GI Radiology > Liver > Masses > Hemangioma


Hepatic Masses

Hemangioma

  1. Pathogenesis:
  • Seen in 7% of adults.
     
  • Hemangioma is a benign proliferation of vascular tissue, lined with endothelium, which has slow hepatic arterial blood flow. Two types: capillary or cavernous. The former is more common.
     
  • Uncommon in cirrhosis. Usually asymptomatic.
     
  • Occurs in the right lobe.
     
  • Can easily be confused with metastases or hepatoma.
     
  • The most common cause of a hyperechoic liver mass on U/S.
     
  • Large hemangioma may appear heterogeneous. There may be thrombosis, or a central stellate scar with a giant hemangioma.
  1. Radiographic findings:
  • U/S: Hyperechoic and well defined.

  • Noncontrast CT: Low attenuation (dark).
     
  • Contrast CT: Focal nodular enhancement. 80% of hemangiomas have centripetal opacification pattern on delayed CT: the periphery of the lesion enhances during the arterial phase, the center fills in (arrows) during the equilibrium phase or early delayed phase. In large hemangioma, the central scar may not enhance due to necrosis.

      

       

  • T1-weighted MRI: Hypointense to liver (arrows). If gadolinium-diethylenetriamine penta-acetic acid (Gd-DTPA) is used, peripheral enhancement is seen initially with central enhancement within 15-30 mins. Enhancement is persistent.
  • T2-weighted MRI: Hyperintense to the liver (just like a cyst; arrows). Looks as bright as a light bulb! Intensity is as high as that of pure fluid (CSF or bile).
  • Gradient Echo: Low signal intensity in MPGRE (looks completely black).
     
  • Nuclear medicine: Lesion fills in on RBC scan (arrows). Useful for diagnosing hemangiomas > 2 cm in diameter.

 

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