RADIOLOGICAL DIAGNOSIS OF BENIGN AND MALIGNANT LIVER TUMOURS

TAKE-HOME MESSAGES • Dynamic MRI, especially Gd-EOB-DTPA-enhanced MRI, is superior to multidetector CT in both sensitivity and specificity. • In patients with a normal liver, a hyperechoic lesion is likely to be a liver haemangioma and US is sufficient for diagnosis, except in oncology patients or those with underlying liver disease. • Diagnosing haemangioma by multiphasic CT or MRI with extracellular agents is based on a typical vascular profile. • FNH can be diagnosed by CEUS, CT, or MRI with nearly 100% specificity when typical imaging features are seen in combination. • In characterising and sub-typing HCA, MRI is superior to all other imaging modalities. • The hallmark diagnostic features of progressed HCC at multiphasic CT or MRI with extracellular agents are HAP hyperenhancement followed by portal venous or delayed phase washout. • MRI with HB agents is the most sensitive method for detecting early HCC, but rather than arterial hypervascularity it typically shows hypo-or isoenhancement relative to liver in the HAP. • Viable tumour size is the most reliable method for assessing tumour response in HCC patients undergoing TACE. • TACE can be repeated continuously if there’s a suspicious viable tumour in follow-up imaging, but there is no consensus on the frequency of TACE and the interval between treatments. • The decision to repeat TACE should be based on tumour necrosis, disease progression and liver function.