25 year old female with incidental finding of several hepatic mass
lesions by CT exam.
One of the more characteristic lesions isdemonstrated in MRI
dynamic contrast imaging. The lesion is of low signal intensity on
images with T1 weighting. There is the obvious demonstration of
initial nodular peripheral enhancement with eventual complete
A hepatic hemangioma is pathologically desribed as a tumor of
numerous vascular channels with a supporting fibrous stroma.
Hemangiomas are the most commonly occurring benign liver lesions,
with an incidence of anywhere between 1 and 20%. There is an
approximate 5:1 Female predominance, with many of the cases
occurring in postmenopausal women. Imaging evaluation of
hemangiomas can be undertaken by Nuclear Medicine, CT, Ultrasound
and MRI. Tagged red cell Nuclear Medicine imaging can be rather
specific for hemangioma, given the early phase photopenia with
eventual prolonged fill-in of the tumor. While other vascular
lesions can also demonstrate this prolonged activity, early uptake
is the rule with most. The classic ultrasound appearance of a
hemangioma is diffuse hyperechogenicity with slight increased
through transmission. The CT appearance of hemangioma consists of a
well demarcated hypodense lesion with somewhat nodular borders.
Contrast enhancement results in peripheral to central fill-in.
There may be a central, non-enhancing region as a result of
fibrosis. Calcification can be seen in between 10 and 20% of
lesions. The MRI diagnosis of hemangioma is similar to CT with post
Gadolinium images demonstrated initial nodular peripheral
enhancement with subsequent fill-in. They also demonstrate
significant high signal on T2 weighted images, but intermixed with
lower signal areas as a result of the fibrous stroma.
Gore, Levine, Laufer. Textbook of Gastrointestinal Radiology. W.B.
Saunders Company, Philadelphia, 1994.