Hemangioma

Demographics

• More common in women

Classic Imaging Appearance

• Enhancement: Peripheral nodular discontinuous enhancement progressing centripetally, persistent enhancement equal to the vessels
  
• Magnetic resonance imaging (MRI):
  
  
  
  • T1-weighted: Hypointense
    
  • T2-weighted: Hyperintense

Differentiating Features

Hemangioma versus Hypervascular Metastasis or Hepatocellular Carcinoma

• Enhancement in hemangiomas is equal to the vessels.
  
• Hemangiomas have persistent enhancement on delayed images.
  
• Hemangiomas have a greater degree of T2-weighted MRI (T2WI) hyperintensity.
  
• Hemangiomas may have perilesional enhancement (however, this can be seen in hepatocellular carcinoma [HCC]).

Cholangiocarcinoma versus Hemangioma

• Peripheral enhancement in cholangiocarcinoma is less than in the vessels and usually continuous rather than nodular and discontinuous.
  
• Both lesions can have capsular retraction.

Focal Nodular Hyperplasia

Demographics

• Young to middle-aged women

Classic Imaging Features

• Central scar
  
• Enhancement: Homogeneous arterial phase enhancement, delayed enhancement of central scar
  
• Computed tomography (CT):
  
  
  
  • Noncontrast: Isodense or hypodense
    
  • Arterial phase: Hyperdense
    
  • Portal phase: Isodense or hypodense
    
  • Delayed phase: Isodense, central scar hyperdense
  
  
• MRI:
  
  
  
  • T1-weighted: Isointense or hypointense
    
  • T2-weighted: Isointense or hyperintense

Differentiating Features

• Central scar
  
• Homogeneity
  
• Arterial phase enhancement

• Greater degree of arterial phase enhancement than adenoma
  
• More likely to be isodense in the portal phase than adenoma
  
• More homogeneous than adenoma
  
• Central scar very rarely seen in adenoma
  
• Hemorrhage very rarely seen in focal nodular hyperplasia (FNH)
  
• Macroscopic fat can be seen in adenomas, but is rare in FNH
  
• Delayed gadobenate dimeglumine (Gd-BOPTA; Multihance, Bracco Imaging, Milan, Italy) uptake is seen in FNH, but not adenomas
  
• Subcapsular feeding arteries more likely in adenoma

Focal Nodular Hyperplasia versus Fibrolamellar Hepatocellular Carcinoma

• In FNH, the central scar is hyperintense on T2WI, hypointense in fibrolamellar HCC.
  
• Delayed enhancement of central scar is seen in FNH, but not fibrolamellar HCC.
  
• Scar is smaller in FNH.
  
• Intracellular lipid detectable by chemical shift MRI is more commonly seen in FNH.
  
• Fibrolamellar HCC is larger, more lobulated, and more heterogeneous.
  
• Calcifications are very rare in FNH, but common in fibrolamellar HCC.

Hepatic Adenoma

Demographics

• Young and middle-aged women
  
• Oral contraceptive use
  
• Men – anabolic steroids or glycogen storage disease

Classic Imaging Features

• Enhancement: Arterial phase enhancement, often heterogeneous
  
• CT:
  
  
  
  • Noncontrast: Isodense or hypodense
    
  • Arterial phase: Hyperdense, often heterogeneous
    
  • Portal phase: Hyperdense, isodense, or hypodense
    
  • Delayed phase: Isodense or hypodense
  
  
• MRI:
  
  
  
  • T1-weighted: Hypointense, often heterogeneous
    
  • T2-weighted: Hyperintense, often heterogeneous

Differentiating Features

• Arterial phase enhancement
  
• Heterogeneity
  
• Hemorrhage
  
• Macroscopic and microscopic fat

Adenoma versus Focal Nodular Hyperplasia

• Lesser degree of arterial phase enhancement than FNH
  
• More likely to be hyperdense in the portal phase than FNH
  
• More heterogeneous than FNH
  
• Central scar is very rarely seen in adenoma.
  
• Hemorrhage is very rarely seen in FNH.
  
• Macroscopic fat can be seen in adenomas, but is rare in FNH.
  
• Delayed Gd-BOPTA (Multihance) uptake is seen in FNH, but not adenomas.
  
• Subcapsular feeding arteries more likely in adenoma

Hepatocellular Carcinoma

Demographics

• Cirrhotic livers
  
• Usually after 30 years of age, later onset in lower incidence areas
  
• More common in men, particularly in high incidence areas

• Enhancement: Heterogeneous arterial phase enhancement
  
• CT:
  
  
  
  • Noncontrast: Hypodense
    
  • Arterial phase: Hyperdense, heterogeneous
    
  • Portal phase: Hypodense, heterogeneous
    
  • Delayed phase: Hypodense
  
  
• MRI:
  
  
  
  • T1-weighted: Hypointense
    
  • T2-weighted: Hyperintense

Differentiating Features

• Cirrhotic liver
  
• Hypervascular
  
• Rapid washout, lack of delayed enhancement
  
• Heterogeneous
  
• T2WI hyperintense
  
• Capsule

HCC versus Regenerating or Dysplastic Nodule