Liver lesions have a broad spectrum of pathologies ranging from benign liver lesions such as hemangiomas to malignant lesions such as primary hepatocellular carcinoma and metastasis. Imaging is a crucial step in diagnosing these conditions as liver enzymes can be elevated in up to 9% of individuals in the USA. A combination of medical history, serologic, and radiologic investigations can provide a diagnosis in most cases. Liver lesions can be categorized into focal and diffuse liver lesions.
Focal liver lesions generally fall into three main clinical categories.
Benign lesions that do not need treatment if they are asymptomatic, including hepatic hemangiomas, focal nodular hyperplasias, and benign liver cysts
Benign lesions that require treatment, including hepatic adenoma, hepatic abscess, and hepatic adenomas
Malignant lesions, including hepatocellular carcinoma, cholangiocarcinoma, hepatic angiosarcoma, and liver metastases
Diffuse liver lesions can be categorized into vascular, inflammatory, and storage diseases.
Benign liver lesions can be classified into three categories based on their tissue origin:
Cholangiocellar: hepatic cyst, biliary cystadenoma, intraductal papillary neoplasm of the bile ducts, peribiliary cyst, intrahepatic bile adenoma
Hepatocellular: focal nodular hyperplasia, hepatic adenoma
Mesenchymal: hemangioma, lipoma
Liver ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI) are the primary imaging modalities to diagnose liver lesions. Postcontrast imaging can help distinguish lesions depending on their degree of vascularity and composition. Postcontrast hepatic imaging falls into three distinct phases: the arterial phase, the portal venous phase, and the delayed venous phase. Ultrasound can be a method of choice as a screening modality, and contrast-enhanced multidetector CT (MDCT) as a modality of choice in most hepatic imaging. MRI plays a role in better characterizing lesions with equivocal features on US and CT.
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