How should I interpret imaging findings in a patient with cirrhosis who has a suspected liver lesion?

In a patient with cirrhosis and a suspected liver lesion, imaging findings should be interpreted with a focus on identifying hepatocellular carcinoma (HCC), the most common primary liver cancer in this population. Contrast-enhanced multiphase imaging, typically with CT or MRI, is essential to characterise lesions. A lesion demonstrating arterial phase hyperenhancement followed by washout in the portal venous or delayed phases is highly suggestive of HCC in the context of cirrhosis ¹ (Nadarevic et al., 2021). This imaging pattern is considered diagnostic in the appropriate clinical setting, potentially obviating the need for biopsy ¹.

Ultrasound is often the initial imaging modality for surveillance, but if a lesion is detected, further characterisation with multiphase CT or MRI is recommended to assess vascular patterns and lesion morphology ¹. The presence of typical imaging features of HCC on CT or MRI should prompt urgent referral for specialist assessment and management ¹.

Recent literature supports the high diagnostic accuracy of multiphase CT in detecting HCC in chronic liver disease, reinforcing guideline recommendations for its use in lesion characterisation (Nadarevic et al., 2021). However, it also highlights that atypical lesions or those without classic imaging features may require further evaluation, including biopsy or additional imaging modalities, to exclude other malignancies or benign lesions (Nadarevic et al., 2021).

In summary, interpretation of imaging in cirrhotic patients with suspected liver lesions relies on recognising characteristic vascular patterns on multiphase CT or MRI, with typical features strongly indicating HCC and guiding urgent referral and management ¹ (Nadarevic et al., 2021).