A 32-years-old young businessman student was found to have with a solitary 2 cm space-occupying lesion of mixed echogenicity in the right lobe of liver on ultrasound examination. The rest of the liver was normal except for mild increase in overall echogenicity. Which of the following test should be done next?
Correct Answer: Triple phase CECT
Description: Modern computed tomography (CT) technology Increased the accuracy of diagnosis and staging of liver lesionsand contrast-enhanced computed tomography is currently the most widely used and best validated modality for liver imaging. Oral contrast enhancement allows visualization of the stomach and duodenum in relation to the liver hilum. The early aerial phase of the intravenous contrast vascular enhancement is paicularly useful for detecting small primary liver cancers, owing to their preferential aerial blood supply. The venous phase maps the branches of the poal vein within the liver and the drainage the hepatic veins. Inflammatory liver lesions often exhibit rim enhancement with intravenous contrast, whereas the common haemangioma characteristically shows late venous enhancement. The density of any liver lesion can be measured, which can be useful in establishing the presence of a cystic lesion. CT has high accuracy in determining the stage, and high sensitivity and specificity in determining resectability of liver tumours. Local and distant metastases can also be detected, although peritoneal metastases are often missed on CT. =Magnetic resonance imaging (MRI) would appear to be as effective an imaging modality as CT in the majority of patients with liver disease. It does, however, offer several advantages. First, the use of iodine-containing intra- venous contrast agents is precluded in many patients because of a history of allergy. These patients should be offered MRI rather than contrast CT. Second, MRI with contrast may be useful for detecting and defining lesions of liver like complex hemangiomas. =Radioisotope scanning can provide impoant diagnostic information. HIDA is a technetium-99m (99mTc)-labelled radio- nuclide that is administered intravenously, removed from the circulation by the liver, processed by hepatocytes and excreted in the bile. Imaging under a gamma camera allows its uptake and excretion to be monitored in real time. This is a useful non- invasive test when there is suspicion of bile leak.
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