title: Rapidly enhancing hepatic hemangiomas at MRI: distinction from malignancies with T2-weighted images.
abstract: The purpose of this study is to describe a subset of atypical hepatic hemangiomas that enhance rapidly and diffusely and to determine whether heavily T2-weighted images could distinguish between atypically enhancing liver hemangiomas and hypervascular malignancies. A retrospective search of MR records identified seven patients with liver hemangiomas that demonstrated diffuse early enhancement and 23 patients with biopsy-proven malignant liver lesions that were hypervascular on dynamic gadolinium-enhanced MR images. Quantitative analysis of signal intensity measurements was performed on the T2-weighted images, heavily T2-weighted (TE > 140), and dynamic gadolinium-enhanced images. Blinded reader comparison of the T2-weighted images and gadolinium-enhanced images was performed. Hypervascular hemangiomas enhanced to a greater degree than hypervascular malignant liver lesions on the early phase gadolinium-enhanced images. Perilesional parenchymal enhancement was demonstrated in five cases of rapidly enhancing hemangiomas. Signal intensity and contrast-to-noise ratios on the heavily T2-weighted images of the hemangiomas were significantly greater than that of the hypervascular malignant lesions (P < .05). Hemangiomas were differentiated from the hypervascular malignant liver lesions with high accuracy (97-100%) by three blinded readers based on the T2-weighted images. A subset of hemangiomas have atypical rapid diffuse enhancement on dynamic gadolinium-enhanced images. These atypical hemangiomas can be distinguished from hypervascular malignant liver lesions on T2-weighted MR images.
authors.affiliation: Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. outwate1@jeflin.tju.edu
authors.forename: E K
authors.initials: EK
authors.lastname: Outwater
authors.forename: K
authors.initials: K
authors.lastname: Ito
authors.forename: E
authors.initials: E
authors.lastname: Siegelman
authors.forename: C E
authors.initials: CE
authors.lastname: Martin
authors.forename: M
authors.initials: M
authors.lastname: Bhatia
authors.forename: D G
authors.initials: DG
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006391:Hemangioma / Q000098:blood supply / Q000175:diagnosis*; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D019786:Gadolinium DTPA