Indeterminate Liver Lesion on Radiology Reports: What It Means

ByA. Mendelson, MD
Please read the disclaimer

Radiology reports of the abdomen sometimes mention an “indeterminate liver lesion.”   This phrase simply means that the radiologist saw a spot or area in the liver for which a diagnosis can not be determined.  Indeterminate does not automatically mean dangerous—it means more information is needed.  This article explains what indeterminate liver lesions are, how radiologists approach them, and what follow-up might be recommended.

What Does “Indeterminate Liver Lesion” Mean?

An indeterminate liver lesion is a finding on a CT scan, MRI, or ultrasound that cannot be confidently classified as benign or something more concerning like cancer.  Many people have incidental lesions in their liver.  Many of these turn out to be cysts or benign growths.  Others require more detailed evaluation to rule out something serious like cancer or metastasis.

Why Liver Lesions Are Common

Liver lesions are very common findings. Because CT and MRI scans are so detailed, radiologists detect liver lesions in many patients. Some of these can not be classified and need further testing or follow up.

The majority of these are benign, meaning they don’t cause problems and don’t require treatment. Examples include:

  • Simple cysts – fluid-filled sacs

  • Hemangiomas – clusters of blood vessels

  • Focal nodular hyperplasia (FNH) – a benign overgrowth of liver tissue

Causes of Indeterminate Liver Lesions

Not every lesion has classic imaging features. Some appear “in between,” making it hard to give a confident diagnosis. Causes of indeterminate lesions include:

  • Too small to characterize: If a lesion is only a few millimeters, the scan may not show enough detail.

  • Overlapping imaging features: Some benign and malignant lesions look similar, especially in early stages.

  • Technical limitations: Motion, contrast timing, or scan quality may make the lesion harder to define.

  • Underlying liver disease: Diagnosis of liver lesions in patients with underlying fatty liver disease or cirrhosis can be more difficult.

How Radiologists Evaluate Liver Lesions

Radiologists use specific features to decide if a liver lesion is benign or suspicious.  The appearance after administration of contrast is especially important for characterizing liver lesions.

If the pattern matches a known benign lesion, the report will often say so directly. If the features don’t fit neatly into a category, the lesion is called indeterminate.

Common Scenarios for Indeterminate Liver Lesions

  1. Incidental finding on CT scan

    • A patient has a CT scan for abdominal pain, and a liver lesion is found that was unrelated to the symptoms.

  2. History of cancer

    • In patients with known cancer, even small indeterminate lesions may require closer follow-up to rule out spread.

  3. Chronic liver disease

    • In patients with cirrhosis, indeterminate lesions can represent early stages of liver cancer, so MRI and closer surveillance are often used.

Next Steps After an Indeterminate Finding

Radiologists usually recommend one of several options depending on your history and the imaging appearance:

  • Follow-up imaging – A repeat CT, MRI, or ultrasound in 3–6 months to see if the lesion changes.

  • MRI with contrast – MRI provides more detailed evaluation for the liver.

  • Specialized liver imaging protocols – Using liver-specific contrast agents to improve accuracy.

  • Biopsy (less common) – Only used if imaging cannot provide a clear answer and the lesion is suspicious.

When to Worry and When Not To

Many indeterminate liver lesions turn out to be benign and harmless. The need for follow-up does not mean cancer is likely—it means the doctors want to be certain.

  • Low-risk patients (no cancer history, normal liver) – small indeterminate lesions are likely to be benign.

  • High-risk patients (history of cancer, cirrhosis, hepatitis) – indeterminate lesions require closer monitoring to ensure early detection of cancer.

Key Takeaways

  • An indeterminate liver lesion means it is not fully characterized and a precise diagnosis can not be made.

  • Many liver lesions are benign, especially in people without underlying liver disease or cancer history.

  • Radiologists often recommend MRI or follow-up scans for indeterminate liver lesions.

  • The finding should be viewed as a call for more information, not an automatic sign of cancer.

Conclusion

Finding an “indeterminate liver lesion” on an imaging study of the abdomen is common.  It simply means that a precise diagnosis can not be made from your scan alone.  This often indicates that further testing or follow up imaging is needed.  Many of these lesions are found to be benign and harmless after workup.  If you see this term in your report, discuss it with your doctor, who can explain what to do next in your particular case.

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC10653571/

https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-022-02135-x

https://www.radiologyinfo.org/en/info/article-lirads-liver-imaging

Disclaimer: The content of this website is provided for general informational purposes only and is not intended as, nor should it be considered a substitute for, professional medical advice. Do not use the information on this website for diagnosing or treating any medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.

Similar Posts