Hypervascular liver lesions

Changed by Yahya Baba, 8 Jul 2023

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Disclosures - updated 8 Apr 2023: Nothing to disclose

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Hypervascular liver lesions are findings that enhance more or similarly to the background hepatic parenchyma in the late arterial phase, on contrast-enhanced CT or MRI.

Differential diagnosis

Non-neoplastic

vascular shunts / fistulas
- intrahepatic arterioportal shunt - arterioportal fistula ⁸
- intrahepatic arteriovenous shunt - arteriovenous fistula
focal hepatic hot spot sign
hepatic artery aneurysm
failing Fontan circulation ³
hepatic peliosis ⁷
~~hepatic arterioportal fistula~~⁸
background liver disease (cirrhosis) ⁶
- regenerative nodules
- dysplastic nodules

Neoplastic

hepatocellular carcinoma (HCC)
- most common hypervascular primary liver malignancy
- early arterial phase enhancement and then rapid wash out
- rim enhancement of capsule may persist
haemangioma
- benign; most common liver tumour overall
- discontinuous, nodular, peripheral enhancement starting in the late arterial phase
- gradual central filling in
- enhancement must match blood pool in each phase, or not a haemangioma (i.e. similar to aorta in arterial, portal vein in portal phase, etc)
- small haemangiomas (<1.5 cm) may demonstrate "flash filling" - complete homogeneous enhancement in arterial phase (no gradual filling in)
focal nodular hyperplasia (FNH)
- bright arterial phase enhancement except central scar
- isodense/isointense to liver on portal venous phase
- central scar enhancement on delayed phase
hepatic adenoma
- arterial phase: transient homogeneous enhancement
- returns to near isodensity on portal venous and delayed phase image
primary hepatic carcinoid

Metastases

Although the majority of liver metastases are hypodense and enhance less than the surrounding liver, metastases from certain primaries demonstrate an increase in the number of vessels, resulting in a hyperechoic ultrasound appearance, and arterial phase hyperenhancement on CT or MRI which washes out on delayed scan (cf. haemangioma which does not show washout). The primaries typically include:

~~-vascular shunts~~
+vascular shunts / fistulas
~~-<li><a href="/articles/intrahepatic-arterioportal-shunt">intrahepatic arterioportal shunt</a></li>~~
~~-<li><a href="/articles/intrahepatic-arteriovenous-shunt">intrahepatic arteriovenous shunt</a></li>~~
+<li><a href="/articles/intrahepatic-arterioportal-shunt">intrahepatic arterioportal shunt</a> - arterioportal fistula 8</li>
+<li><a href="/articles/intrahepatic-arteriovenous-shunt">intrahepatic arteriovenous shunt</a> - arteriovenous fistula</li>
~~-<li><a href="/articles/hepatic-arterioportal-fistula" title="hepatic arterioportal fistula">hepatic arterioportal fistula</a> 8</li>~~
~~-<li><a href="/articles/choriocarcinoma">choriocarcinoma</a></li>~~
+<li><a href="/articles/choriocarcinoma-1">choriocarcinoma</a></li>

References changed:

1. Bressler E, Alpern M, Glazer G, Francis I, Ensminger W. Hypervascular Hepatic Metastases: CT Evaluation. Radiology. 1987;162(1 Pt 1):49-51. <a href="https://doi.org/10.1148/radiology.162.1.3024210">doi:10.1148/radiology.162.1.3024210</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/3024210">Pubmed</a>
2. Eugene Lin. Practical Differential Diagnosis for CT and MRI. (2008) ISBN: 9781588906557 - <a href="http://books.google.com/books?vid=ISBN9781588906557">Google Books</a>
3. Kiesewetter C, Sheron N, Vettukattill J et al. Hepatic Changes in the Failing Fontan Circulation. Heart. 2007;93(5):579-84. <a href="https://doi.org/10.1136/hrt.2006.094516">doi:10.1136/hrt.2006.094516</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/17005713">Pubmed</a>
4. Silva A, Evans J, McCullough A, Jatoi M, Vargas H, Hara A. MR Imaging of Hypervascular Liver Masses: A Review of Current Techniques. Radiographics. 2009;29(2):385-402. <a href="https://doi.org/10.1148/rg.292085123">doi:10.1148/rg.292085123</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/19325055">Pubmed</a>
5. Wolfgang Dähnert. Radiology Review Manual. (2011) ISBN: 9781609139438 - <a href="http://books.google.com/books?vid=ISBN9781609139438">Google Books</a>
6. Khosa F, Khan A, Eisenberg R. Hypervascular Liver Lesions on MRI. AJR Am J Roentgenol. 2011;197(2):W204-20. <a href="https://doi.org/10.2214/AJR.10.5382">doi:10.2214/AJR.10.5382</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21785044">Pubmed</a>
7. Iannaccone R, Federle M, Brancatelli G et al. Peliosis Hepatis: Spectrum of Imaging Findings. AJR Am J Roentgenol. 2006;187(1):W43-52. <a href="https://doi.org/10.2214/AJR.05.0167">doi:10.2214/AJR.05.0167</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/16794138">Pubmed</a>
1. Bressler EL, Alpern MB, Glazer GM et-al. Hypervascular hepatic metastases: CT evaluation. Radiology. 1987;162 (1): 49-51. <a href="http://radiology.rsna.org/content/162/1/49.abstract">Radiology (abstract)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/3024210">Pubmed citation</a><div class="ref_v2"></div>
2. Lin E, Escott E, Garg K et-al. Practical differential diagnosis for CT and MRI. Thieme Medical Pub. (2008) ISBN:1588906558. <a href="http://books.google.com/books?vid=ISBN1588906558">Read it at Google Books</a> - <a href="http://www.amazon.com/gp/product/1588906558?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=1588906558">Find it at Amazon</a><div class="ref_v2"></div>
3. Kiesewetter CH, Sheron N, Vettukattill JJ et-al. Hepatic changes in the failing Fontan circulation. Heart. 2007;93 (5): 579-84. <a href="http://heart.bmj.com/content/93/5/579.full">Heart (full text)</a> - <a href="http://dx.doi.org/10.1136/hrt.2006.094516">doi:10.1136/hrt.2006.094516</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955554">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/17005713">Pubmed citation</a>
4. Silva AC, Evans JM, McCullough AE et-al. MR imaging of hypervascular liver masses: a review of current techniques. Radiographics. 2009;29 (2): 385-402. <a href="http://radiographics.rsna.org/content/29/2/385.full">Radiographics (full text)</a> - <a href="http://dx.doi.org/10.1148/rg.292085123">doi:10.1148/rg.292085123</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/19325055">Pubmed citation</a>
5. Wolfgang Dähnert. Radiology Review Manual. (2011) <a href="https://books.google.co.uk/books?vid=ISBN9781609139438">ISBN: 9781609139438</a>
6. Khosa F, Khan AN, Eisenberg RL. Hypervascular liver lesions on MRI. (2011) AJR. American journal of roentgenology. 197 (2): W204-20. <a href="https://doi.org/10.2214/AJR.10.5382">doi:10.2214/AJR.10.5382</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21785044">Pubmed</a>
7. Iannaccone R, Federle MP, Brancatelli G et-al. Peliosis hepatis: spectrum of imaging findings. AJR Am J Roentgenol. 2006;187 (1): W43-52. <a href="http://dx.doi.org/10.2214/AJR.05.0167">doi:10.2214/AJR.05.0167</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/16794138">Pubmed citation</a><div class="ref_v2"></div>

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