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Incidental liver lesion

ACR 2017CT
Flowchart · click to enlarge
Incidental liver lesion on CT

For incidental liver lesions on CT in adults. Risk status and lesion features drive management at each size.

Definitions

TermCriteria
Benign featuresSharp margin; homogeneous low attenuation (≤20 HU) on unenhanced and/or portal venous phase; characteristic features of hemangioma, FNH, focal fatty sparing or deposition, or perfusional change
Suspicious featuresIll-defined margins; heterogeneous density; intermediate to high attenuation on portal venous phase (>20 HU); enhancement >20 HU; mural thickening or nodularity; thick septa
Flash-fillingHomogeneous arterial-phase enhancement of a small lesion, isoattenuating to blood pool; typically hemangioma but can mimic hypervascular tumor
Low riskNo known malignancy, hepatic dysfunction, or hepatic risk factors
High riskKnown primary malignancy with propensity for liver metastasis, cirrhosis, and/or other hepatic risk factors

Sources

  1. Gore RM, Pickhardt PJ, Mortele KJ, et al. Management of incidental liver lesions on CT: a white paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2017;14:1429–1437.PubMed ↗
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Radessential summarizes published classification systems for practicing radiologists. Summaries are condensed; confirm details against the cited source before relying on them for patient care.