Imaging

Liver Metastases

Preliminary Diagnosis: Liver Metastases

I. What imaging technique is first-line for this diagnosis?

  • Ultrasound of the liver

II. Describe the advantages and disadvantages of this technique for diagnosis of liver metastases.

Advantages

  • Highly portable, relatively quick imaging modality

  • Does not expose patients to ionizing radiation

  • Better adept in detailing the vascularity of a lesion than other imaging modalities

Disadvantages

  • Limited in sensitivity and specificity in detecting, characterizing, and diagnosing hepatic lesions

  • May help guide percutaneous biopsy, treatment, and therapy

III. What are the contraindications for the first-line imaging technique?

  • No specific contraindications to sonographic imaging exist.

IV. What alternative imaging techniques are available?

  • Triple phase liver protocol CT imaging of the liver

  • Triple phase MR imaging of the abdomen and pelvis with contrast per liver protocol

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of liver metastases.

Triple phase liver protocol CT imaging of the liver

Advantages

  • Highly sensitive and specific in diagnosing, characterizing, and detecting liver lesions

  • May help guide percutaneous biopsy, treatment, and therapy

  • Offers exquisite visualization of the surrounding soft tissues , osseous structures, and vasculature

Disadvantages

  • Exposes patients to ionizing radiation

Triple phase MR imaging of the abdomen and pelvis with contrast per liver protocol

Advantages

  • Does not expose patients to ionizing radiation

  • Offers exquisite visualization of the surrounding soft tissues

  • Eovist contrast medium may better delineate biliary versus hepatic pathology

Disadvantages

  • Offers limited evaluation of the surrounding osseous structures

  • May be subject to motion and susceptibility weighted artifact degrading image quality

VI. What are the contraindications for the alternative imaging techniques?

Triple phase liver protocol CT imaging of the liver

  • May be contraindicated in patients who are pregnant

Triple phase MR imaging of the abdomen and pelvis with contrast per liver protocol

  • Contraindicated in patients with non-MR compatible hardware

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