Poster Author of 1 e-Poster
SE-083 - Indeterminate lesions (LI-RADS 3 and 4) lacking arterial phase hyperenhancement on CT and MRI in the cirrhotic liver: outcome and role of ancillary features.
Author of 1 Presentation
SE-083 - Indeterminate lesions (LI-RADS 3 and 4) lacking arterial phase hyperenhancement on CT and MRI in the cirrhotic liver: outcome and role of ancillary features.
Abstract
Purpose
To retrospectively evaluate LI-RADS ancillary imaging features and outcomes of indeterminate
lesions lacking APHE in cirrhotic patients.
Material and methods
In this retrospective study, we included indeterminate lesions (LR-3 and LR-4) up to 3 cm lacking APHE in consecutive cirrhotic patients imaged with CT or MRI. All MRI exams were performed with Gd-EOB-DTPA. All lesions were individually evaluated to determine LI-RADS major and ancillary imaging features at diagnosis and outcome. Reference standard was based on pathology and imaging follow-up.
Results
27 indeterminate lesions lacking APHE (i.e. 20 LR-3, 7 LR-4) in 12 cirrhotic patients (10M, 2F) were included. HCC was proved for 4 [15%] of 27 lesions, including 1 of 10 (10%) lesions imaged with CT at diagnosis, and 3 of (17%) 17 lesions imaged with MRI. Not-HCC malignancy was diagnosed in 1 lesion imaged with MR. Imaging analysis of these 5 malignant lesions showed lack of ancillary features suggesting malignancy on the lesion imaged with CT; conversely at least one ancillary feature suggesting malignancy was detected in the remaining 4 lesions imaged with MR (i.e., hepatobiliary phase hypointensity in 4, restricted diffusion in 3, fat in the mass in 3, and T2-hyperintensity in 2).
Conclusion
HCC is identified in 10% and 17% of indeterminate LR-3 or LR-4 lesions lacking APHE imaged with CT or Gd-EOB-DTPA MRI, respectively. MRI may allow the detection of LI-RADS ancillary features suggesting malignancy and therefore those lesions requiring more aggressive management.