Ultrasound is often the first investigation when a liver lesion is suspected. It is widely available, non-invasive, and does not involve radiation.

However, ultrasound may not fully characterise deep, small, or complex focal liver lesions, which is why further imaging is often required.

A contrast-enhanced triphasic CT scan is a cornerstone of liver lesion diagnosis.

Includes arterial, portal venous, and delayed phases.
Defines blood supply, vascular pattern, lesion behaviour, and spread.
Helps differentiate benign vs malignant liver lesions.
Essential for treatment planning, especially for surgery, ablation, or embolisation

Before CT, kidney function and contrast allergy are carefully assessed to ensure safety.

MRI is the best problem-solving tool when CT findings are unclear.

Excellent for small or indeterminate liver lesions.
Superior soft-tissue contrast helps identify characteristic patterns.
Crucial for confidently differentiating benign vs malignant lesion types such as haemangioma, FNH, adenoma, or HCC.

MRI often avoids unnecessary biopsy when classic imaging features are present.

PET-CT is not routine for all liver lesions but is valuable in selected scenarios.

Some liver tumours and benign lesions may not show strong PET uptake, so PET-CT is used selectively based on clinical context.

Blood tests complement imaging but do not replace scans or biopsies.

These tests support diagnosis and help guide monitoring and treatment.

Liver Lesion: Diagnosis, Symptoms, Scans & Next Steps