Cavernous hemangioma of the liver: pathologic correlation with dynamic CT findings.

Yamashita, Yasuyuki; Ogata, Ichiro; Urata, Joji; Takahashi, Manabu

doi:10.1148/radiology.203.1.9122378

Cited by 142 publications

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“…This result differed from that on enhanced CT. 27,30 It is well known that hemangiomas show various types of enhancement in contrast-enhanced CT and MR imaging, and the possible correlation of the dynamic enhancement pattern of hepatic hemangiomas with the collective size of its constituent vascular spaces has been reported. [31][32][33] The vascular spaces of hemangiomas with diffuse enhancement are relatively small compared to those without diffuse enhancement. 33 Hanafusa's group 4 reported the isoattenuation compared to the surrounding liver parenchyma of approximately half the number of hemangiomas with diffuse enhancement during the portal venous phase on dynamic CT, a pattern also known as high flow hemangioma.…”

Section: Discussionmentioning

confidence: 99%

“…[31][32][33] The vascular spaces of hemangiomas with diffuse enhancement are relatively small compared to those without diffuse enhancement. 33 Hanafusa's group 4 reported the isoattenuation compared to the surrounding liver parenchyma of approximately half the number of hemangiomas with diffuse enhancement during the portal venous phase on dynamic CT, a pattern also known as high flow hemangioma. Doo and colleagues 17 have reported that hemangiomas with diffuse enhancement during the arterial phase show the pseudo washout sign on Gd-EOB-DTPA-enhanced MR imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Yamashita's group 33 have reported that hemangiomas with diffuse enhancement or peripheral nodular enhancement during the arterial phase have smaller vascular spaces than hemangiomas with fill-in enhancement during the portal venous phase. In the present study, we observed no statistically significant differences in the frequency of peripheral nodular enhancement or fill-in enhancement between hemangiomas with and without PWS.…”

Section: Discussionmentioning

confidence: 99%

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Hepatic Hemangiomas: Factors Associated with Pseudo Washout Sign on Gd-EOB-DTPA-enhanced MR Imaging

et al. 2016

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Purpose: Our study aim was to clarify the characteristics of hemangiomas with pseudo washout sign (PWS) by comparing their features with those of hemangiomas without PWS on gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging.Methods: We evaluated the features of hemangiomas on Gd-EOB-DTPA-enhanced MR imaging of 70 hepatic hemangiomas in 31 patients, investigating the presence of peripheral or central nodular enhancement, diffuse enhancement, and arterioportal shunt during the arterial phase, fill-in enhancement during the portal venous phase, and PWS, which is low signal intensity during the late phase. We visually assessed the intensity of contrast enhancement of the lesion during the arterial, portal venous, late, and hepatobiliary phases using a 4-grade scale and used the Fisher exact and Mann-Whitney U tests to compare hemangiomas with and without PWS.Results: We observed PWS in 33 (47%) of 70 hemangiomas, which were significantly smaller than the hemangiomas without PWS (17.4 mm « 20.3 versus 30.1 mm « 28.5; P = 0.005); more frequent diffuse enhancement in hemangiomas with PWS than those without (21.2% versus 2.7%; P = 0.026); and no significant differences in nodular enhancement (P = 0.231), arterioportal shunt (P = 0.403), or fill-in enhancement (P = 0.357) between hemangiomas with and without PWS. Visually determined grades of tumor contrast enhancement were significantly lower in hemangiomas with PWS during the portal venous (P = 0.007) and late (P < 0.001) phases.Conclusions: Small hemangiomas tend to decrease in signal intensity during the portal venous phase and show PWS during the late phase.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hepatic Hemangiomas: Factors Associated with Pseudo Washout Sign on Gd-EOB-DTPA-enhanced MR Imaging

et al. 2016

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“…43 Therefore, hemangiomas should be included in the differential diagnoses of small hypoattenuating lesions as well as hypervascular lesions. CEUS, which has the advantage of real-time dynamic assessment, could be of help in characterizing such lesions.…”

Section: Discussionmentioning

confidence: 99%

Contrast‐enhanced ultrasound of histologically proven liver hemangiomas†

et al. 2007

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Differentiation of small and atypical hemangiomas from other hepatic masses using imaging methods can be difficult, especially in patients with underlying malignant disease. Therefore, contrast-enhanced ultrasound was assessed in patients with histologically confirmed hemangiomas with respect to contrast-enhancing kinetics and tumor characteristics. In 58 patients with indeterminate hepatic lesions demonstrated with at least 2 imaging methods (ultrasound/computed tomography/magnetic resonance imaging), ultrasound-guided liver biopsy revealed hemangioma. In all patients a hepatic neoplasm had been suspected because of underlying malignant disease (n ‫؍‬ 41), liver cirrhosis (n ‫؍‬ 15), or growth of the lesion (n ‫؍‬ 2). All patients underwent nonlinear, low mechanical index real-time contrast-enhanced ultrasound scanning with bolus injections of SonoVue. Peripheral nodular arterial enhancement was detected in 43 patients (74%), whereas the typical metastatic peripheral rim-like enhancement was not observed at all. Strong homogenous arterial enhancement was found in 9 of 58 (16%) patients. In 6 patients (10%), the arterial contrast enhancement pattern could not be determined because of the very small size of the lesions or fibrotic nodules. Forty-five (78%) of the hemangiomas showed homogenous centripetal filling within 180 seconds. Conclusion: Contrast-enhanced ultrasound demonstrates typical hemangioma imaging characteristics, that is, peripheral nodular contrast enhancement and iris-diaphragm sign in a high percentage of patients with undetermined lesions. This technique may therefore improve noninvasive functional characterization and differentiation of hemangiomas. (HEPATOLOGY 2007;45:1139-1145

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“…It is composed of dilated vascular spaces lined by a single layer of endothelial cells and separated by connective tissue stroma (6,7). A definite diagnosis could be made by demonstrating the typical US, CT, and MRI findings (1).…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Multiple Cavernous Hemangiomas with Fluid-Fluid Levels: A Focus on the Radiologic Features of Dynamic MRI with Subtraction

Lee

Kim

Lee

et al. 2011

J Korean Soc Radiol

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The radiologic features of hemangiomas are well established. The diagnostic features on contrast enhanced computed tomography (CT) or magnetic resonance imaging (MRI) include peripheral globular and gradual centripetal enhancement. In most cases, hemangiomas do not require a pathological examination. However, some hemangiomas show atypical radiologic features, such as poor gradual enhancement on sclerosing or hyalinized hemangioma and a fluid-fluid level within a hemangioma (1). The radiologic diagnosis of hemangioma with a fluid-fluid level remains problematic because the typical enhancement pattern of hemangioma is not found on CT and a fluid-fluid level can be reported in various hepatic lesions from malignant to benign tumors (2, 3). Recently, the gadolinium-enhanced dynamic MRI with subtraction has been introduced as a highly sensitive method in the depiction of a vascular pattern and subtle enhancement of focal hepatic lesions (4, 5). To the best of our knowledge, there has been no report about the imaging feature of dynamic MRI with subtraction in a hemangioma with a fluid-fluid level. Herein, multiple cavernous hemangiomas with fluidfluid levels in a patient are presented. Case ReportA 40-year-old man was referred for hepatic nodules detected on a routine health checkup. The man had no specific medical history or laboratory findings. Ultrasound (US) revealed three well-defined echogenic nodules in the right lobe of his liver (Fig. 1A). Their diameters were less than 2 cm (range; 0.9-2 cm). On multiphase enhanced CT, these nodules showed nonspecific subtle enhancement in three phases and subtle single layered attenuation difference between the inferior and superior layer. The inferior layer of all nodules showed higher attenuation than that of the superior layer ( Multiple cavernous hemangiomas with fluid-fluid levels were presented in a 40-year-old male patient. These hemangiomas showed nonspecific radiologic features on ultrasound and computed tomography, but gadolinium-enhanced magnetic resonance imaging (MRI) with subtraction revealed fluid-fluid levels with unique and different enhancement of the inferior and superior layer. This is the first case report of cavernous hemangiomas with fluid-fluid levels, containing radiologic features of dynamic MRI with subtraction.

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Cavernous hemangioma of the liver: pathologic correlation with dynamic CT findings.

Abstract: Dynamic enhancement patterns of cavernous hemangiomas are related to the collective size of their constituent vascular spaces.

Cited by 142 publications

References 0 publications

Hepatic Hemangiomas: Factors Associated with Pseudo Washout Sign on Gd-EOB-DTPA-enhanced MR Imaging

Hepatic Hemangiomas: Factors Associated with Pseudo Washout Sign on Gd-EOB-DTPA-enhanced MR Imaging

Contrast‐enhanced ultrasound of histologically proven liver hemangiomas†

A Case Report of Multiple Cavernous Hemangiomas with Fluid-Fluid Levels: A Focus on the Radiologic Features of Dynamic MRI with Subtraction

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