Liver: Mass CT Characteristics

CT Characteristics

Simple Cyst

  • Well-Demarcated
  • No Enhancement
  • No Visible Wall

Mucinous Cystic Neoplasm (MCN)

  • Unilocular or Multilocular with Septations
  • Thickened Irregular Wall

Hemangioma

  • Arterial Phase: Peripheral Enhancement
  • Portal Venous Phase: Centripetal Flow
  • Delayed Phase: Isodense Then Hypodense
  • MRI:
    • Smooth, Well-Demarcated & Homogenous
    • Low Signal Intensity on T1
    • Peripheral Nodular Enhancement

Simple Cyst of the Liver 1

Hepatic Hemangioma. (a) Early Arterial Peripheral Enhancement, (b) Late Homogenous Attenuation 2

Pyogenic Abscess

  • Well-Defined
  • Central Hypoattenuation
  • Rim Enhancement with Peripheral Edema

Amebic Abscess

  • In Peripheral Liver
  • No Rim Enhancement
  • Peripheral Edema

Hydatid Cyst

  • Inner Wall Infoldings
  • Double-Walled with Calcified Rim
  • May See Septa/Daughter Cysts

Pyogenic Liver Abscess 3

Amebic Abscess 4

Hydatid Cyst of the Liver 5

Focal Nodular Hyperplasia (FNH)

  • Arterial Phase: Homogenous Enhancement
  • Portal Venous Phase: Precontrast Density
  • Central Stellate Scar
  • Liver Scan: Hot

Hepatocellular Adenoma

  • Well Circumscribed
  • Variable Attenuation Depending on Calcification, Hemorrhage (Hyperattenuating) or Fat Content (Hypoattenuating)
  • Similar to FNH
  • Arterial Phase: Homogenous Enhancement
  • Portal Venous Phase: Precontrast Density
  • Liver Scan: Cold

FNH. (a) Early Arterial Homogenous Enhancement with Central Scar, (b) Portal Venous Washout, (c) Delayed Phase Isodensity 6

Hepatic Adenoma. (a) Precontrast, (b) Enhancement on Arterial Phase, (c) Gradual Washout on Delayed Phase 7

Liver Scan. (a) FNH (Hot), (b) HCA (Cold) 8

Hepatocellular Carcinoma (HCC)

  • Arterial Phase: Early Enhancement
  • Portal Venous/Delayed Phase: Washout
  • Liver Scan: Cold

HCC FLC

  • Arterial Phase: No Enhancement
  • May Have Central Scar

Metastases

  • Arterial Phase: No Enhancement
    • Some Such as NET, RCC, etc. May Have Rapid Enhancement

Hepatocellular Carcinoma. (a) Noncontrast, (b) Arterial Phase Enhancement, (c) Portal Phase Washout, (d) Delayed Phase Hypoattenuation 9

Liver Metastasis from Colon Cancer 10

CT Contrast Phases

Early Systemic Arterial Phase

  • Time from Injection: 15-20 Seconds
  • Target: Arteries

Late Systemic Arterial Phase (Arterial Phase)

  • Also Referred to as Early Portal Venous Phase
  • Time from Injection: 35-40 Seconds
  • Target: Structures with Arterial Blood Supply

Hepatic Phase

  • Also Referred to as Late Portal Venous Phase
  • Time from Injection: 70-80 Seconds
  • Target: Liver Parenchyma & Structures with Portal Vein Supply

Systemic Venous Phase

  • Time from Injection: 180 Seconds
  • Target: Venous Thrombosis

Delayed/Washout Phase

  • Time from Injection: 6-15 Minutes
  • Target: Disappearance of All Contrast Unless Tissue Fibrotic

CT Characteristic Comparison

Non-Solid Liver Mass CT Characteristics

  Wall/Rim Periphery Extra
Simple Cyst None – –
MCN Thickened & Irregular – Septations
Hydatid Cyst Double-Walled & Calcified Rim – –
Pyogenic Abscess Rim Enhancement Edema –
Amebic Abscess No Rim Enhancement Edema –

Solid Liver Mass CT Characteristics

  Arterial Phase Portal Venous Phase Extra
Hemangioma Peripheral Centripetal Hypodense Delayed Phase
FNH Homogenous Precontrast Central Stellate Scar Hot Liver Scan
Adenoma Homogenous Precontrast Variable Attenuation
HCC Early Enhancement Washout –
HCC FLC No Enhancement – May Have Scar
Metastases No Enhancement – –

References

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