Hepatic sclerosed hemangioma and sclerosing cavernous hemangioma: a radiological study

Abstract

Purpose: To investigate and compare the CT and MRI features of hepatic sclerosed hemangioma (HSH) and sclerosing cavernous hemangioma (SCH).

Materials and methods: Twelve HSH cases and 36 SCH cases were included, the imaging findings on CT (9 HSH and 34 SCH) and MRI (8 HSH and 10 SCH) were analyzed. Qualitative image analysis included the location, size, shape, capsular retraction, density, calcification, signal intensity on T₁-weighted image (T₁WI) and T₂-weighted image (T₂WI), presence of diffusion restriction, apparent diffusion coefficient (ADC) map, transient hepatic attenuation difference around the lesion, and the dynamic enhancement patterns.

Results: The presence of liver cirrhosis in patients with HSH (3/12) was higher than SCH (1/36) (P = 0.043). The morphology appearance before enhancement showed no significant difference between HSH and SCH. Moreover, SCH had a stronger trend of centripetal enhancement patterns of cavernous hemangiomas (83.3%) compared to HSH (25%) (P < 0.001). Due to more frequent atypical enhancement features, containing rim-like enhancement, no enhancement, and peripheral heterogeneous enhancement, the misdiagnosis rate of HSH (75%) was significantly higher than that of SCH (16.7%) (P < 0.001). Furthermore, the ADC values of HSH and SCH were both higher than that of the surrounding liver parenchyma (P = 0.009, P = 0.002); however, there was no significant difference in ADC values between themselves (P = 0.613).

Conclusion: SCH showed the same trend of centripetal enhancement characteristics as typical hemangioma, while HSH exhibited atypical enhancement features due to complete sclerosis. Higher ADC values might contribute to the identification of atypical HSH and SCH from malignancies.

Keywords: Computed tomography; Diagnosis; Hepatic sclerosed hemangioma; Magnetic resonance imaging; Sclerosing cavernous hemangioma.

Fig. 1

The flowchart of patients

Fig. 2

A case of hepatic sclerosed hemangioma mimicking intrahepatic cholangiocarcinoma (man, 63-years-old). Plain CT revealed a slightly low-density mass with dot-like calcification and irregular margin in segment 2 of the liver (A). The mass showed peripheral heterogeneous enhancement in the arterial phase (B), internal non-enhancement in the portal venous phase (C) and delayed phase (D) (arrows)

Fig. 3

A case of sclerosing cavernous hemangioma mimicking hepatocellular carcinoma on MRI images (a 34-years-old female patient had chronic hepatitis B for more than 10 years). The mass was located in segment 3. It showed slightly hypointense on T₁-weighted fat-suppressed image (A), slightly hyperintense on T₂-weighted fat-suppressed image (B), heterogeneous enhancement in the arterial phase (C), and a subtle low-signal intensity with capsular enhancement in the delayed phase (D). Based on MRI findings, well-differentiated hepatocellular carcinoma was suspected. CT was further performed to rule out hemangioma. Enhanced CT demonstrated a typical nodular enhancement in the arterial phase (E) and continued filling in during the portal venous phase (F) (arrows)

Fig. 4

A case of sclerosing cavernous hemangioma mimicking intrahepatic cholangiocarcinoma (male, 51-years-old). Axial CT in the portal venous phase showed an irregular peripheral heterogeneous enhancement mass with capsular retraction, left lobe atrophy and mild biliary ductal dilatation in the left lobe (A), internal non-enhancement in the delayed phase (B) (arrows)

Fig. 5

A case of sclerosing cavernous hemangioma was misdiagnosed as a malignant disease (A 48-years-old male patient, who had chronic hepatitis B for more than 20 years, referred to our hospital because of AFP elevation (183.8 ng/ml)). The lesion arose from segment 7 of the liver. Axial CT showed peripheral small nodular or dot-like enhancement in the arterial phase (A) (arrows). Coronal CT showed the trend of centripetal enhancement, the majority central non-enhancing areas in the portal venous phase and delayed phase (B, C) (arrows). Hematoxylin and eosin (H&E) staining (40 ×) (K) showed a large number of fibrous tissues, hyaline degeneration, and focal infarction

Fig. 6

A case of the hepatic sclerosed hemangioma was misdiagnosed as a possible malignant disease (female, 56-years-old). The lesion arose from segment 8 of the liver. It showed slight hyperintense on diffusion-weighted image and isointense on ADC map, but the ADC value of the lesion was higher than the surrounding liver parenchyma, suggesting no diffusion restriction (A, B). Arterial phase (C), portal venous (D), and delayed phase (E) of enhanced MR images demonstrated ring enhancement (arrows). Fibrous connective tissue, sclerotic stroma, and hyaline degeneration areas were seen in the lesion in Hematoxylin and eosin (H&E) staining (100 ×) (F)

Fig. 7

A case of multiple hepatic sclerosed hemangiomas was misdiagnosed as a possible malignant disease (male, 50-years-old). Axial CT in the arterial phase and delayed phase demonstrated multiple irregular heterogeneous hypodense lesions in the liver with no obvious enhancement (A–D) (arrows)