Fact-sheet: Metastasis fo liver


Updated on 11/13/2024 at 5:18 PM

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Definition

Liver metastases represent the spread of cancer cells from a primary site (e.g., colon, breast, lung, ...) to the liver.

Clinical features

Patients with liver metastases may be asymptomatic, especially at early stages.

Nonspecific symptoms:

• Hepatomegaly

• Abdominal pain

• Weight loss

• Fatigue

• Jaundice (rare)

Laboratory findings

Certain laboratory abnormalities may be found:

  • Elevated liver enzymes (AST, ALT, alkaline phosphatase)
  • Hyperbilirubinemia (if biliary obstruction)
  • Hypoalbuminemia
  • Increased tumor markers (e.g., CA 19-9 for colorectal cancer)

Ultrasound

Ultrasound is often the first-line examination.

Variable ultrasound appearance of metastases:

  • Hypoechoic (most common)
  • Hyperechoic (less common)
  • Isoechoic (difficult to detect)
  • Cystic (rare, e.g., metastases of ovarian origin)
  • Heterogeneous
  • Doppler may show peripheral vascularity.
  • Contrast-enhanced ultrasound (CEUS) improves the detection and characterization of liver metastases by showing peripheral enhancement during the arterial phase and rapid washout.

CT

A powerful imaging technique for the detection and characterization of liver metastases.

CT appearance of liver metastases:

  • Hypodense on unenhanced imaging
  • Variable enhancement after contrast material injection:
  • Hypovascular (weak and/or delayed enhancement)
  • Hypervascular (intense and early enhancement)
  • Peripheral "target" enhancement
  • More or less rapid washout after peak enhancement
  • Possible calcifications

MRI

Better lesion characterization than CT.

MRI appearance of liver metastases:

  • T1 hypointensity
  • T2 hyperintensity
  • Diffusion hyperintensity
  • Variable enhancement after gadolinium injection (similar to CT): hypervascular or hypovascular. Most often, washout on portal venous and delayed phases

Vascular intervention

  • Percutaneous biopsy for diagnostic purposes
  • Chemoembolization of liver metastases, particularly in Hepatocellular carcinoma
  • Radiofrequency or microwave ablation for local destruction of metastases
  • X-Ray Angiography allows visualization of hepatic vascular anatomy prior to an intervention.

Nuclear medicine

  • FDG PET/CT: useful for detection and staging of liver metastases, especially in colorectal cancer. Highly sensitive.
  • Tagged red blood cell scintigraphy: useful for detecting hepatic hemangiomas, which can mimic metastases.

Differential diagnosis

  • Benign liver lesions:
  • Simple or complicated biliary cyst
  • Hepatic hemangioma
  • Focal nodular hyperplasia (FNH)
  • Hepatocellular adenoma
  • Primary malignant liver lesions:
  • Hepatocellular carcinoma (HCC)
  • Cholangiocarcinoma
  • Other:
  • Hepatic abscess
  • Hydatid cysts
  • Granulomatous infectious lesions