Atypical Hepatic Hemangiomas with Multiple Calcifications Mimicking Hepatic Metastases: Case Report

Although hepatic hemangioma is the most common benign tumor of the liver, it is rarely associated with calcifications. We report on the case of an asymptomatic 58-year-old man in whom multiple hepatic masses containing calcifications were discovered incidentally at ultrasonography. The radiologic features mimicked those of multiple hepatic metastases.

Hepatic Hemangiomas: Spectrum of US Appearances on Gray-scale, Power Doppler, and Contrast-Enhanced US

Because US plays a key role in the initial evaluation of hepatic hemangiomas,knowledge of the entire spectrum of US appearances of these tumors is impor-tant. Most hemangiomas have a distinctive US appearance, and even with those with atypical appearances on conventional gray-scale US, specific diagnoses can be made using pulse-inversion harmonic US with contrast agents. In this essay,we review the spectrum of US appearances of hepatic hemangiomas on conven-tional gray-scale, power Doppler, and pulse-inversion harmonic US with contrast agents.

Wedge-shaped Parenc hymal Enhancement Peripheral to the Hepatic Hemangioma: Two-phase Spiral CT Findings

PURPOSE: To determine the incidence of hepatic hemangiomas associated with wedge-shaped parenchymal enhancements adjacent to the tumors as seen on two-phase spiral CT images obtained during the hepatic arterial phase and to characterize the two-phase spiral CT findings of those hemangiomas. MATERIALS AND METHODS: One hundred and eight consecutive hepatic hemangiomas in 63 patients who underwent two-phase spiral CT scanning during an 11-month period were included in this study. Two-phase spiral CT scans were obtained during the hepatic arterial phase(30-second delay) and portal venous phase(65-second delay) after injection of 120mL of contrast material at a rate of 3mL/sec. We evaluated the frequency with which wedge-shaped parenchymal enhancement was adjacent to the hemangiomas during the hepatic arterial phase and divided hemangiomas into two groups according to whether or not wedge-shaped parenchymal enhancement was noted (Group A and Group B). The presence of such enhancement in hemangiomas was cor-related with tumor size and the grade of intratumoral enhancement. RESULTS: In 24 of 108 hemangiomas, wedge-shaped parenchymal enhancement adjacent to hepatic tumors was seen on two-phase CT images obtained during the hepatic arterial phase. Mean hemangioma size was 22mm in Group A and 24mm in Group B. There was no statistically significant relationship between lesion size and the presence of wedge-shaped parenchymal enhancement adjacent to a hemangioma. In 91.7% and 1 00% of tumors in Group A, and in 9.6% and 17.8% in Group B, hemangiomas showed more than 50% intra-tumoral enhancement during the arterial and portal venous phase, respectively. Wedge-shaped parenchymal enhancements peripheral to hepatic hemangiomas was more frequently found in tumors showing more than 50% intratumoral enhancement during these two phases(p<0.01). CONCLUSION: Wedge-shaped parenchymal enhancements is not uncommonly seen adjacent to hepatic heman-giomas on two-phase spiral CT images obtained during the hepatic arterial phase. A hemangioma showing-wedge-shaped parenchymal enhancement tends to show more than 50% intratumoral enhancements during the arterial and portal venous phase.

CT Findings of Increased Attenuation of the Liver Adjacent to the Hemangioma

PURPOSE: The purpose of this study was to evaluate the frequency, location, and appearance of increasedattenuation of the liver adjacent to a mass during arterial-phase spiral CT in patients with hemangioma. Thecharacteristics of the mass associated with these findings were also evaluated. MATERIALS AND METHODS: Usingspiral CT, 153 lesions in 114 hepatic hemangioma patients were retrospectively reviewed. We evaluated thefrequency, location, and appearance of increased hepatic attenuation adjacent to the hemangioma, and determinedwhether lesion size varied according to whether or not there was increased hepatic attenuation. RESULTS: Areas ofincreased hepatic attenuation adjacent to the hemangioma were identified in 10.5% of cas-es(16/153) and seen inmasses which showed a homogeneously hyperdense (11/16, 69%) or peripherally hy-perdense pattern (5/16, 31%). Thelocation of increased hepatic attenuation was commonly the peripheral por-tion (9/16, 56%), and increased hepaticattenuation was frequently wedge shaped of the mass (11/16, 69%). Lesion size did not vary according to whether ornot there was increased hepatic attenuation. CONCLUSION: Increased hepatic attenuation adjacent to a hemangiomais not rare, and is usually located periph-eral to the mass. It is common in a mass showing a homogeneouslyhyperdense pattern.

Difference of Contrast Enhancement Characteristics of Hepatic Hemangiomas According to the Lesion Size onTwo-Phase Spiral CT

PURPOSE: To determine the different of enhancement patterns of hepatic hemangioma according to the lesionsize, using dual-phase spiral CT. MATERIALS AND METHODS: Fify-nine lesions in 45 patients with hepatichemangiomas were subjected to spiral Ct. According to size, the lesions were divided into two groups(_2.5cm : n=25). The enhancement patterns of the lesions were classified as one of four types (homogeneoushyperdense, peripheral hyperdense, central hyperdense, or hypodense) during the early phase, and as one of fivetypes homogeneous hyperdense, peripheral hyperdense, central hyperdense, hypodense or isodense) during the delayedphase. We evaluated differences in enhancement patterns during the early and delayed phase according to lesionsize. RESULTS: During the early phase, the enhancement patterns of lesions large than 2.5cm were peripheralhyperdense(96%) or homogeneous hyperdense (4%);those of less than 2.5cm were peripheral hyperdense (53%),homogeneous hyperdense(26%), hypodense(18%), or central hyperdense(3%). Thus, hemangiomas in these two groupsusually showed a peripheral enhancement pattern during the early phase, but in those which were smaller than2.5cm, atypical enhancement patterns were more common. During the delayed phase, the enhancement patterns oflesions larger than 2.5cm were peripheral hyperdense (60%) or homogenous hyperdense (40%), while the patterns ofthose smaller than 2.5cm were homogeneous hyperdense (67%), peripheral hyperdense (24%), central hyperdense (3%),hypodense (3%), or isodense (3%). Thus, the enhancement patterns of lesions larger than 2.5cm were usuallyperipherally hyperdense during the delayed phase, while those smaller than 2.5cm showed a homogeneous enhancementpattern. CONCLUSION: The enhancement patterns of hepatic hemangiomas differ according to lesion size. A knowledgeof these differences is helpful in the diagnosis of hepatic hemangioma.

Marked Enlargement and Post-Op Recurrence of Hepatic Hemangiomas: Two Cases Report

Hepatic hemangiomas are the most common benign tumor of the liver, and follow-up radiologic imaging studieshave normally shown no interval change in the diameter of the tumor. Among the very few tumors in which suchchange have been seen, growth has been minimal. However, we experienced some marked enlargement of the tumorfollow-up imaging studies. First, the marked enlargement of the tumor followed by resection, and as a result,hepatic hemangioma was confirmed. Second, hepatic hemangioma was confirmed after resection, but recurred. Tumorenlargement seems to be caused by ectasia of blood-filled cystic space or estrogen stimulation, through we foundno specific etiology.

Liver Hmangioma: Comparison of Echogenecity and Contrast-enhancement on Dynamic MRI

PURPOSE: To evaluate the differences in sonographic appearance and hemodynamics between hypoechoic andhyperechoic hemangioma. MATERIAL AND METHOD: We retrospectively reviewed the sonographic appearance and MRIfindings of 23 hypoechoic hepatic hemangiomas in 16 consecutive patients. Nine were men and seven were women, witha mean age of 50 years(range, 40-72). We analyzed the sonographic appearance such as size, shape, border,echogenecity, posterior acoustic enhancement and the presence of fatty liver, and MRI findings such as signalintensity, enhancement pattern. For comparison, we also reviewed the sonographic appearance and MRI findings of 23hyperechoic hemangiomas in 16 randomly selected patients. RESULTS: There were no differences in size, shape,incidence of posterior acoustic enhancement, MR signal intensity or enhancement pattern between hypoechoic andhyperechoic hemangiomas(p>0.05, Chi-square). However, fatty infiltration of the liver and echogenic rim of themasses were more commonly seen in hypoechoic hemangiomas(9:1, 5:0, respectively, p<0.05). CONCLUSIONS: There wereno differences in MR enhomcement pattern or incidence of posterior acoustic enhancement between hypoechoichyperechoic hemangioma. The vascularity of a mass therefore seems to contribute little to its echogenecity.

Pitfalls of Tc-99m RBC SPECT in Diagnosis of Hepatic Hemangioma: Correlation with Enhancing Pattern on Two-phase Dynamic CT

PURPOSE: To elucidate the pitfalls of Tc-99m RBC liver SPECT in the diagnosis of hepatic hemangioma, and to compare this modality with two-phase dynmic CT. MATERIALS AND METHODS: Forty patients with 48 liver masses, suspected on ultrasonography to be hemangiomas, underwent two-phase dynamic CT scanning and SPECT within a two week period. All masses were diagnosed through pathologic and follow up radiologic studies. The final diagnoses were hemangioma (n=42), metastasis (n=2), abscess (n=2), hepatocellular carcinoma (n=1), and cholangiocarcinoma (n=1). Sensitivities and specificities of CT and Spect for the diagnosis of hemangioma and the relationship between false positives or false negatives seen on SPECT and the Pattern of contrast enhancement seen on CT were investigated. RESULTS: The sensitivities of CT and SPECT for the diagnosis of hemangioma were 95.2 (40/42) and 76.2% (32/42), respectively. The false-negative rate of SPECT was significantly higher in the early enhancing (54.5%, 6/11) than in the late enhancing type (13.8%, 4/29) and in the 'less than 1cm' group, false-negatives (70%, 7/10) were more common than in the 'more than 1cm' group (9.4%, 3/32). for the two lesions with false-positive findings on SPECT, the final diagnosis was metastasis, and two false-negative lesion, seen on CT, were misread as metastases. Four other lesions were negative in both studies. CONCLUSION: For the detection of hepatic hemangioma, two-phase dynamic CT is a better modality than SPECT. False positives on SPECT occurred in metastasis, and false negatives are more common in the small lesion and early enhancing group than in the late enhancing group. Between the two groups, there is a difference in hemodynamics, and considerable further pathological investigation is needed.

The Significance of Echogenic Rim of Atypical Hepatic Hemangioma on Ultrasonogram

PURPOSE: To evaluate whether the presence of a peripheral echogenic rim surrounding internal low echogenicityis helpful in the diagnosis of atypical hepatic hemangioma. MATERIALS AND METHODS: Within a two-year period, aretrospective review of the sonographic appearances of 24 atypical hemangiomas in 21 patients was performed. Diagnosis was made by dynamic and delayed enhanced CT, MR imaging or clinical follow up for one year, including follow-up sonogram. The sonographic appearances of these hemangiomas were analyzed for pattern and thickness ofthe echogenic rim, internal echo pattern, shape, and size. Additionally, forty six lesions of hepatoma, metastasis, abscess and intrahepatic cholangiocarcinoma confirmed by pathology within the same period were also evaluated for the presence of echogenic rim. RESULTS: Twenty-three of 24 lesions showed an echogenic rim ; these were thick in nine cases, and thin in 14 cases. The thickness of the rim was either uniform(n=10) or eccentric(n=13). The average maximum diameter of atypical hemangioma was 4.4cm (range of diameters, 1.5-12cm). The internal echo pattern was partially or entirely hypoechoic in 15 lesions, homogeneously isoechoic in three, and mixed insix cases. Twenty-one lesions were round, and the shape of three was irregular. The other forty six masses including hepatocellular carcinoma, metastases, cholangiocarcinoma and hepatic abscesses did not show an echogenicrim. CONCLUSIONS: The presence of a sonographic echogenic rim in a hepatic mass may help in the diagnosis ofhepatic hemangioma.