A hepatic haemangioma is a benign hypervascular liver lesion. It is the most common benign tumour of the liver, and the most common liver tumour overall.2-4 It is frequently diagnosed as an incidental finding on imaging and most patients are asymptomatic. A peripheral location within the liver is most common. 3
Thought to be congenital in origin and are almost always of the cavernous subtype. Blood supply is predominantly hepatic arterial, as with all liver tumours.4
- typical hepatic haemangioma
atypical hepatic haemangioma 10
- giant hepatic haemangioma
- flash filling hepatic haemangioma - can account for up to 16% of all hepatic haemangiomas
- slow fill hepatic haemangioma - can account for around 8-16% of all haemangiomas 13
- calcified hepatic haemangioma
- hyalinized hepatic haemangioma
- other unusual imaging patterns
Rarely multiple hepatic haemagiomas can also occur - see hepatic haemangiomatosis
- extra hepatic haemangiomata
- hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu disease)
- Kasabach Merritt syndrome - with giant haemangiomas
- hepatic arterio-portal shunts
Nonspecific. They are typically well defined hyperechoic lesions. A small proportion (10%) however are hypoechoic. They may or may not show peripheral feeding vessels on colour Doppler.
Most lesions are relatively well defined. The dynamic enhancement pattern is related to the collective size of their vascular spaces.1
Features of typical lesions include
- noncontrast - often hypoattenuating relative to liver parenchyma
- arterial phase - typically discontinuous, nodular, peripheral enhancement (small lesions may show uniform enhancement)
- portal venous phase - progressive peripheral enhancement with more centripetal fill in.
- delayed phase - further irregular fill in and therefore iso- or hyperattenuating to liver parenchyma
Other described features include
Typical features include
- T1 - hypointense relative to liver parenchyma
- intensely hyperintense relative to liver parenchyma
- this may give a light bulb sign
T1 C + (Gd) - often shows peripheral nodular enhancement which progresses centripetally (inward) on delayed images.
- haemangiomas tend to retain contrast on delayed (>5 minute) contrast-enhanced images.
- atypical haemangiomas may demonstrate slightly altered enhancement patterns.
- in general delayed (1 hour) imaging with Gd-BOPTA (a hepatobiliary-specific MR contrast agent) may not be helpful, since haemangiomas can have a variable appearance that ranges from hypointensity to diffuse and central enhancement.
- DWI - haemangiomas appear hyperintense on diffusion weighted imaging (DWI). This is due to T2 shine-through rather than restricted diffusion.
99Tc RBC labelled SPECT can be sensitive for larger lesions 4 and typically demonstrate decreased activity on initial dynamic images followed by increased activity on delayed, blood pool images.
General imaging differential considerations for typical lesions include
There are much wider differential considerations for atypical lesions
- hypervascular metastases
- Hypervascular metastases show marked early enhancement with a continuous ring that on later images fills in centrally and progressive centripetal fill-in may occur on delayed phases.12
- 1. Yamashita Y, Ogata I, Urata J et-al. Cavernous hemangioma of the liver: pathologic correlation with dynamic CT findings. Radiology. 1997;203 (1): 121-5. Radiology (abstract) - Pubmed citation
- 2. Ros PR, Lubbers PR, Olmsted WW et-al. Hemangioma of the liver: heterogeneous appearance on T2-weighted images. AJR Am J Roentgenol. 1987;149 (6): 1167-70. AJR Am J Roentgenol (abstract) - Pubmed citation
- 3. Vilanova JC, Barceló J, Smirniotopoulos JG et-al. Hemangioma from head to toe: MR imaging with pathologic correlation. Radiographics. 24 (2): 367-85. doi:10.1148/rg.242035079 - Pubmed citation
- 4. Baron R. Liver: Masses Part I: detection and characterization. The Radiology Assistant 2006: http://www.radiologyassistant.nl/en/446f010d8f420.
- 5. Brodsky RI, Friedman AC, Maurer AH et-al. Hepatic cavernous hemangioma: diagnosis with 99mTc-labeled red cells and single-photon emission CT. AJR Am J Roentgenol. 1987;148 (1): 125-9. AJR Am J Roentgenol (abstract) - Pubmed citation
- 6. Gandhi SN, Brown MA, Wong JG et-al. MR contrast agents for liver imaging: what, when, how. Radiographics. 26 (6): 1621-36. doi:10.1148/rg.266065014 - Pubmed citation
- 7. Achong DM, Oates E. Hepatic hemangioma in cirrhotics with portal hypertension: evaluation with Tc-99m red blood cell SPECT. Radiology. 1994;191 (1): 115-7. Radiology (abstract) - Pubmed citation
- 8. Klotz T, Montoriol PF, Da Ines D et-al. Hepatic haemangioma: Common and uncommon imaging features. Diagn Interv Imaging. 2013;94 (9): 849-59. doi:10.1016/j.diii.2013.04.008 - Pubmed citation
- 9. Oto A, Kulkarni K, Nishikawa R et-al. Contrast enhancement of hepatic hemangiomas on multiphase MDCT: Can we diagnose hepatic hemangiomas by comparing enhancement with blood pool?. AJR Am J Roentgenol. 2010;195 (2): 381-6. doi:10.2214/AJR.09.3324 - Pubmed citation
- 10. Vilgrain V, Boulos L, Vullierme MP et-al. Imaging of atypical hemangiomas of the liver with pathologic correlation. Radiographics. 2000;20 (2): 379-97. Radiographics (full text) - Pubmed citation
- 11. Jang HJ, Kim TK, Lim HK et-al. Hepatic hemangioma: atypical appearances on CT, MR imaging, and sonography. AJR Am J Roentgenol. 2003;180 (1): 135-41. doi:10.2214/ajr.180.1.1800135 - Pubmed citation
- 12. Sica GT, Ji H, Ros PR. CT and MR imaging of hepatic metastases. AJR Am J Roentgenol. 2000;174 (3): 691-8. doi:10.2214/ajr.174.3.1740691 - Pubmed citation
- 13. Focal Liver Lesions: Detection, Characterization, Ablation. Springer. ISBN:3642084141. Read it at Google Books - Find it at Amazon
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Hepatic cavernous haemangioma||✗|
|Hemangioma of the liver||✗|