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Utility of Sonography for Small Hepatic Lesions Found on Computed Tomography in Patients With Cancer

Objective. To assess the performance of sonography in evaluating small indeterminate liver lesions detected on computed tomography in patients with cancer. Methods. Radiology database review from January 1, 1998, to August 4, 2000, identified 76 patients with 124 indeterminate hepatic lesions smaller than 1.5 cm on computed tomography who had abdominal sonography within 3 months. Sonographic reports and images were reviewed to assess whether lesions were referenced or specifically sought and to verify lesion correspondence, detection, and characterization. The validity of sonographic characterization was determined by histopathologic examination or follow‐up imaging (mean time to follow up, 17 months; range, 6.5–38.8 months). Results. Sixty (48%) of 124 indeterminate lesions were evident on sonography. Detection improved when lesions were specifically sought and lesion size was greater than 0.5 cm. Forty (66%) of 61 lesions were detected when the radiologist referenced the preceding computed tomography versus 20 (32%) of 63 lesions when the computed tomographic findings were not referenced (P = .0004). Fifty‐one (67%) of 76 lesions measuring 0.6 to 1.5 cm were detected on sonography versus 9 (19%) of 48 lesions measuring 0.1 to 0.5 cm. Lesion size (P < .0001) and body habitus (P = .02) were significant factors influencing lesion detection. Sonography characterized 56 (93%) of 60 detected lesions (33 cysts, 18 solid lesions/metastases, and 5 hemangiomas). Sonographic diagnoses were supported in 42 (93%) of 45 lesions by follow‐up imaging (37 of 40) or histopathologic examination (5 of 5). Conclusions. Sonography may be useful in cancer patients with average body habitus to characterize small (0.6‐ to 1.5‐cm) indeterminate liver lesions detected on computed tomography.