Introduction:
1. Metastatic disease to the liver is a very common clinical situation in oncology.
2. Primary hepatoma is one of most lead death of malignancy per year in recent 10 years in Taiwan.

Purpose:
Liver tumors are frequency detected by routine daily image study in patients with known extrahepatic tumors. We use ultrasound, computed-tomography and clinical data (including viral hepatic markers and tumor markers) for improvement of differential diagnosis of liver tumors.

Patients and methods:
1. We analysis the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ultrasound or computed- tomography scan only of metastatic liver tumor under histology report and add the tumor markers .

Results:
1. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ultrasound and d computed- tomography detected metastatic liver tumors were 0.994, 0.525, 0.949, 0.913 and 0.947, and 0.992, 0.611, 0.965, 0.88 and 0.960, respectively and after added clinical data, The datas were 0.997, 0.944, 0.995, 0.971, and 0.993, respectively.

Discussions:
1. With advanced image improvement, the detection of metastatic liver tumors has high sensitivity rate. But Taiwan is endemic area of primary hepatocellular carcinoma. The diagnosis rate of hepatoma is low in patients with primary extrahepatic tumors.
2. We analysis clinical data with combination of ultrasound and CT scan can much improvement detective rate of primary hepatoma.

Conclusions:
In spite of primary extrahepatic tumor, the liver tumors must be diagnosed by radiologic images and clinical data which include viral hepatic markers and tumor markers. And that will be improved the differential diagnosis between metastatic hepatic tumor and primary hepatoma.