Hepatic Cavernous Hemangioma

 Arterial phase: Early peripheral, nodular or globular, discontinuous enhancement

• Small hemangiomas (capillary): < 2 cm
image Arterial and venous phases: Homogeneous enhancement (flash-filling)

• Typical hemangiomas: 2-10 cm in diameter
image Venous phase: Progressive centripetal enhancement to uniform filling, still isodense to blood vessels

• Giant hemangioma: > 10 cm in diameter
image Venous and delayed phases: Incomplete centripetal filling of lesion (scar does not enhance)

• US: Peripheral rim or homogeneously hyperechoic mass ± acoustic enhancement


• Cholangiocarcinoma (peripheral)

• Hypervascular metastases

• Hepatic angiosarcoma


• Small hepatocellular carcinomas and hypervascular metastases
image Can mimic small hemangiomas by their uniform homogeneous enhancement pattern

• Hemangiomas
image Remain isodense to blood vessels on portal venous and delayed phases of enhancement

• Other benign and malignant liver masses
image Usually become hypodense to blood vessels and liver (except cholangiocarcinoma)

(Left) Graphic shows 2 hemangiomas image as nonencapsulated collections of blood within enlarged sinusoidal spaces. The liver is otherwise normal.

(Right) Low-power photomicrograph shows dilated vascular spaces filled with blood. Note the somewhat irregular interface between the hemangioma and the surrounding liver. (Courtesy L. Lamps, MD.)

(Left) Axial T2WI MR demonstrates a mass image with marked hyperintensity, similar to that of CSF. A central scar image within the mass is even more hyperintense, a typical feature of a large or giant hemangioma.

(Right) Axial arterial phase T1WI MR in the same patient shows nodular, discontinuous, peripheral enhancement image of the hemangioma, isointense to hepatic vessels, that persisted and progressed on subsequent phases (not shown).



• Cavernous hemangioma of liver

• Capillary hemangioma (small lesion)


• Benign tumor composed of multiple vascular channels lined by single layer of endothelial cells supported by thin fibrous stroma


General Features

• Best diagnostic clue
image Peripheral nodular enhancement on arterial phase scan with slow, progressive, centripetal enhancement isodense to vessels

• Location
image Common in subcapsular area in posterior right lobe of liver

• Size
image Varies from few mm to > 20 cm

image Giant hemangiomas: > 10 cm (arbitrary)

• Morphology
image Usually solitary and slow growing

image May be multiple in up to 50% of cases

image Calcification is rare (< 10%)
– Usually within scar of giant hemangioma

CT Findings

image Small (1-2 cm) and typical (2-10 cm) hemangioma
– Well-circumscribed, spherical to ovoid mass isodense to blood

image Giant hemangioma (> 10 cm)
– Heterogeneous hypodense mass

– Central low-density scar ± calcification

image Small hemangiomas (capillary): < 2 cm
– Arterial and venous phases: Usually show homogeneous enhancement (flash-filling)

image Typical hemangiomas: 2-10 cm in diameter
– Arterial phase: Early peripheral, nodular or globular, discontinuous enhancement

– Venous phase: Progressive centripetal enhancement to uniform filling, still isodense to blood vessels

– Delayed phase: Persistent complete filling

image Giant hemangioma: > 10 cm in diameter
– Arterial phase: Typical peripheral nodular, cloud-like, or globular enhancement

– Venous and delayed phases: Incomplete centripetal filling of lesion (scar does not enhance)

image Atypical hemangioma
– May appear to enhance from inside in centrifugal pattern

– Coronal imaging may reveal more typical centripetal enhancement pattern

image Hyalinized (sclerosed) hemangioma
– Shows minimal or no enhancement

– Cannot be diagnosed with confidence by imaging

– Probably the same as “solitary necrotic nodule” described by pathologists

image Hemangioma in cirrhotic liver
– Flash-filling of small lesion may mimic hepatocellular carcinoma (HCC)
image Does not washout, unlike HCC

– ↓ size and ↑ fibrosis over time
image May lose characteristic enhancement pattern

image Capsular retraction over shrunken lesion

MR Findings

• T1WI
image Small and typical hemangiomas
– Well marginated

– Isointense to blood or hypointense

image Giant hemangioma
– Hypointense mass

– Central cleft-like area of marked decreased intensity (scar or fibrous tissue)

• T2WI
image Small and typical hemangiomas
– Hyperintense, similar to CSF

image Giant hemangioma
– Hyperintense mass

– Marked hyperintense center (scar or fibrosis)

– Hypointense internal septa

• T1WI C+
image Same enhancement pattern as on CT

image Small hemangiomas (< 2 cm)
– Homogeneous enhancement in arterial and portal phases

image Typical and giant hemangiomas
– Arterial phase: Peripheral, nodular, discontinuous enhancement

– Venous phase: Progressive centripetal filling

– In both phases: Isointense to blood

– Central scar: No enhancement and remains hypointense

Ultrasonographic Findings

• Grayscale ultrasound
image Small hemangioma (< 2 cm)
– Well-defined hyperechoic lesion

image Typical hemangioma (2-10 cm)
– Homogeneous hyperechoic mass with acoustic enhancement

image Giant hemangioma (> 10 cm)
– Lobulated heterogeneous mass with hyperechoic border

image Atypical hemangioma
– Well defined

– Iso-/hypoechoic mass with hyperechoic rim

• Color Doppler
image Shows filling vessels in periphery of tumor

image No significant color Doppler flow in center of lesion

Nov 16, 2016 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Hepatic Cavernous Hemangioma

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