From the Guidelines
The next step for a patient with an enhancing liver mass on CT scan should be a multidisciplinary evaluation including additional imaging and possibly biopsy.
Key Considerations
- The patient should undergo an MRI with liver-specific contrast agents (such as gadoxetate disodium) to better characterize the lesion, as it provides superior soft tissue contrast and can help distinguish between benign lesions (like hemangiomas or focal nodular hyperplasia) and malignant tumors 1.
- Laboratory tests including liver function tests, alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), and CA 19-9 should be ordered to aid in the diagnosis and management plan.
- If the lesion remains suspicious after MRI, an image-guided liver biopsy should be performed to obtain tissue for definitive diagnosis, as the management plan will differ dramatically based on the diagnosis 1.
Diagnostic Approach
- The diagnostic algorithm for hepatocellular carcinoma (HCC) involves first-line imaging studies such as multiphasic contrast-enhanced CT or MRI, and second-line imaging studies such as contrast-enhanced ultrasound 1.
- The radiological hallmarks for diagnosing "definite" HCC on multiphasic contrast-enhanced CT or MRI are arterial phase hyperenhancement (APHE) with washout appearance in the portal venous, delayed, or hepatobiliary phases 1.
Management Plan
- The patient should be referred to specialists including a hepatologist, oncologist, and hepatobiliary surgeon for comprehensive care planning, as the management plan will depend on the diagnosis and may involve surgery, chemotherapy, or other treatments.
- A multidisciplinary approach is necessary to ensure that the patient receives the most appropriate and effective treatment for their condition, and to minimize morbidity, mortality, and improve quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Next Steps for Enhancing Liver Mass on CT Scan
- The next step for a patient with an enhancing liver mass on a computed tomography (CT) scan would involve further characterization of the lesion to determine its nature, whether benign or malignant 2, 3.
- Magnetic Resonance Imaging (MRI) can play a significant role in the characterization of liver lesions, especially for subcentimeter focal liver lesions detected on multidetector row helical computed tomography (MDCT), as it has been shown to have higher accuracy compared to CT alone 3.
- For patients with cirrhosis, CT sensitivity and specificity in detecting malignancies are relatively low, suggesting the need for careful evaluation and possibly the use of other diagnostic tools or techniques 4.
- In the case of small (5-10-mm) arterially enhancing nodules, follow-up CT scans are crucial, as these nodules have a significant probability of developing into hepatocellular carcinoma (HCC), especially in patients with risk factors such as a history of HCC treatment, larger size of the nodule, presence of coexistent HCC, and absence of typical arterioportal shunts 5.
Diagnostic Considerations
- The diagnosis of liver masses, including enhancing lesions, often requires a combination of imaging techniques and clinical correlation, as the appearance on CT or MRI can be nonspecific 6, 2.
- Immunohistochemical staining and electron microscopy may be necessary for definitive diagnosis, especially in cases where the imaging findings are suggestive but not conclusive of a specific type of malignancy, such as primary malignant mesothelioma of the liver 6.
Management and Follow-Up
- The management of enhancing liver masses depends on the diagnosis, with options ranging from surveillance for benign lesions to surgical intervention, ablation, or systemic therapy for malignant tumors.
- Regular follow-up with imaging studies is essential for monitoring the growth or change in characteristics of the lesion, as well as for early detection of potential complications or spread of disease 5.