancement (open arrows) that is isoattenuating with the aorta. There is an irregular, cleftlike, central hypoattenuating scar. (b) Section obtained during the portal venous phase at the same level shows more nodular enhancement of the mass, which is still isoattenuating with the aorta. The irregular, elongated, hypoattenuating central scar (arrow) is seen more clearly with the increase in lesion enhancement.