Abdominal Imaging

, Volume 36, Issue 4, pp 415–424 | Cite as

Hepatic epithelioid hemangioendothelioma: findings at CT and MRI including preliminary observations at diffusion-weighted echo-planar imaging

  • Melanie BruegelEmail author
  • Daniela Muenzel
  • Simone Waldt
  • Katja Specht
  • Ernst J. Rummeny



Hepatic epithelioid hemangioendothelioma (EHE) is a rare vascular tumor with low- to intermediate-grade malignant potential. We describe cross-sectional imaging findings of pathologically confirmed EHE including preliminary observations on lesion characteristics and apparent diffusion coefficients (ADCs) at diffusion-weighted MR imaging (DWI).


CT and MRI examinations in five patients were retrospectively reviewed. Two radiologists evaluated lesion growth patterns, attenuation, signal intensity characteristics, and contrast enhancement patterns. Additionally, DWI features on low and high b-value images as well as ADCs were assessed in three patients.


Imaging features of EHE included multifocal hepatic disease (n = 5), predominantly subcapsular location (n = 5), coalescence of nodules (n = 5), capsular retraction (n = 3), and intralesional calcifications (n = 3). Contrast-enhanced CT and MR images showed variable degrees of peripheral rim enhancement. T2-weighted MR images, low b-value DWI and ADC maps frequently depicted a “target-sign” appearance of tumor nodules. A markedly hyperintense central area corresponding to hypocellular stroma was surrounded by a moderately hyperintense outer rim reflecting hypercellular tumor regions. The mean ADC of lesions was 1.86 × 10−3 mm2/s.


Cross-sectional imaging displayed typical features of EHE. The mean ADC value of lesions was found to be relatively high in comparison with other hepatic malignancies, which may be helpful in suggesting the diagnosis.


Liver neoplasms Epithelioid hemangioendothelioma Multislice spiral CT Diffusion-weighted MRI ADC value 


  1. 1.
    Makhlouf HR, Ishak KG, Goodman ZD (1999) Epithelioid hemangioendothelioma of the liver: a clinicopathologic study of 137 cases. Cancer 85:562–582PubMedCrossRefGoogle Scholar
  2. 2.
    Weiss SW, Enzinger FM (1982) Epithelioid hemangioendothelioma: a vascular tumor often mistaken for a carcinoma. Cancer 50:970–981PubMedCrossRefGoogle Scholar
  3. 3.
    Mehrabi A, Kashfi A, Fonouni H, et al. (2006) Primary malignant hepatic epithelioid hemangioendothelioma: a comprehensive review of the literature with emphasis on the surgical therapy. Cancer 107:2108–2121PubMedCrossRefGoogle Scholar
  4. 4.
    Weitz J, Klimstra DS, Cymes K, et al. (2007) Management of primary liver sarcomas. Cancer 109:1391–1396PubMedCrossRefGoogle Scholar
  5. 5.
    Buetow PC, Buck JL, Ros PR, Goodman ZD (1994) Malignant vascular tumors of the liver: radiologic-pathologic correlation. Radiographics 14:153–166PubMedGoogle Scholar
  6. 6.
    Radin DR, Craig JR, Colletti PM, Ralls PW, Halls JM (1988) Hepatic epithelioid hemangioendothelioma. Radiology 169:145–148PubMedGoogle Scholar
  7. 7.
    Earnest F, Johnson CD (2006) Case 96: Hepatic epithelioid hemangioendothelioma. Radiology 240:295–298PubMedCrossRefGoogle Scholar
  8. 8.
    Kehagias DT, Moulopoulos LA, Antoniou A, et al. (2000) Hepatic epithelioid hemangioendothelioma: MR imaging findings. Hepatogastroenterology 47:1711–1713PubMedGoogle Scholar
  9. 9.
    Mermuys K, Vanhoenacker PK, Roskams T, D’Haenens P, Van HL (2004) Epithelioid hemangioendothelioma of the liver: radiologic-pathologic correlation. Abdom Imaging 29:221–223PubMedCrossRefGoogle Scholar
  10. 10.
    Kim KA, Kim KW, Park SH, et al. (2006) Unusual mesenchymal liver tumors in adults: radiologic-pathologic correlation. AJR Am J Roentgenol 187:W481–W489PubMedCrossRefGoogle Scholar
  11. 11.
    Lyburn ID, Torreggiani WC, Harris AC, et al. (2003) Hepatic epithelioid hemangioendothelioma: sonographic, CT, and MR imaging appearances. AJR Am J Roentgenol 180:1359–1364PubMedGoogle Scholar
  12. 12.
    Ros LH, Fernandez L, Villacampa VM, Ros PR (1999) Epithelioid hemangioendothelioma of the liver–characteristics on magnetic resonance imaging: case report. Can Assoc Radiol J 50:387–389PubMedGoogle Scholar
  13. 13.
    Ohtomo K, Araki T, Itai Y, et al. (1992) MR imaging of malignant mesenchymal tumors of the liver. Gastrointest Radiol 17:58–62PubMedCrossRefGoogle Scholar
  14. 14.
    Yu RS, Chen Y, Jiang B, Wang LH, Xu XF (2008) Primary hepatic sarcomas: CT findings. Eur Radiol 18:2196–2205PubMedCrossRefGoogle Scholar
  15. 15.
    Furui S, Itai Y, Ohtomo K, et al. (1989) Hepatic epithelioid hemangioendothelioma: report of five cases. Radiology 171:63–68PubMedGoogle Scholar
  16. 16.
    Lin J, Ji Y (2010) CT and MRI diagnosis of hepatic epithelioid hemangioendothelioma. Hepatobiliary Pancreat Dis Int 9:154–158PubMedGoogle Scholar
  17. 17.
    Miller WJ, Dodd GD III, Federle MP, Baron RL (1992) Epithelioid hemangioendothelioma of the liver: imaging findings with pathologic correlation. AJR Am J Roentgenol 159:53–57PubMedGoogle Scholar
  18. 18.
    Van Beers B, Roche A, Mathieu D, et al. (1992) Epithelioid hemangioendothelioma of the liver: MR and CT findings. J Comput Assist Tomogr 16:420–424PubMedCrossRefGoogle Scholar
  19. 19.
    Bruegel M, Holzapfel K, Gaa J, et al. (2008) Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique. Eur Radiol 18:477–485PubMedCrossRefGoogle Scholar
  20. 20.
    Bruegel M, Rummeny EJ (2010) Hepatic metastases: use of diffusion-weighted echo-planar imaging. Abdom Imaging 35:454–461PubMedCrossRefGoogle Scholar
  21. 21.
    Koh DM, Collins DJ (2007) Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 188:1622–1635PubMedCrossRefGoogle Scholar
  22. 22.
    Ishak KG, Sesterhenn IA, Goodman ZD, Rabin L, Stromeyer FW (1984) Epithelioid hemangioendothelioma of the liver: a clinicopathologic and follow-up study of 32 cases. Hum Pathol 15:839–852PubMedCrossRefGoogle Scholar
  23. 23.
    Lerut JP, Orlando G, Adam R, et al. (2007) The place of liver transplantation in the treatment of hepatic epitheloid hemangioendothelioma: report of the European liver transplant registry. Ann Surg 246:949–957PubMedCrossRefGoogle Scholar
  24. 24.
    Blachar A, Federle MP, Brancatelli G (2002) Hepatic capsular retraction: spectrum of benign and malignant etiologies. Abdom Imaging 27:690–699PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Melanie Bruegel
    • 1
    Email author
  • Daniela Muenzel
    • 1
  • Simone Waldt
    • 1
  • Katja Specht
    • 2
  • Ernst J. Rummeny
    • 1
  1. 1.Department of Radiology, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  2. 2.Institute of Pathology, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany

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