Evaluating Focal Hepatic Lesions with Triple Phase Contrast Computed Tomography: A Prospective Observational Study

BACKGROUND: Detection and characterisation of focal liver lesions (FLLs) remain challenging. Computed tomography (CT) provides crucial information on lesion number, location, nature and growth dynamics of FLLs over time. AIM: The study evaluated the use of contrast-enhanced triple-phase CT (TPCT) amongst patients with suspected FLLs in a tertiary hospital setting. METHODS: This was a prospective, observational study. Patients with clinically suspected FLL or prior history of FLLs who underwent contrast-enhanced TPCT scans at the tertiary care centre between June 2022 and November 2023 were enrolled. Descriptive statistics were used for presenting study outcomes. Biopsy was performed selectively, particularly for representative lesions (up to 2 in number) in patients with multiple FLLs. Where histopathology was not feasible, diagnoses were confirmed through a composite reference standard. The accuracy and adequacy of TPCT in the diagnosis of FLLs were also evaluated. A P < 0.05 was considered statistically significant. RESULTS: Eighty patients were enrolled, the mean age was 54.1 ± 12.14 years and most were males (61.3%). Of the 299 FLLs, 154 were benign, while 145 were malignant. Metastases and haemangiomas were the most commonly identified malignant and benign lesions, respectively. The FLLs were categorised as hypovascular (59%) and hypervascular (41%). TPCT showed 100% sensitivity and specificity for diagnosing abscesses, cysts, intrahepatic cholangiocarcinoma and focal nodular hyperplasia. The specificity for diagnosing all cases was 100%. CONCLUSIONS: This study further validates the significance of TPCT in assessing FLLs and characterising focal liver abnormalities across various pathological scenarios and stages of the disease.