DIAGNOSTIC PERFORMANCE OF TRIPLE-PHASE CT IN DIFFERENTIATING BENIGN AND MALIGNANT FOCAL HEPATIC LESIONS: A SYSTEMATIC REVIEW

Abstract

Focal hepatic lesions comprise a heterogeneous group of benign and malignant abnormalities with overlapping imaging appearances. Triple-phase computed tomography (TPCT) enables dynamic assessment of lesion vascularity across arterial, portal venous, and delayed phases, potentially improving lesion characterization. The objective of this systematic review was to evaluate the diagnostic performance of triple-phase CT in differentiating benign and malignant focal hepatic lesions. This systematic review was conducted according to PRISMA principles. A total of 366 records were identified, and 11 eligible studies published between 2017 and 2026 were included in the qualitative synthesis. Data were extracted on study design, population, lesion type, CT characteristics, reference standards, and diagnostic performance. Methodological quality was assessed using QUADAS-2. Triple-phase CT demonstrated generally favorable diagnostic performance for focal hepatic lesion characterization. Hepatocellular carcinoma commonly showed arterial hyperenhancement followed by portal venous or delayed washout, whereas hemangiomas typically demonstrated progressive centripetal enhancement. Metastatic lesions were frequently hypovascular or showed peripheral enhancement. Delayed-phase behaviour, lesion morphology, size, and vascular invasion provided additional discriminatory information. However, diagnostic performance varied because of differences in study populations, lesion distributions, imaging protocols, and reference standards. Triple-phase CT provides clinically useful non-invasive differentiation of benign and malignant focal hepatic lesions. Combined interpretation of all contrast phases improves characterization, although standardized prospective multicentre studies are required to strengthen the evidence.