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Hepatic haemangioma

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

Sub types

Rarely multiple hepatic haemagiomas can also occur - see hepatic haemangiomatosis


Radiographic features


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
  • T2 -
    • 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.
Nuclear medicine

99Tc RBC labelled SPECT can be sensitive for larger lesions and typically demonstrate decreased activity on initial dynamic images followed by increased activity on delayed, blood pool images.

Differential diagnosis

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

See also

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