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Differentiation of hepatic abscess from metastasis on contrast-enhanced dynamic computed tomography in patients with a history of extrahepatic malignancy: emphasis on dynamic change of arterial rim enhancement

Authors
Oh, Jae GuChoi, Seo-YounLee, Min HeeLee, Ji EunYi, Boem HaKim, Seung SooMin, Ji HyeLee, Bora
Issue Date
Feb-2019
Publisher
Springer New York
Keywords
Liver abscess; Metastasis; Computed tomography
Citation
Abdominal Radiology, v.44, no.2, pp 529 - 538
Pages
10
Journal Title
Abdominal Radiology
Volume
44
Number
2
Start Page
529
End Page
538
URI
https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/4745
DOI
10.1007/s00261-018-1766-y
ISSN
2366-004X
2366-0058
Abstract
ObjectivesThe objective of the study is to identify computed tomography (CT) findings that differentiate hepatic abscess from hepatic metastasis in a patient with a history of extrahepatic malignancy.Materials and methodsThis retrospective study included 30 patients with 93 hepatic abscesses and 40 patients with 125 hepatic metastases who had a history of extrahepatic malignancy and underwent contrast-enhanced dynamic CT with arterial phase (AP) and portal venous phase (PVP). The diagnosis of hepatic abscess and hepatic metastasis was made using pathological confirmation or clinical diagnosis. Margin, patchy parenchymal enhancement, arterial rim enhancement, dynamic change of arterial rim enhancement, size discrepancy of lesions between arterial and portal phases, bile duct dilatation, perilesional hyperemia, and perilesional low density were evaluated by two radiologists independently. Significant findings for differentiating two groups were identified at univariate and multivariate analysis with nomogram for predicting hepatic abscess. Interobserver agreement was also analyzed for each variable.ResultsMultivariate analysis revealed that patchy parenchymal enhancement (P<0.001), arterial rim enhancement persistent through PVP (P<0.001), and perilesional hyperemia (P=0.013) were independent significant findings to predict hepatic abscess than metastasis. Among them, arterial rim enhancement persistent through PVP showed a highest odds ratio (OR 33.73) on multivariate analysis and a highest predictor point on a nomogram for predicting hepatic abscess. When two of these three criteria were combined, 80.7% (75/93) of hepatic abscess were correctly identified, with a specificity of 85.6% (107/125). When all three criteria were satisfied, specificity was up to 100% (125/125).ConclusionsAt contrast-enhanced dynamic CT, patchy parenchymal enhancement, arterial rim enhancement persistent through PVP, perilesional hyperemia, and their combinations may be reliable CT features for differentiating hepatic abscess from metastasis in patients with a history of primary extrahepatic malignancy.
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