ACR Appropriateness Criteria® Liver Lesion-Initial Characterization EVIDENCE TABLE Reference 1.

2.

3.

4.

Leifer DM, Middleton WD, Teefey SA, Menias CO, Leahy JR. Follow-up of patients at low risk for hepatic malignancy with a characteristic hemangioma at US. Radiology. 2000; 214(1):167-172. Winterer JT, Kotter E, Ghanem N, Langer M. Detection and characterization of benign focal liver lesions with multislice CT. Eur Radiol. 2006; 16(11):2427-2443. Bolondi L, Gaiani S, Celli N, et al. Characterization of small nodules in cirrhosis by assessment of vascularity: the problem of hypovascular hepatocellular carcinoma. Hepatology. 2005; 42(1):2734. Holalkere NS, Sahani DV, Blake MA, Halpern EF, Hahn PF, Mueller PR. Characterization of small liver lesions: Added role of MR after MDCT. J Comput Assist Tomogr. 2006; 30(4):591-596.

Patients/ Events 213 patients

Study Objective (Purpose of Study) To determine if follow-up imaging is needed in patients with low-risk of malignancy and a typical-appearing hemangioma at US.

Follow-up imaging is not needed in patients with a low-risk of malignancy and a typicalappearing hemangioma at US.

Review/OtherDx

N/A

To provide an overview of the current status of MDCT in the characterization of benign FLLs.

Currently, MDCT allows the acquisition of thin slices in daily routine diagnostics which improves detection of small liver lesions.

4

ObservationalDx

59 patients 72 lesions

Prospective study to look at the impact of arterial hypervascularity as a criterion for characterizing small (1-3 cm) nodules in cirrhosis.

Relying on imaging techniques in nodules of 1 to 2 cm would miss the diagnosis of HCC in up to 38% of cases. Any nodule >2 cm should be regarded as highly suspicious for HCC.

3

ObservationalDx

59 patients

A retrospective study to evaluate the added role of MRI in characterizing subcentimeter FLLs detected on MDCT.

Sensitivity, specificity, PPV, and NPV in differentiation of benign from malignant lesions on MDCT were 81.2%, 77.3%, 60.5%, 90.6 % and on MRI were 83.3%, 97.5%, 92.1%, and 94.4 %, respectively. Liver MRI has significantly higher accuracy for characterization of subcentimeter FLLs discovered on MDCT. MRI interpreted 55 lesions as benign, 17 lesions as malignant, and 9 as indeterminate lesions. If the indeterminate lesions were assumed as benign lesions, sensitivity, specificity, PPV, and NPV, are 68.4%, 93.6%, 76.5%, and 90.6%, respectively. MRI can supplement CT scan in characterization of small hepatic lesion. Small hepatic lesions demonstrated interval growth in 11.6% patients (6+ months followup) and were considered metastatic. In 80.2% of patients there was no interval growth (mean follow-up 25.6 months; range, 6-56 months). These were presumed benign. 8.2% of patients had