Imaging Characteristics of Focal Liver Lesions on Contrast-Enhanced Helical Computed Tomography

  • Sonika Rani Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India
  • Purva Tripathi Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India
Keywords: Benign, Contrast-enhanced helical computed tomography, Hepatic, Malignant


Introduction: The discovery of computed tomography (CT) by G.N. Hounsfield in 1972 has been a milestone in medical
diagnostic imaging as cross-sectional imaging took a step into diagnostic radiology. The use of contrast agents for CT of the
liver has been used since long back. However, the advent of multidetector helical CT has made the dream of multiphasic
imaging a reality. This has led to imaging the liver during the various phases of enhancement and helping in characterization
and detection of the lesions.
Material and methods: This prospective study was done in the Department of Radiodiagnosis and Imaging at Bhopal Medical
Centre, Bhopal, Madhya Pradesh, India. Atotal of 100 patients who were referred to our department with strong clinical suspicion
of focal liver lesion and those diagnosed by ultrasonography underwent multiphasic contrast-enhanced CT evaluation of abdomen
using single-slice spiral CT scanner from March 2010 to May 2012.
Results: In our study, the majority of cases diagnosed were that of malignant lesions in 47% of cases. The other lesions
diagnosed were benign lesions in 34% of cases and inflammatory lesions in 19% of cases. Among the malignant lesions, the
most common diagnosis was that of metastases seen in 67% of cases. The next most common was hepatocellular carcinoma
(HCC) seen in 29% of cases.
Discussion: Contrast-enhanced multiphasic CT plays an indispensable role in the detection and characterization of focal
lesions of the liver. The aspects of the identified liver abnormalities influence the clinical and surgical decision-making. Benign
abnormalities such as cysts and hemangioma do not require treatment, but some benign cases require treatment such as FNH
and hepatocellular adenoma requires treatment in some cases. Malignant lesions arising from the liver such as HCC often need
treatment. Metastases may or may not be amenable to treatment.
Conclusion: The accuracy of contrast-enhanced multiphasic CT in detecting and characterizing focal liver lesions is high, and
it should be considered in the imaging workup of any patient with focal liver lesions. This helps in guiding further management
of these patients avoiding unnecessary investigations and workup for the diagnosis as there is a high incidence of benign
pathologies in the liver.

Author Biographies

Sonika Rani, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India

Senior Resident, Department of Radiodiagnosis, 

Purva Tripathi, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India

Senior Resident, Department of Radiodiagnosis,


1. Kamel IR, Choti MA, Horton KM, Braga HJ, Birnbaum BA, Fishman EK, et
al. Surgically staged focal liver lesions: Accuracy and reproducibility of dualphase helical CT for detection and characterization. Radiology 2003;227:752-7.
2. Reimer P, Jahnke N, Fiebich M, Schima W, Deckers F, Marx C, et al.
Hepatic lesion detection and characterization: Value of nonenhanced MR
imaging, superparamagnetic iron oxide-enhanced MR imaging, and spiral
CT-ROC analysis. Radiology 2000;217:152-8.
3. Hammersting R, Adam G, Ayuso JR, van Beers B, Belfiore G, Bellin MF,
et al. Comparison of 1.0 M gadobutrol and 0.5 M gadopentetate
dimeglumine-enhanced magnetic resonance imaging in five hundred
seventy-two patients with known or suspected liver lesions: Results of a
multicenter, double-blind, interindividual, randomized clinical phase-III
trial. Invest Radiol 2009;44:168-76.
4. Joseph KT, Sagel SS, Stanley RJ, Heiken JP. Computed body tomography
with MRI correlation. Philadelphia, PA: Lippincott Williams & Wilkins; 2004.
5. John RH, Dogra VS, Michael F, Gilkeson RC, Ha KH, Sundaram M,
et al. CT and MRI of the Whole Body. 5th ed. St Louis: Elsevier; 2009.
6. van Leeuwen MS, Noordzij J, Feldberg MA, Hennipman AH,
Doornewaard H. Focal liver lesions: Characterization with triphasic spiral
CT. Radiology 1996;201:327-36.
7. Murcio MN, Olcott EW, Jeffrey RB, Lamm RL, Beaulieu CF, Jain KA, et al.
Focal liver lesions: Pattern based classification scheme for enhancement at
arterial phase CT. Radiology 2000;215:746-51.
8. Fernandez MP, Redvanly RD. Primary hepatic malignant neoplasms.
hepatic imaging. Radiol Clin Am 1998;362:333-48.
9. Evelyne ML, Hsiao C, Dubrow RA, David CL, Eftekhari F, CharnsangavejC,
et al. Hepatocellular carcinoma and intrahepatic cholangiocarcinoma:
Enhancement patterns with quadruple phase helical CT-a comparative
study. Radiology 1999;212:866-75.
10. Abraham HD, Lichtenstein JE, Friedman AC, Hartman DS. Infantile
hemangioendothelioma of the liver. A radiologic-pathologic-clinical
correlation. AJR 1983;140:1091-6.
11. Yasuhiro K, Matsui O, Kitagawa K. Macronodular tuberculoma of the liver:
CT and MR findings. AJR 1992;158:311-3.