MRI of Peliosis Hepatis: A Case Series Presentation With a 2022 Systematic Literature Update

Abstract

BackgroundPeliosis hepatis (PH) is a rare benign condition, characterized by hepatic sinusoidal dilatation and blood‐filled cystic cavities, often found incidentally, with still challenging diagnosis by imaging due to polymorphic appearance.PurposeBased on a retrospective analysis of our series (12 patients) and systematic literature review (1990–2022), to organize data about PH and identify features to improve characterization.Study TypeRetrospective case series and systematic review.PopulationTwelve patients (mean age 48 years, 55% female) with pathology‐proven PH and 49 patients (mean age 52 years, 67% female) identified in 33 studies from the literature (1990–2022).Field Strength/Sequence1,5‐T; T1‐weighted (T1W), T2‐weighted (T2W), diffusion‐weighted (DW), contrast‐enhanced (CE) T1W imaging.AssessmentWe compared our series and literature data in terms of demographic (gender/age/ethnicity), clinical characteristics (symptoms/physical examination/liver test), associated conditions (malignancies/infectious/hematologic/genetic or chronic disorders/drugs or toxic exposure) percentage. On magnetic resonance imaging lesion numbers/shape/mean maximum diameter/location/mass effect/signal intensity were compared. PH pathological type/proposed imaging diagnosis/patient follow‐up were also considered.Statistical TestsJoanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports/Series quality assessment. Intraclass correlation and Cohen's kappa coefficients for levels of inter/intrareader agreement in our experience.ResultsPatients were mainly asymptomatic (92% vs. 70% in our study and literature) with associated conditions (83% vs. 80%). Lesions showed homogeneous T1W‐hypointensity (58% vs. 65%) and T2W‐hyperintensity (58% vs. 66%). Heterogeneous nonspecific (25% vs. 51%), centrifugal (34% vs. 8%), or rim‐like centripetal (25% vs. 23%) patterns of enhancement were most frequent, with hypointensity on the hepatobiliary phase (HBP), without restricted diffusivity. Good inter‐ and intrareader agreement was observed in our experience. Concerning JBI Checklist, 19 out of 31 case reports met at least 7 out of 8 criteria, whereas 2 case series fulfilled 5 and 6 out of 10 items respectively.Data ConclusionA homogeneous, not well‐demarcated T1W‐hypointense and T2W‐hyperintense mass, with heterogeneous nonspecific or rim‐like centripetal or centrifugal pattern of enhancement, and hypointensity on HBP, may be helpful for PH diagnosis. Among associated conditions, malignancies and drug exposures were the most frequent.Level of Evidence4Technical EfficacyStage 2

Longitudinal CT, MRI, and 18F-FDG PET/CT Imaging Findings of Peliosis Hepatis: A Case Report

“…PH is a rare vascular condition characterized by focal or diffuse blood-filled cavities within the liver parenchyma. The cysts are lined by endothelial cells in the phlebectatic subtype while they lack an endothelial lining in the parenchymal subtype, and the cystic spaces can vary in size from 1 mm to several centimeters [ 3 , 5 ]. Definitive diagnosis requires a liver biopsy showing the characteristic histological features.…”

“…PH is frequently associated with conditions including various kinds of drugs (e.g., anabolic steroids, corticosteroids, immunosuppressants, selective estrogen receptor modulators, and androgen), hematological malignancies, and chronic infections (e.g., tuberculosis, human immunodeficiency virus) [ 2 ]. According to a systematic review study of 49 patients with PH, the most frequently associated condition was drug-induced PH (35%) [ 3 ]. In the present case, raloxifene hydrochloride (a selective estrogen receptor modulator) was considered a causative drug for PH, because selective estrogen receptor modulators have been known to trigger PH through sinusoidal epithelial damage, glutathione depletion, idiosyncratic reactions to metabolites, estrogenic effects, or post-sinusoidal obstruction [ 1 ].…”

“…The condition is not well-recognized among clinicians, and its imaging findings can be diverse, making diagnosis challenging. Consequently, it is frequently misdiagnosed as liver metastases, primary liver tumors, or abscesses [ 2 , 3 ]. Correct diagnosis of PH by imaging is important for appropriate management [ 1 ].…”

“…The percentage was cited from Calistri et al[3]. CT, computed tomography; MRI, magnetic resonance imaging; 18F-FDG PET, 18F-fluorodeoxyglucose positron emission tomography…”

Editorial for “MRI of Peliosis Hepatis: A Case Series Presentation With a 2022 Systematic Literature Update”

“…5 A comprehensive retrospective work by Calistri et al aims to organize the existing PH data and identify its spectrum of characteristic clinical and radiologic features in attempt to improve prospective diagnosis at imaging. 6 With this goal in mind, the authors performed a systematic literature review of MR features of PH as well as described their own experience with 12 new pathology-proven MRI cases.…”