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

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

  • Abdominal Radiology/Radiologia Addominale
  • Published:
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Abstract

Purpose

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.

Results

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.

Conclusions

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.

Riassunto

Obiettivo

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.

Risultati

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).

Conclusioni

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.

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Authors and Affiliations

  1. Dipartimento di Scienze Chirurgiche, Radiologiche e Odontostomatologiche, Sezione di Radiologia Diagnostica ed Interventistica, Università di Perugia, Ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06134, Perugia, Italy

    M. Scialpi & L. Lupattelli

  2. Dipartimento di Patologia Umana ed Oncologia, Sezione di Scienze Radiologiche, Università di Siena, Policlinico S. Maria alle Scotte, Viale Bracci 2, Siena, Italy

    L. Volterrani & M.A. Mazzei

  3. Dipartimento di Medicina Clinica e Sperimentale e Chirurgia “F. Magrassi”, II Università di Napoli, Azienda Ospedaliera Universitaria, 80100, Napoli, Italy

    S. Cappabianca

  4. Dipartimento di Scienze Chirurgiche, Radiologiche e Odontostomatologiche, Unità di Oncologia Chirurgica Università di Perugia, Ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06134, Perugia, Italy

    F. Barberini

  5. Dipartimento di Radiologia, Ospedale di Budrio, Azienda Sanitaria Locale Bologna, 40054, Budrio, Italy

    I. Piscioli

  6. Dipartimento di Scienze della Salute, Sezione di Diagnostica per Immagini, Università del Molise, C.da Tappino, 86100, Campobasso, Italy

    L. Brunese

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  1. M. Scialpi
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  2. L. Volterrani
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  3. M.A. Mazzei
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  4. S. Cappabianca
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  5. F. Barberini
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  7. L. Brunese
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  8. L. Lupattelli
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Correspondence to M. Scialpi.

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Scialpi, M., Volterrani, L., Mazzei, M. et al. Small (≤2 cm) atypical hepatic haemangiomas in the non-cirrhotic patient: pattern-based classification scheme for enhancement at triple-phase helical CT. Radiol med 114, 935–947 (2009). https://doi.org/10.1007/s11547-009-0427-1

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