The Diagnosis and Management of Focal Liver Lesions(beta)
Official guideline of the American College of Gastroenterology.
An MRI or triple-phase CT should be obtained in patients with cirrhosis with an ultrasound showing a lesion of >1 cm.
Patients with chronic liver disease, especially with cirrhosis, who present with a solid FLL are at a very high risk for having HCC and must be considered to have HCC until otherwise proven.
A diagnosis of HCC can be made with CT or MRI if the typical characteristics are present: a solid FLL with enhancement in the arterial phase with washout in the delayed venous phase should be considered to have HCC until otherwise proven.
MRI or CT should be obtained if CCA is suspected clinically or by ultrasound.
Oral contraceptives, hormone-containing IUDs, and anabolic steroids are to be avoided in patients with hepatocellular adenoma.
Obtaining a biopsy should be reserved for cases in which imaging is inconclusive and biopsy is deemed necessary to make treatment decisions.
Pregnancy is not generally contraindicated in cases of hepatocellular adenoma <5 cm and an individualized approach is advocated for these patients.
In hepatocellular adenoma ≥5 cm, intervention through surgical or nonsurgical modalities is recommended, as there is a risk of rupture and malignancy.
An MRI or CT scan should be obtained to confirm a diagnosis of hemangioma.
Liver biopsy should be avoided if the radiologic features of a hemangioma are present.
Pregnancy and the use of oral contraceptives or anabolic steroids are not contraindicated in patients with a hemangioma.
An MRI or CT scan should be obtained to confirm a diagnosis of FNH. A liver biopsy is not routinely indicated to confi rm the diagnosis.
Pregnancy and the use of oral contraceptives or anabolic steroids are not contraindicated in patients with FNH.
Liver biopsy is required to confirm the diagnosis of NRH.
Pregnancy and the use of oral contraceptives or anabolic steroids are not contraindicated in patients with an NRH.
A hepatic cyst identified on US with septations, fenestrations, calcifications, irregular walls, or daughter cysts should prompt further evaluation with a CT or MRI.
Asymptomatic simple hepatic cysts should be observed with expectant management.
Aspiration of asymptomatic, simple hepatic cysts is not recommended.
Routine fluid aspiration is not recommended when BCA is suspected because of limited sensitivity and the risk of malignant dissemination.
Imaging characteristics suggestive of BC or BCA, such as internal septations, fenestrations, calcifications, or irregular walls, should lead to referral for surgical excision.
Routine medical therapy with mammalian target of rapamycin inhibitors or somatostatin analogs is not recommended.
Aspiration, deroofing, resection of a dominant cyst(s) can be performed based on the patient’s clinical presentation and underlying hepatic reserve.
MRI is preferred over CT for concomitant evaluation of the biliary tree and cystic contents.
Monotherapy with antihelminthic drugs is not recommended in symptomatic patients who are surgical or percutaneous treatment candidates.
Adjunctive therapy with antihelminthic therapy is recommended in patients undergoing PAIR or surgery, and in those with peritoneal rupture or biliary rupture.
Percutaneous treatment with PAIR is recommended for patients with active hydatid cysts who are not surgical candidates, who decline surgery, or who relapse after surgery.
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