Lobulated margination of liver hemangiomas: Is this a definitive feature?

Heterogeneity analysis of triphasic CT scan perfusion parameters in differential diagnosis of hepatocellular carcinoma and hemangioma

This study is to investigate quantitative measures and heterogeneity of perfusion parameters in the differential diagnosis of hepatocellular carcinoma (HCC) and hemangioma.In total, 32 HCC and 44 hemangioma (types 1, 2, and 3) cases were included in this retrospective study. Hepatic artery coefficient (HAC), portal vein coefficient (PVC), and arterial enhancement fraction (AEF) were calculated. Tumor heterogeneity was analyzed. Perfusion parameters and corresponding percentiles were compared between the HCC and hemangioma (especially atypical hemangioma) cases, as well as between the substantial lesion part and surrounding normal tissue.The mean value, and the 10th, 50th, 75th, and 90th percentiles of PVC were significantly lower in the HCC cases than the types 1 and 2 hemangioma cases (P < .01). Moreover, the 90th percentile PVC in the HCC cases was also significantly lower than the type 3 hemangioma case (P < .01), while the mean value, and all the percentiles of AEF in the HCC cases were higher than the types 2 and 3 hemangioma cases (P < .01). The 10th percentile HAC in the HCC cases was higher than the type 2 hemangioma cases (P < .05). The mean value, and the 10th and 50th percentile HAC in the HCC cases were higher than the type 3 hemangioma case (P < .05). However, there was no statistically significant difference in HAC between the HCC and type 1 hemangioma cases (P > .05).Quantitative measurement of perfusion parameters and heterogeneity analysis show significance differences in the early detection and differential diagnosis of HCC and hemangioma cases, which might contribute to increasing the diagnostic accuracy.

MRI features of primary rare malignancies of the liver: A report from four university centres

PURPOSE

To determine if rare primary malignancies of the liver may have consistent features on magnetic resonance imaging (MRI).

MATERIALS AND METHODS

This IRB-compliant retrospective study reviewed the records from the pathology departments of four university centres over an 11-year period from 2005-2016 to identify rare primary malignant tumours, which were cross-referenced with MRI records. MRI studies of these patients were reviewed to determine if these tumours exhibited consistent and distinctive features.

RESULTS

Sixty patients were identified with rare primary liver tumours. The following distinctive features and frequency of occurrence were observed: mixed hepatocellular carcinoma-cholangiocarcinoma showed regions of wash-out in 7/19 of patients; 6/6 of fibrolamellar carcinomas demonstrated large heterogeneous lesions with large heterogeneous central scars; epithelioid haemangioendothelioma larger than 2 cm showed target-like enhancement in late-phase enhancement in 9/13; sarcomas excluding angiosarcoma had central necrosis in 3/9 and haemorrhage in 5/9; angiosarcomas showed centripedal progressive nodular enhancement in 3/6 and showed regions of haemorrhage in 3/6; and 7/7 of primary hepatic lymphomas showed encasement of vessels.

CONCLUSION

Although helpful features for the differentiation of rare primary malignancies of the liver are identified, no MRI features appear to be specific and therefore histopathological confirmation is usually required for definitive diagnosis.

KEY POINTS

• No MRI features appear to be specific for rare primary liver malignancies. • Haemorrhage is a helpful sign in diagnosis of primary hepatic sarcomas. • Angiosarcomas may show progressive nodular enhancement towards the centre mimicking haemangioma. • Vessel encasement is a helpful sign in diagnosis of primary hepatic lymphoma.