Hepatic Hemangioma: Pitfalls & Mimics, Part I
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- Опубліковано 30 чер 2024
- In this video lecture, we discuss tips and tricks to diagnose everybody’s favorite hepatic tumor on CT, MRI and ultrasound.
Key points include:
1) Hemangioma is the most common benign hepatic tumor, and it is more common in females.
2) These tumors are usually asymptomatic and typically require no treatment, but can rarely cause pain, rupture if large, or cause Kasabach-Merritt syndrome.
3) On nonenhanced CT, hemangiomas will be hypodense to liver parenchyma and homogeneously isodense to the blood pool.
4) There are three major enhancement patterns for typical hemangiomas, and all patterns will show persistent delayed enhancement without contrast washout.
5) Peripheral, nodular, interrupted enhancement with gradual centripetal progression to uniform enhancement is the most common pattern.
6) Smaller lesions (less than 1-2 cm) can have immediate uniform enhancement and appear flash-filling.
7) Larger hemangiomas may have a central scar that does not enhance.
8) MRI is highly specific in the diagnosis of hemangioma.
9) On MRI, hemangiomas will appear T1 hypointense and T2 hyperintense to liver parenchyma, or (perhaps more importantly) T1 isointense to the blood pool and T2 hyperintense to the spleen.
10) Hemangiomas usually do not show restricted diffusion.
11) If present, the central scar of hemangioma will appear T1 hypointense and T2 hyperintense on MRI.
12) Additional liver masses that may have a central scar include focal nodular hyperplasia, fibrolamellar hepatocellular carcinoma, cholangiocarcinoma, and hepatocellular carcinoma.
13) On ultrasound, hemangiomas are usually uniformly echogenic.
14) 40% of hemangiomas can have a “reverse target” appearance with an echogenic periphery and hypoechoic center.
15) Hemangiomas usually have no color Doppler flow on ultrasound, but they may occasionally exhibit mild flow.
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Amazing lesson. Can't wait for more!
so informative , thanks
Oh My God this is so informative and explanatory. Thankyou so much.
You are welcome!
Great lecture. Truly worth watching.
Thank you, really appreciate that feedback!
Awesome lectures...kindly continue this great work...
Please complete all the Abdominal Imaging...
Thank you so much Ashish Chaubey! I will try my best.
We want more ,excellent lecture👍
Appreciate that, thank you! I’ll be releasing a case of the week each week
Thank you for your nice topics and presentations . i am interested in your topics.
I'm glad to hear that you like the topics, thank you.
❤❤ hi, great channel you have here! striving my best to create good revision videos for medical students as well 😄
Thank you Medic Notes! Looks like you've been busy with your channel as well, keep up the great work :)
Is there any correlation with a high C-Reactive protein and a liver hemangioma?
Thank you very much
You’re welcome!
Awesome
Thank you!
100% specificity WOW.............
Indeed, the power of MRI...
Thank you so much for this lecture! I wonder can ultrasound show small hepatic hemangiomas but CT scan not?
You're welcome! Yes, depending on the CT slice thickness and resolution of the ultrasound transducer, sometimes we can detect tiny (sub 5-mm) hemangiomas on US that can be difficult to resolve on CT scan. Also, if the CT is done in the portal venous phase without an arterial phase, a small flash-filling hemangioma may blend in with the background enhancing parenchyma.
@Radquarters thank you 😊
So what if MRI says most probably hemangioma and less likely metastasis?
as someone that has been diagnosed with 3 hemangioma and never got to see the scan, this makes me feel more at ease that this isn't going kill me, LOL
I was just diagnosed with 3 as well.. My report says likely hemangiomas and also lesion seen in gallbladder. The doctor didn’t seem concerned but I am.. I go back in 6 months to see if there are any changes.
And they can be caused because of medications taken over a long period of time. Which is what I think caused mine.
@@caryncambra300 How did your appointment go?
@@jenniferfrank4716 I’m still waiting to be scheduled for my followup scan for comparison but my PCP said I had no need to worry. She said if there was any question that it could possibly be anything other than hemangiomas they’d have me in for further evaluation. That helped to relieve some of my stress and anxiety. Thank you for asking! Do you need continued follow up scans?
@@caryncambra300 Aw that’s great news! My bloodwork has come back a third time with excellent results. Doc says there’s need to go back. 😊😊. Thank God because the waiting is not fun!!
Hey thanks for the excellent video.
Can confirm the following imaging interpretation is right or wrong??
19. A 35-year-old pregnant woman (28 weeks gestation) presents to her doctor with right upper quadrant abdominal pain and is found to have abnormal liver function tests. An abdominal ultrasound is performed and demonstrates a diffusely hyperechoic liver with a discrete (4-cm) hypoechoic lesion in the right lobe. An MRI is performed 3 weeks later, showing that the liver lesion has increased in size, now measuring 7 cm diameter. The lesion is isointense on in-phase T1W images, losing signal on out-of-phase images. Following intravenous gadolinium there is immediate and intense enhancement with early washout. What is the most
likely diagnosis?
A. Choriocarcinoma
B. Focal nodular hyperplasia
C. Hepatic adenoma
D. Liver haemangioma
19.
Ans: C
MRI findings are highly suggestive of a hepatic adenoma and history of rapid growth during pregnancy is supportive of this diagnosis.
Glad you liked the video Dr. Guarav! Hemangiomas and even FNH can sometimes show growth during pregnancy, but hormone-induced growth is more typical for hepatic adenomas. Also, the HNF 1 alpha mutated subtype in particular can show signal dropout on the out-of-phase T1W GRE series due to the presence of microscopic (intracellular/intravoxel) fat.
Thank a lot for making it further clear 😊
I went in for a CT Scan of my lungs (pneumonia) and they glimpsed my liver. Hemangioma!
It is ridiculous...Old doctors treated it with a proper diet (on schedule), massage of upper right quadrant, with no problem...After my disk herniation surgery, which did not find any herniation but resulted in insurance paying 100K for an elective surgery, I trust no doctors no more...I would rather die
Same happen with my mother
Quick question. Can Hemangiomas cause abnormal liver function test?
Hi Party of Nine M., liver function tests are usually normal with hemangiomas, but abnormal LFTs have rarely been described in the setting of giant hemangiomas causing biliary compression.
@@Radquarters Hi and thank you for your response!
I was diagnosed with beign hemangiomas but why do they hurt I get pain from them
Hemangiomas are usually asymptomatic, but you should follow-up with your doctor if you are experiencing pain.
How accurate is an MRI for liver masses?
It depends on the lesion being evaluated, but the accuracy of MRI is typically greater than 90% for lesions like cysts, hemangiomas, focal nodular hyperplasia and hepatocellular carcinoma.
@@Radquarters got It. I had an ultrasound done and it needed further investigation. MRI with and without contrast I did and 3 liver masses were identified and one was FNH and the 2 was Hemangiomas.
My favotite tumor is HCC .
Hopefully, hemangioma is your second favorite?
Can hemangiomas ever have washout?
Typical hemangiomas should not have washout. High-flow hemangiomas have been described to show "pseudo-washout" using Eovist gadolinium contrast, but that is not true washout.