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

Abstract

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.

Performance of Gd‑EOB‑DTPA‑enhanced MRI for the diagnosis of LI‑RADS 4 category hepatocellular carcinoma nodules with different diameters

“…The typical enhancement pattern for hemangioma is delayed phase enhancement on extracellular contrast agent based-enhanced imaging (32). However, previous studies report that a 'pseudo washoutʼ sign can be observed in hemangioma during the transitional phase using Gd-EOB-DTPA as the contrast agent, probably owing to the excellent liver to lesion contrast when compared to extracellular contrast agent (33,34). In the present study, 'pseudo washoutʼ sign is also observed in some cases.…”

FLAIR in Gd-EOB-DTPA Enhanced MRI: Does It Make a Difference?

“…an increased cost, 2) increased examination time with the addition of the hepatobiliary phase which may be 10 minutes to hours after contrast agent administration, 3) the characteristics of the late phase images are different compared to non-hepatobiliary specific agents [27] [28].…”

“…The differentiation of hemangiomas and metastasis is sometimes difficult [6] [28] [30]. When using Gd-EOB-DTPA as a contrast agent, the late phase is different compared to non-hepatobiliary specific contrast agents, because the contrast agent is taken in by hepatocytes, and may become a pitfall [28]. Although not statistically significant, an increase for the sensitivity of metastasis and hemangiomas was seen for both readers A and B with the addition of FLAIR.…”

Evaluation of Primary Liver Cancers Using Hepatocyte‐Specific Contrast‐Enhanced MRI: Pitfalls and Potential Tips

“…Flash‐filling hemangioma may show APHE and pseudo‐washout in HSCM‐enhanced MRI 104,105 . In general, as hemangiomas show a bright T 2 signal, and no washout on MRI with ECCM, it may not be difficult to differentiate them from HCC.…”

“…Flash-filling hemangioma may show APHE and pseudo-washout in HSCM-enhanced MRI. 104,105 In general, as hemangiomas show a bright T 2 signal, and no washout on MRI with ECCM, it may not be difficult to differentiate them from HCC. However, on HSCMenhanced MRI, some hemangiomas may appear hypointense because of the contrast uptake of the background liver in TP, called "pseudo-washout".…”