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LIVER LESIONS (CT)

Last modified: September 23, 2025

Main reference: CAR 2020

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Target population

  • • ≥ 18 years old

  • No previously known liver damage

  • Incidental lesion discovered on abdominal ultrasound or CT scan

  • Not for non-dedicated examinations (e.g. breast MRI, chest CT)

See table above for low vs high risk patients

  • Increased liver function tests alone do not increase risk

  • If clinical context unknown, no extrahepatic neoplasia or chronic liver disease, mention that benign-looking lesion does not require follow-up

Important Notes

  • 1-year stability in low-risk patient = benign, no further investigation

Additional Notes

  • Incidence of incidental liver injury: 10-33%

  • 50-80% of incidental liver masses are benign

    • Hemangiomas

      • Discontinuous nodular enhancement in the arterial phase, progression in the portal phase, then iso- to hyper-dense

      • <1 cm: rapid filling (homogeneous enhancement in the arterial phase)

        • Malignant lesions become hypodense in the portal phase

    • Focal nodular hyperplasia

      • Intense, isodense arterial enhancement in portal phase

      • Late enhancement of the central scar

  • MRI favored for further study

    • Multiphasic CT if too much delay in MRI

    • Multiphasic MRI and CT generally equally effective for lesions >2 cm

Figures

Figure 1. Original CAR 2020 summary recommendations for the management of incidental liver lesions on CT

References

  1. Bird JR, Brahm GL, Fung C, Sebastian S, Kirkpatrick IDC. Recommendations for the Management of Incidental Hepatobiliary Findings in Adults: Endorsement and Adaptation of the 2017 and 2013 ACR Incidental Findings Committee White Papers by the Canadian Association of Radiologists Incidental Findings Working Group. Can Assoc Radiol J. 2020 Nov;71(4):437-447. doi:10.1177/0846537120928349.

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