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1
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Aslan S, Onder RO, Sulun E, Taşdemir MN. Evaluation of qualitative and quantitative imaging features of hepatic hemangiomas with and without pseudo-washout sign on gadoxetic acid-enhanced MRI: a descriptive and comparative study. Acta Radiol 2024; 65:23-32. [PMID: 37264586 DOI: 10.1177/02841851231177399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Hepatic hemangiomas are the most common benign liver tumors. It is important to know the imaging features of hemangiomas on gadoxetic acid (GA)-enhanced magnetic resonance imaging (MRI). PURPOSE To evaluate the qualitative and quantitative imaging features of hemangiomas on GA-enhanced MRI, and to compare imaging features of hemangiomas with and without pseudo-washout sign (PWS). MATERIAL AND METHODS We retrospectively included 93 cases of hemangioma that underwent GA-enhanced MRI. The presence of an enhancement pattern in the arterial phase (AP) and PWSs in the transitional phase (TP) were evaluated. Signal-to-norm ratios (SINorm) of hemangiomas, liver parenchyma, and portal vein (PV) as well as contrast-to-norm ratio (CNorm) were assessed. Additionally, hemangiomas with and without PWSs were defined as two separate subgroups, and imaging features were compared. RESULTS Of the 93 cases of hemangiomas, 49 (52.6%) had PWSs in the TP. The mean SINorms of hemangiomas showed the highest value in the AP (P < 0.05). The mean CNorms showed positive values in the AP, and gradually decreased (P < 0.05). Hemangiomas with PWSs were significantly rapidly enhanced and smaller in size (P < 0.05), and the mean SINorms was lower in the TP (P = 0.023). While the mean CNorms showed a significant difference in the AP between subgroups (P < 0.001), the enhancement pattern was equal to that of the PV. CONCLUSION When evaluating GA-enhanced MRI, radiologists should utilize quantitative measures in addition to qualitative assessment and should be aware that SI matching with PV in all phases can be a distinguishing finding in the diagnosis of hemangioma.
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Affiliation(s)
- Serdar Aslan
- Department of Radiology, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Ramazan Orkun Onder
- Department of Radiology, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Emrah Sulun
- Department of Radiology, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Merve Nur Taşdemir
- Department of Radiology, Giresun University Faculty of Medicine, Giresun, Turkey
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2
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Focal Benign Liver Lesions and Their Diagnostic Pitfalls. Radiol Clin North Am 2022; 60:755-773. [DOI: 10.1016/j.rcl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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3
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Dane B, Shanbhogue K, Menias CO, Taffel MT. The humbling hemangioma: uncommon CT and MRI imaging features and mimickers of hepatic hemangiomas. Clin Imaging 2021; 74:55-63. [PMID: 33434867 DOI: 10.1016/j.clinimag.2020.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/12/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
Cavernous hemangiomas are among the most common liver lesions encountered in abdominal imaging. While classical imaging characteristics usually aid the radiologist in confidently arriving at its diagnosis, atypical hemangiomas can prove to be difficult to distinguish from other more worrisome hepatic lesions such as metastases and hepatocellular carcinoma. Furthermore, some malignant lesions can display features that simulate hemangiomas. The radiologist must be aware of these pitfalls to make an accurate diagnosis, when possible.
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Affiliation(s)
- Bari Dane
- NYU Langone Health, Department of Radiology, United States of America.
| | | | - Christine O Menias
- Mayo Clinic, Department of Radiology, Scottsdale, AZ, United States of America
| | - Myles T Taffel
- NYU Langone Health, Department of Radiology, United States of America
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4
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Gunter D, Riaz S, Haider EA, Rebello R, Patlas MN, Alabousi A. Hepatic perfusional changes on CT and MRI: a radiology primer. Abdom Radiol (NY) 2021; 46:179-196. [PMID: 33047227 DOI: 10.1007/s00261-020-02787-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/16/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Abstract
Hepatic perfusional changes are common in response to, or as a result of, a multitude of pathological processes. These can be neoplastic, inflammatory, fibrotic, or ischemic in origin, to name a few. The liver, having a dual blood supply, is a unique organ to study using contrast-enhanced CT and MRI imaging due to its varied appearance on multiphasic imaging. Knowledge of the CT and MRI appearance of hepatic perfusional changes, in addition to the clinical presentation, can often result in an accurate differential diagnosis. Many of the conditions that cause these changes in hepatic blood flow result in similar appearances on imaging. As a result, it is important that radiologists be aware of common pitfalls when dealing with hepatic perfusional changes to prevent misdiagnosis or delayed diagnosis. As such, this review will focus on some of the various causes of hepatic perfusional changes and how to accurately identify and diagnose them based on their CT and MRI appearance.
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Affiliation(s)
- Dane Gunter
- University College Cork, School of Medicine, Cork, Ireland
| | - Shaista Riaz
- Department of Radiology, McGill University, Montreal, QC, Canada
| | - Ehsan A Haider
- Department of Radiology, McMaster University, St Joseph's Healthcare, Hamilton, ON, L8N 4A6, Canada
| | - Ryan Rebello
- Department of Radiology, McMaster University, St Joseph's Healthcare, Hamilton, ON, L8N 4A6, Canada
| | - Michael N Patlas
- Department of Radiology, McMaster University, Hamilton General Hospital, Hamilton, ON, Canada
| | - Abdullah Alabousi
- Department of Radiology, McMaster University, St Joseph's Healthcare, Hamilton, ON, L8N 4A6, Canada.
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Renzulli M, Brocchi S, Ierardi AM, Milandri M, Pettinari I, Lucidi V, Balacchi C, Muratori P, Marasco G, Vara G, Tovoli F, Granito A, Carrafiello G, Piscaglia F, Golfieri R. Imaging-based diagnosis of benign lesions and pseudolesions in the cirrhotic liver. Magn Reson Imaging 2021; 75:9-20. [PMID: 32926993 DOI: 10.1016/j.mri.2020.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023]
Abstract
Liver cirrhosis is a leading cause of death worldwide, with 1-year mortality rates of up to 57% in decompensated patients. Hepatocellular carcinoma (HCC) is the most common primary tumor in cirrhotic livers and the second leading cause of cancer-related mortality worldwide. Annually, up to 8% of patients with cirrhosis develop HCC. The diagnosis of HCC rarely requires histological confirmation: in fact, according to the most recent guidelines, the imaging features of HCC are almost always sufficient for a certain diagnosis. Thus, the role of the radiologist is pivotal because the accurate detection and characterization of focal liver lesions in patients with cirrhosis are essential in improving clinical outcomes. Despite recent technical innovations in liver imaging, several issues remain for radiologists regarding the differentiation of HCC from other hepatic lesions, particularly benign lesions and pseudolesions. It is important to avoid misdiagnosis of benign liver lesions as HCC (false-positive cases) because this diagnostic misinterpretation may lead to ineligibility of a patient for potentially curative treatments or inappropriate assignment of high priority scores to patients on waiting lists for liver transplantation. This review presents a pocket guide that could be useful for the radiologist in the diagnosis of benign lesions and pseudolesions in cirrhotic livers, highlighting the imaging features that help in making the correct diagnosis of macroregenerative nodules; siderotic nodules; arterioportal shunts; hemangiomas, including fast-filling hemangiomas, hemangiomas with pseudowashout, and sclerosed hemangiomas; confluent fibrosis; pseudomasses in chronic portal vein thrombosis; and focal fatty changes.
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Affiliation(s)
- Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.
| | - Stefano Brocchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Anna Maria Ierardi
- Unit of Radiology, IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Milandri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Irene Pettinari
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Vincenzo Lucidi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Caterina Balacchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Paolo Muratori
- Department of the Science for the quality of life (QUVI), University of Bologna, Bologna, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giulio Vara
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Francesco Tovoli
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Granito
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Fabio Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
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6
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Kim JH, Joo I, Lee JM. Atypical Appearance of Hepatocellular Carcinoma and Its Mimickers: How to Solve Challenging Cases Using Gadoxetic Acid-Enhanced Liver Magnetic Resonance Imaging. Korean J Radiol 2020; 20:1019-1041. [PMID: 31270973 PMCID: PMC6609440 DOI: 10.3348/kjr.2018.0636] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/17/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) can be diagnosed noninvasively with contrast-enhanced dynamic computed tomography, magnetic resonance imaging, or ultrasonography on the basis of its hallmark imaging features of arterial phase hyperenhancement and washout on portal or delayed phase images. However, approximately 40% of HCCs show atypical imaging features, posing a significant diagnostic challenge for radiologists. Another challenge for radiologists in clinical practice is the presentation of many HCC mimickers such as intrahepatic cholangiocarcinoma, combined HCC-cholangiocarcinoma, arterioportal shunt, and hemangioma in the cirrhotic liver. The differentiation of HCCs from these mimickers on preoperative imaging studies is of critical importance. Hence, we will review the typical and atypical imaging features of HCCs and the imaging features of its common mimickers. In addition, we will discuss how to solve these challenges in practice.
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Affiliation(s)
- Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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7
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Makamure J, Zhao D, Liu Y, Wang Y, Zheng C, Liang B. Hepatic hemangioma with arterioportal shunt: Prevalence and lesion characteristics based on DSA, CT and MR imaging. Eur J Radiol 2019; 121:108715. [PMID: 31677545 DOI: 10.1016/j.ejrad.2019.108715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 09/09/2019] [Accepted: 10/12/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the prevalence and lesion characteristics of hepatic hemangioma (HH) with arterioportal shunt (APS) based on digital subtraction angiography (DSA), computed tomography (CT) and magnetic resonance (MR) imaging. METHOD Ninety-eight consecutive patients with 189 HHs who underwent DSA, CT and/or MR imaging of the liver between January 2014 and December 2017 were included. The diagnosis of APS was established by DSA. APS was categorized as peripheral and central shunt based on imaging findings. The incidence and appearance of APS on DSA were compared with those on CT/MR images. Eleven possible lesion characteristics associated with APS were compared between HHs with and those without APS. Multiple logistic regression modeling was used to identify the independent lesion characteristics associated with APS. RESULTS APS was diagnosed in 103 (103/189, 54.5%) HHs on DSA, of which 96 lesions appeared as peripheral APS and 7 appeared as central. In contrast, APS was detected only in 57 HHs (57/103, 55.34%) on CT/MR imaging, of which 50 (50/96, 52.08%) appeared as peripheral APS while 7 (7/7, 100%) appeared as central. Lesion size (P < .001), enhancement rapidity (P = .031), and vascularization degree (P < .001) were found to be significant independent imaging characteristics associated with APS. CONCLUSIONS APS can occur in HH with high frequency. DSA was superior to CT/MR imaging in detection of APS, particularly for the peripheral APS. Lesion size, enhancement rapidity and vascularization degree were associated with the presence of APS.
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Affiliation(s)
- Joyman Makamure
- Department of Radiology, Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China
| | - Dan Zhao
- Department of Radiology, Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China
| | - Yiming Liu
- Department of Radiology, Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China
| | - Yong Wang
- Department of Radiology, Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China
| | - Chuansheng Zheng
- Department of Radiology, Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China
| | - Bin Liang
- Department of Radiology, Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China.
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8
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Cao QY, Zou ZM, Wang Q, He CN, Zou Q, Wang B. MRI manifestations of hepatic perfusion disorders. Exp Ther Med 2018; 15:5199-5204. [PMID: 29805544 PMCID: PMC5958701 DOI: 10.3892/etm.2018.6090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/06/2017] [Indexed: 12/25/2022] Open
Abstract
The present study aimed to analyze the magnetic resonance imaging (MRI) results from patients with hepatic perfusion disorders (HPD) and liver diseases, in order to assess the pathogenetic mechanisms. This was completed byanalyzing the causes of HPD in 35 patients to assess if they were associated with arterioportal shunt, and classify the patients according to results from the MRI scans. Of the 35 patients, 26 (74.3%) with HPD presented with hepatocellular carcinoma, a major cause of HPD. The HPD phenomenon in 35 patients was not identified as obvious abnormal lesions on T2WI and T1WI according to the isointensity on diffusion weighted images. Enhanced scanning showed hyperintense signals on the arterial phase images, isointense or hyperintense signals on portal phase and delayed phase images. According to their MRI findings, hepatic perfusion disorders may be divided into different types, as follows: Diffuse, lobe or segment type, wedge type and platy. The HPD phenomenon may herald an underlying abnormality of liver disease and MRI may accurately diagnose HPDs in liver diseases.
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Affiliation(s)
- Qing-Yong Cao
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Zhi-Meng Zou
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Qi Wang
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Chun-Ni He
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Qing Zou
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Bin Wang
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China.,Medical Imaging Center, Binzhou Medical University, Yantai, Shandong 264100, P.R. China
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9
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Kim B, Byun J, Lee J, Park B, Kwon HJ, Lee J, Lee S, Won H, Shin Y, Kim P. Imaging findings of primary hepatic angiosarcoma on gadoxetate disodium-enhanced liver MRI: comparison with hepatic haemangiomas of similar size. Clin Radiol 2018; 73:244-253. [DOI: 10.1016/j.crad.2017.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/19/2017] [Accepted: 09/29/2017] [Indexed: 12/18/2022]
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10
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Sousa MSC, Ramalho M, Herédia V, Matos AP, Palas J, Jeon YH, Afonso D, Semelka RC. Perilesional enhancement of liver cavernous hemangiomas in magnetic resonance imaging. ACTA ACUST UNITED AC 2016; 39:722-30. [PMID: 24531350 DOI: 10.1007/s00261-014-0100-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate on magnetic resonance imaging (MRI) the occurrence rate of temporal perilesional parenchymal enhancement (PPE) associated with hepatic hemangiomas in a large consecutive series and to determine which aspects are associated with this observation. MATERIALS AND METHODS Institutional review board approved this retrospective study. A computerized search of the MRI database was performed for consecutive patients between January 2008 and January 2012. The study population included 513 liver hemangiomas in 224 patients (104 males and 120 females; mean age of 55.2 ± 13.5 years; age range 24-89 years). Two readers independently reviewed the frequency of PPE, size, speed of enhancement and location of each hemangioma. Marginal models with generalized estimating equation were used. Wald test was applied to verify if the model coefficients were significant. RESULTS 80/513 (15.6%) hemangiomas showed PPE. The incidence of PPE was significantly higher (p < 0.05) in hemangiomas with Type1 speed of enhancement (51/80, 63.8%) than in those with Type2 or Type3. 66/80 (82.5%) hemangiomas with PPE were subcapsular (p < 0.05). Conversely, the majority (280/433, 64.7%) of hemangiomas without PPE were deep in location (p < 0.001). Lesser proportion of hemangiomas with PPE was located in segment IVa (p < 0.05). CONCLUSION PPE is not uncommonly seen along with hepatic hemangiomas. This appearance is most frequently observed in rapidly enhancing small lesions with a subcapsular location.
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Affiliation(s)
- Marta S C Sousa
- Department of Radiology, Hospital Garcia de Orta, 2801-951, Almada, Portugal
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11
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Kim TK, Lee E, Jang HJ. Imaging findings of mimickers of hepatocellular carcinoma. Clin Mol Hepatol 2015; 21:326-43. [PMID: 26770920 PMCID: PMC4712159 DOI: 10.3350/cmh.2015.21.4.326] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 08/15/2015] [Indexed: 12/27/2022] Open
Abstract
Radiological imaging plays a crucial role in the diagnosis of hepatocellular carcinoma (HCC) as the noninvasive diagnosis of HCC in high-risk patients by typical imaging findings alone is widely adopted in major practice guidelines for HCC. While imaging techniques have markedly improved in detecting small liver lesions, they often detect incidental benign liver lesions and non-hepatocellular malignancy that can be misdiagnosed as HCC. The most common mimicker of HCC in cirrhotic liver is nontumorous arterioportal shunts that are seen as focal hypervascular liver lesions on dynamic contrast-enhanced cross-sectional imaging. Rapidly enhancing hemangiomas can be easily misdiagnosed as HCC especially on MR imaging with liver-specific contrast agent. Focal inflammatory liver lesions mimic HCC by demonstrating arterial-phase hypervascularity and subsequent washout on dynamic contrast-enhanced imaging. It is important to recognize the suggestive imaging findings for intrahepatic cholangiocarcinoma (CC) as the management of CC is largely different from that of HCC. There are other benign mimickers of HCC such as angiomyolipomas and focal nodular hyperplasia-like nodules. Recognition of their typical imaging findings can reduce false-positive HCC diagnosis.
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Affiliation(s)
- Tae Kyoung Kim
- Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Eunchae Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun-Jung Jang
- Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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12
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Affiliation(s)
- Rafel Tappouni
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Michelle D Sakala
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC
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13
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Enhancement patterns and pseudo-washout of hepatic haemangiomas on gadoxetate disodium-enhanced liver MRI. Eur Radiol 2015; 26:191-8. [DOI: 10.1007/s00330-015-3798-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 04/04/2015] [Accepted: 04/13/2015] [Indexed: 12/18/2022]
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14
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Klotz T, Montoriol PF, Da Ines D, Petitcolin V, Joubert-Zakeyh J, Garcier JM. Hepatic haemangioma: common and uncommon imaging features. Diagn Interv Imaging 2013; 94:849-59. [PMID: 23796395 DOI: 10.1016/j.diii.2013.04.008] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The haemangioma, the most common non-cystic hepatic lesion, most often discovered by chance, may in certain situations raise diagnostic problems in imaging. In this article, the authors first demonstrate that the radiological appearance of the hepatic haemangioma, in its typical form, is closely related to three known histological sub-types. They then show that certain atypical features should be known in order to establish a diagnosis. They also observe the potential interactions between the haemangioma, an active vascular lesion, and the adjacent hepatic parenchyma. Finally, they discuss the specific paediatric features of hepatic haemangiomas and illustrate the case of a hepatic angiosarcoma.
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Affiliation(s)
- T Klotz
- CHU de Clermont-Ferrand, CHU Estaing, Service de Radiologie et Imagerie Médicale, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
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15
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Dietrich CF, Sharma M, Gibson RN, Schreiber-Dietrich D, Jenssen C. Fortuitously discovered liver lesions. World J Gastroenterol 2013; 19:3173-3188. [PMID: 23745019 PMCID: PMC3671069 DOI: 10.3748/wjg.v19.i21.3173] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/28/2013] [Indexed: 02/06/2023] Open
Abstract
The fortuitously discovered liver lesion is a common problem. Consensus might be expected in terms of its work-up, and yet there is none. This stems in part from the fact that there is no preventive campaign involving the early detection of liver tumors other than for patients with known liver cirrhosis and oncological patients. The work-up (detection and differential diagnosis) of liver tumors comprises theoretical considerations, history, physical examination, laboratory tests, standard ultrasound, Doppler ultrasound techniques, contrast-enhanced ultrasound (CEUS), computed tomography and magnetic resonance imaging, as well as image-guided biopsy. CEUS techniques have proved to be the most pertinent method; these techniques became part of the clinical routine about 10 years ago in Europe and Asia and are used for a variety of indications in daily clinical practice. CEUS is in many cases the first and also decisive technical intervention for detecting and characterizing liver tumors. This development is reflected in many CEUS guidelines, e.g., in the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines 2004, 2008 and 2012 as well as the recently published World Federation for Ultrasound in Medicine and Biology-EFSUMB guidelines 2012. This article sets out considerations for making a structured work-up of incidental liver tumors feasible.
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16
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Jang HJ, Khalili K, Yu H, Kim TK. Perfusion and parenchymal changes related to vascular alterations of the liver. ACTA ACUST UNITED AC 2012; 37:404-21. [PMID: 21667327 DOI: 10.1007/s00261-011-9767-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Imaging plays a significant role in the diagnosis of vascular abnormalities of the liver and sometimes provides the only clue to the correct diagnosis. With advances of imaging techniques and multiphasic acquisition of liver imaging, various perfusion changes are frequently encountered. Correct imaging diagnosis of significant vascular diseases can prompt appropriate work-up and timely management. Accurate differentiation of clinically insignificant perfusion phenomena from clinically significant findings including neoplastic conditions and in the setting of post-transplantation is essential. This pictorial essay illustrates various perfusion and parenchymal changes associated with portal venous inflow, hepatic venous outflow, and non-portal venous third inflow and describes brief background pathophysiology and differential points.
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Affiliation(s)
- Hyun-Jung Jang
- Department of Medical Imaging, Toronto General Hospital, University of Toronto, ON, Canada.
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Abstract
PURPOSE To describe fading hemangiomas [substantially lower attenuation (>30 HU) than vascular pool in the portal venous phase (PVP)] and to determine their incidence and characteristics on multiphasic CT. METHODS The study population composed of 168 hemangiomas (≥5 mm) in 114 consecutive patients which were imaged on multiphasic CT and also proved by diagnostic findings on MRI. The size of hemangiomas and CT attenuation number of the enhancing area within the hemangioma, liver parenchyma, and portal vein were measured on both arterial phase (AP) and PVP images. The rapidity of enhancement (slow, <50%; rapid, 50%-99%; flash-filler, 100% filling in the AP) and association with arterioportal shunting (APS) were also determined by two independent reviewers. Imaging features were compared between fading and non-fading hemangiomas using Kruskal-Wallis test. RESULTS Of 168 hemangiomas, the enhancing area of 27 hemangiomas (16%, 27/168) showed substantially lower attenuation than that of PV (fading) in the PVP. When the attenuation difference was compared with the rapidity of enhancement, flash-fillers showed lower attenuation than PV in the PVP more frequently than both slow-fillers (P < 0.05) and rapid-fillers (P < 0.05). The proportion of fading hemangiomas was 52% (14/27) in flash-fillers, much more frequent than in rapid-fillers (4/27, 15%) as well as slow-fillers (9/27, 33.3%). The size of fading hemangiomas (17.9 ± 4.5 mm) was significantly smaller than that of non-fading (24.2 ± 3.6 mm) (P = 0.032). Although APS was more frequent in fading hemangiomas (55.6%, 15/27) than that of non-fading hemangiomas (37.6%, 53/141), there was no statistically significant difference (P = 0.086). CONCLUSIONS Sixteen percentage (27/168) of the hemangiomas in our study showed substantially lower attenuation than the portal vein in the PVP CT and this was more frequent in flash-fillers (52%, 14/27). The knowledge that fading does not preclude the diagnosis of hemangioma as well as of its high incidence in flash-fillers is important, as flash-filling hemangiomas with fading may cause a diagnostic challenge in patients suspected to have hypervascular malignancy.
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Spectral CT in patients with small HCC: investigation of image quality and diagnostic accuracy. Eur Radiol 2012; 22:2117-24. [PMID: 22618521 DOI: 10.1007/s00330-012-2485-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 03/20/2012] [Accepted: 03/27/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess image quality and diagnostic accuracy of monochromatic imaging from spectral CT in patients with small HCC (≤3 cm). METHODS Twenty-seven patients with 31 HCC underwent spectral CT to generate conventional 140-kVp polychromatic images (group A) and monochromatic images with energy levels from 40 to 140 keV (group B) during the late arterial phase (LAP) and the portal venous phase (PVP). Two-sample t tests compared the tumour-to-liver contrast-to-noise ratio (CNR) and mean image noise. Lesion detection for LAP, reader confidence and readers' subjective evaluations of image quality were recorded. RESULTS Highest CNRs in group B were distributed at 40, 50 and 70 keV. Higher CNR values and lesion conspicuity scores (LCS) were obtained in group B than in group A (CNR 3.36 ± 2.07 vs. 1.47 ± 0.89 in LAP; 2.29 ± 2.26 vs. 1.58 ± 1.75 in PVP; LCS 2.82, 2.84, 2.63 and 2.53 at 40-70 keV, respectively, vs. 1.95) (P < 0.001). Lowest image noise for group B was at 70 keV, resulting in higher image quality than that in group A (4.70 vs. 4.07; P < 0.001). CONCLUSION Monochromatic energy levels of 40-70 keV can increase detectability in small HCC and this increase might not result in image quality degradation. KEY POINTS • Spectral computed tomography may help the detection of small hepatocellular carcinoma. • Monochromatic energy levels of 40-70 keV increase the sensitivity for detection. • Prospective study showed that monochromatic imaging provides greater diagnostic confidence. • Monochromatic energy level of 70 keV improves the overall image quality.
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Clinical significance of the transitional phase at gadoxetate disodium-enhanced hepatic MRI for the diagnosis of hepatocellular carcinoma: preliminary results. J Comput Assist Tomogr 2012; 35:723-7. [PMID: 22082543 DOI: 10.1097/rct.0b013e3182372c40] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate the clinical significance of the "transitional phase" at gadoxetate disodium (Gd-EOB)-enhanced magnetic resonance imaging for diagnosing hepatocellular carcinoma (HCC). METHODS We studied 54 patients with 70 histologically diagnosed HCC. Transitional- and hepatobiliary-phase (TP, HBP) images were acquired 3 and 20 minutes after Gd-EOB injection, respectively. Radiologists measured the size of the hepatic tumors on images and surgical specimens and qualitatively evaluated the signal intensity of the hepatic tumors during TP and HBP independently. RESULTS In 4 patients with portal tumor embolism who had undergone percutaneous transhepatic portal embolization and who manifested arterioportal (AP) shunts, the low-intensity area was larger during HBP than TP. Of the 70 HCCs, 4 were of high signal intensity during HBP and 2 were of slightly low intensity during TP. CONCLUSION Tumor extension seen during TP rather than HBP more accurately reflected histological findings in patients with HCC with portal tumor thrombi, percutaneous transhepatic portal embolization, or AP shunt.
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Tamada T, Ito K, Ueki A, Kanki A, Higaki A, Higashi H, Yamamoto A. Peripheral low intensity sign in hepatic hemangioma: diagnostic pitfall in hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI of the liver. J Magn Reson Imaging 2011; 35:852-8. [PMID: 22127980 DOI: 10.1002/jmri.23514] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 10/26/2011] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To describe the presence of "peripheral low intensity sign" in hepatic hemangioma in the hepatobiliary phase (HP) of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and to compare the frequency of this sign between hepatic hemangiomas and hepatic metastases. MATERIALS AND METHODS The Institutional Review Board approved this study and waived the requirement for informed consent. Sixty-four patients with 51 hepatic hemangiomas (n = 31 patients) and with 58 hepatic metastases (n = 33 patients) underwent Gd-EOB-DTPA-enhanced MRI. In all hepatic hemangiomas, 41 lesions were the typical type and 10 were the high flow type. HP images were qualitatively evaluated for the frequency of peripheral low intensity sign in hepatic hemangiomas and hepatic metastases using a four-point scale. Statistical evaluations were performed with a Mann-Whitney U-test. RESULTS Peripheral low intensity signs were demonstrated in 24 (47%) of 51 hepatic hemangiomas, while they were seen in 27 (47%) of 58 hepatic metastases. There was no significant difference in the mean visual score of peripheral low intensity sign between all hepatic hemangiomas (0.84 ± 1.03) and hepatic metastases (0.76 ± 0.92). The mean visual score of peripheral low intensity sign in typical hemangiomas (1.02 ± 1.06) was significantly higher than that in high flow hemangiomas (0.10 ± 0.32) (P = 0.008). CONCLUSION Peripheral low intensity sign is not specific for malignant tumors, and can be seen even in hepatic hemangiomas on HP of Gd-EOB-DTPA-enhanced MRI.
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Affiliation(s)
- Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan.
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Zhou X, Luo Y, Peng YL, Cai W, Lu Q, Lin L, Sha XX, Li YZ, Zhu M. Hepatic Perfusion Disorder Associated with Focal Liver Lesions: Contrast-enhanced US Patterns—Correlation Study with Contrast-enhanced CT. Radiology 2011; 260:274-281. [PMID: 21467250 DOI: 10.1148/radiol.11101454] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Hepatic hemangiomas: evaluation of enhancement patterns at dynamic MRI with gadoxetate disodium. AJR Am J Roentgenol 2011; 196:824-30. [PMID: 21427331 DOI: 10.2214/ajr.10.5113] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this retrospective study was to assess the enhancement patterns of hepatic hemangiomas on gadoxetate disodium. MATERIALS AND METHODS A total of 22 patients with 32 hepatic hemangiomas (23 typical type and nine high-flow type) in normal liver underwent gadoxetate disodium-enhanced MRI. Contrast-enhanced images were obtained before and after contrast injection, including arterial phase, portal phase, equilibrium phase, and three hepatobiliary phases (10, 15 and 20 minutes). Signal-to-phantom ratios of hemangiomas and the portal vein as well as lesion-to-liver contrast-to-phantom ratios were assessed. RESULTS Mean signal-to-phantom ratios of all 32 hemangiomas showed the highest value on the arterial phase and subsequently decreased over time (p = 0.029 to p < 0.001). Mean lesion-to-liver contrast-to-phantom ratios of all 32 hemangiomas showed a positive value during the arterial phase and increasingly negative values at later time points (p = 0.001 to p < 0.001). The enhancement pattern of hemangiomas was equal to that of the portal vein at all time points. There was no significant difference in signal-to-phantom ratio between typical hemangiomas and high-flow hemangiomas at any time point. CONCLUSION Most hepatic hemangiomas showed hypointensity relative to surrounding liver parenchyma during the equilibrium phase and the hepatobiliary phase. In addition, hepatic hemangiomas showed a signal intensity matching the portal vein at all phases, a finding we believe may be characteristic for hepatic hemangiomas on gadoxetate disodium-enhanced MR images.
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Lv P, Lin XZ, Li J, Li W, Chen K. Differentiation of small hepatic hemangioma from small hepatocellular carcinoma: recently introduced spectral CT method. Radiology 2011; 259:720-9. [PMID: 21357524 DOI: 10.1148/radiol.11101425] [Citation(s) in RCA: 174] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the usefulness of computed tomographic (CT) spectral imaging parameters in differentiating small (≤3 cm) hepatic hemangioma (HH) from small hepatocellular carcinoma (HCC), with or without cirrhosis, during the late arterial phase (AP) and portal venous phase (PVP). MATERIALS AND METHODS This prospective study was institutional review board approved, and written informed consent was obtained from all patients. The authors examined 49 patients (39 men, 10 women; 65 lesions) with CT spectral imaging during the AP and the PVP. Twenty-one patients had HH; nine, HCC with cirrhosis; and 19, HCC without cirrhosis. Iodine concentrations were derived from iodine-based material-decomposition CT images and normalized to the iodine concentration in the aorta. The difference in iodine concentration between the AP and PVP (ie, iodine concentration difference [ICD]) and the lesion-to-normal parenchyma ratio (LNR) were calculated. Two readers qualitatively assessed lesion types on the basis of conventional CT characteristics. Sensitivity and specificity were compared between the qualitative and quantitative studies. The two-sample t test was performed to compare quantitative parameters between HH and HCC. RESULTS Normalized iodine concentrations (NICs) and LNRs in patients with HH differed significantly from those in patients with HCC and cirrhosis and those in patients with HCC without cirrhosis: Mean NICs were 0.47 mg/mL ± 0.24 (standard deviation) versus 0.23 mg/mL ± 0.10 and 0.23 mg/mL ± 0.08, respectively, during the AP and 0.83 mg/mL ± 0.38 versus 0.47 mg/mL ± 0.86 and 0.52 mg/mL ± 0.11, respectively, during the PVP. Mean LNRs were 5.87 ± 3.36 versus 2.56 ± 1.10 and 2.29 ± 0.87, respectively, during the AP and 2.01 ± 1.33 versus 0.96 ± 0.16 and 0.93 ± 0.26, respectively, during the PVP. The mean ICD for the HH group (1.37 mg/mL ± 0.84) was significantly higher than the mean ICDs for the HCC-cirrhosis (0.33 mg/mL ± 0.29) (P < .001) and HCC-no cirrhosis (0.82 mg/mL ± 0.99) (P = .03) groups. The combination of NIC and LNR had higher sensitivity and specificity compared with those of conventional qualitative CT image analysis during individual and combined phases. CONCLUSION Use of spectral CT with fast tube voltage switching may increase the sensitivity for differentiating small hemangiomas from small HCCs in two-phase scanning.
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Affiliation(s)
- Peijie Lv
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Rd, Shanghai, China 200025
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Kim YH, Shin SS, Burke LMB, Lee CH, Ku YM, Vachiranubhap B, Semelka RC. Hemangioma hepático subcapsular com realce perilesional: achados de RM. Radiol Bras 2010. [DOI: 10.1590/s0100-39842010000600010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever os achados de imagem de RM no hemangioma hepático com realce perilesional. MATERIAIS E MÉTODOS: Realizou-se uma pesquisa no banco de dados da unidade de RM para identificar todos os casos de hemangioma hepático com realce perilesional entre março de 2008 e julho de 2009. Todos os pacientes foram submetidos a RM pré-contraste em imagens ponderadas em T1 e T2 e em imagens dinâmicas após injeção de gadolínio. Características do hemangioma e do realce perilesional foram avaliadas nas imagens de RM. RESULTADOS: Sete hemangiomas em sete pacientes (cinco homens, duas mulheres; faixa etária entre 41-69 anos; média de 57 anos) foram incluídos no presente estudo. O tamanho das lesões variou de 7 a 20 mm (média de 12,4 mm). Na fase dominante arterial hepática, todos os sete hemangiomas mostraram realce perilesional cuneiforme que se atenuou nas imagens dois minutos após injeção de gadolínio. Quatro dessas lesões demonstraram realce capsular adjacente. CONCLUSÃO: Todos os hemangiomas hepáticos com realce perilesional eram lesões capsulares medindo menos que 2 cm. Tal localização sugere que esses hemangiomas podem recrutar vasos capsulares responsáveis pelo realce perilesional
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Affiliation(s)
- Young Hoon Kim
- University of North Carolina, EUA; Seoul National University
| | - Sang Soo Shin
- University of North Carolina, EUA; Chonnam National University, Coreia do Sul
| | | | - Chang Hee Lee
- University of North Carolina, EUA; Korea University, Coreia do Sul
| | - Young Mi Ku
- University of North Carolina, EUA; Catholic University of Korea, Coreia do Sul
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Ibn Majdoub Hassani K, Mohsine R, Belkouchi A, Bensaid Y. Post-traumatic arteriovenous fistula of the hepatic pedicle. J Visc Surg 2010; 147:e333-6. [PMID: 20932817 DOI: 10.1016/j.jviscsurg.2010.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hepatico-portal fistula (HPF) is a rare condition, most often of post-traumatic or iatrogenic origin and occasionally secondary to a ruptured aneurysm of the hepatic artery into the portal vein. HPF in extrahepatic locations often results in portal hypertension (PHT). While Doppler ultrasound, CT angiography, and magnetic resonance angiography are usually demonstrative, arteriography remains indispensable to clarify the exact anatomical configuration. In the treatment of these arteriovenous (AV) fistulas, open surgical approaches have increasingly given way to radiological embolization techniques, especially in intrahepatic locations, but surgery remains indicated for AV fistulas of the hepatic pedicle where maintenance of hepatic arterial flow is a priority of treatment. We report a patient who had an AV fistula of the hepatic pedicle with resultant PHT presenting 5 years after open abdominal trauma. Treatment was surgical; the immediate and long-term postoperative course was uneventful with regression of PHT. Through analysis of this case and a review of the literature, we discuss the clinical, paraclinical, therapeutic, and prognostic features of this lesion.
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Scialpi M, Volterrani L, Mazzei M, Cappabianca S, Barberini F, Piscioli I, Brunese L, Lupattelli L. Small (≤2 cm) atypical hepatic haemangiomas in the non-cirrhotic patient: pattern-based classification scheme for enhancement at triple-phase helical CT. Radiol Med 2009; 114:935-47. [DOI: 10.1007/s11547-009-0427-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 06/10/2008] [Indexed: 01/26/2023]
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Ryu CW, Kim JK, Kim SJ, Lee JH, Kim JH, Ha HI, Suh DC. Head and neck vascular lesions: characterization of the flow pattern by the use of three-phase CT. Korean J Radiol 2009; 10:323-32. [PMID: 19568459 PMCID: PMC2702040 DOI: 10.3348/kjr.2009.10.4.323] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 03/02/2009] [Indexed: 01/16/2023] Open
Abstract
Objective This study was designed to evaluate the usefulness of three-phase CT to characterize the hemodynamics of vascular lesions in the head and neck area. Materials and Methods We analyzed vascular malformations of head and neck regions in 21 patients with the use of three-phase CT, including pre-contrast phase, vascular phase (scan delay: 20-35 seconds after intravenous contrast material injection) and equilibrium phase (scan delay: 3-5 minutes) imaging. The flow characteristic of each lesion was determined and categorized as either a high- or a low-flow lesion according to findings on selective arteriography and/or direct puncture venography. The CT number was acquired from two areas in a vascular lesion, sorted by the enhancement pattern: area 1, a highly enhanced area seen on the vascular phase; area 2, a delayedly enhanced area seen on the equilibrium phase. The CT numbers of each phase were compared between high- and low-flow lesions with use of the unpaired t-test. The flow patterns of high- and low-flow lesions were analyzed by assessment of time-density curves of three phase CT. Results High-flow lesions were detected in nine patients and low-flow lesions were detected in 12 patients. On the vascular phase, the CT number of areas 1 and 2 of high-flow lesions was significantly higher than for low-flow lesions (p < 0.05). Contrary to early peaks seen in time-density curves of high-flow lesions, low-flow lesions showed a delayed peak. Conclusion Three-phase CT seems to be a valuable non-invasive method to differentiate a high-flow lesion from a low flow lesion of head and neck vascular lesions.
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Affiliation(s)
- Chang-Woo Ryu
- Department of Radiology, East-West Neomedical Center, Kyung Hee University, College of Medicine, Seoul, Korea
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Kuroda H, Hosho K, Koda M, Murawaki Y, Ouchi Y, Kaminou T, Iwamoto A, Hirooka Y. Idiopathic intrahepatic arterioportal fistula treated by hepatectomy assisted by balloon-occluded retrograde transvenous obliteration: Report of an elderly case. Hepatol Res 2008; 38:847-50. [PMID: 18479416 DOI: 10.1111/j.1872-034x.2008.00341.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
An 80-year-old woman with hepatic encephalopathy and esophagogastric varices was admitted. Doppler sonography and arteriography demonstrated an arterioportal fistula in the right anterior superior segment of the liver. Two attempts at transcatheter arterial embolization failed to manage the fistula and portacaval collaterals. We carried out hepatectomy and balloon-occluded retrograde transvenous obliteration, by which the portal flow changed from hepatofugal to hepatopetal. The resected specimen demonstrated multiple small holes in the right portal vein, which are arterioportal fistula. The underlying liver was normal. After treatment, esophagogastric varices and hepatic encephalopathy were markedly improved. Hepatectomy is useful as a reliable therapy for arterioportal fistula in case of failure of transarterial embolization.
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Sparing of Fatty Infiltration Around Focal Hepatic Lesions in Patients with Hepatic Steatosis: Sonographic Appearance with CT and MRI Correlation. AJR Am J Roentgenol 2008; 190:1018-27. [PMID: 18356450 DOI: 10.2214/ajr.07.2863] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wang D, Zhao DL, Zhang ZR. Research progress on transient hepatic peritumoral enhancement. Shijie Huaren Xiaohua Zazhi 2007; 15:1520-1525. [DOI: 10.11569/wcjd.v15.i13.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Multi-slice computed tomography (MSCT) has been widely used in the clinical examination for livers. CT can not only complete scanning in a short time, but also achieve multi-phase scanning, so MSCT has unique advantages in the diagnosis of abnormal hepatic perfusion, showing as transient hepatic peritumoral enhancement (THPE). Based on this, in combination with the mechanism of THPE, the image characteristics of MSCT and clinical data, MSCT can make great contribution to identify the causes of THPE and diagnose the lesion property.
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Dietrich CF, Mertens JC, Braden B, Schuessler G, Ott M, Ignee A. Contrast-enhanced ultrasound of histologically proven liver hemangiomas. Hepatology 2007; 45:1139-45. [PMID: 17464990 DOI: 10.1002/hep.21615] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
UNLABELLED 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.
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Affiliation(s)
- Christoph F Dietrich
- Second Department of Internal Medicine, Caritas Hospital Bad Mergentheim, Bad Mergentheim, Germany.
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Mörk H, Ignee A, Schuessler G, Ott M, Dietrich CF. Analysis of neuroendocrine tumour metastases in the liver using contrast enhanced ultrasonography. Scand J Gastroenterol 2007; 42:652-62. [PMID: 17454888 DOI: 10.1080/00365520601021765] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Imaging of liver tumours might be improved by contrast-enhanced ultrasonography, which allows much better demonstration of the microvascular system. The aim of this study was to assess the sonographic morphology and vascularity of neuroendocrine liver metastases. METHODS Forty-eight patients with histologically proven neuroendocrine tumours (NET) and suspected liver metastases--as well as 50 consecutive patients with liver metastases of other origins--were included in a prospective study to evaluate tumour characteristics using B-mode, colour Doppler (CDI) and contrast-enhanced ultrasound (CEUS). RESULTS In 4/48 patients with NET, liver biopsy revealed hemangiomas. The typical B-mode appearance was that of both echo-rich and echo-poor combined, also inhomogeneous depending on the size, and often centrally cystic. With CDI, neuroendocrine metastases appeared hypervascular (66%) or isovascular (34%). Metastases of another origin were hypovascular in 82%. With CEUS, neuroendocrine metastases showed increased arterial enhancement in 38 patients and hypoechoic appearance in the portalvenous phase in 39 patients. In liver metastases of another origin, the sensitivity for malignancy due to a hypoechoic appearance during the portalvenous phase was 100%. In liver metastases of NET origin the sensitivity for malignancy was 39/48 (82%). CONCLUSIONS Neuroendocrine tumour metastases might show characteristics which are similar to hemangiomas. In patients with liver cirrhosis and severe fatty liver disease the identification of NET with CEUS as a malignant lesion is more difficult. The sensitivity of CEUS in identifying malignancy based on the lack of portalvenous enhancement is higher for metastases of other origin.
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Affiliation(s)
- Hubert Mörk
- Department of Gastroenterology and Internal Medicine, Hospital of Nagold, Germany
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Filippone A, Iezzi R, Di Fabio F, Cianci R, Grassedonio E, Storto ML. Multidetector-row computed tomography of focal liver lesions treated by radiofrequency ablation: spectrum of findings at long-term follow-up. J Comput Assist Tomogr 2007; 31:42-52. [PMID: 17259832 DOI: 10.1097/01.rct.0000232264.36178.1e] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess serial changes in liver tumors after percutaneous radiofrequency ablation at follow-up multidetector-row computed tomography. MATERIALS AND METHODS Forty patients with 65 malignant lesions underwent multidetector-row computed tomography immediately, 1 month and every 3 months, up to a maximum of 15 months after radiofrequency ablation. The computed tomography (CT) appearance of the treated lesions (non-enhanced attenuation, enhancement pattern, shape and size) was assessed at each follow-up. The relationship between each CT finding and the treatment outcome was evaluated by chi2 test (P < 0.05). RESULTS No significant differences were found in lesion shape and in non-enhanced CT attenuation between successfully and unsuccessfully treated lesions, whereas over time change of lesion size was significantly different. The no enhancement and nodular enhancement pattern prevalence was significantly (P < 0.0001) different between successfully and unsuccessfully treated lesions, whereas non-nodular enhancement pattern did not show any relationship with the treatment outcome. CONCLUSIONS Lesion size increase and nodular enhancement pattern resulted significantly related to the treatment failure.
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Affiliation(s)
- Antonella Filippone
- Department of Clinical Sciences and Bioimages, Section of Radiology, University G. d'Annunzio, Chieti, Italy.
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Colagrande S, Centi N, Galdiero R, Ragozzino A. Transient hepatic intensity differences: part 1, Those associated with focal lesions. AJR Am J Roentgenol 2007; 188:154-9. [PMID: 17179358 DOI: 10.2214/ajr.05.1368] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate, on MRI, transient hepatic signal intensity differences (THID) that have already been seen on CT as transient hepatic attenuation differences (THAD) and to show the range of appearance of such arterial phenomena, when associated with focal lesions, in an effort to correlate morphology, cause, and pathogenesis. CONCLUSION Hepatic arterial phenomena visualized on MRI should be known and recognized to avoid incorrect diagnoses and to improve the characterization of focal liver lesions because their shape can lead to an understanding of pathogenetic mechanisms.
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Affiliation(s)
- Stefano Colagrande
- Department of Clinical Physiopathology, Section of Radiodiagnostics, University of Florence, Viale Morgagni 85, Florence 50134, Italy.
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Abstract
In this article, we have reviewed the hepatic perfusion disorder (HPD), etiopathogenesis of HPD and corresponding diseases. Review of the literature was based on computer searches (PubMed, Index Medicus) and personal experiences. We considered HPD reflects perfusion differences due to redistribution of arterial blood flow among segments, subsegments and lobes of the liver. The plain CT scan findings of HPD manifests as triangular or wedge-shaped areas of low attenuation. On contrast-enhanced CT scan, HPD manifests multiple (or single) transient wedge-shaped, rotundloid or irregular appearance, homogeneous hyperattenuation (in less cases, hypoattenuation) during the hepatic arterial phase (HAP) and isoattenuated or slightly hyperattenuated areas during the portal arterial phase. Dynamic enhanced magnetic resonance (MR) features are similar to enhanced CT scan. Angiographic findings include non-opacification of portal vein on portograms or wedge-shaped segmental staining in arterial and parenchymal phases on hepatic angiograms. The causes of HPD are arterioportal shunts (APS), intrahepatic vascular compressions and portal vein occlusion, steal phenomenon by hypervascular tumors, vascular variations and any other unknown reasons. It is very important for radiologists to be familiar with the various appearances of HPD to avoid false-positive diagnosis of pseudolesions and not to overestimate the extent of the disease.
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Affiliation(s)
- Jin-Lin Tian
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, China.
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38
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Abstract
In this article, we have reviewed the hepatic perfusion disorder (HPD), etiopathogenesis of HPD and corresponding diseases. Review of the literature was based on computer searches (PubMed, Index Medicus) and personal experiences. We considered HPD reflects perfusion differences due to redistribution of arterial blood flow among segments, subsegments and lobes of the liver. The plain CT scan findings of HPD manifests as triangular or wedge-shaped areas of low attenuation. On contrast-enhanced CT scan, HPD manifests multiple (or single) transient wedge-shaped, rotundloid or irregular appearance, homogeneous hyperattenuation (in less cases, hypoattenuation) during the hepatic arterial phase (HAP) and isoattenuated or slightly hyperattenuated areas during the portal arterial phase. Dynamic enhanced magnetic resonance (MR) features are similar to enhanced CT scan. Angiographic findings include non-opacification of portal vein on portograms or wedge-shaped segmental staining in arterial and parenchymal phases on hepatic angiograms. The causes of HPD are arterioportal shunts (APS), intrahepatic vascular compressions and portal vein occlusion, steal phenomenon by hypervascular tumors, vascular variations and any other unknown reasons. It is very important for radiologists to be familiar with the various appearances of HPD to avoid false-positive diagnosis of pseudolesions and not to overestimate the extent of the disease.
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Affiliation(s)
- Jin-Lin Tian
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, China.
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39
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Winterer JT, Kotter E, Ghanem N, Langer M. Detection and characterization of benign focal liver lesions with multislice CT. Eur Radiol 2006; 16:2427-43. [PMID: 16724204 DOI: 10.1007/s00330-006-0247-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Revised: 02/17/2006] [Accepted: 03/02/2006] [Indexed: 12/27/2022]
Abstract
MDCT is a rapidly evolving technique that significantly improves CT imaging for several indications including depiction of focal benign lesions. Imaging mainly profits from improved longitudinal spatial resolution allowing high-quality non-axial reformations and 3D reconstructions and CT angiography as well as rapid accurate multiphase imaging with short breath-holding periods. This review provides an overview of the current status of MDCT with respect to liver imaging and the implications for characterizing benign focal liver lesions. MDCT currently allows the acquisition of thin slices in daily routine diagnostics providing an improved detection rate of small liver lesions. Whereas large benign focal liver lesions exhibit typical patterns of morphology, attenuation and perfusion, which also may be assessed with single-slice scanners, small lesions remain challenging even with MDCT, since the specific criteria for confident diagnosis become more ambiguous. Here, MR imaging provides more detailed information about tissue components and the availability of liver-specific contrast agents, adding further impact to this technique. With respect to dose considerations, the number of necessary multiphase scans as well as the application of very thin collimation should be strictly checked for each patient undergoing MDCT based on the individual clinical situation and question.
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Affiliation(s)
- J T Winterer
- Department of Diagnostic Radiology, Hugstetter Str. 55, D-79106, Freiburg, Germany.
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40
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Kim TK, Jang HJ, Wilson SR. Imaging diagnosis of hepatocellular carcinoma with differentiation from other pathology. Clin Liver Dis 2005; 9:253-79. [PMID: 15831272 DOI: 10.1016/j.cld.2004.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Recent advances in liver imaging techniques and better understanding of imaging findings have facilitated the detection and characterization of hepatocellular nodules in a cirrhotic liver. It is important to recognize that various types of benign nodules and pseudolesions are identified on all imaging scans performed for the diagnosis of hepatocellular carcinoma. An accurate differentiation between them is critical for adequate management of cirrhotic patients. Unfortunately, any of the imaging tests and even percutaneous biopsy are not diagnostic for borderline lesions. Intimate collaboration of hepatologists, pathologists, surgeons, and radiologists with reasonable imaging and clinical criteria estimating the degree of malignancy is imperative.
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Affiliation(s)
- Tae Kyoung Kim
- Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada.
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Kim HJ, Kim AY, Kim TK, Byun JH, Won HJ, Kim KW, Shin YM, Kim PN, Ha HK, Lee MG. Transient hepatic attenuation differences in focal hepatic lesions: dynamic CT features. AJR Am J Roentgenol 2005; 184:83-90. [PMID: 15615955 DOI: 10.2214/ajr.184.1.01840083] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Hyoung Jung Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-dong, Songpa-Ku, Seoul, South Korea
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