Small hypervascular enhancing lesions on arterial phase images of multiphase dynamic computed tomography in cirrhotic liver: fate and implications.
OBJECTIVE
Our purpose was to determine the significance of small hypervascular enhancing lesions exclusively on the arterial phase images of dynamic computed tomography in cirrhotic liver.


METHODS
One hundred sixty-nine enhancing lesions (>5 and <30 mm) on the arterial phase images of dynamic computed tomography in 67 patients with cirrhotic liver, not distinguished from background hepatic parenchyma on equilibrium phase images without hypoattenuation density on portal phase images, were subjected to a retrospective assessment in terms of the lesion growth in addition to the location, size, and contour of the lesions, depending on the final diagnoses of the individual lesions.


RESULTS
Twenty-eight (17%) of the 169 enhancing lesions were hepatocellular carcinomas (HCCs). All of the 43 wedge-shaped, subcapsular lesions were benign, and 126 nodular or irregular lesions were subcapsularly (benign, n = 59; HCC, n = 11) or centrally (benign, n = 39; HCC, n = 17) located. Significant differences were found between HCCs and benign lesions in terms of their shape (P = 0.002) and location (P = 0.041), and the positive and negative predictive values of centrally located lesions for diagnosing HCCs were 21% and 85%, respectively. The positive and negative predictive values for the diagnosis of HCC based on the lesion growth were 90% and 93%, respectively.


CONCLUSIONS
Because of the low positive predictive value of non-wedge-shaped, centrally located, early enhancing lesions in the diagnosis of HCC, the serial follow-up for examining lesion growth is essential to the correct diagnosis of small arterial hypervascular lesions in cirrhotic liver.
Hwang
Sung Ho
SH
Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, YongDong Severance Hospital, Dogok-Dong, Gangnam-Gu, Seoul, Republic of Korea.
Yu
Jeong-Sik
JS
Kim
Ki Whang
KW
Kim
Joo Hee
JH
Chung
Jae-Joon
JJ
D000328:Adult; D000368:Aged; D001158:Arteries; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008099:Liver / Q000000981:diagnostic imaging*; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide