Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
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Volume 2, Number 5, October 2009, pages 259-267

Approach to Solid Liver Masses in the Cirrhotic Patient


Table 1. Accuracy and key features of imaging techniques in the diagnosis of most common liver masses in cirrhosis
LesionsUS- US Doppler, Contrast ultrasoundTriphasic Dynamic CTMRIPET SCANCT-Angiography
+, degree of accuracy; SS sensitivity; SP specificity; a; Intraoperatrive ultrasound, contrast ultrasound and EUS are highly sensitive to detect liver mass; From Assy N, World J Gastroenterol. 2009;15:3217-27.
Hypo or hyper echoic
Doppler: hyper vascular.
index and flow high, spectral broadening
hyper vascular, often irregular borders
Heterogeneous> Homogeneous
abnormal internal vessel
Hallmark feature is arterial hypervascular-
and venous wash-out
SS 52-54%
hyper vascular
Poor different: Hypo intense T-1, Hyper intense T2;
Well different: Hype intense T-1, Iso intense T-2
SS 53-78%
Increased uptake. but many HCC do not show uptake at PET
Hyper vascular
Av shunting
Cholangio -CABile duct dilatation if major ducts are involved
Intrahepatic CCC: no bile dilatation
Hypo dense lesion
Delayed enhancement
Hypo intense T1
Hyper intense T2
MRCP is useful
SS 93%
Increase uptake
Hyper vascular
SS 40-70 %
hypo echoic to hyper echoic; Doppler; low index and flow; presence of spectral broadening
SS 49-74 %
complete ring enhancement
SS 68 -90 %
Low intensity T-1
High intensity T-2
SS 90-100%
colon, pancreas
SS 88-95%
hyper vascular
Hyper echoic
Doppler: low flow, low index, absence of spectral broadening
Peripheral puddles, fill in from periphery, enhancement on delayed scan
Peripheral enhancement centripetal progression
hypo intense T1
SS >95%,
SP 95%
No uptake+++
Cotton wool pooling of contrast, normal vessels without AV shunt, persistent enhancement
Focal fatty liver+
hyper echoic, no mass effect, no vessel displacement
Sharp interface
Low density (<40u)
+++No uptakenormal finding
Hyper echoic
If haemorrhage: anechoic centre. Doppler: variable flow and spectral broadening
Peripheral feeders filling in from periphery
Hyper intense T1
(intra lesion fat )
no uptake
uptake if degeneration to HCC
Hyper vascular
Large peripheral
Vessel. Central scar
if haemorrhage


Table 2. Accuracy of tumor markers in the diagnosis of HCC
Normal valueSensitivity %Specificity %PPV %NPV %Diagnostic accuracy %
Des-gamma-carboxy prothrombin (DCP). Tissue polypeptide antigen (TPA), alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), From Grazi GL, liver transplantation and surgery 1995;1: 249-255.
AFP (ng/dL)205597956977
CEA (ng/dL)72278485151
TPA (U/L)907061627066
DCP (AU/ml)0.095388886671


Table 3. Accuracy of magnetic resonance imaging (MRI) and spiral computed (CT) in the diagnosis of liver mass (nodule)
From: de Ledinghen: Eur J Gastroenterol Hepatol, 2002;14:159-165.
Positive predictive value9295
Negative predictive value5643
Diagnostic Accuracy8274


Table 4. The sensitivity (%) of FNA cytology, needle core biopsy, and combined FNA/FNCB in malignant and in benign liver lesions
Biopsy SiteFNA %FNCB %Combined %
FNA, fine needle aspiration. FNCB, needle core biopsy, From: Stewart CJ; J Clin Pathol. 2002; 55: 93–97.
Liver Metastasis868388
Hepatocellular Carcinoma10089100
Benign Liver Lesions10089100