CT and MR Imaging Features of Pathologically Proven Atypical Giant  Hemangiomas of the Liver

Coumbaras, M.; Wendum, Dominique; Monnier‐Cholley, Laurence; Dahan, H.; Tubiana, Jean-Michel; Arrivé, Lionel

doi:10.2214/ajr.179.6.1791457

Cited by 44 publications

(17 citation statements)

References 6 publications

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“…46 In a series of 25 consecutive patients who underwent surgery for giant hemangiomas, CT and MR images were reviewed retrospectively and revealed similar results in accordance with our findings. 47 Although hemangiomas can occur at any age, most of them grow very slowly and are rarely diagnosed during childhood. We observed 2 patients with more than 50% growth in 1 year.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasound of histologically proven liver hemangiomas

et al. 2007

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Differentiation of small and atypical hemangiomas from other hepatic masses using imaging methods can be difficult, especially in patients with underlying malignant disease. Therefore, contrast-enhanced ultrasound was assessed in patients with histologically confirmed hemangiomas with respect to contrast-enhancing kinetics and tumor characteristics. In 58 patients with indeterminate hepatic lesions demonstrated with at least 2 imaging methods (ultrasound/computed tomography/magnetic resonance imaging), ultrasound-guided liver biopsy revealed hemangioma. In all patients a hepatic neoplasm had been suspected because of underlying malignant disease (n ‫؍‬ 41), liver cirrhosis (n ‫؍‬ 15), or growth of the lesion (n ‫؍‬ 2). All patients underwent nonlinear, low mechanical index real-time contrast-enhanced ultrasound scanning with bolus injections of SonoVue. Peripheral nodular arterial enhancement was detected in 43 patients (74%), whereas the typical metastatic peripheral rim-like enhancement was not observed at all. Strong homogenous arterial enhancement was found in 9 of 58 (16%) patients. In 6 patients (10%), the arterial contrast enhancement pattern could not be determined because of the very small size of the lesions or fibrotic nodules. Forty-five (78%) of the hemangiomas showed homogenous centripetal filling within 180 seconds. Conclusion: Contrast-enhanced ultrasound demonstrates typical hemangioma imaging characteristics, that is, peripheral nodular contrast enhancement and iris-diaphragm sign in a high percentage of patients with undetermined lesions. This technique may therefore improve noninvasive functional characterization and differentiation of hemangiomas. (HEPATOLOGY 2007;45:1139-1145

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Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasound of histologically proven liver hemangiomas

et al. 2007

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“…CT and magnetic resonance imaging point out to the correct diagnosis by showing an enhancing rim with globular vessels and centripetal filling, with sparing of the large central lacunar areas [26] . Hepatocellular carcinoma and cholangiocarcinoma may occasionally present as a large hypodense and multiseptated mass at CT scan, simulating a cystic lesion or a biliary cyst tumor.…”

Section: A B Cmentioning

confidence: 98%

Cystic tumors of the liver: A practical approach

Poggio¹,

Buonocore²

2008

WJG

113

110

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Biliary cyst tumors (cystadenoma and cystadenocarcinoma) are an indication for liver resection. They account for only 5% of all solitary cystic lesions of the liver, but differential diagnosis with multiloculated or complicated biliary cysts, atypical hemangiomas, hamartomas and lymphangiomas may be difficult. The most frequent challenge is to differentiate biliary cyst tumors from hemorrhagic cysts. Computerized tomography (CT) and magnetic resonance imaging (MRI) are often not diagnostic and in these cases fine needle aspiration (FNA) is used to confirm the presence of atypical biliary cells. FNA, however, lacks adequate sensitivity and specificity and should always be used in conjunction with imaging. Pre-operative differentiation o f c y s t a d e n o m a f r o m c y s t a d e n o c a r c i n o m a i s impossible and surgery must be performed if a biliary cyst tumor is suspected. When multiple cystic lesions are observed throughout the liver parenchyma, it is important to exclude liver metastasis, of which colonic cancer is the most common primary site. Multiple biliary hamartomas (von Meyenburg complex) can appear as a mixture of solid and cystic lesions and can be confused with cystic metastasis. Strong and uniform T2 hyperintensity on MRI is usually diagnostic, but occasionally a percutaneous biopsy may be required.

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“…US exams using contrast produce mild side effects in a small number of patients (17,19) . The diagnostic concordance between contrast US and magnetic resonance MR is over 90% in the diagnosis of hepatic hemangiomas (4) . In spite of numerous studies, the true value of contrast ultrasound has not yet been clearly defined in our milieu.The aim of this study was to evaluate the concordance between contrast ultrasound and magnetic resonance MR in the diagnosis of hepatic hemangiomas.…”

Section: Introductionmentioning

confidence: 96%

“…This method has low specificity in the differential diagnosis of hepatic nodules, while colored Doppler does not detect vascularization in the majority of hepatic hemangiomas (11) . Computerized tomography (CT) and magnetic resonance (MR) are the imaging methods used to diagnose hepatic hemangiomas, both of which entail the use of contrast agents (2,4,7) . Contrasts for use in ultrasonography have been undergoing development since 1968 and the latest contrasts, considered second generation, are used in more than 60 countries (15,16) .…”

Section: Introductionmentioning

confidence: 99%

Prospective study of ultrasound with perflutrene contrast compared to magnetic resonance imaging in the diagnosis of hepatic hemangiomas

Schmillevitch

Szutan²,

Ferreira³

et al. 2011

Arq. Gastroenterol.

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-Context -The incidence of hepatic hemangiomas ranges from 0.4% to 20% in the general population. Conventional ultrasound is usually the first diagnostic method to identify these hemangiomas, typically as an incidental finding. Ultrasonography with second generation contrast materials is being used in various areas of hepatology, yielding similar results to those obtained with computerized tomography and magnetic resonance imaging in the diagnosis of hepatic hemangiomas. Objective -To evaluate the agreement between ultrasound with perflutrene contrast and magnetic resonance imaging in the diagnosis of hepatic hemangiomas.Methods -A total of 37 patients were prospectively examined between January 2006 and August 2008. A total of 57 hepatic nodules were documented in this group as incidental findings on routine ultrasound exams. The 37 patients were administered perflutrene contrast without adverse reactions, and were all submitted to magnetic resonance exams. Results -Conventional ultrasound identified 15 patients with nodules typical of hemangiomas and 22 patients with other nodules. In 35 patients, the contrast characteristics were consistent with hepatic hemangiomas. Conclusion -Agreement between the data obtained from ultrasound with contrast and magnetic resonance was 94.5%. In discordant cases, the magnetic resonance diagnosis prevailed. In the case which presented indeterminate findings on contrast ultrasonography, magnetic resonance was repeated after 3 months, confirming the diagnosis of a hepatic hemangioma. A biopsy was performed on the suspected malignant nodule which also confirmed the presence of a hepatic hemangioma. Ultrasonography with contrast has the advantages of being more accessible to the public at large and lower cost than magnetic resonance. The results of our study highlight the need for a new protocol in hepatic nodules incidentally identified on conventional ultrasonography. In the case of typical hemangiomas, conventional ultrasound is sufficient for diagnosis. However, for poorly defined nodules, ultrasonography with contrast is indicated. After confirming the presence of a hepatic hemangioma on contrast ultrasonography, no further exams are needed to finalize the diagnosis.

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CT and MR Imaging Features of Pathologically Proven Atypical Giant Hemangiomas of the Liver

Cited by 44 publications

References 6 publications

Contrast-enhanced ultrasound of histologically proven liver hemangiomas

Contrast-enhanced ultrasound of histologically proven liver hemangiomas

Cystic tumors of the liver: A practical approach

Prospective study of ultrasound with perflutrene contrast compared to magnetic resonance imaging in the diagnosis of hepatic hemangiomas

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