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E2221. Eye of the Storm: A Multimodality Review of Indeterminate Liver Lesions
Authors
  1. Joseph Carbone; University of California Irvine Department of Radiological Sciences
  2. Thanh-Lan Bui; University of California Irvine Department of Radiological Sciences
  3. Raj Mehta; University of California Irvine Department of Radiological Sciences
  4. Justin Glavis-Bloom; University of California Irvine Department of Radiological Sciences
  5. Medhat Hanna; University of California Irvine Department of Radiological Sciences
  6. Roozbeh Houshyar; University of California Irvine Department of Radiological Sciences
  7. Garrett Ward; University of California Irvine Department of Radiological Sciences
Background
Patients with cirrhosis and chronic liver disease frequently undergo routine sonographic screening for hepatocellular carcinoma. Incidental lesions are often found and are difficult to characterize. Ultrasound has difficulty visualizing infiltrative HCC and has poor sensitivity for evaluating smaller lesions. While ultrasound is portable and affordable, it is highly user dependent. Differentiation based on hyper- or hypoechogenicity cannot always reliably predict whether a lesion is benign or malignant, especially in the setting of chronic liver disease and cirrhosis. Indeterminate lesions require further characterization with contrast-enhanced ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). Failure to appreciate or diagnose indeterminate liver lesions can lead to unnecessary testing or delayed diagnoses. It is important for radiologists to be aware of both the shortcomings of sonography, as well as the potential connection between certain sonographic findings and their 3D imaged counterparts. In this case-based review, we present a pictorial essay for correlating initial ultrasound findings of indeterminate liver lesions with findings seen on follow-up imaging at the time of diagnosis.

Educational Goals / Teaching Points
Our goal is to provide a framework for the initial evaluation of hepatic lesions using sonography, as well as to educate radiologists on sonographic characteristics of common and uncommon hepatic lesions and their respective findings on follow-up imaging.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Sonography is a popular imaging modality used to screen patients with chronic liver disease. Often, sonographic findings are inadequate to completely characterize liver lesions, requiring follow-up contrast-enhanced 3D imaging. We provide a case-based pictorial essay to illustrate many common sonographic findings of benign and malignant liver lesions and their correlative findings on CT or MRI.

Conclusion
Incidental indeterminate hepatic lesions are commonly seen during sonographic screening. Radiologists must be aware of the shortcomings of sonography when evaluating patients with chronic liver disease. Indeterminate sonographic characteristics can be correlated with specific diagnostic findings on follow-up imaging, which can decrease the time from presentation to diagnosis.