• Author
    Jasmine Tran
  • Discovery PI

    Lauren Hoff, MD; Tyler Sevco, MD

  • Project Co-Author

  • Abstract Title

    Outcomes of Incidental Ultrasound-Detected Hyperechoic Liver Lesions on Subsequent Multiphasic CT/MR

  • Discovery AOC Petal or Dual Degree Program

    Basic, Clinical, & Translational Research

  • Abstract

    Keywords: Hepatic, liver, hyperechoic

    Background: Hyperechoic liver lesions are often encountered incidentally on abdominal ultrasound (US). In the absence of a history of chronic liver disease or known malignancy, lesions <1 cm are usually presumed to be benign with no further workup. There is less diagnostic certainty for hyperechoic lesions ≥ 1 cm, and thus a greater proclivity to recommend additional imaging despite limited evidence guiding management. 

    Objective: Evaluate the diagnostic yield of CT/MR in patients with hyperechoic liver lesions selected for additional imaging and identify high-risk patients and/or imaging characteristics that should prompt additional evaluation with multiphasic CT and/or MR. 

    Methods: This retrospective study was conducted at a single tertiary academic medical center and included patients ≥18 years old with at least one hyperechoic liver lesion ≥1 cm on US between October 2023 and December 2024. Only patients who had a multiphase CT/MR within 6 months of the initial ultrasound were included. Patients with a history of malignancy and/or who met LI-RADS criteria were excluded. Ultrasound images were reviewed for lesion size, number, and atypical features such as heterogeneity, shadowing, internal vascularity, and irregular margins.  Imaging outcomes were categorized as benign/indeterminate or malignant. Odd ratios and the number needed to scan (NSS) were calculated, and statistical significance was assessed using Fisher’s exact and independent t-tests. 

    Results: The final patient cohort consisted of 213 adult patients, 37.0% (83/213) male, with a mean age of 51.2 +/- 13.9 years. On US, 43.2% (92/213) had ≥2 lesions, average lesion size was 2.8 +/- 2.1 cm, and 32.9% (70/213) had atypical feature(s). Follow-up imaging was recommended in 52.6% (112/213) of cases. MR was performed in 88.7% (189/213) and CT in 11.3% (24/213). The NNS, using CT/MR, to detect one malignant lesion was 36. Age was the only variable significantly associated with malignancy (p = 0.013), with all malignant lesions occurring in patients ≥50 years old. Imaging features such as lesion size or atypical characteristics were not significantly associated with malignancy. 

    Conclusions: Patient age was the only variable significantly associated with having a malignant hyperechoic liver lesion ≥ 1cm in this study. This may be a useful indicator for further characterization with multiphase CT/MR. Additional multi-center studies and/or meta-analyses are needed as we continue to work towards the development of official evidence-based management recommendations for incidentally detected hyperechoic liver lesions. 

Back