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Hepatic hemangioendothelioma: CT, MR, and FDG-PET-CT in 67 patients—a bi-institutional comprehensive cancer center review

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the imaging features of hepatic epithelioid hemangioendothelioma (HEH) on multiphasic CT, MR, and FDG-PET-CT.

Methods

Bi-institutional review identified 67 adults (mean age, 47 years; 23 M/44 F) with pathologically proven HEH and pretreatment multiphasic CT (n = 67) and/or MR (n = 30) and/or FDG-PET-CT (n = 13).

Results

HEHs were multifocal in 88% (59/67). Mean size of the dominant mass was 4.1 cm (range, 1.4–19 cm). The tumors were located in the peripheral, subcapsular regions of the liver in 96% (64/67). Capsular retraction was present in 81% (54/67 cases) and tumors were coalescent in 61% (41/67). HEH demonstrated peripheral ring enhancement on arterial phase imaging in 33% (21/64) and target appearance on the portal venous phase in 69% (46/67). Persistent peripheral enhancement on the delayed phase was seen in 49% (31/63). On MR, multilayered target appearance was seen on the T2-weighted sequences in 67% (20/30) and on the diffusion-weighted sequences in 61% (11/18). Target appearance on hepatobiliary phase of MRI was seen in 57% (4/7). On pre-therapy FDG-PET-CT, increased FDG uptake above the background liver parenchyma was seen in 62% (8/13).

Conclusion

HEHs typically manifest as multifocal, coalescent hepatic nodules in peripheral subcapsular location, with associated capsular retraction. Peripheral arterial ring enhancement and target appearance on portal venous phase are commonly seen on CT. Similarly, multilayered target appearance correlating with its histopathological composition is typically seen on multiple sequences of MR including T2-weighted, diffusion-weighted, and dynamic contrast-enhanced multiphasic MR.

Key Points

• Hepatic epithelioid hemangioendotheliomas manifest on CT and MR as multifocal, coalescent hepatic nodules in peripheral subcapsular location, with associated capsular retraction.

• Enhancement pattern on contrast-enhanced CT and MR can vary but peripheral ring enhancement on arterial phase and target appearance on portal venous phase are commonly seen.

• Retrospective two-center study showed that cross-sectional imaging may help in the diagnosis.

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Abbreviations

CT:

Computed tomography

FDG-PET-CT:

Fluoro-deoxy-glucose positron emission tomography

HEH:

Hepatic epithelioid hemangioendothelioma

HIPAA:

Health Insurance and Portability and Accountability Act

MR:

Magnetic resonance imaging

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Funding

This study has received funding by MD Anderson Cancer Center Support Grant No. NIH/NCI P30 CA016672 from the National Cancer Institute, National Institutes of Health.

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Authors and Affiliations

  1. Division of Diagnostic Imaging, Body Imaging Section, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA

    Dhakshinamoorthy Ganeshan, Cihan Duran & Khaled M. Elsayes

  2. Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA

    Perry J. Pickhardt & Meghan G. Lubner

  3. Division of Diagnostic Imaging, Unit 1473, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA

    Ajaykumar C. Morani & Sanaz Javadi

  4. Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 3SCR2.3810, 1881 East Rd, Houston, TX, 77054, USA

    Mohab M. Elmohr, Cihan Duran & Khaled M. Elsayes

Authors
  1. Dhakshinamoorthy Ganeshan
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  2. Perry J. Pickhardt
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  3. Ajaykumar C. Morani
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  4. Sanaz Javadi
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  5. Meghan G. Lubner
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  6. Mohab M. Elmohr
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  7. Cihan Duran
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  8. Khaled M. Elsayes
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Corresponding author

Correspondence to Dhakshinamoorthy Ganeshan.

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Guarantor

The scientific guarantor of this publication is Khaled Elsayes.

Conflict of interest

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Multicenter study

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Ganeshan, D., Pickhardt, P.J., Morani, A.C. et al. Hepatic hemangioendothelioma: CT, MR, and FDG-PET-CT in 67 patients—a bi-institutional comprehensive cancer center review. Eur Radiol 30, 2435–2442 (2020). https://doi.org/10.1007/s00330-019-06637-3

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  • DOI: https://doi.org/10.1007/s00330-019-06637-3

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