Hypervascular liver lesions

Last revised by Edgar Druce on 30 Dec 2023

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

  • hepatocellular carcinoma (HCC)

    • most common hypervascular primary liver malignancy

    • early arterial phase enhancement and then rapid wash out

    • rim enhancement of capsule may persist

  • hemangioma

    • benign; most common liver tumor 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 hemangioma (i.e. similar to aorta in arterial, portal vein in portal phase, etc)

    • small hemangiomas (<1.5 cm) may demonstrate "flash filling" - complete homogeneous enhancement in arterial phase (no gradual filling in)

  • hepatic adenoma

    • arterial phase: transient homogeneous enhancement

    • returns to near isodensity on portal venous and delayed phase image

  • primary hepatic carcinoid


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. hemangioma which does not show washout). The primaries typically include:

See also

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Cases and figures

  • Case 1: metastasis from lung cancer
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  • Case 2: hepatocellular carcinoma
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  • Case 3: hepatic carcinoid
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  • Case 4: FNH - embolization
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  • Case 5: FNH - embolization
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  • Case 6: focal nodular hyperplasia
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  • Case 7: hepatic hemangiomas - focal nodular hyperplasia
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  • Case 8: metastases of renal cell cancer (CEUS)
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