Incidental Liver Lesion (CT)
Walk the decision tree step by step, see it as a flowchart, or view the whole algorithm at once.
ACR IFC 2017·reviewed 2026-07-01
- •'Low risk' = no known primary malignancy, no hepatic risk factors (cirrhosis, chronic hepatitis, hemochromatosis, sclerosing cholangitis, anabolic steroids, or a familial cancer syndrome). 'High risk' = a known primary cancer, hepatic dysfunction/risk factors, or a clinical history that raises suspicion.
- •Benign 'flash' diagnoses that need no follow-up: simple cyst, classic hemangioma (peripheral discontinuous nodular enhancement following blood pool), focal fat / focal fat sparing in typical distribution, and transient perfusional abnormalities/pseudolesions.
- •'Benign imaging features' for indeterminate lesions include well-defined margins, homogeneity, and low attenuation (approaching fluid) without suspicious features (heterogeneity, ill-defined or thick enhancing margins, mural nodularity, washout, or interval growth).
- •Any suspicious imaging feature, or interval growth, moves a lesion out of the 'probably benign' pathway toward MRI/multiphase CT or biopsy regardless of size.
- •This algorithm is for patients not undergoing dedicated liver imaging; in a known cirrhotic being screened, use LI-RADS instead.
Is the lesion a definitely-benign 'flash' diagnosis?
Simple cyst, classic hemangioma, focal fat / focal fat sparing in a typical distribution, or a perfusional pseudolesion.
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Sources
- Gore RM, et al. Management of Incidental Liver Lesions on CT: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2017;14(11):1429-1437.
Educational reference for clinicians — not medical advice. Verify against the primary source before acting on it; guidelines change. Final decisions rest with the interpreting physician and your institution's protocols.