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A Review of the Appropriateness of the Current Italian Guidelines for Noninvasive Imaging Assessment of Focal Liver Lesions

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Giovanna Ferraioli1, Carolina Dellafiore1, Maria Franca Meloni2, Fabrizio Calliada3, Carlo Filice1

1) Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, Pavia, Italy
2) Department of Radiology, Ospedale Valduce, Como, Italy
3) Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, Pavia, Italy

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.244.itl

In 2007 the Italian National Institute of Health issued Guidelines for the use of diagnostic imaging techniques in the detection and the characterization of focal liver lesions. Since the publication of these guidelines in 2008, several studies relating to this topic have been published. Thus, we felt the need to assess whether interval research and new advancements in diagnostic imaging have yielded new evidence that should modify the recommendations that were previously issued. The literature search confirmed the appropriateness of the current guidelines. Although most modalities did not show substantial changes, interval introduction of DW-MRI is a valuable technique with a high diagnostic accuracy in the detection and characterization of FLLs, and its sensitivity is higher when combined with MRI.

Key words: diagnostic imaging techniques – focal liver lesions – guidelines – liver – contrast-enhanced ultrasound – computed tomography – magnetic resonance imaging – positron emission tomography – ultrasound – ablation therapy.

Abbreviations: AASLD: American Association for the Study of Liver Disease; CE-IOUS: contrast-enhanced intraoperative US; CEUS: contrast-enhanced ultrasound; CRLM: colorectal liver metastasis; DW-MRI: diffusion weighted MRI; EOB-MRI: gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid MRI; FLLs: focal liver lesions; HCC: hepatocellular carcinoma; LR+: positive likelihood ratio; LR-: negative likelihood ratio; NPV: negative predictive value; PET: positron emission tomography; PPV: positive predictive value; RF: radiofrequency; TACE: transarterial chemoembolization