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Transient homogeneously enhancing hepatic masses: can size predict benignity?
Fiona Hughes-Cassidy1, Jeffrey Wong, Diego Aguirre
1Liver Imaging Research Group and Department of Radiology, University of California, San Diego, 408 Dickinson St., San Diego, CA 92103-8226, USA.
AJR. American Journal of Roentgenology
|January 24, 2008
Summary
In noncirrhotic livers, larger hepatic masses (>= 22 mm) that homogeneously hyperenhance on CT arterial phase imaging and fade to isoattenuation are likely benign. Smaller lesions may be malignant, requiring further evaluation.
Area of Science:
- Radiology
- Hepatology
- Oncology
Background:
- Distinguishing benign from malignant liver masses is crucial for patient management.
- Homogeneous arterial phase hyperenhancement followed by washout is a common pattern for hepatocellular carcinoma, but can also be seen in some benign lesions.
Purpose of the Study:
- To evaluate the hypothesis that large size predicts benignity of liver masses with homogeneous arterial phase hyperenhancement and subsequent isoattenuation on CT.
- To determine if mass size is a reliable predictor of malignancy in noncirrhotic livers.
Main Methods:
- Retrospective review of multiphasic CT scans from 55 noncirrhotic patients with 227 hepatic masses.
- Analysis of mass size (per lesion and per patient) and enhancement characteristics.
- Receiver operator characteristic (ROC) analysis and logistic regression modeling to assess size as a predictor of lesion classification.
Main Results:
- Liver masses ranged from 5 to 84.5 mm; all 29 masses >= 22 mm were benign.
- Mass size was a statistically significant classifier of benign versus malignant lesions (ROC area under the curve).
- Size was a significant or trend-level predictor of tumor type in per-patient analysis.
Conclusions:
- Relatively large size is a significant predictor for benign tumors in noncirrhotic livers.
- Homogeneously hyperenhancing masses >= 22 mm that fade to isoattenuation are benign.
- Smaller masses with this enhancement pattern may be malignant and warrant further investigation.
