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Abdominal Radiology

, Volume 37, Issue 5, pp 775–780 | Cite as

Fading hepatic hemangiomas on multiphasic CT

  • Samira Alturkistany
  • Hyun-Jung JangEmail author
  • Hojun Yu
  • Kyoung Ho Lee
  • Tae Kyoung Kim
Article

Abstract

Purpose

To describe fading hemangiomas [substantially lower attenuation (>30 HU) than vascular pool in the portal venous phase (PVP)] and to determine their incidence and characteristics on multiphasic CT.

Methods

The study population composed of 168 hemangiomas (≥5 mm) in 114 consecutive patients which were imaged on multiphasic CT and also proved by diagnostic findings on MRI. The size of hemangiomas and CT attenuation number of the enhancing area within the hemangioma, liver parenchyma, and portal vein were measured on both arterial phase (AP) and PVP images. The rapidity of enhancement (slow, <50%; rapid, 50%–99%; flash-filler, 100% filling in the AP) and association with arterioportal shunting (APS) were also determined by two independent reviewers. Imaging features were compared between fading and non-fading hemangiomas using Kruskal–Wallis test.

Results

Of 168 hemangiomas, the enhancing area of 27 hemangiomas (16%, 27/168) showed substantially lower attenuation than that of PV (fading) in the PVP. When the attenuation difference was compared with the rapidity of enhancement, flash-fillers showed lower attenuation than PV in the PVP more frequently than both slow-fillers (P < 0.05) and rapid-fillers (P < 0.05). The proportion of fading hemangiomas was 52% (14/27) in flash-fillers, much more frequent than in rapid-fillers (4/27, 15%) as well as slow-fillers (9/27, 33.3%). The size of fading hemangiomas (17.9 ± 4.5 mm) was significantly smaller than that of non-fading (24.2 ± 3.6 mm) (P = 0.032). Although APS was more frequent in fading hemangiomas (55.6%, 15/27) than that of non-fading hemangiomas (37.6%, 53/141), there was no statistically significant difference (P = 0.086).

Conclusions

Sixteen percentage (27/168) of the hemangiomas in our study showed substantially lower attenuation than the portal vein in the PVP CT and this was more frequent in flash-fillers (52%, 14/27). The knowledge that fading does not preclude the diagnosis of hemangioma as well as of its high incidence in flash-fillers is important, as flash-filling hemangiomas with fading may cause a diagnostic challenge in patients suspected to have hypervascular malignancy.

Keywords

Hemangioma Liver CT 

References

  1. 1.
    Itai Y, Furui S, Araki T, Yashiro N, Tasaka A (1980) CT of cavernous hemangioma of the liver. Radiology 137:149–155CrossRefPubMedGoogle Scholar
  2. 2.
    Freeny PC, Marks WM (1986) Hepatic hemangioma: dynamic bolus CT. AJR Am J Roentgenol 147:711–719CrossRefPubMedGoogle Scholar
  3. 3.
    Quinn SF, Benjamin GC (1992) Hepatic cavernous hemangiomas: simple diagnostic sign with dynamic bolus CT. Radiology 182:545–548CrossRefPubMedGoogle Scholar
  4. 4.
    Leslie DF, Johnson CD, Johnson CM, Ilstrup DM, Harmsen WS (1995) Distinction between cavernous hemangiomas of the liver and hepatic metastases on CT: value of contrast enhancement patterns. AJR Am J Roentgenol 164:625–629CrossRefPubMedGoogle Scholar
  5. 5.
    Oto A, Kulkarni K, Nishikawa R, Baron RL (2010) Contrast enhancement of hepatic hemangiomas on multiphase MDCT: can we diagnose hepatic hemangiomas by comparing enhancement with blood pool? AJR Am J Roentgenol 195:381–386CrossRefPubMedGoogle Scholar
  6. 6.
    Semelka RC, Brown ED, Ascher SM, et al. (1994) Hepatic hemangiomas: a multi-institutional study of appearance on T2-weighted and serial gadolinium-enhanced gradient-echo MR images. Radiology 192:401–406CrossRefPubMedGoogle Scholar
  7. 7.
    Kim KW, Kim TK, Han JK, et al. (2001) Hepatic hemangiomas with arterioportal shunt: findings at two-phase CT. Radiology 219:707–711CrossRefPubMedGoogle Scholar
  8. 8.
    Yamashita Y, Ogata I, Urata J, Takahashi M (1997) Cavernous hemangioma of the liver: pathologic correlation with dynamic CT findings. Radiology 203:121–125CrossRefPubMedGoogle Scholar
  9. 9.
    Gaa J, Saini S, Ferrucci JT (1991) Perfusion characteristics of hepatic cavernous hemangioma using intravenous CT angiography (IVCTA). Eur J Radiol 12:228–233CrossRefPubMedGoogle Scholar
  10. 10.
    Jang HJ, Choi BI, Kim TK, et al. (1998) Atypical small hemangiomas of the liver: “bright dot” sign at two-phase spiral CT. Radiology 208:543–548CrossRefPubMedGoogle Scholar
  11. 11.
    Kim T, Federle MP, Baron RL, Peterson MS, Kawamori Y (2001) Discrimination of small hepatic hemangiomas from hypervascular malignant tumors smaller than 3 cm with three-phase helical CT. Radiology 219:699–706CrossRefPubMedGoogle Scholar
  12. 12.
    Marti-Bonmati L, Casillas C, Graells M, Masia L (1999) Atypical hepatic hemangiomas with intense arterial enhancement and early fading. Abdom Imaging 24:147–152CrossRefPubMedGoogle Scholar
  13. 13.
    Jang HJ, Kim TK, Lim HK, et al. (2003) Hepatic hemangioma: atypical appearances on CT, MR imaging, and sonography. AJR Am J Roentgenol 180:135–141CrossRefPubMedGoogle Scholar
  14. 14.
    Hanafusa K, Ohashi I, Himeno Y, Suzuki S, Shibuya H (1995) Hepatic hemangioma: findings with two-phase CT. Radiology 196:465–469CrossRefPubMedGoogle Scholar
  15. 15.
    Monzawa S, Ichikawa T, Nakajima H, et al. (2007) Dynamic CT for detecting small HCC: usefulness of delayed phase imaging. AJR Am J Roentgenol 188:147–153CrossRefPubMedGoogle Scholar
  16. 16.
    Luca A, Caruso S, Milazzo M, et al. (2010) Multidetector-row computed tomography (MDCT) for the diagnosis of hepatocellular carcinoma in cirrhotic candidates for liver transplantation: prevalence of radiological vascular patterns and histological correlation with liver explants. Eur Radiol 20:898–907CrossRefPubMedGoogle Scholar
  17. 17.
    Jeong MG, Yu JS, Kim KW (2000) Hepatic cavernous hemangioma: temporal peritumoral enhancement during multiphase dynamic MR imaging. Radiology 216:692–697CrossRefPubMedGoogle Scholar
  18. 18.
    Byun JH, Kim TK, Lee CW, et al. (2004) Arterioportal shunt: prevalence in small hemangiomas vs. that in hepatocellular carcinomas 3 cm or smaller at two-phase helical CT. Radiology 232:354–360CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Samira Alturkistany
    • 1
  • Hyun-Jung Jang
    • 1
    Email author
  • Hojun Yu
    • 1
  • Kyoung Ho Lee
    • 1
  • Tae Kyoung Kim
    • 1
  1. 1.Department of Medical ImagingUniversity of Toronto, Toronto General HospitalTorontoCanada

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