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Hypervascullar Lesions in the Liver
Hello, my blood lab results have been indicating elevated liver levels for about 2 years now, my current dr. (a liver specialist) ordered an MRI which has revealed the following:
3 small hypervascullar lesions in the right lobe of the liver at the dome of 1.2 cm, .5 cm and 6mm, spleen, pancreas, adrenals and kydneys appear normal and there's no retroperitoneal lymphadenopathy and no ascites is seen.
what can this be an indication of? my dr. has ordered another MRI in 3 months.
3 small hypervascullar lesions in the right lobe of the liver at the dome of 1.2 cm, .5 cm and 6mm, spleen, pancreas, adrenals and kydneys appear normal and there's no retroperitoneal lymphadenopathy and no ascites is seen.
what can this be an indication of? my dr. has ordered another MRI in 3 months.
You might consider whether you might try Naturemade brand of Sam-E, which is supposed to promote liver health (as well as promoting mood and joint comfort). See PM for more info.
thank you again for taking the time to read my post, I will update my information as needed just to keep you posted.
"Milk Thistle" helps repair the liver? how true is this? and should I consider taking it?
No. I recent clinical trial followed 154 people with the disease for 24 weeks. Some were given a placebo while others received silymarin, the active ingredient in milk thistle, three times a day in either normal or high doses. By monitoring enzymes indicative of liver function, the researchers found that the herbal extract did not create any improvement compared with the placebo.
"these MRIs are done with contrast at a transplant center, correct? No my MRI was done at an MRI center from the same hospital that my current Dr. is in."
As long as the MRI technician and the doctor interpreting the image results regularly diagnose HCC (liver) then they should be about to tell the difference between HCC and a benign lesion.
Then follow your hepatologist's advice. They are the experts.
Hector
No. I recent clinical trial followed 154 people with the disease for 24 weeks. Some were given a placebo while others received silymarin, the active ingredient in milk thistle, three times a day in either normal or high doses. By monitoring enzymes indicative of liver function, the researchers found that the herbal extract did not create any improvement compared with the placebo.
"these MRIs are done with contrast at a transplant center, correct? No my MRI was done at an MRI center from the same hospital that my current Dr. is in."
As long as the MRI technician and the doctor interpreting the image results regularly diagnose HCC (liver) then they should be about to tell the difference between HCC and a benign lesion.
Then follow your hepatologist's advice. They are the experts.
Hector
Secondly, you said you are seeing a liver specialist, so you are seeing a hepatologist correct? Correct
Third, these MRIs are done with contrast at a transplant center, correct? No my MRI was done at an MRI center from the same hospital that my current Dr. is in.
Forth, What is your AFP blood level? I don't have the exact numbers but my Dr. stated that my levels are "slightly elevated" and that they aren't even 1/3 of where they should be to cause any alarming.
His closing statements were that I shouldn't worry about this since I am still young, not over weight and have no other health issues and to schedule a follow-up MRI within 3 months.
Third, these MRIs are done with contrast at a transplant center, correct? No my MRI was done at an MRI center from the same hospital that my current Dr. is in.
Forth, What is your AFP blood level? I don't have the exact numbers but my Dr. stated that my levels are "slightly elevated" and that they aren't even 1/3 of where they should be to cause any alarming.
His closing statements were that I shouldn't worry about this since I am still young, not over weight and have no other health issues and to schedule a follow-up MRI within 3 months.
I have already been tested for all Hepatitis types and all came back negative, since I am not a drinker I have no cirrhosis either. I've been reading that "Milk Thistle" helps repair the liver? how true is this? and should I consider taking it? Thanks for taking the time to read my post and feel free to pitch in.
I am not a drinker or a smoker, I used to drink BUT only on special occasions (b-days etc.) and not heavily either. I have completely stopped ALL alcoholic consumption of any kind for the past 2 years too (since it was discovered that my liver levels were elevated). My gall bladder was also removed due to gall stones about 7 years ago too. Thanks for taking the time to read my post and feel free to pitch in.
what can this be an indication of?
LivingHope is correct on all points.
Hypervascular lesions can be benign lesions (such as small hemangiomas) or HCC (liver cancer tumors). So it is very important to tell the difference. Radiological testing is done with a 4-phase CT or dynamic MRI to diagnose what the lesions are.
Your risk of having HCC depends upon your current stage of liver disease. And in order to properly diagnose what these lesions are, only highly trained and experienced medical personnel working at a liver transplant center can determine what they are.
First, for the vast majority of patients, they must have cirrhosis (stage 4 liver disease) in order to have a higher than normal risk of developing HCC (liver cancer).
Do you have cirrhosis? If not, chances of having HCC is very low. (Unless you have chronic hepatitis B).
If hepatitis C caused your liver disease, the risk of HCC in patients with chronic hepatitis C is highest among patients who have established cirrhosis, where the incidence of HCC is between 2%-8% per year.
Secondly, you said you are seeing a liver specialist, so you are seeing a hepatologist correct?
Third, these MRIs are done with contrast at a transplant center, correct? Only transplant center have personal qualified to perform the correct protocols for viewing HCC and only pathologists or oncologists at transplant centers know what to interpret the images and tell the difference between varies types of masses in the liver.
I am just saying it so that others who may read this understand all of these important aspects of diagnosing liver masses.
Forth, What is your AFP blood level?
The 1.2 cm lesion should be large enough to tell what it is in most cases as LH said. For some reason they seem to not be able to determine what it is. They should try another method. 4-phase multidetector CT scan if they can't tell using the MRI. But the MRI should be able to see more normally. The smaller lesions should be re-imaged again in 3 months as is being done to look for growth and changes.
Hypervascular lesions:
Arterially enhancing lesions are mostly benign lesions and include primary liver tumors as FNH, adenoma and small hemangiomas that fill rapidly with contrast.
These benign tumors have to be differentiated from the most common hypervascular malignant liver tumor, which is HCC and metastases from hypervascular tumors like melanoma, renal cell carcinoma, breast, sarcoma and neuroendocrine tumors (islet cell tumors, carcinoid, pheochromocytoma).
Hypervascular lesions may look very similar in the arterial phase.
Differentiation is done by looking at the enhancement pattern in the other phases and additional gross pathologic features together with clinical findings. Hypervascular metastases will be considered in patients with a known primary tumor.
In general HCC is considered when there is a setting of cirrhosis, while
FNH is considered in young women and hepatic adenoma in patients on oral contraceptives, anabolic steroids or with a history of glycogen storage disease.
Here are the AASLD Practice Guidelines for "Management of Hepatocellular Carcinoma" Updated 2011
http://www.aasld.org/practiceguidelines/documents/bookmarked%20practice%20guidelines/hccupdate2010.pdf
"...smaller lesions are more likely to be associated with treatment that will be curative. Finally decision analysis also confirms that ideally, for the best outcome, the lesion should be smaller than 2 cm at diagnosis. It is therefore important to make the diagnosis of HCC as early as possible. However, it is equally important not to apply invasive treatment to lesions that do not have any malignant potential and may still regress. This is a fine distinction that is not always possible to make. An additional concern about thin needle liver biopsy is the risk of bleeding and needle track seeding. Most studies that report needle track seeding do not specify the size of the lesion being biopsied. Although the rate of needle track seeding
after biopsy of small lesions (<2 cm) has not been accurately measured, it is probably uncommon. The current rate of bleeding from thin needle biopsy of small HCC has not been reported, but is probably no different than for biopsy of the liver in general."
Recommendations
6. Nodules found on ultrasound surveillance that are smaller than 1 cm should be followed with ultrasound at intervals from 3-6 months (level III). If
there has been no growth over a period of up to 2 years, one can revert to routine surveillance (level III).
7. Nodules larger than 1 cm found on ultrasound screening of a cirrhotic liver should be investigated further with either 4-phase multidetector CT scan or dynamic contrast enhanced MRI. If the appearances are typical of HCC (i.e., hypervascular in the arterial phase with washout in the portal venous or delayed phase), the lesion should be treated as HCC.
If the findings are not characteristic or the vascular profile is not typical, a second contrast enhanced study with the other imaging modality should be
performed, or the lesion should be biopsied (level II).
You should mention any concerns to your doctor and you should discuss what the different outcomes would mean.
Good luck. Hopefully these are benign growths as most lesions are. But if it is HCC you want to catch it early so it can be treated.
I have HCC and had two tumors over 2.0 cm both of which were treated with T.A.C.E. and now can't be found.
Hector
LivingHope is correct on all points.
Hypervascular lesions can be benign lesions (such as small hemangiomas) or HCC (liver cancer tumors). So it is very important to tell the difference. Radiological testing is done with a 4-phase CT or dynamic MRI to diagnose what the lesions are.
Your risk of having HCC depends upon your current stage of liver disease. And in order to properly diagnose what these lesions are, only highly trained and experienced medical personnel working at a liver transplant center can determine what they are.
First, for the vast majority of patients, they must have cirrhosis (stage 4 liver disease) in order to have a higher than normal risk of developing HCC (liver cancer).
Do you have cirrhosis? If not, chances of having HCC is very low. (Unless you have chronic hepatitis B).
If hepatitis C caused your liver disease, the risk of HCC in patients with chronic hepatitis C is highest among patients who have established cirrhosis, where the incidence of HCC is between 2%-8% per year.
Secondly, you said you are seeing a liver specialist, so you are seeing a hepatologist correct?
Third, these MRIs are done with contrast at a transplant center, correct? Only transplant center have personal qualified to perform the correct protocols for viewing HCC and only pathologists or oncologists at transplant centers know what to interpret the images and tell the difference between varies types of masses in the liver.
I am just saying it so that others who may read this understand all of these important aspects of diagnosing liver masses.
Forth, What is your AFP blood level?
The 1.2 cm lesion should be large enough to tell what it is in most cases as LH said. For some reason they seem to not be able to determine what it is. They should try another method. 4-phase multidetector CT scan if they can't tell using the MRI. But the MRI should be able to see more normally. The smaller lesions should be re-imaged again in 3 months as is being done to look for growth and changes.
Hypervascular lesions:
Arterially enhancing lesions are mostly benign lesions and include primary liver tumors as FNH, adenoma and small hemangiomas that fill rapidly with contrast.
These benign tumors have to be differentiated from the most common hypervascular malignant liver tumor, which is HCC and metastases from hypervascular tumors like melanoma, renal cell carcinoma, breast, sarcoma and neuroendocrine tumors (islet cell tumors, carcinoid, pheochromocytoma).
Hypervascular lesions may look very similar in the arterial phase.
Differentiation is done by looking at the enhancement pattern in the other phases and additional gross pathologic features together with clinical findings. Hypervascular metastases will be considered in patients with a known primary tumor.
In general HCC is considered when there is a setting of cirrhosis, while
FNH is considered in young women and hepatic adenoma in patients on oral contraceptives, anabolic steroids or with a history of glycogen storage disease.
Here are the AASLD Practice Guidelines for "Management of Hepatocellular Carcinoma" Updated 2011
http://www.aasld.org/practiceguidelines/documents/bookmarked%20practice%20guidelines/hccupdate2010.pdf
"...smaller lesions are more likely to be associated with treatment that will be curative. Finally decision analysis also confirms that ideally, for the best outcome, the lesion should be smaller than 2 cm at diagnosis. It is therefore important to make the diagnosis of HCC as early as possible. However, it is equally important not to apply invasive treatment to lesions that do not have any malignant potential and may still regress. This is a fine distinction that is not always possible to make. An additional concern about thin needle liver biopsy is the risk of bleeding and needle track seeding. Most studies that report needle track seeding do not specify the size of the lesion being biopsied. Although the rate of needle track seeding
after biopsy of small lesions (<2 cm) has not been accurately measured, it is probably uncommon. The current rate of bleeding from thin needle biopsy of small HCC has not been reported, but is probably no different than for biopsy of the liver in general."
Recommendations
6. Nodules found on ultrasound surveillance that are smaller than 1 cm should be followed with ultrasound at intervals from 3-6 months (level III). If
there has been no growth over a period of up to 2 years, one can revert to routine surveillance (level III).
7. Nodules larger than 1 cm found on ultrasound screening of a cirrhotic liver should be investigated further with either 4-phase multidetector CT scan or dynamic contrast enhanced MRI. If the appearances are typical of HCC (i.e., hypervascular in the arterial phase with washout in the portal venous or delayed phase), the lesion should be treated as HCC.
If the findings are not characteristic or the vascular profile is not typical, a second contrast enhanced study with the other imaging modality should be
performed, or the lesion should be biopsied (level II).
You should mention any concerns to your doctor and you should discuss what the different outcomes would mean.
Good luck. Hopefully these are benign growths as most lesions are. But if it is HCC you want to catch it early so it can be treated.
I have HCC and had two tumors over 2.0 cm both of which were treated with T.A.C.E. and now can't be found.
Hector
Of course the best person to discuss this with is your liver specialist. I have a couple of liver lesions myself that have been identified as hemangiomas (not cancer), which are blood vessels bunched together, but the doctor should tell you if the MRI report identified what your lesions are. You should be able to request a copy of your report if you haven't. The smaller ones they may not be able to identify properly because of their small size, but the one over a centimeter they should have better information on. It's good the doctor is following up with another scan in three months to appraise whether or not your lesions are stable.
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