Hepatic rule 1:Hepatic lesions classification

Hepatic lesions classification:
-Hepatic lesions are classified into three groups which must be diagnosed in enhanced CT or MRI.
1-Cysts(most probably considered as a benign group).
As the following
-Simple cyst.
-Hydatid cyst.
-Pyogenic abscess.
-Amebic abscess.
-Hemangioma.
-A rare condition known as biliary cyst adenoma.
2-Solid lesions(considered to be malignant lesions).
Can be classified into Benign and malignant.
Malignant lesions are
-Hepatocellular carcinoma which are the most common hepatic solid lesion.
-Cholangiocarcinoma.
-Lymphoma.
-Metastases
Benign lesions are
-Focal nodular hyperplasia.
-Hepatic adenoma.
3-Mixed lesions  
containing cystic and solid parts should be considered as solid lesions as malignant lesions.
-To judge hepatic lesions, this must be done in contrast study and not in non contrast one.
-According to clinical practice, any solid lesion or mixed lesion in a healthy or cirrhotic liver should be considered a hepatocellular carcinoma until prove otherwise by biopsy(this include also benign group of solid lesions of the liver).
4-Simple cyst should be has the following characters
-Sharply defined edge.
-Thin paper wall.
-Clear fluid content.
And should not contain the following
-Calcification.
-Mural nodules.
-Enhancement.
-Septation.
5-I f the cyst contain contains calcification in its wall, this suggests hydatid cyst.
Hydatid cyst could be presented by three forms
The first one is a cyst with calcified wall.
The second one is a cyst with multiple small cysts inside it.
The third one is a cyst with multiple linear floating shadows inside it.
6-If contains mural nodules, this suggests malignancy.
7-If contains wall enhancement with or without air inside its cavity, this suggest pyogenic abscess.
8-If it shows wall enhancement with peripheral thin surrounding area of edema, this suggests amebic abscess.
In clinical practice, usually we cannot really differentiating between pyogenic and amebic abscess.
9- Finally if this cyst shows peripheral nodular enhancement pattern(closed iris sign), this will suggests hemangioma as a presenting pathology.


10-Cholangio carcinoma shows multiple dilated surrounded biliary radicles suggesting its presence.
This appearance can be seen with hepatocellular carcinoma but with less extent.
11-Lymphoma characterized by absence of volume effect on the edge of the liver if it is near it and also by presence of splenic lesions.
12-Metastases characterized by known primary and by presence of other lesions in other places.