The liver, one of the body's largest organs, is common location to a wide range of benign and neoplastic tumours. It is always remaining also a frequent site for metastatic deposits from primary tumors located in other organs. Moreover, it is significantly impacted by complex diffuse conditions such as cirrhosis and chronic viral infections^[1].

Functionally, the liver performs diverse and essential tasks, including waste detoxification, plasma protein synthesis, bile production to support digestion, and nutrient storage ^[2]. its extensive vascularization via the hepatic artery (HA) and portal vein, is highly susceptible to a range of diseases and pathological alterations and present considerable challenges for clinicians and surgeons in the effective management of hepatic neoplasms. Over the past two decades, liver imaging practices have undergone substantial advancements ^[3].

Liver lesions (LLs) encompass a spectrum of diseases, from benign entities such as hemangiomas to neoplastic conditions like primary HCC and metastatic deposits ^[4,5]. A focal liver lesion (FLL) refers to an abnormality that deviates from the typical hepatic parenchymal architecture, displaying variable and often unpredictable dimensions. Such lesions prevalence exhibiting marked geographic and ethnic variations ^[6].

Since the mid-1970s, advancements in imaging technology for the liver have grown exponentially, providing clinicians with a diverse and sophisticated range of diagnostic tools for evaluating both focal and diffuse hepatic diseases. Selecting the most appropriate imaging strategy is fundamentally dependent on the specific clinical indication ^[1]. Ultrasonography is commonly employed as a preliminary screening modality for hepatic lesions (HLs). However, its diagnostic specificity is limited due to overlapping imaging characteristics, and it proves insufficient as a standalone modality, particularly in the context of underlying parenchymal LDs such as cirrhosis^[7].

MDCT evaluation was performed using a GE 16-Slice CT Scanner and Dunlee 6-Slice Whole-Body CT Scanner. Prior to imaging, each patient received a thorough clinical evaluation that included a thorough history taking, physical examination, and review of laboratory results. Using standardized procedures, multiphase CT scanning of the abdomen was performed on each patient. With tube current modulation ranging from 80 to 160 mAs, scans were obtained at 140 kVp. Reconstructions were carried out at 5-mm intervals after images were acquired with a section thickness of 3 mm and a pitch of 0.7. The scanning protocol included axial images with coronal and sagittal reformations performed as required.

Systematic interpretation of imaging findings was carried out by experienced radiologists. The imaging results were later correlated with histopathological findings wherever tissue diagnosis was available.

Inclusion Criteria

• Patients aged ≥ 18 years referred for MDCT evaluation of HLs.

Exclusion Criteria

• Patients with hepatic trauma.
• Patients aged < 18 years.
• Pregnant women.

Table 1: Demographic and Clinical Profile of Patients with Hepatic Lesions

The age distribution showed predominance in the older age groups, with the highest proportion observed in patients aged more than 60 years (29 patients, 30.85%), followed by those in the 51–60 years group (25 patients, 26.60%). The 41–50 years age group accounted for 21 patients (22.34%), while the <40 years group comprised 19 patients (20.21%). Regarding gender distribution, there was a slight female predominance, with 50 females (53.19%) compared to 44 males (46.81%). In terms of presenting symptoms, weight loss was the most frequently reported symptom, affecting 19 patients (20.21%), followed by anorexia in 18 patients (19.15%). Both fatigue and nausea were noted in 15 patients each (15.96%), while jaundice was present in 14 patients (14.89%). Interestingly, abdominal pain was the least reported among the major symptoms, observed in 13 patients (13.83%). This demographic and clinical profile reflects a study population skewed towards older adults with a balanced sex ratio, and with systemic symptoms such as weight loss and anorexia being more prominent than localized pain or jaundice.

Table 2: MDCT Imaging Characteristics of Hepatic Lesions

The analysis of hepatic lesion sizes on MDCT revealed that most lesions were in the 5–10 cm range (36 patients, 38.30%), followed closely by lesions less than 5 cm (30 patients, 31.91%) and lesions larger than 10 cm (28 patients, 29.79%). Anatomically, lesions were more frequently located in the left lobe (50 patients, 53.19%) compared to the right lobe (44 patients, 46.81%). Morphologically, the majority of lesions exhibited a round shape (45 patients, 47.87%), while irregular shapes were observed in 22 patients (23.40%), and lobulated shapes in 13 patients (13.83%); a small fraction (1 patient, 1.06%) had an ovoid shape. Lesion focality was predominantly focal (71 patients, 75.53%), with multifocal involvement reported in 13 patients (13.83%) and focal/multifocal patterns in 9 patients (9.57%); only 1 patient (1.06%) had a solitary lesion. Marginal assessment showed that most lesions had smooth margins (52 patients, 55.32%), while irregular margins were seen in 41 patients (43.62%), and only 1 patient (1.06%) had an ill-defined margin. Similarly, well-defined lesion margins were noted in 52 patients (55.32%), whereas poorly defined margins were found in 41 patients (43.62%), and irregular definition was reported in 1 patient (1.06%). Overall, MDCT depicted HLs as predominantly medium-sized, round, focal, and smooth-margined, with a slight preference for the left hepatic lobe.

Table 3: Additional Lesion Characteristics on MDCT

Assessment of additional lesion characteristics revealed no surrounding effect in 27 patients (28.72%), normal liver parenchyma in 25 patients (26.60%), bile duct dilatation in 13 patients (13.83%), and surrounding edema in 13 patients (13.83%). Portal vein thrombosis was identified in 9 patients (9.57%), while edema was separately reported in 6 patients (6.38%) and hypoattenuating surroundings in 1 patient (1.06%). Intralesional calcification was categorized as rare in 48 patients (51.06%), absent in 36 patients (38.30%), and possible in 9 patients (9.57%). Similarly, calcified walls were rare in 39 patients (41.49%), absent in 36 patients (38.30%), and possible in 19 patients (20.21%). A scar was observed in 13 patients (13.83%), while no scar was found in 80 patients (85.11%), and rarely present in 1 patient (1.06%). These ancillary findings provide valuable insights into the surrounding tissue and lesion-specific markers, aiding differential diagnosis.

Table 4: Enhancement Pattern across Phases in MDCT

Pattern across phases, during the arterial phase, lesions exhibited diverse enhancement: strong hyperenhancement (16 patients, 17.02%), arterial hyperenhancement + scar (13 patients, 13.83%), rim enhancement (6 patients, 6.38%), peripheral nodular enhancement (12 patients, 12.77%), mild to no enhancement (13 patients, 13.83%), no enhancement (11 patients, 11.70%), and peripheral rim/hypovascular pattern (14 patients, 14.89%). In the venous phase, enhancement patterns included isoattenuation/washout (16 patients, 17.02%), progressive enhancement (13 patients, 13.83%), hypodense/heterogeneous (14 patients, 14.89%), partial fill-in (12 patients, 12.77%), no enhancement (11 patients, 11.70%), and washout (9 patients, 9.57%). The delayed phase featured iso/minimal washout (16 patients, 17.02%), persistent hypodensity (14 patients, 14.89%), scar enhancement (13 patients, 13.83%), marked enhancement (13 patients, 13.83%), centripetal fill-in (12 patients, 12.77%), and hypodensity (15 patients, 15.96%). These dynamic-phase observations facilitate lesion characterization by highlighting vascular behavior.

Triple Phase MDCT remains a first-line modality because it is widely available, provides near-isotropic voxels that facilitate multiphase acquisition, and achieves pooled sensitivities approaching 96 % for lesion detection in non-cirrhotic livers^[8]. Nevertheless, performance varies with lesion biology, size and enhancement pattern and observer expertise; CT alone may under-stage up to half of small (<3 cm) HCC when compared with MRI or combined CT/MRI LI-RADS pathways^[9].

Our cohort was skewed toward older adults (mean 55 ± 12 y; 30.9 % > 60 y) with a slight female predominance (53.2 %).

Our female-to-male ratio (1.1:1) contrasts with the male preponderance (57.5 %) in the Kerala cohort^[10] and the marked female dominance (1.5–5:1) typically reported for cavernous haemangioma, underscoring geographic and lesion-specific variability.
Systemic “B-symptoms” led presentations (weight loss 20.2 %, anorexia 19.1 %), echoing the Indian Bioinformation series, where constitutional complaints dominated and correlated with neoplastic histology^[11].

In terms of presenting symptoms, we found weight loss was the most frequently reported symptom, affecting 19 patients (20.21%), followed by anorexia in 18 patients (19.15%). Both fatigue and nausea were noted in 15 patients each (15.96%), while jaundice was present in 14 patients (14.89%). Interestingly, abdominal pain was the least reported among the major symptoms, observed in 13 patients (13.83%). Partially comparable to findings Tomar et el.^[12] who reported most prevalent clinical sign accordingly  abdominal pain (90–91 percent); the top three signs among patients were pallor (80–00 percent), icterus (45–45 percent), and lump RHC (18–18 percent).

MDCT reliably characterizes lesion morphology, density, enhancement pattern, and anatomical distribution. These findings support the integration of MDCT as a frontline imaging modality for hepatic lesion evaluation, enabling accurate characterization, guiding biopsy decisions, and facilitating surgical or interventional planning. However, caution is warranted in interpreting atypical lesions, as occasional false positives and false negatives may occur, necessitating histopathological confirmation in suspicious or inconclusive cases.

MDCT reliably characterizes lesion morphology, density, enhancement pattern, and anatomical distribution. These findings support the integration of MDCT as a frontline imaging modality for hepatic lesion evaluation, enabling accurate characterization, guiding biopsy decisions, and facilitating surgical or interventional planning. However, caution is warranted in interpreting atypical lesions, as occasional false positives and false negatives may occur, necessitating histopathological confirmation in suspicious or inconclusive cases.