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Differentiation of Small Hepatic Abscess From Hepatic Metastasis With a Combination of Imaging Parameters

Objective We aimed to evaluate the diagnostic performance of the combination imaging features to differentiate small (the lesion size of 3 cm or less) hepatic abscess from metastasis. Methods This retrospective study included patients with preexisting malignancy and small hepatic lesions who underwent contrast-enhanced computed tomography (CT) and gadoxetic acid–enhanced magnetic resonance imaging (MRI) within 4 days between March 2017 and July 2020. Two radiologists independently evaluated the imaging features of each focal hepatic lesion. Laboratory parameters were also recorded. Significant parameters differentiating hepatic abscess from hepatic metastasis were identified by univariate generalized estimating equation regression. We compared the diagnostic performances of laboratory parameters, imaging features, and their combinations. Results We included 16 patients (10 males and 6 females) with 35 hepatic abscesses and 21 patients (13 males and 8 females) with 62 metastases with a mean age of 70.3 years in this study. Abnormal segmental neutrophil, pathy parenchymal enhancement on CT, and absence of dark rim on MRI were associated with hepatic abscess (all P < 0.01). The combination of CT and MRI parameters showed significantly higher specificity and positive predictive value than CT alone (P ≤ 0.031), without significant difference in sensitivity and negative predictive value. Conclusions We have demonstrated that the combination of CT and MRI imaging features is helpful for the differentiation of small hepatic abscess from metastasis.