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Liver lesions have a broad spectrum of pathologies, ranging from benign lesions such as hemangiomas to malignant lesions such as primary hepatocellular carcinoma and metastasis. Imaging is a crucial step in diagnosing these conditions, as liver enzymes can be elevated in 9% of people in the U.S. This activity will review liver imaging for an interprofessional team. Objectives: Identify the options for liver imaging with an emphasis on CT and MRI. Assess the indications for each liver imaging option. Evaluate the complications of liver imaging. Communicate interprofessional strategies for improving liver imaging. Access free multiple choice questions on this topic.

Liver lesions have a broad spectrum of pathologies, ranging from benign lesions such as hemangiomas to malignant lesions such as primary hepatocellular carcinoma and metastasis. Imaging is a crucial step in diagnosing these conditions, as liver enzymes can be elevated in up to 9% of individuals in the USA.[1][2] A combination of medical history, serologic, and radiologic investigations can provide a diagnosis in most cases.[3] Liver lesions can be categorized into focal and diffuse liver lesions. Focal liver lesions generally fall into 3 main clinical categories. Benign lesions that do not need treatment if they are asymptomatic, including hepatic hemangiomas, focal nodular hyperplasias, and benign liver cysts Benign lesions that require treatment, including hepatic adenoma, hepatic abscess, and hepatic adenomas Malignant lesions, including hepatocellular carcinoma, cholangiocarcinoma, hepatic angiosarcoma, and liver metastases Diffuse liver lesions can be categorized into vascular, inflammatory, and storage diseases. Benign liver lesions can be classified into 3 categories based on their tissue origin: Cholangiocellar: hepatic cyst, biliary cystadenoma, intraductal papillary neoplasm of the bile ducts, peribiliary cyst, intrahepatic bile adenoma (see Image. Hepatic Biloma). Hepatocellular: focal nodular hyperplasia, hepatic adenoma Mesenchymal: hemangioma, lipoma Liver ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) are the primary imaging modalities to diagnose liver lesions. Postcontrast imaging can help distinguish lesions depending on their degree of vascularity and composition. Postcontrast hepatic imaging falls into 3 distinct phases: the arterial phase, the portal venous phase, and the delayed venous phase.[4] Ultrasound can be a method of choice as a screening modality, and contrast-enhanced multidetector CT (MDCT) is a modality of choice in most hepatic imaging.[5] MRI plays a role in better-characterizing lesions with equivocal features on US and CT.