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Indeterminate Liver Mass on CT: Hemangioma

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This next case is a 46-year-old female with a history

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of colon cancer for which a staging CT was performed.

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As we scroll through these images, we see

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a whole bunch of liver lesions that are

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really indeterminate in their appearance.

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The first one we can see along the

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posterior aspect of the right hepatic lobe.

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It's quite small and very difficult

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to accurately characterize.

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As you scroll downwards, we can see a larger lesion

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within the lateral left hepatic lobe over here.

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Also, indeterminate based on its CT imaging, uh, appearance.

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And so for this reason, an MRI was, uh,

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performed in order to characterize these lesions.

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So we'll start our MR evaluation of these

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lesions with our T2-weighted sequence.

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On this sequence, you can see that the lesion

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more posteriorly has hyperintense T2 signal.

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It's not as bright as CSF, but certainly,

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um, somewhere in between the signal you

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see within the CSF and within the spleen.

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By and large, when I see this type of signal,

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I'm more or less reassured that this is going

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to be something I don't need to worry about.

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As you scroll downwards, we'll see the other lesion.

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This lesion, too, is noted to have

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relatively hyperintense T2 signal.

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Once again, not as bright as the CSF, but certainly

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brighter than what we would see in the spleen over here.

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And so, again, this sort of T2

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signal is somewhat reassuring for me.

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However, we can't rely on this alone, and we have to look

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at our additional sequences in order to characterize this.

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The next set of sequences that we look at are

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the T1 in-phase and out-of-phase sequences.

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As we scroll downwards, I'll just focus

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on the larger of the two liver lesions.

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On the out-of-phase sequence over here,

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you can see that it's T1 hypointense.

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On the in-phase sequence over here, similarly,

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you can see that the lesion is T1 hypointense.

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There's no signal loss in the out-of-phase image to

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suggest that it contains fat, and there's no signal

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loss in the in-phase image to suggest that it contains

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content that causes increased susceptibility,

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like metallic content or um, clip symbolization coils,

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anything like that, no gas within this lesion either.

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We'll then move on to our T1-weighted fat

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saturated pre-contrast imaging sequence

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to see what this lesion looks like.

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So on this sequence, we can also see

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that this lesion is T1 hypointense.

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It doesn't contain any hyperintense T1 content,

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such as methemoglobin, proteinaceous debris,

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melanin, And so then we have to evaluate and see

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what it looks like on the post-contrast images.

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So here we have our post-contrast images.

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We'll once again focus on the lesion in question.

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And the enhancement pattern in this case is

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quite familiar, uh, as we've seen it before.

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On the arterial phase, we can once again see

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that this lesion over here has peripheral

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discontinuous puddling of contrast.

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On the portal venous phase image, we can see that

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this, uh, lesion has more centripetal enhancement.

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Some of the enhancement becomes, uh, a little bit more

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prominent, like over here and over here and over here.

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And finally, on the equilibrium phase

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images, we can see that this lesion almost

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is completely filled up with contrast.

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So once again, this is an example of a hemangioma.

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And I wanted to show this case, To sort of showcase that

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oftentimes these hemangiomas can be first detected on CT

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imaging or ultrasound imaging as we've seen in prior cases.

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And this is a good example of how MRI could

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be used in order to definitively characterize

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these lesions, um, as this benign entity.

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So what does this lesion do on

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the dynamic post-contrast images?

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Well, the enhancement pattern is somewhat

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familiar as we've seen it in a prior case already.

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again, in the left hepatic lobe.

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On the arterial phase image, it demonstrates

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peripheral discontinuous puddling of contrast.

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On the portal venous phase, you can see that some of those

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puddles of contrast start to extend more centrally, i.e., centripetal enhancement.

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And finally, on the equilibrium phase, we can see that

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the lesion further continues to enhance centrally.

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And the majority of it now is filled with contrast.

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So these imaging features are

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characteristic of hepatic hemangiomas.

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And this case showcases how you can use MRI imaging to

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evaluate these hemangiomas when they have an indeterminate

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imaging appearance first detected on CT imaging.

Report

Faculty

Mahan Mathur, MD

Associate Professor, Division of Body Imaging; Vice Chair of Education, Dept of Radiology and Biomedical Imaging

Yale School of Medicine

Tags

Vascular

Non-infectious Inflammatory

MRI

Liver

Idiopathic

Gastrointestinal (GI)

CT

Body

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