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Matteini F, Cannella R, Dioguardi Burgio M, Torrisi C, Sartoris R, Brancatelli G, Vilgrain V, Ronot M, Vernuccio F. Discontinuous peripheral enhancement of focal liver lesions on CT and MRI: outside the box of typical cavernous hemangioma. Abdom Radiol (NY) 2024:10.1007/s00261-024-04522-2. [PMID: 39192088 DOI: 10.1007/s00261-024-04522-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024]
Abstract
The discontinuous peripheral enhancement is a pattern of enhancement usually attributed to typical cavernous hemangioma, that is the most common benign solid lesion of the liver. The discontinuous peripheral enhancement, however, may be encountered in many other benign and malignant focal liver lesions as an atypical presentation or evolution, and hemangiomas with discontinuous peripheral hyperenhancement on hepatic arterial phase may not always have the typical post-contrast pattern on portal venous and delayed phases. Therefore, abdominal radiologists may be challenged in their practice by lesions with discontinuous peripheral enhancement. This pictorial essay aims to review the spectrum of benign and malignant focal liver lesions that may show discontinuous peripheral enhancement. A particular point of interest is the diagnostic tree pathway that may guide the radiologists in the differential diagnosis.
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Affiliation(s)
- Francesco Matteini
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro, 129, 90127, Palermo, Italy.
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- INSERM U1149 Centre de Recherche sur l'Inflammation (CRI), Université Paris Cité, Paris, France
| | - Chiara Torrisi
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Riccardo Sartoris
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- INSERM U1149 Centre de Recherche sur l'Inflammation (CRI), Université Paris Cité, Paris, France
| | - Giuseppe Brancatelli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- INSERM U1149 Centre de Recherche sur l'Inflammation (CRI), Université Paris Cité, Paris, France
| | - Maxime Ronot
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- INSERM U1149 Centre de Recherche sur l'Inflammation (CRI), Université Paris Cité, Paris, France
| | - Federica Vernuccio
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Via del Vespro 129, 90127, Palermo, Italy
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Matteini F, Cannella R, Garzelli L, Dioguardi Burgio M, Sartoris R, Brancatelli G, Vilgrain V, Ronot M, Vernuccio F. Benign and malignant focal liver lesions displaying rim arterial phase hyperenhancement on CT and MRI. Insights Imaging 2024; 15:178. [PMID: 39020233 PMCID: PMC11254889 DOI: 10.1186/s13244-024-01756-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/22/2024] [Indexed: 07/19/2024] Open
Abstract
Rim arterial phase hyperenhancement is an imaging feature commonly encountered on contrast-enhanced CT and MRI in focal liver lesions. Rim arterial phase hyperenhancement is a subtype of arterial phase hyperenhancement mainly present at the periphery of lesions on the arterial phase. It is caused by a relative arterialization of the periphery compared with the center of the lesion and needs to be differentiated from other patterns of peripheral enhancement, including the peripheral discontinuous nodular enhancement and the corona enhancement. Rim arterial phase hyperenhancement may be a typical or an atypical imaging presentation of many benign and malignant focal liver lesions, challenging the radiologists during imaging interpretation. Benign focal liver lesions that may show rim arterial phase hyperenhancement may have a vascular, infectious, or inflammatory origin. Malignant focal liver lesions displaying rim arterial phase hyperenhancement may have a vascular, hepatocellular, biliary, lymphoid, or secondary origin. The differences in imaging characteristics on contrast-enhanced CT may be subtle, and a multiparametric approach on MRI may be helpful to narrow the list of differentials. This article aims to review the broad spectrum of focal liver lesions that may show rim arterial phase hyperenhancement, using an approach based on the benign and malignant nature of lesions and their histologic origin. CRITICAL RELEVANCE STATEMENT: Rim arterial phase hyperenhancement may be an imaging feature encountered in benign and malignant focal liver lesions and the diagnostic algorithm approach provided in this educational review may guide toward the final diagnosis. KEY POINTS: Several focal liver lesions may demonstrate rim arterial phase hyperenhancement. Rim arterial phase hyperenhancement may occur in vascular, inflammatory, and neoplastic lesions. Rim arterial phase hyperenhancement may challenge radiologists during image interpretation.
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Affiliation(s)
- Francesco Matteini
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Palermo, Italy
| | - Lorenzo Garzelli
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation"; CRI, Paris, France
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation"; CRI, Paris, France
| | - Riccardo Sartoris
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation"; CRI, Paris, France
| | - Giuseppe Brancatelli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Palermo, Italy
| | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation"; CRI, Paris, France
| | - Maxime Ronot
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation"; CRI, Paris, France
| | - Federica Vernuccio
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Palermo, Italy.
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Poras M, Katsanos G, Agrafiotis AC, Demetter P, Pezzullo M, Lucidi V. Case report: Sclerosed hemangioma of the liver: A diagnostic challenge. Front Surg 2022; 9:985849. [PMID: 36644528 PMCID: PMC9834279 DOI: 10.3389/fsurg.2022.985849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/05/2022] [Indexed: 12/30/2022] Open
Abstract
Hemangiomas are the most common noncystic benign hepatic tumors and are usually incidentally discovered during routine radiological examinations. The diagnosis of hepatic hemangiomas with a typical presentation is generally easy with plain and cross-sectional imaging; however, it can be complicated when hemangiomas undergo histological changes such as fibrosis. Sclerosed hepatic hemangioma (SHH) is the extreme presentation of this fibrotic process. These atypical lesions can be misdiagnosed as primary hepatic malignancies or metastasis. Their diagnosis is established by histological examination. We report the case of a patient with an SHH, which was misdiagnosed as an intrahepatic cholangiocarcinoma. This article's aim is to draw attention to this infrequent pathology and underline the features of this benign tumor that could suggest its diagnosis prior to surgery to avoid unnecessary hepatic resections.
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Affiliation(s)
- M. Poras
- Department of Abdominal Surgery, St Pierre University Hospital (Université Libre de Bruxelles), Brussels, Belgium,Department of Abdominal Surgery, Erasme University Hospital (Université Libre de Bruxelles), Brussels, Belgium,Correspondence: Mathilde Poras
| | - G. Katsanos
- Department of Abdominal Surgery, Erasme University Hospital (Université Libre de Bruxelles), Brussels, Belgium
| | - A. C. Agrafiotis
- Department of Abdominal Surgery, Erasme University Hospital (Université Libre de Bruxelles), Brussels, Belgium
| | - P. Demetter
- Department of Pathology, Erasme University Hospital (Université Libre de Bruxelles), Brussels, Belgium
| | - M. Pezzullo
- Department of Radiology, Erasme University Hospital (Université Libre de Bruxelles), Brussels, Belgium
| | - V. Lucidi
- Department of Abdominal Surgery, Erasme University Hospital (Université Libre de Bruxelles), Brussels, Belgium
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Wang F, Numata K, Nihonmatsu H, Chuma M, Ideno N, Nozaki A, Ogushi K, Tanab M, Okada M, Luo W, Nakano M, Otani M, Inayama Y, Maeda S. Added Value of Ultrasound-Based Multimodal Imaging to Diagnose Hepatic Sclerosed Hemangioma before Biopsy and Resection. Diagnostics (Basel) 2022; 12:diagnostics12112818. [PMID: 36428878 PMCID: PMC9689571 DOI: 10.3390/diagnostics12112818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Imaging methods have the overwhelming advantage of being non-invasive in the diagnosis of hepatic lesions and, thanks to technical developments in the field of ultrasound (US), radiation exposure can also be avoided in many clinical situations. In particular, contrast-enhanced US (CEUS) outperforms other radiological methods in regard to real-time images, repeatability, and prompt reporting and demonstrates relatively few contraindications and adverse reactions. In this study, we reported in detail a rare benign tumor: hepatic sclerosed hemangioma (HSH). We described US-based multimodal imaging (B-flow imaging, US elastography, and Sonazoid CEUS) features of this HSH case. Furthermore, by summarizing the recently published literature on the imaging diagnosis of HSH, we offered readers comprehensive knowledge of conventional imaging methods (CT, MRI) and CEUS in the diagnosis of HSH and preliminarily discussed their mechanism of pathology-based diagnosis. Our multimodal imaging approach may provide a diagnostic strategy for HSH, thus avoiding unnecessary biopsy or resection.
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Affiliation(s)
- Feiqian Wang
- Ultrasound Department, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an 710061, China
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
- Correspondence: ; Tel.: +81-45-261-5656 or +81-45-261-9492
| | - Hiromi Nihonmatsu
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Makoto Chuma
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Naomi Ideno
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Akito Nozaki
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Katsuaki Ogushi
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Mikiko Tanab
- Division of Diagnostic Pathology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Wen Luo
- Department of Ultrasound, Xijing Hospital, Air Force Military Medical University, No. 127 Changle West Road, Xi’an 710032, China
| | - Masayuki Nakano
- Tokyo Central Pathology Laboratory, 838-1, Utsukimachi, Hachioji 192-0024, Japan
| | - Masako Otani
- Division of Diagnostic Pathology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Yoshiaki Inayama
- Division of Diagnostic Pathology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Shin Maeda
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
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Caserta MP, Fetzer DT, Swensson JK, Rodgers SK, Boyum JH. When Benign Behaves Badly: Atypical Hemangiomas on Contrast-Enhanced Ultrasonography. Ultrasound Q 2022; 38:133-141. [PMID: 35362690 DOI: 10.1097/ruq.0000000000000555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Hemangioma is the most common benign liver tumor and is frequently encountered as an incidental finding on imaging. The classic enhancement pattern of hemangioma is diagnostic on contrast-enhanced ultrasound (CEUS), and it follows the same pattern of enhancement on computed tomography and magnetic resonance imaging. However, there is a subset of hemangiomas that demonstrate atypical enhancement patterns on CEUS. The ability to recognize the different enhancement patterns and discern when additional imaging or biopsy may be necessary is essential to accurately interpret an atypical hemangioma on CEUS. This article reviews various enhancement patterns of hemangioma on CEUS to avoid pitfalls in characterization of focal liver lesions on CEUS.
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Affiliation(s)
| | - David T Fetzer
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Jordan K Swensson
- Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN
| | - Shuchi K Rodgers
- Department of Radiology, Einstein Medical Center, Philadelphia, PA
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Takinoshita S, Ishimaru H, Okano S, Otsuka T, Ishimaru Y, Miyazaki S, Nakagawa J, Koga M, Soyama A, Hidaka M, Fukumoto M, Eguchi S, Uetani M. Hepatic sclerosing haemangioma showing restricted diffusion: A case report with histopathologic correlation. BJR Case Rep 2022; 8:20220029. [DOI: 10.1259/bjrcr.20220029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/23/2022] [Accepted: 04/06/2022] [Indexed: 11/05/2022] Open
Abstract
Hepatic sclerosing haemangiomas are rare benign tumours that are often difficult to distinguish from malignant tumours because these tumours do not show the typical imaging features of cavernous haemangiomas. We report a case of a sclerosing haemangioma that showed restricted diffusion and was difficult to differentiate from a malignancy. A 60-year-old female was referred to our hospital for evaluation of a hepatic mass that was incidentally diagnosed after a CT scan for right lower quadrant abdominal pain. Contrast-enhanced dynamic CT showed hepatic capsular retraction, with a small peripheral enhancement of the mass. The lesion appeared homogeneously hypointense on T1-weighted images, heterogeneously hyperintense on T2-weighted images, hyperintense on diffusion-weighted images, and hypointense on apparent diffusion coefficient (ADC) map. The lesion was suspected to be a cholangiocellular carcinoma and was surgically resected, but a final diagnosis of hepatic sclerosing haemangioma was made. Hepatic sclerosing/sclerosed haemangiomas are usually considered to show an increased ADC, which is useful for distinguishing them from malignant tumours. However, in this particular case, most of the lesion contained many obliterated or narrowed vascular channels, which might have acted as septa restricting the diffusion of water molecules in the intervening fibrous and/or hyalinized tissue. Hepatic sclerosing haemangiomas in the process of becoming completely fibrotic may show restricted diffusion, similar to malignant tumours.
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Affiliation(s)
| | - Hideki Ishimaru
- Departments of Radiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Shinji Okano
- Departments of Pathology, Nagasaki University Hospital, Nagasaki, Japan
| | - Tetsuhiro Otsuka
- Departments of Radiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Yutaka Ishimaru
- Department of Radiology, Nagasaki Prefecture Shimabara Hospital, Shimabara, Japan
| | - Shuhei Miyazaki
- Departments of Radiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Jun Nakagawa
- Departments of Radiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Miyuki Koga
- Departments of Radiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Akihiko Soyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaaki Hidaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masayuki Fukumoto
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masataka Uetani
- Departments of Radiology, Nagasaki University Hospital, Nagasaki, Japan
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Hepatic sclerosed hemangioma and sclerosing cavernous hemangioma: a radiological study. Jpn J Radiol 2021; 39:1059-1068. [PMID: 34041675 PMCID: PMC8568860 DOI: 10.1007/s11604-021-01139-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022]
Abstract
Purpose To investigate and compare the CT and MRI features of hepatic sclerosed hemangioma (HSH) and sclerosing cavernous hemangioma (SCH). Materials and methods Twelve HSH cases and 36 SCH cases were included, the imaging findings on CT (9 HSH and 34 SCH) and MRI (8 HSH and 10 SCH) were analyzed. Qualitative image analysis included the location, size, shape, capsular retraction, density, calcification, signal intensity on T1-weighted image (T1WI) and T2-weighted image (T2WI), presence of diffusion restriction, apparent diffusion coefficient (ADC) map, transient hepatic attenuation difference around the lesion, and the dynamic enhancement patterns. Results The presence of liver cirrhosis in patients with HSH (3/12) was higher than SCH (1/36) (P = 0.043). The morphology appearance before enhancement showed no significant difference between HSH and SCH. Moreover, SCH had a stronger trend of centripetal enhancement patterns of cavernous hemangiomas (83.3%) compared to HSH (25%) (P < 0.001). Due to more frequent atypical enhancement features, containing rim-like enhancement, no enhancement, and peripheral heterogeneous enhancement, the misdiagnosis rate of HSH (75%) was significantly higher than that of SCH (16.7%) (P < 0.001). Furthermore, the ADC values of HSH and SCH were both higher than that of the surrounding liver parenchyma (P = 0.009, P = 0.002); however, there was no significant difference in ADC values between themselves (P = 0.613). Conclusion SCH showed the same trend of centripetal enhancement characteristics as typical hemangioma, while HSH exhibited atypical enhancement features due to complete sclerosis. Higher ADC values might contribute to the identification of atypical HSH and SCH from malignancies.
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Kim YY, Kang TW, Cha DI, Min JH, Kim YK, Kim SH, Sinn DH, Won H, Kim S. Gadoxetic acid-enhanced MRI for differentiating hepatic sclerosing hemangioma from malignant tumor. Eur J Radiol 2020; 135:109474. [PMID: 33352374 DOI: 10.1016/j.ejrad.2020.109474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND To investigate the imaging features of gadoxetic acid-enhanced magnetic resonance imaging (MRI) to differentiate hepatic sclerosing hemangioma from malignant tumors. METHODS This retrospective case-control study included 18 patients with sclerosing hemangioma and 54 patients with common hepatic malignant tumor, including hepatocellular carcinoma, metastatic adenocarcinoma, and cholangiocarcinoma, who were examined using gadoxetic acid-enhanced liver MRI from January 2008 to June 2019. Imaging features including signal intensity, tumor margins, enhancement pattern, and presence or absence of diffusion restriction were analyzed. Significant MRI features for predicting sclerosing hemangioma were identified using multivariable logistic regression analysis. Diagnostic performances of each imaging feature and combinations of significant imaging features were summarized. RESULTS In the multivariable analysis, irregular margins (odds ratio [OR], 10.12; 95 % confidence interval [CI], 1.27-80.94; p = 0.029), centripetal or internal nodular enhancement in the transitional phase (OR, 13.58; 95 % CI, 1.48-124.82; p = 0.021), and absence of diffusion restriction (OR, 39.20; 95 % CI, 4.82-318.49; p = 0.001) were significant imaging features for the diagnosis of sclerosing hemangioma. Presence of at least two significant imaging features had a sensitivity, specificity, and accuracy of 88.9 %, 96.3 %, and 94.4 %, respectively, for diagnosing sclerosing hemangioma. CONCLUSION Combinations of two or more of the significant imaging features (irregular margins, centripetal or internal nodular enhancement in the transitional phase, and absence of diffusion restriction) were effective for differentiating hepatic sclerosing hemangioma from malignant tumors using gadoxetic acid-enhanced MRI.
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Affiliation(s)
- Yeun-Yoon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hojeong Won
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea.
| | - Seonwoo Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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Akahoshi S, Yamamura K, Sato N, Oda E, Kinoshita K, Yuki H, Motohara T, Deguchi A, Komohara Y, Beppu T. A hepatic sclerosed hemangioma with drastic changes in contrast-enhanced ultrasonography. Clin J Gastroenterol 2020; 13:1252-1257. [PMID: 32705537 DOI: 10.1007/s12328-020-01194-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022]
Abstract
Hepatic sclerosed hemangioma is a rare benign liver tumor that originated from hepatic cavernous hemangioma; however, the process of its formation has been unclear. We herein present the patient of a histologically proven hepatic sclerosed hemangioma that showed drastic changes in diagnostic images in a short period. A 56-year-old man was referred to our hospital for the treatment of suspicious hepatocellular carcinoma with hepatitis C, approximately 2 cm in diameter in liver segment 8. Initially, the tumor manifested as early entire enhancement with mildly delayed washout in contrast-enhanced ultrasonography; however, it manifested as continuous peripheral enhancement with the central non-enhanced area after 1 month in various diagnostic images. He completely quit drinking and smoking 1 month preoperatively. No special symptoms and signs were found to suggest tumor ischemia. Anatomical resection of segment 8 was completed. Histological examination confirmed the final diagnosis of common type hepatic sclerosed hemangioma, derived from atypically enhancing cavernous hemangioma. No signs of impaired blood flow were observed in both diagnostic images and histological examination. Sclerosing changes in hepatic cavernous hemangioma may be completed in a relatively short time with no apparent reason.
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Affiliation(s)
- Shinichi Akahoshi
- Department of Surgery, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan.
| | - Kensuke Yamamura
- Department of Surgery, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan
| | - Nobutaka Sato
- Department of Surgery, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan
| | - Eri Oda
- Department of Surgery, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan
| | - Koichi Kinoshita
- Department of Surgery, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan
| | - Hideaki Yuki
- Department of Radiology, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan
| | - Toshihiko Motohara
- Department of Gastroenterology, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan
| | - Akihiro Deguchi
- Department of Internal Medicine, Kagawa Rosai Hospital, 3-3-1 Jyoto, Marugame, Kagawa, 763‑8502, Japan
| | - Yoshihiro Komohara
- Department of Cell Pathology, Graduate School of Life Sciences, Kumamoto University, 1-1-1, honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Toru Beppu
- Department of Surgery, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan
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10
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Sweed DM, Fayed ZA, Sweed EM, El-Sherif A, Mohamady M. Hepatic sclerosing hemangioma mimics hepatic malignancies: a case report and multidisciplinary approach. EGYPTIAN LIVER JOURNAL 2019. [DOI: 10.1186/s43066-019-0007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hepatic sclerosing hemangiomas (HSH) are rare benign vascular tumors that mimic radiologically hepatic malignancies. HSH is characterized by extensive fibrosis and hyalinosis as a result of degeneration and thrombosis. Pre-operative diagnosis is very difficult and most of the cases undergo surgical resections.
Case presentation
A 65 years old, hepatitis C virus-infected female presented by an accidentally discovered hepatic focal lesion. Magnetic resonance imaging (MRI) showed a T2 hyperintense mass displaying peripheral enhancement in porto-venous phase. The patient had a simultaneous typical hepatic hemangioma and multiple vertebral bodies’ hemangiomata. Tissue-guided biopsy revealed a densely sclerotic stroma containing vascular spaces with occasional obliteration of the lumen. Immunohistochemical staining was performed for Pan CK, CD34, SMA, VEGF, and c-Kit which confirmed the vascular nature of neoplasm and the involuting phase of hemangioma development. The patient was reassured and recommended for a regular radiological follow-up to reassess the lesion size.
Conclusion
The definitive preoperative diagnosis of HSH is still problematic. However, the awareness of surgeons by this entity, peripheral enhancement in porto-venous phase on dynamic MRI, the presence of simultaneous typical hepatic hemangioma in the absence of cancer history could raise suspicion for HSH. Liver biopsy is still the gold standard in approaching the accurate diagnosis.
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Yugawa K, Yoshizumi T, Harada N, Motomura T, Harimoto N, Itoh S, Ikegami T, Soejima Y, Maehara Y. Multiple hepatic sclerosing hemangiomas: a case report and review of the literature. Surg Case Rep 2018; 4:60. [PMID: 29916092 PMCID: PMC6006004 DOI: 10.1186/s40792-018-0468-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022] Open
Abstract
Background Hepatic sclerosing hemangioma, a very rare benign tumor, is characterized by fibrosis and hyalinization occurring in association with degeneration of a hepatic cavernous hemangioma. Such atypical hemangiomas can be diagnosed incorrectly as primary or metastatic malignancies based on imaging characteristics. We present herein a rare case of giant and multiple hepatic sclerosing hemangiomas that are difficult to differentiate from hepatic malignancies and review the relevant literature. Case presentation The patient was a 48-year-old male who was found to have multiple hepatic tumors and a giant tumor (67 × 53 mm) superior to the inferior vena cave by an abdominal ultrasonography during a routine medical examination. The patient was referred to our hospital for further evaluations and diagnosis of the multiple hepatic tumors. Dynamic CT showed low-density tumors in the delayed phase suggestive of membrane-covered lesions. EOB-MRI demonstrated a mass with low-signal intensity mass on T1-weighted images and areas of high-signal intensity on T2-weighted images and a hypointense mass in the hepatobiliary phase, which showed high intensity on DWI-based ADC map. FDG-PET showed no accumulation of [18F]-FDG. A provisional diagnosis of multiple scirrhous hepatocellular carcinomas was made on the basis of these imaging studies, and caudate lobectomy of the liver and partial hepatectomy of S2 and S6 were performed. Histopathological examination showed that the tumors were composed of various sized irregularly dilated vessels with some blood thrombi, inflammatory cell infiltration, fibrous and hyalinized sclerotic or myxomatous stroma, resulting in a diagnosis of multiple hepatic sclerosing hemangiomas. Conclusions Differentiation of multiple sclerosing hemangiomas from other hepatic malignant tumors, such as intrahepatic cholangiocarcinoma, metastatic liver cancer, and scirrhous hepatocellular carcinoma characterized by abundant fibrous stroma, is difficult because the radiological findings are very similar. Inclusion of hepatic sclerosing hemangioma in the differential diagnosis of multiple liver tumors could enable optimal management; this possibility is important to consider before planning invasive therapies.
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Affiliation(s)
- Kyohei Yugawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Noboru Harada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takashi Motomura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Norifumi Harimoto
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Showa-machi 3-39-22, Maebashi-shi, Gunma, 371-85111, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Toru Ikegami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuji Soejima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
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