Hemangioma (liver)

• Commonest benign hepatic tumor 
• 4-20% post-mortem prevalence
• Vascular channels of varying size, lined with endothelium, has intervening fibrous tissue
• Asymptomatic incidental findings 
• Lesions 2-4 cm in size show typical imaging findings 

Imaging 

• US: well defined, lobular, homogeneous, increased echo reflectivity. No doppler flow due to slow flow
• MRI: most sensitive and specific. Extended ECHO time (120 to 160 ms) T2w SE sequences shows lesions to be homogeneously bright, almost fluid signal equivalent. Malignant lesions do not have increasing intensity in T2 at longer TE. Arterial phase shows rapidly enhancing vessels in periphery. Over time, lesion fills in centrally to become iso to slightly hyper intense than liver parenchyma
• CT: well defined lobulation lesion with attenuation similar to blood in plain study. Pattern of enhancement similar to MRI 
• Liver sulphur colloid: photopenic lesions
• Tc 99 m blood pool studies: increase in uptake

Atypical hemangiomas

• Lesions <1.5 cm in size difficult to characterize, do not show typical enhancement pattern. Often enhances rapidly and mimics other arterial enhancing lesions
• Larger lesions can have central area of fibrosis that does not enhance until in delayed scans
• Lesions when in doubt should be core biopsied. Core biopsy of hemangioma is safe unlike previously thought 

Read more

Heilo, Arne, and Anna Elisabeth Stenwig. “Liver hemangioma: US-guided 18-gauge core-needle biopsy.” Radiology 204.3 (1997): 719-722.

Blachar, Arye, et al. “Radiologists’ performance in the diagnosis of liver tumors with central scars by using specific CT criteria.” Radiology 223.2 (2002): 532-539.