Imaging Pearls ❯ Liver ❯ Metastases
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- “Liver metastases without sufficient contrast enhancement, those in patients with hepatic steatosis, those in subcapsular locations, and those found at examinations for indications other than to assess for tumors were significantly more likely to be overlooked.”
Imaging Characteristics of Liver Metastases Overlooked at Contrast-Enhanced CT
Naka H et al.
AJR 2019; 212:782–787 - “CT is often used to image not only liver metastases but also a wide range of potential sites of extrahepatic disease during the same examination. Consequently, CT is recommended as part of the initial workup of many tumors and subsequent surveillance for metastatic disease after a diagnosis of primary cancer. During CT interpretation, however, liver metastases in the early stages are occasionally overlooked, and the best chance to treat them is lost.”
Imaging Characteristics of Liver Metastases Overlooked at Contrast-Enhanced CT
Naka H et al.
AJR 2019; 212:782–787 - “There are many types of error in diagnostic radiology, but two broad categories have been identified: perceptual errors (those in which an important abnormality is missed on images) and cognitive errors (those in which the abnormality is visually detected but the meaning or importance of the finding is not correctly understood or appreciated). Perceptual errors are also thought to be the main cause of overlooked liver metastases, especially in patients with known malignant tumors.”
Imaging Characteristics of Liver Metastases Overlooked at Contrast-Enhanced CT
Naka H et al.
AJR 2019; 212:782–787 - “We investigated the imaging character- istics of liver metastases overlooked at contrast-enhanced CT. The results showed that missed lesions were significantly associated with lower CNR, subcapsular location, hepatic steatosis, and examination indication other than assessment of malignant tumors.”
Imaging Characteristics of Liver Metastases Overlooked at Contrast-Enhanced CT
Naka H et al.
AJR 2019; 212:782–787 - “In this study, missed lesions were significantly associated with subcapsular location. A prior study showed that a common cause of perceptual errors is the location of a finding, and radiologists tend to overlook findings in the periphery of the locations of interest. We may misinterpret subcapsular liver metastases as soft tissue outside the liver because of the thin boundary with background liver. We also may have a tendency to unconsciously focus on the central area of the liver.”
Imaging Characteristics of Liver Metastases Overlooked at Contrast-Enhanced CT
Naka H et al.
AJR 2019; 212:782–787 - “Missed lesions were significantly associat- ed with examinations performed for indica- tions other than survey of malignant tumors. We may not spend more time and energy to find liver metastases after making the first finding during the examination. This is known as satisfaction of search, the second most common type of diagnostic error.”
Imaging Characteristics of Liver Metastases Overlooked at Contrast-Enhanced CT
Naka H et al.
AJR 2019; 212:782–787 - “The causes of overlooking metastases, like the causes of missing other lesions, are mul- tifactorial, extremely subjective, and difficult to analyze. They cannot be separated from the interpretation environment of radiologists, such as fatigue, anxiety, and lack of concentration. Knowledge of the specific imaging characteristics that we describe may help radiologists detect liver metastases correctly.”
Imaging Characteristics of Liver Metastases Overlooked at Contrast-Enhanced CT
Naka H et al.
AJR 2019; 212:782–787 - “In summary, we performed a retrospective study to investigate the imaging characteristics of liver metastases overlooked at contrast-enhanced CT. We conclude that liver metastases without sufficient contrast, those in a subcapsular location, those in patients with hepatic steatosis, and those on scans ob- tained for indications other than survey of malignant tumors may have a tendency to be overlooked. We should keep these points in mind when looking for liver metastases at contrast-enhanced CT.”
Imaging Characteristics of Liver Metastases Overlooked at Contrast-Enhanced CT
Naka H et al.
AJR 2019; 212:782–787
- Metastases
- Hypervascular metastases: “MR CT PET”
- M – Melanoma
- R – Renal cell carcinoma
- C – Choriocarcinoma
- T – Thyroid cancer
- PET – Neuroendocrine tumor
- Use MIP images to identify subtle lesions
- “Metastases were present on 36% (181/508) of the index examinations and most commonly involved the liver (47%) and pelvic lymph nodes (27%). Lower extremity primaries had the highest rate of metastasis (52%). Ocular and head and neck melanomas have a predilection to metastasize to the liver (hepatic involvement in 70% and 63%, respectively, of patients with metastatic disease) and metastases from lower extremity primaries most commonly involve pelvic lymph nodes (54% of patients with metastatic disease). Metastases to atypical locations were present in 14% of patients and most commonly occurred in the subcutaneous tissue and spleen. Primary tumors of the lower extremity, back and head and neck were most commonly associated with atypical metastases.”
Melanoma metastases in the abdomen and pelvis: Frequency and patterns of spread.
Trout AT et al.
World J Radiol. 2013 Feb 28;5(2):25-32. - “Metastases were present on 36% (181/508) of the index examinations and most commonly involved the liver (47%) and pelvic lymph nodes (27%).”
Melanoma metastases in the abdomen and pelvis: Frequency and patterns of spread.
Trout AT et al.
World J Radiol. 2013 Feb 28;5(2):25-32.
- Liver Metastases
- Most common site of solid organ metastases
- Most common hepatic metastases are hypovascular
- Most common lesions
- Colon, lung, breast, pancreas, neuroendocrine, melanoma, stomach
- 50% of colorectal cancer patients