Korean J Radiol.  2002 Dec;3(4):240-244. 10.3348/kjr.2002.3.4.240.

Focal Eosinophilic Necrosis of the Liver in Patients with Underlying Gastric or Colorectal Cancer: CT Differentiation from Metastasis

• Jang HJ
• Lee WJ
• Lee SJ
• Kim SH
• Lim HK
• Lim JH

• KMID: 1118791
• DOI: http://doi.org/10.3348/kjr.2002.3.4.240

Abstract

OBJECTIVE
To determine the helical CT findings which help differentiate between focal eosinophilic necrosis (FEN) of the liver and metastasis in patients with underlying gastric or colorectal cancer. MATERIALS AND METHDOS: In 21 patients with underlying gastric and colorectal cancer examined during a recent 18-month period, the presence of FEN (n=90) was proven at CT. The diagnosis was verified by biopsy in eight patients and by the transient nature of the findings related to peripheral eosinophilia (>10%) in the remainder. For comparison, 20 consecutive patients with pathologically proven hepatic metastasis from gastric or colorectal cancer (n=158) were selected. Single-phase helical CT images (7-mm collimation, pitch 1:1) were independently analyzed in a random order by two blinded readers. The parameters evaluated included the margin (depicted border, fuzzy), shape (spherical, non-spherical), attenuation (subtle hypoattenuation, hypoattenuation), and the presence or absence of rim enhancement. RESULTS: FEN far more frequently showed a fuzzy margin (81%, 84%), subtle hypoattenuation (89%, 91%), and a non-spherical shape (84% for both readers) than metastasis, for which the respective findings were 6%, 22%; 20%, 39%; and 15%, 23%. Rim enhancement was seldom found in FEN (0%, 2%), but was recognized by both readers in 40% of metastases. For all parameters, the results were statistically significant (p < .01), and showed that both readers correctly differentiated FEN from metastasis in 78% of the patients (32/41). Interobserver agreement was, in addition, excellent (K= 0.66). CONCLUSION: When focal hepatic lesions with a fuzzy margin, non-spherical shape and subtle hypoattenuation without rim enhancement are found, the possibility of FEN should be considered even in patients with underlying gastrointestinal malignancy.

Keyword

Liver, CT; Liver neoplasms, metastasis

MeSH Terms

Algorithms
Colonic Neoplasms/*radiography
Eosinophilia/*pathology
Female
Human
Liver/*pathology
Male
Middle Age
Necrosis
Rectal Neoplasms/*radiography
Stomach Neoplasms/*radiography
*Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Focal eosinophilic necrosis of the liver in a 51-year-old man with gastric cancer and peripheral eosinophilia (11.7%). Contrast-enhanced CT scan obtained during the portal venous phase shows that in both hepatic lobes, several non-spherical lesions (arrows) with a fuzzy margin are present, and there is subtle hypoattenuation without rim enhancement.

• 

  Fig. 2 Contrast-enhanced helical CT scan of focal eosinophilic necrosis of the liver in a 49-year-old man with colon cancer and peripheral eosinophilia (13.1%). A. Hepatic arterial-phase image depicts a minimally conspicuous but very suspicious lesion (arrow) in the right hepatic lobe. B. Portal venous-phase image reveals greater lesion conspicuity (straight arrow) than is apparent in A. Also visible are two additional lesions (curved arrows). C. Image obtained after a three-minute delay depicts no recognizable lesions.

• 

  Fig. 3 Metastases from rectal cancer first evident at follow-up CT performed seven months after surgery in a 62-year-old man. Contrast-enhanced helical CT scan obtained during the portal venous phase shows small hypoattenuating lesions (arrows) with an obvious rim- or target-like enhancement pattern.

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