Abdominal Imaging

, Volume 38, Issue 4, pp 745–754 | Cite as

Hepatic angiosarcoma: cross-sectional imaging findings in seven patients with emphasis on dynamic contrast-enhanced and diffusion-weighted MRI

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



Primary hepatic angiosarcoma is a very rare and aggressive malignancy of vascular origin. We describe cross-sectional imaging findings of this entity with emphasis on dynamic contrast-enhanced (DCE) and diffusion-weighted (DWI) MR imaging.


Seven cases of pathologically confirmed hepatic angiosarcoma were retrospectively reviewed (CT and MRI examinations were available in seven and six patients, respectively). Two radiologists evaluated lesion growth patterns, attenuation, signal intensity characteristics, contrast enhancement patterns, and apparent diffusion coefficients (ADCs).


Multifocal hepatic disease was present in six patients by means of a mixed pattern of large dominant masses and multiple small nodules; one patient had a solitary large mass. Unenhanced images depicted hemorrhagic areas and a markedly heterogeneous internal architecture within large tumors. Contrast-enhanced early phase images showed variable patterns including patchy peripheral or bizarre shaped intralesional foci of enhancement, peripheral rim enhancement, and small lesions without enhancement. On DCE images, the majority of lesions presented with varying degrees of progressive enhancement. Small nodules frequently displayed homogeneous enhancement on delayed phase images due to complete fill-in. DWI revealed a high interlesional variability of ADC values (range 0.57–2.41 × 10−3 mm2/s, mean 1.37 × 10−3 mm2/s).


Cross-sectional imaging findings of hepatic angiosarcoma reflect the varied histopathological composition of the tumors. Multifocal disease, hemorrhage within large lesions, as well as progressive enhancement on DCE images are typical features of hepatic angiosarcoma. The mean ADC of lesions was found to be slightly elevated in comparison with other hepatic malignancies.


Liver neoplasms Angiosarcoma Multislice spiral CT Dynamic contrast-enhanced MRI diffusion-weighted MRI ADC value 


  1. 1.
    Alrenga DP (1975) Primary angiosarcoma of the liver: review article. Int Surg 60:198–203PubMedGoogle Scholar
  2. 2.
    Falk H, Herbert J, Crowley S, et al. (1981) Epidemiology of hepatic angiosarcoma in the United States: 1964–1974. Environ Health Perspect 41:107–113PubMedCrossRefGoogle Scholar
  3. 3.
    Locker GY, Doroshow JH, Zwelling LA, Chabner BA (1979) The clinical features of hepatic angiosarcoma: a report of four cases and a review of the English literature. Medicine (Baltimore) 58:48–64CrossRefGoogle Scholar
  4. 4.
    Kim HR, Rha SY, Cheon SH, et al. (2009) Clinical features and treatment outcomes of advanced stage primary hepatic angiosarcoma. Ann Oncol 20:780–787. doi: 10.1093/annonc/mdn702 PubMedCrossRefGoogle Scholar
  5. 5.
    Drinkovic I, Brkljacic B (1996) Two cases of lethal complications following ultrasound-guided percutaneous fine-needle biopsy of the liver. Cardiovasc Intervent Radiol 19:360–363. doi: 10.1007/BF02570192 PubMedCrossRefGoogle Scholar
  6. 6.
    Mahony B, Jeffrey RB, Federle MP (1982) Spontaneous rupture of hepatic and splenic angiosarcoma demonstrated by CT. AJR Am J Roentgenol 138:965–966PubMedCrossRefGoogle Scholar
  7. 7.
    Rademaker J, Widjaja A, Galanski M (2000) Hepatic hemangiosarcoma: imaging findings and differential diagnosis. Eur Radiol 10:129–133. doi: 10.1007/s003300050018 PubMedCrossRefGoogle Scholar
  8. 8.
    Kim KA, Kim KW, Park SH, et al. (2006) Unusual mesenchymal liver tumors in adults: radiologic-pathologic correlation. AJR Am J Roentgenol 187:W481–W489. doi: 10.2214/AJR.05.0659 PubMedCrossRefGoogle Scholar
  9. 9.
    Yu RS, Chen Y, Jiang B, et al. (2008) Primary hepatic sarcomas: CT findings. Eur Radiol 18:2196–2205. doi: 10.1007/s00330-008-0997-7 PubMedCrossRefGoogle Scholar
  10. 10.
    Buetow PC, Buck JL, Ros PR, Goodman ZD (1994) Malignant vascular tumors of the liver: radiologic-pathologic correlation. Radiographics 14:153–166PubMedGoogle Scholar
  11. 11.
    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 18:477–485. doi: 10.1007/s00330-007-0785-9 PubMedCrossRefGoogle Scholar
  12. 12.
    Koh DM, Collins DJ (2007) Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 188:1622–1635. doi: 10.2214/AJR.06.1403 PubMedCrossRefGoogle Scholar
  13. 13.
    Fracanzani AL, Conte D, Fraquelli M, et al. (2001) Increased cancer risk in a cohort of 230 patients with hereditary hemochromatosis in comparison to matched control patients with non-iron-related chronic liver disease. Hepatology 33:647–651. doi: 10.1053/jhep.2001.22506 PubMedCrossRefGoogle Scholar
  14. 14.
    Levy DW, Rindsberg S, Friedman AC, et al. (1986) Thorotrast-induced hepatosplenic neoplasia: CT identification. AJR Am J Roentgenol 146:997–1004PubMedCrossRefGoogle Scholar
  15. 15.
    Koyama T, Fletcher JG, Johnson CD, et al. (2002) Primary hepatic angiosarcoma: findings at CT and MR imaging. Radiology 222:667–673. doi: 10.1148/radiol.2223010877 PubMedCrossRefGoogle Scholar
  16. 16.
    Weitz J, Klimstra DS, Cymes K, et al. (2007) Management of primary liver sarcomas. Cancer 109:1391–1396. doi: 10.1002/cncr.22530 PubMedCrossRefGoogle Scholar
  17. 17.
    Peterson MS, Baron RL, Rankin SC (2000) Hepatic angiosarcoma: findings on multiphasic contrast-enhanced helical CT do not mimic hepatic hemangioma. AJR Am J Roentgenol 175:165–170PubMedCrossRefGoogle Scholar
  18. 18.
    Silverman PM, Ram PC, Korobkin M (1983) CT appearance of abdominal thorotrast deposition and thorotrast-induced angiosarcoma of the liver. J Comput Assist Tomogr 7:655–658PubMedCrossRefGoogle Scholar
  19. 19.
    White PG, Adams H, Smith PM (1993) The computed tomographic appearances of angiosarcoma of the liver. Clin Radiol 48:321–325PubMedCrossRefGoogle Scholar
  20. 20.
    Worawattanakul S, Semelka RC, Kelekis NL, Woosley JT (1997) Angiosarcoma of the liver: MR imaging pre- and post-chemotherapy. Magn Reson Imaging 15:613–617PubMedCrossRefGoogle Scholar
  21. 21.
    Chung YE, Kim MJ, Park YN, et al. (2009) Varying appearances of cholangiocarcinoma: radiologic-pathologic correlation. Radiographics 29:683–700. doi: 10.1148/rg.293085729 PubMedCrossRefGoogle Scholar
  22. 22.
    Bruegel M, Rummeny EJ (2010) Hepatic metastases: use of diffusion-weighted echo-planar imaging. Abdom Imaging 35:454–461. doi: 10.1007/s00261-009-9541-8 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

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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