Hepatic Hemangioma: Atypical Appearances on CT, MR Imaging, and Sonography
Hyun-Jung Jang1,2,
Tae Kyoung Kim3,
Hyo Keun Lim4,
Sang Jae Park2,
Jung Suk Sim1,
Hyae Young Kim1 and
Joo-Hyuk Lee1
1 Radiation Medicine Branch, Research Institute, National Cancer Center, 809
Madu 1-dong, Ilsan-gu, Goyang-si, Gyeonggi-do, 411-764, Korea.
2 Center for Liver Cancer, National Cancer Center Hospital, National Cancer
Center, Gyeonggi-do, 411-764, Korea.
3 Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan
College of Medicine, 388-1, Poongnap-dong, Songpa-gu, Seoul, 138-736,
Korea.
4 Department of Radiology and Gastrointestinal Center, Sungkyunkwan University
School of Medicine, Samsung Medical Center, 50 Ilwon-dong, Kangnam-gu, Seoul,
135-710, Korea.
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Fig. 1A. —Hypoattenuating hemangioma with "bright-dot" sign
in 62-year-old woman with rectal carcinoma. Contrast-enhanced CT scan obtained
during portal venous phase shows small hypoattenuating mass with tiny
enhancing dots (arrows).
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Fig. 1B. —Hypoattenuating hemangioma with "bright-dot" sign
in 62-year-old woman with rectal carcinoma. T2-weighted MR image (TR/TE,
3800/138) shows mass (arrows) with typical bright signal
intensity.
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Fig. 1C. —Hypoattenuating hemangioma with "bright-dot" sign
in 62-year-old woman with rectal carcinoma. Dynamic gadolinium-enhanced
T1-weighted MR images obtained 1 min (C) and 5 min (D) after
initiation of contrast agent administration show very slow enhancement
(arrows), a finding that is known to be rare in small
hemangiomas.
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Fig. 1D. —Hypoattenuating hemangioma with "bright-dot" sign
in 62-year-old woman with rectal carcinoma. Dynamic gadolinium-enhanced
T1-weighted MR images obtained 1 min (C) and 5 min (D) after
initiation of contrast agent administration show very slow enhancement
(arrows), a finding that is known to be rare in small
hemangiomas.
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Fig. 2A. —Hemangioma in 56-year-old man with gastric carcinoma.
Preoperative CT scan obtained during portal venous phase shows small
hypoattenuating hepatic lesion (arrow) with no discernible area of
enhancement.
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Fig. 2B. —Hemangioma in 56-year-old man with gastric carcinoma.
Longitudinal scans of left hepatic lobe on contrast-enhanced gray-scale
harmonic sonograms obtained 1 min (B) and 3 min (C) after
initiation of contrast agent administration show typical nodular enhancement
with progressive fill-in pattern in mass (arrows), diagnostic of
hemangioma. CR = cranial aspect, CAUD = caudal aspect.
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Fig. 2C. —Hemangioma in 56-year-old man with gastric carcinoma.
Longitudinal scans of left hepatic lobe on contrast-enhanced gray-scale
harmonic sonograms obtained 1 min (B) and 3 min (C) after
initiation of contrast agent administration show typical nodular enhancement
with progressive fill-in pattern in mass (arrows), diagnostic of
hemangioma. CR = cranial aspect, CAUD = caudal aspect.
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Fig. 3A. —Hemangioma in 59-year-old man with gastric carcinoma.
T2-weighted MR image (TR/TE, 3800/138) shows small nodule (long
arrow) with unusually lower signal intensity than that of cerebrospinal
fluid (short arrows).
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Fig. 3B. —Hemangioma in 59-year-old man with gastric carcinoma. Dynamic
gadolinium-enhanced T1-weighted MR image obtained 30 sec after initiation of
contrast agent administration shows rapid, uniform enhancement
(arrow). Intraoperative biopsy of hepatic lesion during gastric
surgery revealed cavernous hemangioma.
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Fig. 4A. —Sclerosing hemangioma proven by sonography-guided core biopsy
in 47-year-old woman. T2-weighted MR image (TR/TE, infinite/134) shows mass
(long arrow) with hypointensity relative to cerebrospinal fluid
(short arrows).
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Fig. 5. —Hemangioma in 41-year-old woman. Contrast-enhanced CT scan
obtained during portal venous phase shows ovoid mass (arrow)
isoattenuating relative to hepatic vessels, which is apt to be overlooked
without scrutiny. Diagnosis was verified by typical homogeneous
hyperechogenicity and absence of new growth on follow-up sonography (not
shown) after 17 months.
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Fig. 4B. —Sclerosing hemangioma proven by sonography-guided core biopsy
in 47-year-old woman. Contrast-enhanced CT scan obtained during portal venous
phase shows fuzzy area of enhancement within mass hypoattenuating relative to
hepatic vessels (arrow), which is unusual for hemangioma.
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Fig. 6. —Hemangioma in 59-year-old man with gastric carcinoma.
Preoperative CT scan obtained during single portal venous phase shows small
nodule with area of enhancement (thick arrow) hypoattenuating to
aorta (a) and to portal vein (thin arrow). Diagnosis was verified by
typical findings on MR imaging and absence of new growth on 1-year follow-up
CT scan (not shown).
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Fig. 7A. —Multiple angiosarcomas in 48-year-old man with no
predisposing factor. Dynamic gadolinium-enhanced T1-weighted MR images
obtained 45 sec (A) and 3 min (B) after initiation of contrast
agent administration show multiple masses (arrows, B) with
progressive fill-in pattern. Also visible is globular enhancement
(arrows, A), as seen in typical hemangioma.
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Fig. 7B. —Multiple angiosarcomas in 48-year-old man with no
predisposing factor. Dynamic gadolinium-enhanced T1-weighted MR images
obtained 45 sec (A) and 3 min (B) after initiation of contrast
agent administration show multiple masses (arrows, B) with
progressive fill-in pattern. Also visible is globular enhancement
(arrows, A), as seen in typical hemangioma.
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Fig. 7C. —Multiple angiosarcomas in 48-year-old man with no
predisposing factor. T2-weighted MR image (TR/TE, infinite/134) shows masses
(arrows) with bright but slightly heterogeneous signal intensity,
which is unusual for hemangioma. Ascites (asterisks) is visible in
perihepatic and perisplenic spaces.
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Fig. 8A. —Rapidly enhancing hemangioma with arterioportal shunt in
43-year-old woman. Contrast-enhanced CT scan obtained during hepatic arterial
phase shows mass (large arrow) with strong homogeneous enhancement.
Also seen are hypoattenuating lesions (small arrows), proven to be
other hemangiomas.
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Fig. 8B. —Rapidly enhancing hemangioma with arterioportal shunt in
43-year-old woman. Contrast-enhanced CT scan obtained during hepatic arterial
phase at level next caudal to A shows wedge-shaped faint enhancement
(arrows) with early draining portal branch (arrowheads)
accompanying mass seen in A.
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Fig. 9A. —Rapidly enhancing hemangioma with arterioportal shunt in
58-year-old man. Dynamic gadolinium-enhanced T1-weighted MR image obtained 30
sec after initiation of contrast agent administration shows two masses
(black arrows) with nearly complete fill-in pattern of enhancement.
Also visible is wedge-shaped faint peritumoral enhancement (white
arrows) that became isoattenuating relative to normal parenchyma on later
phases (not shown).
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Fig. 9B. —Rapidly enhancing hemangioma with arterioportal shunt in
58-year-old man. T2-weighted MR image (TR/TE, infinite/134) shows bright
signal intensity of masses (arrows), typical for hemangioma.
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Fig. 10A. —Metastasis from breast carcinoma in 37-year-old woman with
severe fatty liver. Contrast-enhanced CT scan obtained 3 min after initiation
of contrast agent administration shows mass (arrow) mimicking
prolonged homogeneous enhancement of hemangioma. Hepatic arterial and portal
venous phase images (not shown) also revealed homogeneous
hyperattenuation.
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Fig. 10B. —Metastasis from breast carcinoma in 37-year-old woman with
severe fatty liver. Unenhanced CT scan shows relative hyperattenuation
(arrow) because of background fatty liver.
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Fig. 11A. —Hemangioma with hypoechoic halo in 37-year-old man with
background fatty liver. Longitudinal sonogram shows hypoechoic mass with
darker halo (arrows).
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Fig. 11B. —Hemangioma with hypoechoic halo in 37-year-old man with
background fatty liver. Opposed-phase T1-weighted MR image shows hyperintense
rim representing focal spared zone (arrows) around mass.
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Fig. 11C. —Hemangioma with hypoechoic halo in 37-year-old man with
background fatty liver. Dynamic gadolinium-enhanced T1-weighted MR image
obtained 90 sec after initiation of contrast agent administration shows
typical peripheral globular enhancement (arrows) that can lead to
confident diagnosis of hemangioma.
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Fig. 12A. —Hemangioma in 59-year-old man with cirrhosis and known
hepatocellular carcinoma in right lobe (not shown). Contrast-enhanced CT scan
obtained during portal venous phase shows nodule (arrows) with subtle
hypoattenuation.
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Fig. 12B. —Hemangioma in 59-year-old man with cirrhosis and known
hepatocellular carcinoma in right lobe (not shown). Intraoperative sonogram
shows hyperechoic nodule (arrows), which cannot exclude possibility
of hepatocellular carcinoma. Surgical resection revealed cavernous
hemangioma.
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Fig. 12C. —Hemangioma in 59-year-old man with cirrhosis and known
hepatocellular carcinoma in right lobe (not shown). Photomicrograph of
surgical specimen shows large noncommunicating vascular spaces (v) and
abundant fibrosis (f), which may be responsible for lack of enhancement. (H
and E, x 200)
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Fig. 13A. —Early hepatocellular carcinoma in 51-year-old man. Patient
had another known hepatocellular carcinoma (not shown) in lower part of right
lobe and underlying cirrhosis. Sonogram shows homogeneous hyperechoic nodule
(arrows), indistinguishable from typical hemangioma.
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Fig. 13B. —Early hepatocellular carcinoma in 51-year-old man. Patient
had another known hepatocellular carcinoma (not shown) in lower part of right
lobe and underlying cirrhosis. Photomicrograph of surgical specimen reveals
early hepatocellular carcinoma with extensive fatty infiltration (clear
spaces). (H and E, x 40)
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Copyright © 2003 by the American Roentgen Ray Society.
