Hepatocellular carcinoma: detection with triple-phase multi-detector row helical CT in patients with chronic hepatitis. Radiology. 2011;259:7308. Address correspondence and reprint requests to Dr. H. K. Lim at Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Kangnam-gu 135-710, Seoul, Korea. WebFinally, the interpreters might have been influenced by the presence of additional lesions, either in the liver or in other abdominal organs. 17.13). Focal nodular hyperplasia: natural course observed with CT and MRI. Benign SLAHs were smaller (6.4 3.1 mm;P < 0.001) and more frequently had discrete margin (P < 0.001) and markedly low attenuation (P < 0.001) than metastases (9.3 2.7 mm). 2013;20:140512. Sultana S, Awai K, Nakayama Y, et al. Arterially hypervascular enhancing lesions include FNH, HCA, HCC, and metastases from neuroendocrine tumors, melanoma, renal cell carcinoma, and breast cancer. Nearly all liver cysts are benign (noncancerous) and dont grow large enough to cause symptoms. Hepatic helical CT: contrast material injection protocol. Surgical resection confirmed an inflammatory adenoma. Diffusion-weighted MRI provides additional value to conventional dynamic contrast-enhanced MRI for detection of hepatocellular carcinoma. The liver is the most common organ to be affected by colorectal metastasis1. J Ultrasound Med. Cancer Manag. Martin DR, Kalb B, Sarmiento JM, et al. US reveals a cystic lesion with internal echoes. Effects of injection rates of contrast material on arterial phase hepatic CT. AJR Am J Roentgenol. J Comput Assist Tomogr. WebAnother common systemic occurrence is cholestatic pruritus which can result from diseases of the liver, gallbladder, or biliary tract. The number of resected nodes ranged from 3 to 117. What is important for radiologists? AJR Am J Roentgenol. The majority of liver lesions are noncancerous, or benign. is typical (i.e., 1.7 mL/kg b.w. Radiology. 2019, 18. Hemangioma is the most common benign liver tumor. Radiology. Liver-specific MR contrast agents are recommended for evaluation of patients with potentially resectable colorectal liver metastases. Radiology. Integrated ratio of metastatic to examined lymph nodes and number of metastatic lymph nodes into the AJCC staging system for colon cancer. Other ways you may be able to lower your risk of developing liver lesions include: Liver lesions are common. 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Therefore, the objective of this study was to observe the natural course of indeterminate hepatic nodules detected on MRI and evaluate appropriate management strategies for these lesions. Thank you for visiting nature.com. Langella, S. et al. 2004;127:S13343. Malignancy was detected in 9 (56.3%) of patients who received neoadjuvant chemotherapy. By comparison, thick, irregular, heterogeneous enhancement or the presence of peripheral washout at the delayed phase suggests a malignant mass, such as metastases, CCC, or even HCC. 1997;202:38993. Amebic liver abscess is nonspecific. However, in the delayed phase, after 3 min, there may be pseudowashout (hypointensity) due to early hepatocellular enhancement of liver parenchyma (Fig. Eur Radiol. All survival curves were generated using Kalplan-Meier analyses. The impact of primary tumor location on long-term survival in patients undergoing hepatic resection for metastatic colon cancer. The lollipop sign: a new cross-sectional sign of hepatic epithelioid hemangioendothelioma. 2000;118:5604. In addition the surgeons or radiologists who had full knowledge of the preoperative imaging findings performed intraoperative liver ultrasonography (SSD-3500, Aloka, Japan; MylLab 25 Gold, Esaote Biomedica, Italy; or iU22, Philips Medical Systems, The Netherlands) to detect new lesions and further characterization of small indeterminate nodules13. For the detection and characterization of focal liver lesions, late arterial phase imaging (with a delay of aortic transit time plus 1518 s) [6, 7] and a venous phase scan (2030 s interscan delay or with fixed delay of ~6070 s) are performed. Your doctor can diagnose liver lesions with a combination of imaging, blood tests, and sometimes a small tissue sample. (b) Arterial phase T1-weighted contrast-enhanced image shows hypervascularity of the lesion. Subcentimeter lesions in the liver are common in patients with a new diagnosis of pancreatic cancer. Small lesions (up to ~2 cm) may show immediate and complete enhancement in the arterial phase, with sustained enhancement in the venous and delayed phases (type I, flash filling) [31] (Fig. Smaller lesions are typically homogeneous and larger lesions heterogeneous. DWI with high b-values (e.g., 600800) is very helpful for detecting small liver metastases, which may otherwise escape detection (Fig. A recent report found an association of KRAS with worse recurrence free survival (RFS) and overall survival (OS) among patients with a left-sided primary CRC6. Bile duct cysts are areas of dilation within the biliary system that connects the liver, gallbladder, and small intestine. They can also mimic liver abscesses in the appropriate clinical setting. Some benign regenerating nodules may appear hypointense at the hepatobiliary phase of contrast enhancement, although the majority appears isointense of the liver [60]. Gadoxetic acid-enhanced liver MRI was additionally performed if there was a new hepatic lesion or substantial interval growth of the previously noted equivocal lesion to assess resectability. Epithelioid hemangioendothelioma (EHE) is a rare tumor of vascular origin, not to be confused with infantile hemangioendothelioma, which is a very different tumor. Inflammatory HCA appear strongly hyperintense on T2-weighted MRI, which may be diffuse or rim-like in the periphery of the lesion (Atoll sign). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Specific acquisition sequences vary by manufacturer, patient compliance, and the clinical question being addressed. In segment 4, a lesion is only faintly seen. (a) Typical large subcapsular abscess with an air-fluid level and a reactive pleural effusion. Copyright 2012 American Society for Radiation Oncology. https://doi.org/10.3350/cmh.2018.0107 (2019). All rights reserved. 40, 545550. The authors declare no competing interests. T1-weighted contrast-enhanced images in the (b) arterial and (c) portal venous phase demonstrate multiple ring-enhancing lesions in both lobes of the liver. Provided by the Springer Nature SharedIt content-sharing initiative. At MR, metastases are usually hypointense on T1-weighted and hyperintense on T2-weighted images [75]. at 300 mg/mL). https://doi.org/10.3350/cmh.2018.0067 (2019). Among patients whose indeterminate nodules were not detected by IOUS, 17 (63.0%) were followed up while the others underwent radiofrequency ablation or the lesions were resected unintentionally. On the (b) 10 mins delayed image, the tumor demonstrates late enhancement, which allows better delineation of the tumor (arrows) from the surrounding hepatic parenchyma, Peripheral cholangiocarcinoma. Occasionally, bile duct hamartomas can be very large, up to 20 cm, and be symptomatic from internal hemorrhage or pressure on adjacent structures [46]. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. 2006;24:133341. Inactivating mutations of hepatocyte nuclear factor 1 alpha (HNF1A) are observed in 4050% of HCA. Learn how jaundice appears in people with darker skin tones and what symptoms to look out for. Of seven patients who underwent resection, two (28.6%) were diagnosed with malignant nodules. To summarize, many MR characteristics are often associated with HCC (arterial-phase hyperintensity, T2 hyperintensity, venous- or equilibrium-phase washout, lack of hepatobiliary MR contrast agent uptake on hepatobiliary phase images, and restricted diffusion on high-b-value DWI). In a study of 295 patients in Scotland, the total number of lymph nodes retrieved and the total number of negative lymph nodes were not associated with overall survival in either colon or rectal cancers. Some benign tumors require treatment while others dont. Evaluation of patients with small, subcentimeter nodules Semin Respir Crit Care Med. Chin. AJR Am J Roentgenol. Fibrolamellar HCC (FL-HCC) is a less aggressive tumor with a better prognosis than typical HCC. At contrast-enhanced T1-weighted MRI, they are hypervascular, often with contrast washout in the portal venous or delayed phase. At MR imaging, such a nodule can exhibit higher signal intensity on T2-weighted images and display hypervascularity on arterial-phase images. Article There is a subtle hypointensity in the right lobe in a subcapsular location. They return variable T2 signal. If benign liver lesions are large and If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The prognostic impact after hepatic resection for CRLM varies based on KRAS status and site of the primary CRC6. Surg. We avoid using tertiary references. 14-2018-032 from SNUBH Research Fund. 17.6) [33] because of its vascular component. Vardhanabhuti V, Loader R, Roobottom CA. 96(1), 5155 (2007). Colon Rectal Surg. In the meantime, to ensure continued support, we are displaying the site without styles Google Scholar. Radiology. See additional information. What are the risk factors for liver lesions? If your intended use exceeds what is permitted by the license or if The lesions are shown with the same conspicuity. IOUS could be used as an adjunct to preoperative investigation of indeterminate lesions because of its high positive predictive value. Oliver JH, Baron RL. Part of Springer Nature. Focal liver lesions Clin. Thus, accurate diagnosis of these lesions is of paramount importance. Arterial phase hypervascular lesions include FNH, adenoma, HCC, and metastases from NET, melanoma, renal cell carcinoma, and (sometimes) breast cancer. Hepatic angiosarcoma: findings on multiphasic contrast-enhanced helical CT do not mimic hepatic hemangioma. For more information, please refer to our Privacy Policy. Crit Rev Diagn Imaging. HCC: MRI with liver-specific contrast agent (gadoxetic acid). By contrast, patients with severe liver disease (HR 0.81) and metastatic disease (HR 0.66) were less likely to receive RRT for ESRD. 2013;48:16774. PubMed Central Lee MH, Kim YK, Park MJ, Hwang J, Kim SH, Lee WJ, Choi D. Gadoxetic acid-enhanced fat suppressed three-dimensional T1-weighted MRI using a multiecho dixon technique at 3 tesla: emphasis on image quality and hepatocellular carcinoma detection. regenerate the damaged liver. (a) Unenhanced CT shows a siderotic (hyperattenuating) large nodule, which contains a low-density (non-siderotic) focus (arrow). If a lesion shows peripheral and nodular enhancement, with the density of enhancing portions showing the same general levels of blood vessels in the arterial, venous, and delayed phases, a hemangioma can be confidently diagnosed. Clipboard, Search History, and several other advanced features are temporarily unavailable. Thus, DWI is helpful for detecting liver solid focal liver lesions [19,20,21]. Surg. Focal Liver Lesions. J Hepatol. Larger lesions (>5 cm) or lesions with central thrombosis/fibrosis may lack central fill-in (type III) (Fig. Primary hepatic angiosarcoma: findings at CT and MR imaging. Dose-modified 256-MDCT of the abdomen using low tube current and hybrid iterative reconstruction. 2000;217:14551. Intralesional fat is uncommon and, when present, is often patchy or heterogeneous. Small HCCs may have a nodule-in-nodule appearance on CT and MR images, especially when the disease develops within a regenerative or dysplastic nodule (Fig. 2009;193:7526. Although of no clinical significance, they can mimic disseminated small liver metastases in the patient with cancer. For 200 randomly selected SLAHs, interobserver agreement for each parameter was assessed. is responsible for the concept and design of work, critical revision of the manuscript for important intellectual content, administrative, final approval of the version to be published and is accountable for all aspects of the work. Radiology. Katabathina VS, Menias CO, Shanbhogue AK, et al. Ichikawa T, Federle MP, Grazioli L, et al. Eur J Radiol. Scientific Reports (Sci Rep) J. Oncol. Altenbernd J, Heusner TA, Ringelstein A, Ladd SC, Forsting M, Antoch G. Dual-energy-CT of hypervascular liver lesions in patients with HCC: investigation of image quality and sensitivity. CRC patients treated with chemotherapy primarily underwent surgery for CRC along with liver resection if synchronous metastasis were present. Blood tests can identify viral hepatitis infection or markers that identify liver disease. Radiographics. 2015 Jan;274(1):161-9. doi: 10.1148/radiol.14140796. is responsible for the concept and design of work, critical revision of the manuscript, material support, final approval of the version to be published and is accountable for all aspects of the work. Well go over what this could mean and explain why it likely isnt a big deal. Jhaveri KS, Halankar J, Aguirre D, et al. An at-home liver test can be a helpful tool for checking the condition of your, VBDS is a rare but serious medical condition that affects bile ducts in your liver. Careers. In recent years, dual-energy and spectral CT technique has emerged, where the utilization of dual-source or polychromatic X-ray beams and the differential attenuation of such beams of different energies in tissues are applied to improve the detection of hypervascular hepatocellular carcinomas [14] or for the quantification of hepatic iron content [15]. Your message has been successfully sent to your colleague. These lesions are often heterogeneous in appearances (mosaic architecture) on both CT and MR [56]. None of the liver lesions in this study appeared to be a rectal metastasis during follow-up. Continuous data were expressed as meanStandard deviation. 2016;26:4595615. 39, 11611166. Delayed phase CT/MR imaging (after 515 min) may show enhancement homogeneously or in the center of the lesion due to its rich fibrous stroma, which is suggestive of the diagnosis of CCC [68]. The presence of intratumoral fat helps to narrow the differential diagnosis of a hypervascular lesion, as hemangioma can be excluded and metastases and FNH rarely contain fat. Mol. Jai Young Cho. Hilar cholangiocarcinoma: elderly man with progressive jaundice. https://doi.org/10.1148/radiol.2016151975 (2016). Hyperintensity on T2-weighted MRI helps to differentiate hemangiomas from other solid neoplasms [27, 28]. is responsible for the acquisition and analysis of data, drafting the manuscript, statistical analysis, final approval of the version to be published and is accountable for all aspects of the work. Nonetheless, the majority of small hypodense liver lesions even in the oncology patient are usually benign. Liver resection currently is the only potentially curative treatment for CRLM. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. At CT and MR imaging, lesions tend to be hypodense at unenhanced CT and hypointense on T1-weighted images, with peripheral enhancement at dynamic contrast-enhanced studies [67]. Assessment of image quality on effects of varying tube voltage and automatic tube current modulation with hybrid and pure iterative reconstruction techniques in abdominal/pelvic CT: a phantom study. Among various imaging methods, MRI has its superiority in e.g. (d) The delayed phase scan reveals washout of the lesion, which is now hypoattenuating (arrow). Target-enhancement was far more frequent in metastases (64.4%) than benign SLAHs (1.2%;P < 0.001). The enhancement pattern is typical for FNH. MDCT of chest, abdomen, and pelvis using attenuation-based automated tube voltage selection in combination with iterative reconstruction: an intrapatient study of radiation dose and image quality. PLoS ONE 12, e0189797. Google Scholar. Assessment of liver lesions takes into consideration their appearance and vascularity on a variety of imaging modalities: cystic liver lesions hypervascular liver lesions liver tumors (d) On the gadoxetic acid-enhanced images in the hepatobiliary phase, there is little to no enhancement. From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (H-J. WebA small subset of sporozoite is taken up by CD11c+ dendritic cells in the skin resulting in a nonproductive infection. Liver function tests help determine the health of your liver. Cysts should not show mural thickening, nodularity, or contrast enhancement. Liver lesions are any abnormal growths on your liver. Subcapsular lesions that do not exhibit mass effect or a round nature should be carefully evaluated before suggesting the diagnosis of HCC. Size Most incidental liver lesions <1 cm are benign, while some small lesions may be difficult to definitively characterize by imaging methods . T.Y. PubMed With a small plot of four hectares we could produce 17440 Keywords: dual-energy CT, enhancement, incidental, iodine, liver lesions official website and that any information you provide is encrypted There are some limitations to our study. The use of the DIXON images for dynamic contrast-enhanced acquisition has also been shown to improve the detection of hepatocellular carcinoma compared with standard fat-suppressed sequences. Alomari AI. WebThese lesions have created a new set of challenges for patients and their physicians. In particular, delayed enhancement is a feature of CC due to is fibrotic stroma. https://doi.org/10.1245/s10434-016-5361-6 (2016). A 45-year-old woman with incident lesion (arrows) in the right lobe of the liver. 97, 7682. 2011;261:17281. Their marked hyperintensity on T2-weighted imaging provides greater confidence toward the diagnosis of small cysts on MRI. Abdominal CT: comparison of adaptive statistical iterative and filtered back projection reconstruction techniques. Park, J. H. & Kim, J. H. Pathologic differential diagnosis of metastatic carcinoma in the liver. Much more important is that it can help to make a firm diagnosis of HCC by showing typical lesion contrast washout, if it had not been present in the portal venous phase [52]. Some lesions may have a central area of hyperintensity (target sign) on T2-weighted images, which corresponds to central necrosis. AJR Am J Roentgenol. AJR Am J Roentgenol. 2). Vilgrain V, Esvan M, Ronot M, Caumont-Prim A, Aub C, Chatellier G. A meta-analysis of diffusion-weighted and gadoxetic acid-enhanced MR imaging for the detection of liver metastases. AJR Am J Roentgenol. Before The central scar often showed delayed enhancement (Fig. These symptoms tend to first occur in people who are aged 60 years or older. Google Scholar. If a suspected lesion is less than 1 cm, the AASLD and EASL guidelines recommend repeating the examination at 3-month intervals, using the same imaging technology used to detect the lesion, to determine whether there is growth or changing in character. In most cases these lesions represent cysts, hemangiomas, or biliary hamartomas. The excess accumulation of iron in the liver may cause severe symptoms and may lead to several liver lesions and cancer complications. All rights reserved. Of these lesions, two-thirds were too small to characterize, whereas the others were predominantly cysts or hemangiomas. (b) On T1-weighted GRE opposed-phase image, the marginal nodule shows low signal intensity (arrow). AJR Am J Roentgenol. IntraoperatIve ultrasonography In detectIng and assessment of colorectal lIver metastases. MDCT allows imaging to be performed in multiple planes. On MR imaging examinations, cysts are well-defined, homogeneous lesions that appear hypointense on T1-weighted images and markedly hyperintense on T2-weighted images. Dr. Sewa Legha answered Medical Oncology 52 years experience Dr. Gurmukh Singh answered Pathology 51 years experience government site. The most common risk factor worldwide for liver cancer is chronic hepatitis B or hepatitis C infection. To describe the approach of the family physician to clinical problems. Liver lesions: improved detection with dual-detector-array CT and routine 2.5-mm thin collimation. Subcentimeter HCC may be treated by locoregional therapy, thus avoiding the morbidity and mortality associated with radical surgery. two of whom underwent repeat surgery for the recurrence, and the nodule was confirmed to be pathologically benign in one patient (Fig. Additional possible causes of liver lesions include: The cause of benign lesions can vary depending on the type of lesion: Anybody can develop liver lesions, but some people are at a higher risk than others. LIVER MRI IS increasingly used for detection and characterization of focal liver lesions and for the evaluation of diffuse liver disease (1-6). Adenoma: inflammatory type. 2011;53:10202. Gadoxetic acid-enhanced magnetic resonance imaging: Hepatocellular carcinoma and mimickers. According to the growth characteristics, CCC is classified as mass forming, periductal infiltrating, or intraductal growing, with the mass-forming type being most common in intrahepatic CCC [66]. Larger lesions causing symptoms may need to be surgically removed. Besides showing greater accuracy for the diagnosis of indeterminate nodules found on CT, MRI revealed new lesions in 138/389 patients (35.5%). Prevalence and importance of small hepatic lesions found at CT in patients with cancer. 7. World J. Surg. Benign hepatic neoplasms: an update on cross-sectional imaging spectrum. There are many types of liver disease, ranging from those that are treatable to those that require a liver transplant. Using Cox regression, we calculated adjusted hazard ratios to determine the association between presence of liver lesions and overall survival. Buetow PC, Buck JL, Pantongrag-Brown L, et al. Approximately 16% of these lesions represent In the arterial phase, there is also associated increased parenchyma enhancement surrounding many of the lesions. In case of just a primary colorectal tumor, surgery was done and liver metastasis was detected on routine follow-up. On contrast-enhanced imaging, there is usually intense arterial enhancement, with persistent enhancement on delayed phase imaging (Figs. Azizaddini S, et al. 25, 1220. Theyre found in as many as 30 percent of people over the age of 40. We attempted to identify any differences in clinicopathological variables among patients with malignant nodules on follow up. Bernshteyn MA, et al. is responsible for the analysis and interpretation of data for the work, critical revision of the article, statistical analysis, final approval of the version to be published and is accountable for all aspects of the work. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. Hepatic angiosarcoma is a rare tumor. Radiographics. The dendritic cells traffic to the skin dLN and present the processed sporozoite antigens to nave CD8+ T cells. Ichikawa T, Kitamura T, Nakajima H, et al. 2011;21:73843. (a) In- and (b) opposed-phase T1-weighted imaging shows no significant intralesional fat. Receiver operating characteristic analysis of diffusion-weighted magnetic resonance imaging in differentiating hepatic hemangioma from other hypervascular liver lesions. The typical MR imaging features of larger HCC include a fibrous capsule/ pseudocapsule, intratumoral septa, daughter nodules, and tumor thrombus (Fig. Liver cysts are fluid-filled sacs that appear on your liver. 17.20). Kim TK, Lee KH, Jang JJ, et al. DWIs main clinical benefit is the detection of focal liver lesions, which may be missed on conventional and contrast-enhanced imaging sequences. Subcentimeter hypervascular nodule with typical imaging findings of hepatocellular carcinoma in patients with history of hepatocellular carcinoma: natural course on serial gadoxetic acid-enhanced MRI and diffusion-weighted imaging. T1-weighted chemical shift or DIXON imaging is useful for detecting intratumoral fat, while the presence of high T1-signal before contrast administration will raise the suspicion of spontaneous hemorrhage. Radiologic Features of Hepatic Masses Without Underlying 2001;219:618. They are usually discovered incidentally at abdominal imaging. Purysko AS, Remer EM, Coppa CP, et al. 17.16). By contrast, late presentation disease (including tumor in non-cirrhotic patients) is characterized by more advanced disease, presenting as a larger heterogeneous lesion. Intriguingly, among patients in whom nodules were detected by IOUS, 96% of patients had malignant nodules, which explained the high specificity and positive predictive value of IOUS for detecting indeterminate nodules (93.75% and 96.6%, respectively). 17.12). The latest molecular classification categorizes HCA into the following six subgroups: HNF1A-inactivated HCA, inflammatory HCA, CTNNB1-mutated HCA in exon 3, CTNNB1 mutated in exon 7 and 8 HCA, sonic hedgehog HCA, and unclassified HCA [43, 44]. CT of small pyogenic hepatic abscesses: the cluster sign. Finally, of this group, 5 patients (5.0% of total, 16.1% of patients with lesions) eventually had a metastatic focus at the specific site of the original lesion. Jones et al. PubMed Central Abscesses. Conventional CT: Notice tiny liver lesion. Recurrence was detected by imaging in eight (47.0%) patients. As most FNH are asymptomatic and rarely grow, these lesions are often discovered incidentally by routine abdominal ultrasound [ 3 5 ]. KRAS mutation detected in approximately 3050% of CRC is a predictor of oncologic outcomes8. Mutations of catenin b1 (CTNNB1) in exon 3 (coding for b-catenin) are seen in 1015% of HCA. The T stage of the primary was mostly T3 or above. 2008;32:82940. If only one of the two findings are present, then the guidelines require obtaining a different modality with contrast imaging to determine whether these findings can be verified. To learn the optimal imaging techniques and the relevance of differential diagnosis for liver diseases, To discuss current indications for liver-specific contrast agents, To review the imaging features of benign and malignant focal liver lesions, To discuss the differential diagnosis of primary and secondary hepatic tumors. Genetics and imaging of hepatocellular adenomas: 2011 update. Quantitative ADC measurements can support the characterization of focal liver lesions, with higher ADC values (e.g., >1.7 103 mm2/s) favoring benign lesions [22]. Characteristics and distinguishing features of hepatocellular adenoma and focal nodular hyperplasia on gadoxetate disodium-enhanced MRI. (c) In the hepatobiliary phase after 20 min, the lesion shows hypointensity due to lack of hepatocellular uptake. J Magn Reson Imaging. WebHepatic lesions too small to characterize are a common finding on CT in women with newly diagnosed breast cancer. However, the use of combinations of these imaging phases also depends on specific indications [8]. Cholangiocarcinoma: pictorial essay of CT and cholangiographic findings. However, in multivariable analysis, the pLNR was an independent predictor of overall survival in patients with colon cancer (hazard ratio, 11.65; 95% confidence interval, 5.0027.15; P<0.001) or rectal cancer (hazard ratio, 13.40; 95% confidence interval, 3.6449.10; P<0.001)23. 2002;179:7518. For these lesions, radiologists would often report their diagnostic impression (eg, cystic, hemangioma, suspicious for metastatic disease) yet still deem the lesion to be of uncertain signicance due to the subcentimeter size.

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