Case 212: Hemangioma
35 year old woman with enlarging liver mass on ultrasound performed to evaluate periumbilical pain (not shown). Images from CT done three years earlier are shown.
MR: Giant, atypical, centrally hyalinized
MR shows giant hemangioma with central hyalinization in the right liver and a second smaller typical cavernous hemangioma posterior to the giant hemangioma.
Typical findings of this giant hemangioma include high signal intensity onT2 ("light bulb" intensity, but signal not as high as fluid signal) and progressive centripetal contrast enhancement that follows blood pool signal on the equilibrium phase.
However this giant hemangioma contains several atypical findings. On the arterial phase it demonstrates a continuous ring of enhancement with radial spokes or septations as opposed to the discontinuous perpipheral "puddling" pattern that is typical pattern of hemangiomas. Lack of central enhancement in large hemangiomas in the equilibrium phase is not uncommon and can result from insufficient time for contrast to completely fill the hemangioma. However in this giant hemangioma the lack of central enhancement is due to hyalinization. Note that scars enhance on equilibrium and more delayed contrast phase when extracellular contrast agents are used.
Right hemihepatectomy was done and pathology confirmed giant hyalinized hemangioma. Small adjacent cavernous hemangioma is not included in this specimen photograph. The smaller cavernous hemangioma posteriorly however has typical imaging findings throughout all MR sequences.
Select CT of this case, which was obtained years earlier, to see evolution of both hemangiomas - both grew significantly over time.
Pathology specimen photo courtesy of Matthew M. Yeh, MD, PhD, Department of Pathology, University of Washington, Seattle, WA.