When Should You Worry About a Liver Lesion?

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When a radiology report mentions a “liver lesion,” it can feel alarming. The truth is that most liver lesions found on imaging are benign, especially in people without liver disease or a history of cancer. This article explains what liver lesions are, how they appear on imaging tests, and the situations in which they are more concerning.

What is a liver lesion on imaging?

A liver lesion is an area of the liver that looks different from the surrounding tissue on an imaging test. Radiologists may call it a:

Liver mass
Liver nodule
Focal liver lesion

These terms describe appearance, not diagnosis. Many lesions detected on imaging are harmless findings such as:

Simple cysts
Hemangiomas
Focal nodular hyperplasia (FNH)
Areas of fat or scarring

Imaging patterns help radiologists determine which lesions are benign and which need further workup.

How liver lesions are found: ultrasound, CT, and MRI

Many liver lesions are discovered incidentally, when imaging is performed for unrelated symptoms or routine evaluations.

Ultrasound can detect liver lesions but is not great at determining what they are with the exception of cysts.

CT scans with contrast are good at detecting lesions and sometimes providing a diagnosis. Different phases of imaging such as arterial, portal venous, and delayed help distinguish benign from suspicious patterns.

MRI with contrast provides the most detailed evaluation. MRI with and without contrast can often determine the diagnosis of a liver lesion or at least determine which lesions need follow up or biopsy.

Common benign liver lesions and their imaging patterns

Some liver lesions have classic appearances that can be confidently diagnosed on imaging. When the pattern is typical, no further testing is usually needed.

Simple liver cyst

Smooth, round, fluid-filled.
Can often be diagnosed on ultrasound, CT or MRI
No contrast enhancement

Hemangioma (benign blood vessel cluster)

One of the most common benign liver lesions
On CT/MRI: enhancement starts at the outer edges and gradually fills inward
On ultrasound: usually bright with well-defined borders

If the appearance is typical, hemangiomas usually require no follow-up.

Focal nodular hyperplasia (FNH)

Benign growth usually seen in young to middle-aged adults
Often shows strong enhancement on early contrast phases
Frequently has a “central scar”

FNH usually requires no treatment once confirmed.

When a liver lesion is more concerning

A liver lesion becomes more worrisome when imaging features or personal risk factors raise the likelihood of cancer. These include:

Cirrhosis or chronic hepatitis B or C
A history of cancer that often spreads to the liver
Irregular or spiculated borders on imaging
Rapid growth over time
A pattern of strong early enhancement with quick washout
Multiple lesions without classic benign characteristics

In people with chronic liver disease, radiologists sometimes use a grading system called LI-RADS to classify lesions according to their suspicion of liver cancer.

Understanding incidental liver lesions on CT or MRI

Because incidental liver lesions are so common, expert societies have created guidelines to help determine who needs additional imaging. These guidelines consider:

Age
History of cancer
Chronic liver disease
Lesion size
Whether the lesion looks cystic, solid, or has a classic benign pattern

In healthy adults without risk factors, many small lesions are considered benign and do not require further follow-up. Larger or unclear lesions may need ultrasound, MRI, or repeat imaging.

You should pay closer attention and speak with your doctor promptly if:

You have cirrhosis or chronic hepatitis
You have a history of a cancer that spreads to the liver
The radiologist mentions “suspicious” features
There is a typical liver cancer pattern such as early enhancement with washout
The lesion is large and does not match a benign pattern
Additional imaging or biopsy is recommended

Reassuring signs include:

The lesion is described as a “simple cyst” or a “typical hemangioma”
The radiologist states no follow-up is needed
The lesion has been stable for many years.

The “Impression” section of your report summarizes the radiologist’s level of concern and recommended next steps.

Follow-up imaging and biopsy

If a lesion does not clearly look benign or malignant, next steps may include:

MRI with contrast for further evaluation
Repeat imaging in 3 to 6 months to check for growth
Biopsy when imaging remains uncertain and the result will guide treatment

Biopsy is not usually the first step. Many lesions can be confidently diagnosed by imaging alone.

What to do if your report mentions a liver lesion

If your report includes a liver lesion:

Ask your doctor what type of lesion the radiologist suspects
Ask your doctor whether you are considered low-risk or high-risk
Understand whether the lesion is likely benign, unclear, or concerning
Make sure you know the recommended next step

Conclusion

Many liver lesions found on imaging are benign, especially in people without risk factors like cirrhosis or a history of cancer. Imaging features on ultrasound, CT, and MRI help radiologists decide whether a lesion is benign, needs follow-up, or may represent cancer. Radiologists will also provide a diagnosis when possible and the next steps in management.

References

https://my.clevelandclinic.org/health/diseases/14628-liver-lesions

https://radiologyassistant.nl/abdomen/liver/characterisation-of-liver-masses

https://pmc.ncbi.nlm.nih.gov/articles/PMC11524743/

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.