Radiology Lectures | Radquarters

Hepatic Hemangioma: Pitfalls & Mimics, Part I

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In this video lecture, we discuss tips and tricks to diagnose everybody’s favorite hepatic tumor on CT, MRI and ultrasound.

Key points include:

  • Hemangioma is the most common benign hepatic tumor, and it is more common in females.
  • These tumors are usually asymptomatic and typically require no treatment, but can rarely cause pain, rupture if large, or cause Kasabach-Merritt syndrome.
  • On nonenhanced CT, hemangiomas will be hypodense to liver parenchyma and homogeneously isodense to the blood pool.
  • There are three major enhancement patterns for typical hemangiomas, and all patterns will show persistent delayed enhancement without contrast washout.
  • Peripheral, nodular, interrupted enhancement with gradual centripetal progression to uniform enhancement is the most common pattern.
  • Smaller lesions (less than 1-2 cm) can have immediate uniform enhancement and appear flash-filling.
  • Larger hemangiomas may have a central scar that does not enhance.
  • MRI is highly specific in the diagnosis of hemangioma.
  • On MRI, hemangiomas will appear T1 hypointense and T2 hyperintense to liver parenchyma, or (perhaps more importantly) T1 isointense to the blood pool and T2 hyperintense to the spleen.
  • Hemangiomas usually do not show restricted diffusion.
  • If present, the central scar of hemangioma will appear T1 hypointense and T2 hyperintense on MRI.
  • Additional liver masses that may have a central scar include focal nodular hyperplasia, fibrolamellar hepatocellular carcinoma, cholangiocarcinoma, and hepatocellular carcinoma.
  • On ultrasound, hemangiomas are usually uniformly echogenic.
  • 40% of hemangiomas can have a “reverse target” appearance with an echogenic periphery and hypoechoic center.
  • Hemangiomas usually have no color Doppler flow on ultrasound, but they may occasionally exhibit mild flow.

    • The post Hepatic Hemangioma: Pitfalls & Mimics, Part I appeared first on Radquarters.

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    Radiology Lectures | RadquartersBy Daniel J. Kowal, MD
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