La radiologia medica

, Volume 114, Issue 6, pp 935–947 | Cite as

Small (≤2 cm) atypical hepatic haemangiomas in the non-cirrhotic patient: pattern-based classification scheme for enhancement at triple-phase helical CT

  • M. Scialpi
  • L. Volterrani
  • M.A. Mazzei
  • S. Cappabianca
  • F. Barberini
  • I. Piscioli
  • L. Brunese
  • L. Lupattelli
Abdominal Radiology/Radiologia Addominale



The aim of this study was to determine by triplephase helical computed tomography (CT) the appearance of atypical small (≤2 cm) hepatic haemangiomas (HHs) in the non-cirrhotic patient.

Materials and methods

We retrospectively reviewed the hepatic arterial-dominant phase (HAP), portal venous phase (PVP) and delayed-phase (DP) helical CT images of 47 patients with 52 atypical small (≤2cm) HHs associated with 34 typical small HHs. Images were assessed to identify the patterns of enhancement of atypical HHs and correlate their appearance with that of typical small HHs in the delayed phase. Interobserver variability and kappa value were calculated. Statistical significance was calculated by the Fisher exact test.


The 52 atypical small HHs were categorised as follows: type 1a (hyperattenuating in the HAP, n=17), type 1b [hyperattenuating with transient hepatic attenuation difference (THAD) around the lesion in the HAP, n=12], type 2a (homogeneously hypoattenuating in the HAP or PVP, n=9), type 2b (hypoattenuating with “bright-dot” sign in the HAP or PVP, n=13) and type 3 (hypoattenuating with central enhancing area, n=1). Interobserver agreement was perfect for HHs of types 1a, 1b, 2a and 3. On DP images, the appearance of atypical small HHs was identical to that of typical small HHs in all cases (p<0.0001), with lesions showing homogeneous isoattenuation to the aorta or liver parenchyma without peripheral capsule.


Triple-phase helical CT scans can distinguish several types of atypical small HHs. The demonstration of patterns similar to those of typical forms on DP CT is fundamental for the diagnosis.


Liver Tumors Hepatic haemangioma Triphasic Computed Tomography 

Emangiomi epatici atipici di piccole dimensioni (≤2 cm) nel paziente non-cirrotico: classificazione in base al pattern di enhancement in TC spirale trifasica



Determinare mediante tomografia computerizzata (TC) spirale trifasica l’aspetto degli emangiomi epatici (EE) atipici di piccole dimensioni (≤2 cm) in pazienti con fegato non-cirrotico.

Materiali e metodi

Sono stati valutati retrospettivamente gli esami TC trifasici in fase dominante-arteriosa (FA), fase venosa portale (FVP) e fase tardiva (FT), di 47 pazienti con 52 emangiomi epatici (EE) atipici di piccole dimensioni (≤2 cm) associati a 34 EE tipici piccoli. Le immagini sono state esaminate al fine di individuare i patterns di enhancement degli EE atipici e correlare in FT il loro aspetto con quello degli EE piccoli tipici. Sono state calcolate la variabilita interosservatore e le differenze statistiche mediante il test esatto di Fisher.


I 52 EE atipici di piccole dimensioni erano così distribuiti: tipo 1a EE iperdenso in FA (n=17), tipo 1b EE iperdenso con transient hepatic attenuation difference (THAD) in FA (n=12), tipo 2a EE ipodenso in FA o FVP (n=9), tipo 2b EE ipodenso con puntiforme/i iperdensita periferica in FA o FVP (n=13), e tipo 3 EE ipodenso con iperdensità centrale ad enhancement centrifugo in FVP (n=1). È stata riscontrata completa concordanza tra i tre osservatori relativamente agli EE di tipo 1a, 1b, 2a, e 3. In FT l’aspetto degli EE atipici di piccole dimensioni (isodensità rispetto all’aorta o al parenchima epatico con assenza di capsula periferica) è risultato sovrapponibile a quello degli EE tipici di piccole dimensioni (p<0,0001).


La TC trifasica consente di distinguere diverse forme di EE atipici di piccole dimensioni che in FT presentano aspetto analogo alle forme tipiche di piccole dimensioni.

Parole chiave

Fegato Neoplasie Emangioma epatico Tomografia Computerizzata trifasica 


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Copyright information

© Springer-Verlag Italia 2009

Authors and Affiliations

  • M. Scialpi
    • 1
  • L. Volterrani
    • 2
  • M.A. Mazzei
    • 2
  • S. Cappabianca
    • 3
  • F. Barberini
    • 4
  • I. Piscioli
    • 5
  • L. Brunese
    • 6
  • L. Lupattelli
    • 1
  1. 1.Dipartimento di Scienze Chirurgiche, Radiologiche e Odontostomatologiche, Sezione di Radiologia Diagnostica ed InterventisticaUniversità di Perugia, Ospedale S. Maria della MisericordiaPerugiaItaly
  2. 2.Dipartimento di Patologia Umana ed Oncologia, Sezione di Scienze RadiologicheUniversità di SienaSienaItaly
  3. 3.Dipartimento di Medicina Clinica e Sperimentale e Chirurgia “F. Magrassi”II Università di Napoli, Azienda Ospedaliera UniversitariaNapoliItaly
  4. 4.Dipartimento di Scienze Chirurgiche, Radiologiche e OdontostomatologicheUnità di Oncologia Chirurgica Università di Perugia, Ospedale S. Maria della MisericordiaPerugiaItaly
  5. 5.Dipartimento di RadiologiaOspedale di Budrio, Azienda Sanitaria Locale BolognaBudrioItaly
  6. 6.Dipartimento di Scienze della Salute, Sezione di Diagnostica per ImmaginiUniversità del MoliseCampobassoItaly

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