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
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
- T1 - hypointense relative to liver parenchyma
- T2 - intensely hyperintense relative to liver parenchyma
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 include
- 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. Accessed 10-29-2012.
- 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
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Hepatic cavernous haemangioma||✗|
|Hemangioma of the liver||✗|