ARRS 2022 Abstracts

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E1933. The Bad: Imaging Appearance of Malignant Masses in the Liver
Authors
  1. Aren Vierra; Santa Clara Valley Medical Center
  2. Vishesh Jain; Santa Clara Valley Medical Center
  3. Luyao Shen; Stanford University Medical Center
  4. Edwina Chang; Santa Clara Valley Medical Center; Stanford University Medical Center
Background
Hepatic masses, benign and malignant, may have a myriad of appearances on ultrasound, CT, and MRI. Hepatic masses, commonly found incidentally on imaging, may oftentimes be benign in etiology based on imaging features on subsequent dedicated ultrasound, CT, and MRI protocols. However, metastases may oftentimes present first as an indeterminate mass in the liver prior to a diagnosis of the most common primary cancers, including of the lung, breast, and colon. Understanding the typical and atypical images of benign and malignant hepatic masses on multimodality imaging will enable the novice and experienced radiologist to make a clinically appropriate differential diagnosis in the indeterminate hepatic mass based on imaging features and clinical history. This educational exhibit will review the uncommon imaging appearance of common malignant hepatic masses, as well as the common imaging appearance of uncommon malignant hepatic masses, using key pearls and pitfalls that will aid in diagnosis.

Educational Goals / Teaching Points
The goals of this exhibit are to review the US, CT, and MRI protocol for diagnosing hepatic masses; briefly review the clinical risk factors associated with malignant entities; learn the uncommon imaging appearance of malignant hepatic masses; learn the common imaging appearance of uncommon malignant hepatic masses; analyze the imaging characteristics of the indeterminate hepatic mass by its content (blood, fat, enhancement characteristic, growth, fluid); and understand the pearls and pitfalls in putting together a clinically appropriate differential diagnosis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit includes the US, CT, and MRI protocol for diagnosing hepatic masses for entities including: HCC, cholangiocarcinoma, angiosarcoma, epithelioid hemangioendothelioma, primary lymphoma, biliary cystadenocarcinoma, and metastases (and differing imaging appearance of metastases of differing primary; for example, hypervascular RCC metastasis versus hypovascular colonic metastasis).

Conclusion
Hepatic masses, benign and malignant, may have a myriad of appearances on ultrasound, CT, and MRI. Metastases may oftentimes present first as an indeterminate mass in the liver prior to a diagnosis of the most common primary cancers, including of the lung, breast, and colon. Similarly, hepatocellular carcinoma may arise due to risk factors not limited to cirrhosis. Understanding the typical and atypical images of benign and malignant hepatic masses on multimodality imaging will enable the novice and experienced radiologist to make a clinically appropriate differential diagnosis in the indeterminate hepatic mass based on imaging features and clinical history. This educational exhibit will review the uncommon imaging appearance of common malignant hepatic masses, as well as the common imaging appearance of uncommon malignant hepatic masses, using key pearls and pitfalls that will aid in diagnosis.