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European Radiology

, Volume 25, Issue 2, pp 315–322 | Cite as

Primary hepatic angiosarcoma: multi-institutional comprehensive cancer centre review of multiphasic CT and MR imaging in 35 patients

  • Perry J. PickhardtEmail author
  • Douglas Kitchin
  • Meghan G. Lubner
  • Dhakshina M. Ganeshan
  • Sanjeev Bhalla
  • Anne M. Covey
Oncology

Abstract

Objective

To assess the imaging features of primary hepatic angiosarcoma on multiphasic CT and MR.

Methods

Multi-institutional review identified 35 adults (mean age, 57.1 years; 22M/13F) with pathologically proven hepatic angiosarcoma and pretreatment multiphasic CT (n = 33) and/or MR (n = 7).

Results

Multifocal hepatic involvement was seen in all 35 cases, with at least 10 lesions in 74.3 % (26/35). Mean size of the dominant mass was 8.9 ± 4.7 cm (range, 2.6–20 cm). Individual nodules were typically circumscribed. Arterial-phase foci of hypervascular enhancement without washout were seen in 89.7 % (26/29). Heterogeneously expanding foci of enhancement generally followed blood pool in 88.6 % (31/35). Progressive centripetal (n = 16) or diffuse “flash-fill” (n = 4) enhancement pattern resembling cavernous haemangiomas predominated in 20 cases, whereas a “reverse haemangioma” centrifugal pattern predominated in 11 cases. Rapid interval growth was seen in 24 (96.0 %) of 25 cases with serial imaging. Vascular invasion was not seen in any case. Underlying cirrhotic morphology was seen in 42.3 % (15/35).

Conclusion

Primary hepatic angiosarcomas typically manifest as aggressive multifocal tumors containing small heterogeneous hypervascular foci that progressively expand and follow blood pool. The appearance can mimic cavernous haemangiomas, but distinction is generally possible. In the setting of cirrhosis, lack of tumour washout and vascular invasion argue against multifocal hepatocellular carcinoma.

Key Points

Hepatic angiosarcoma manifests on CT and MR as rapidly progressive multifocal tumours

Multiphasic imaging demonstrates hypervascular foci that progressively expand and follow blood pool

Enhancement pattern can resemble cavernous haemangiomas or show areversecentrifugal pattern

Lack of tumour washout of hypervascular lesions argues against multifocal hepatocellular carcinoma

Careful assessment of the cross-sectional imaging findings may suggest the diagnosis

Keywords

Angiosarcoma CT MR Liver Haemangioma 

Notes

Acknowledgements

The scientific guarantor of this publication is Perry J. Pickhardt, MD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, observational, multicentre study.

References

  1. 1.
    Bruegel M, Muenzel D, Waldt S, Specht K, Rummeny EJ (2013) Hepatic angiosarcoma: cross-sectional imaging findings in seven patients with emphasis on dynamic contrast-enhanced and diffusion-weighted MRI. Abdom Imaging 38:745–754PubMedCrossRefGoogle Scholar
  2. 2.
    Koyama T, Fletcher JG, Johnson CD, Kuo MS, Notohara K, Burgart LJ (2002) Primary hepatic angiosarcoma: findings at CT and MR imaging. Radiology 222:667–673PubMedCrossRefGoogle Scholar
  3. 3.
    Locker GY, Doroshow JH, Zwelling LA, Chabner BA (1979) Clinical features of hepatic angiosarcoma - report of 4 cases and a review of the English literature. Medicine 58:48–64PubMedCrossRefGoogle Scholar
  4. 4.
    Popper H, Thomas LB, Telles NC, Falk H, Selikoff IJ (1978) Development of hepatic angiosarcoma in man induced by vinly chloride, thorotrast, and arsenic - comparison with cases of unknown etiology. Am J Pathol 92:349–376PubMedCentralPubMedGoogle Scholar
  5. 5.
    Chiu O, Frank JD, Dow CA (2005) Hepatic angiosarcoma: detection with computed tomography. Australas Radiol 49:163–165PubMedCrossRefGoogle Scholar
  6. 6.
    Heo SH, Jeong YY, Shin SS, Chung TW, Kang HK (2007) Solitary small hepatic angiosarcoma: initial and follow-up imaging findings. Korean J Radiol 8:180–183PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Itai Y, Teraoka T (1989) Angiosarcoma of the liver mimicking cavernous hemangioma on dynamic CT. J Comput Assist Tomogr 13:910–912PubMedCrossRefGoogle Scholar
  8. 8.
    Ohmoto K, Hirokawa M, Takesue M, Yamamoto S (2000) Hepatic angiosarcoma with early central enhancement and arterioportal shunt on dynamic CT. Hepatogastroenterology 47:1717–1718PubMedGoogle Scholar
  9. 9.
    Okano A, Sonoyama H, Masano Y et al (2012) The natural history of a hepatic angiosarcoma that was difficult to differentiate from cavernous hemangioma. Intern Med 51:2899–2904PubMedCrossRefGoogle Scholar
  10. 10.
    Park YS, Kim JH, Kim KW et al (2009) Primary hepatic angiosarcoma: imaging findings and palliative treatment with transcatheter arterial chemoembolization or embolization. Clin Radiol 64:779–785PubMedCrossRefGoogle Scholar
  11. 11.
    Peterson M, Baron RL, Rankin SC (2000) Hepatic angiosarcoma: findings on multiphasic contrast-enhanced helical CT do not mimic hepatic hemangioma. Am J Roentgenol 175:165–170CrossRefGoogle Scholar
  12. 12.
    Rademaker J, Widjaja A, Galanski M (2000) Hepatic hemangiosarcoma: imaging findings and differential diagnosis. Eur Radiol 10:129–133PubMedCrossRefGoogle Scholar
  13. 13.
    Yu RS, Zhang SZ, Hua JM (2003) Hepatic angiosarcoma: CT findings. Chin Med J 116:318–320PubMedGoogle Scholar
  14. 14.
    Ginsberg F, Slavin JD, Spencer RP (1986) Hepatic angiosarcoma - mimicking of angioma on 3-phase Tc-99 m red-blood-cell scintigraphy. J Nucl Med 27:1861–1863PubMedGoogle Scholar
  15. 15.
    Buetow PC, Buck JL, Ros PR, Goodman ZD (1994) Malignant vascular tumors of the liver: radiologic-pathological correlation. Radiographics 14:153–166PubMedCrossRefGoogle Scholar
  16. 16.
    Iannaccone R, Federle MP, Brancatelli G et al (2006) Peliosis hepatis: spectrum of imaging findings. AJR Am J Roentgenol 187:W43–W52PubMedCrossRefGoogle Scholar
  17. 17.
    Falk S, Krishnan J, Meis JM (1993) Primary angiosarcoma of the spleen - a clinicopathological study of 40 cases. Am J Surg Pathol 17:959–970PubMedCrossRefGoogle Scholar
  18. 18.
    Thompson WM, Levy AD, Aguilera NS, Gorospe L, Abbott RM (2005) Angiosarcoma of the spleen: imaging characteristics in 12 patients. Radiology 235:106–115PubMedCrossRefGoogle Scholar
  19. 19.
    Mahony B, Jeffrey RB, Federle MP (1982) Spontaneous rupture of hepatic and splenic angiosarcoma demonstrated by CT. Am J Roentgenol 138:965–966CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Perry J. Pickhardt
    • 1
    Email author
  • Douglas Kitchin
    • 1
  • Meghan G. Lubner
    • 1
  • Dhakshina M. Ganeshan
    • 2
  • Sanjeev Bhalla
    • 3
  • Anne M. Covey
    • 4
  1. 1.Department of RadiologyUniversity of Wisconsin School of Medicine & Public HealthMadisonUSA
  2. 2.Department of RadiologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Mallinckrodt Institute of RadiologyWashington University School of MedicineSt. LouisUSA
  4. 4.Department of RadiologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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