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

  • Oncology
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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 a “reverse” centrifugal 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

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References

  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 38:745–754

    Article  PubMed  Google Scholar 

  2. Koyama T, Fletcher JG, Johnson CD, Kuo MS, Notohara K, Burgart LJ (2002) Primary hepatic angiosarcoma: findings at CT and MR imaging. Radiology 222:667–673

    Article  PubMed  Google Scholar 

  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 58:48–64

    Article  CAS  PubMed  Google Scholar 

  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 92:349–376

    CAS  PubMed Central  PubMed  Google Scholar 

  5. Chiu O, Frank JD, Dow CA (2005) Hepatic angiosarcoma: detection with computed tomography. Australas Radiol 49:163–165

    Article  CAS  PubMed  Google Scholar 

  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 8:180–183

    Article  PubMed Central  PubMed  Google Scholar 

  7. Itai Y, Teraoka T (1989) Angiosarcoma of the liver mimicking cavernous hemangioma on dynamic CT. J Comput Assist Tomogr 13:910–912

    Article  CAS  PubMed  Google Scholar 

  8. Ohmoto K, Hirokawa M, Takesue M, Yamamoto S (2000) Hepatic angiosarcoma with early central enhancement and arterioportal shunt on dynamic CT. Hepatogastroenterology 47:1717–1718

    CAS  PubMed  Google Scholar 

  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 51:2899–2904

    Article  PubMed  Google Scholar 

  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 64:779–785

    Article  CAS  PubMed  Google Scholar 

  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 175:165–170

    Article  CAS  Google Scholar 

  12. Rademaker J, Widjaja A, Galanski M (2000) Hepatic hemangiosarcoma: imaging findings and differential diagnosis. Eur Radiol 10:129–133

    Article  CAS  PubMed  Google Scholar 

  13. Yu RS, Zhang SZ, Hua JM (2003) Hepatic angiosarcoma: CT findings. Chin Med J 116:318–320

    PubMed  Google Scholar 

  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 27:1861–1863

    CAS  PubMed  Google Scholar 

  15. Buetow PC, Buck JL, Ros PR, Goodman ZD (1994) Malignant vascular tumors of the liver: radiologic-pathological correlation. Radiographics 14:153–166

    Article  CAS  PubMed  Google Scholar 

  16. Iannaccone R, Federle MP, Brancatelli G et al (2006) Peliosis hepatis: spectrum of imaging findings. AJR Am J Roentgenol 187:W43–W52

    Article  PubMed  Google Scholar 

  17. Falk S, Krishnan J, Meis JM (1993) Primary angiosarcoma of the spleen - a clinicopathological study of 40 cases. Am J Surg Pathol 17:959–970

    Article  CAS  PubMed  Google Scholar 

  18. Thompson WM, Levy AD, Aguilera NS, Gorospe L, Abbott RM (2005) Angiosarcoma of the spleen: imaging characteristics in 12 patients. Radiology 235:106–115

    Article  PubMed  Google Scholar 

  19. Mahony B, Jeffrey RB, Federle MP (1982) Spontaneous rupture of hepatic and splenic angiosarcoma demonstrated by CT. Am J Roentgenol 138:965–966

    Article  CAS  Google Scholar 

Download references

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.

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Authors and Affiliations

  1. Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI, 53792-3252, USA

    Perry J. Pickhardt, Douglas Kitchin & Meghan G. Lubner

  2. Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Dhakshina M. Ganeshan

  3. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA

    Sanjeev Bhalla

  4. Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Anne M. Covey

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  1. Perry J. Pickhardt
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  2. Douglas Kitchin
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  4. Dhakshina M. Ganeshan
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  5. Sanjeev Bhalla
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  6. Anne M. Covey
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Correspondence to Perry J. Pickhardt.

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Pickhardt, P.J., Kitchin, D., Lubner, M.G. et al. Primary hepatic angiosarcoma: multi-institutional comprehensive cancer centre review of multiphasic CT and MR imaging in 35 patients. Eur Radiol 25, 315–322 (2015). https://doi.org/10.1007/s00330-014-3442-0

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  • DOI: https://doi.org/10.1007/s00330-014-3442-0

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