Abdominal Imaging

, Volume 40, Issue 3, pp 500–509 | Cite as

CT and MR imaging findings of hepatic epithelioid hemangioendotheliomas: emphasis on single nodular type

  • Eu Hyun Kim
  • Sung Eun RhaEmail author
  • Young Joon Lee
  • Ie Ryung Yoo
  • Eun Sun Jung
  • Jae Young Byun



To evaluate imaging findings of hepatic epithelioid hemangioendothelioma (HEH), with emphasis on solitary form at the initial presentation.

Materials and methods

Ten cases of pathologically confirmed HEH were retrospectively reviewed; seven patients had CT and MR images and three had only CT images. Two radiologists assessed the followings in consensus: lesion number, size, location, presence of capsular retraction and calcification, attenuation, signal intensity, and enhancement pattern.


Initially, HEHs manifested as a single mass (n = 5) or multiple masses (n = 5). One case demonstrated a solitary nodule at first, which subsequently transformed to multifocal nodules on serial follow-up. The maximal diameter of the lesions ranged from 1.8 to 10 cm (mean 4.2 cm). All cases showed predominant subcapsular location. Capsular retraction was seen in multinodular types, but not in solitary types. Two patients had intra-lesional calcifications. HEHs showed minimal enhancement (7/7 patients) on the hepatic arterial phase CT and rim-like enhancement (5/10 patients), minimal enhancement (2/10 patients), multilayered target enhancement (2/10 patients), and peripheral nodular enhancement (1/10 patients) on the portal venous phase CT. On MR images (n = 7), HEHs showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images. Dynamic contrast-enhanced MR images revealed progressive centripetal fill-in enhancement (7/7 patients). On Gd-EOB-DTPA-enhanced hepatobiliary phase images, HEH manifested as homogeneous hypointensity (3/5 patients) and target-shaped hypointensity (2/5 patients).


HEH can manifest as single nodular, multinodular, or diffuse type. Common imaging features of HEH are multiple subcapsular nodules with coalescence, capsular retraction, peripheral, and delayed enhancement. However, HEH can manifest as a solitary subcapsular mass with minimal or rim-like enhancement at early phase and progressive centripetal fill-in enhancement during dynamic phase imaging, representing early stage of HEH. A single nodular type can progress to multifocal nodular type during follow-up.


CT Hepatic epithelioid hemangioendothelioma Liver MRI PET/CT 


  1. 1.
    Amin S, Chung H, Jha R (2011) Hepatic epithelioid hemangioendothelioma: MR imaging findings. Abdom Imaging 36(4):407–414. doi: 10.1007/s00261-010-9662-0 CrossRefPubMedGoogle Scholar
  2. 2.
    Azzam RI, Alshak NS, Pham HP (2012) AIRP best cases in radiologic-pathologic correlation: hepatic epithelioid hemangioendothelioma. Radiographics 32(3):789–794. doi: 10.1148/rg.323115010 CrossRefPubMedGoogle 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(9):2108–2121CrossRefPubMedGoogle Scholar
  4. 4.
    Ishak KGAP, Anthony PP, Niederau C, Nakanuma Y (2010) Mesenchymal tumors of the liver. In: Hamilton SR, Aaltonen AL (eds) World Health Organization classification of tumours Pathology and genetics of Tumours of the digestive system. Lyon: IARC press, pp 195–196Google Scholar
  5. 5.
    Chen Y, Yu RS, Qiu LL, et al. (2011) Contrast-enhanced multiple-phase imaging features in hepatic epithelioid hemangioendothelioma. World J Gastroenterol 17(30):3544–3553. doi: 10.3748/wjg.v17.i30.3544 CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Lin J, Ji Y (2010) CT and MRI diagnosis of hepatic epithelioid hemangioendothelioma. Hepatobiliary Pancreat Dis Int 9(2):154–158PubMedGoogle Scholar
  7. 7.
    Makhlouf HR, Ishak KG, Goodman ZD (1999) Epithelioid hemangioendothelioma of the liver: a clinicopathologic study of 137 cases. Cancer 85(3):562–582CrossRefPubMedGoogle Scholar
  8. 8.
    Lyburn ID, Torreggiani WC, Harris AC, et al. (2003) Hepatic epithelioid hemangioendothelioma: sonographic, CT, and MR imaging appearances. AJR Am J Roentgenol 180(5):1359–1364. doi: 10.2214/ajr.180.5.1801359 CrossRefPubMedGoogle Scholar
  9. 9.
    Miller WJ, Dodd GD 3rd, Federle MP, Baron RL (1992) Epithelioid hemangioendothelioma of the liver: imaging findings with pathologic correlation. AJR Am J Roentgenol 159(1):53–57CrossRefPubMedGoogle Scholar
  10. 10.
    Dong A, Dong H, Wang Y, et al. (2013) MRI and FDG PET/CT findings of hepatic epithelioid hemangioendothelioma. Clin Nucl Med 38(2):e66–e73. doi: 10.1097/RLU.0b013e318266ceca CrossRefPubMedGoogle Scholar
  11. 11.
    Ji ZF, Shen XZ, Zhang DY, et al. (2010) Hepatic epithelioid hemangioendothelioma: a report of six patients. J Dig Dis 11(4):254–258. doi: 10.1111/j.1751-2980.2010.00447.x PubMedGoogle Scholar
  12. 12.
    Economopoulos N, Kelekis NL, Argentos S, et al. (2008) Bright-dark ring sign in MR imaging of hepatic epithelioid hemangioendothelioma. J Magn Reson Imaging 27(4):908–912. doi: 10.1002/jmri.21052 CrossRefPubMedGoogle Scholar
  13. 13.
    Paolantonio P, Laghi A, Vanzulli A, et al. (2014) MRI of hepatic epithelioid hemangioendothelioma. J Magn Reson Imaging 40(3):552–558. doi: 10.1002/jmri.24391 CrossRefPubMedGoogle Scholar
  14. 14.
    Bruegel M, Muenzel D, Waldt S, Specht K, Rummeny EJ (2011) Hepatic epithelioid hemangioendothelioma: findings at CT and MRI including preliminary observations at diffusion-weighted echo-planar imaging. Abdom Imaging 36(4):415–424. doi: 10.1007/s00261-010-9641-5 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Eu Hyun Kim
    • 1
  • Sung Eun Rha
    • 1
    Email author
  • Young Joon Lee
    • 1
  • Ie Ryung Yoo
    • 1
  • Eun Sun Jung
    • 2
  • Jae Young Byun
    • 1
  1. 1.Department of Radiology, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
  2. 2.Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea

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