Novel and Specific MRI Features Indicate the Clinical Features of Patients With Rare Hepatic Tumor Epithelioid Hemangioendothelioma

Abstract

ObjectiveTo investigate the MRI features and clinical significance of hepatic epithelioid hemangioendothelioma (HEHE).MethodsClinical records and MRI findings were retrospectively evaluated in nine HEHE patients from May 2010 to January 2020.ResultThere were 121 lesions in nine patients with a predominantly peripheral distribution. Five lesions (4.13%) in two patients (22.22%) had evidence of capsular retraction, and three patients had lung metastasis (33.33%). Dynamic contrast-enhanced MRI showed progressive enhancement, mainly in two ways: ring enhancement with hypovascularity in four patients (44.44%) and ring enhancement with hypervascularity in five patients (55.56%). Imaging demonstrated a multilayer ring appearance, which was typically observed on T2-weighted imaging (T2WI). The most common appearance consisted of two layers of varying signal, with some images displaying up to four layers. There were significant differences in the size of lesions between different layers of multilayer ring appearance (p < 0.001). All lesions exhibited a two-layer appearance on diffusion-weighted imaging (DWI), with hyperintensity at the periphery and a slightly high signal at the center (except for those with a single layer on T2WI). The “vascular penetration sign” was observed in most lesions, and the blood vessels of 112 lesions (92.56%) were portal vein branches, and five (4.13%) were hepatic vein branches. Pulmonary metastasis was found in three patients with the “vascular penetration sign” of hepatic vein branches.ConclusionThe multilayer ring appearance on T2WI, the “vascular penetration sign”, and the two enhancement patterns may be of great significance in the diagnosis and treatment of HEHE. The “vascular penetration sign” of hepatic vein branches may indicate extrahepatic metastasis.

Specific imaging features indicate the clinical features of patients with hepatic perivascular epithelioid cell tumor by comparative analysis of CT and ultrasound imaging

“…These were called “slow outs.” Among all patients, no washout was observed in all lesions within the first 60 s; in four patients, the washout started at 60–180 s (36.36%), and in another four (36.36%); it started at 180–300 s. The remaining three patients showed no signs of washout even at 360 s (27.27%) ( Table 3 ). Therefore, on CEUS, all lesions showed an enhancement pattern of “fast in and slow out” (FISO), which was consistent with the pathological features reported in the literature ( 11 ); that is, these imaging features were more suggestive of expansile growth and benign lesions ( 12 , 13 ). These results were significantly different from CECT ( p = 0.008) ( Table 4 ).…”

Sirolimus combined with interferon-alpha 2b therapy for giant hepatic epithelioid hemangioendothelioma: a case report

“…Usually, the tumor was detected occasionally with no symptom. The characteristic MRI appearances of HEH have been reported, such as coalescent lesion, subcapsular lesion, capsular retraction, lollipop sign and target sign (5,16,17). We have concluded the MRI appearances of 57 HEH patients and the results showed that capsular retraction and lollipop sign were specific features of HEH, which could be used for differential diagnosis (5).…”

ACG Clinical Guideline: Focal Liver Lesions

“…Enhancement can vary and present as mild homogeneous enhancement seen on all phases or thin ring-like enhancement in the arterial phase, with progressive enhancement in the portal venous phase (171) (Figure 9). The characteristic imaging sign is the “lollipop” sign, which is due to tumor spread along the portal and hepatic vein branches and sinusoids, resulting in vascular and sinusoidal narrowing and obstruction (172). As a result, there is tapering of the portal and hepatic vein branches as they approach the lesion.…”