Materiały źródłowe

• #1 Liver hemangioma – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/liver-hemangioma/symptoms-causes/syc-20354234

  Most cases of liver hemangiomas are discovered during an imaging study done for some other condition. […] A liver hemangioma usually occurs as a single abnormal collection of blood vessels that is less than about 1.5 inches (about 4 centimeters) wide. […] In most people, a liver hemangioma will never grow and never cause any signs and symptoms. But in a small number of people, a liver hemangioma will grow to cause symptoms and require treatment. It’s not clear why this happens. […] Make an appointment with your doctor if you experience any persistent signs and symptoms that worry you. […] Women who have been diagnosed with liver hemangiomas face a risk of complications if they become pregnant. […] Very rarely, a growing hemangioma can cause signs and symptoms that may require treatment, including pain in the upper right quadrant of the abdomen, abdominal bloating or nausea. […] Medications that affect hormone levels in your body, such as birth control pills, could cause an increase in size and complications if you’ve been diagnosed with a liver hemangioma.

• #2 Hepatic hemangioma: What internists need to know

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6952297/

  Hepatic hemangioma (HH) is the most common benign liver tumor and it is usually found incidentally during radiological studies. […] The diagnosis can be established by the identification of HH hallmarks in several imaging studies. […] In asymptomatic patients treatment is not required and follow up is usually reserved for HH of more than 5 cm. […] The natural progression of HH varies, previously these lesions were considered to remain stable. However, multiple studies have shown progression and increase in size when followed throughout the years. […] HH unique features by imaging are the presence of peripheral nodular enhancement and a progressive centripetal fill-in. Ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are the most common imaging tests. […] US is usually the first diagnostic imaging test due to its availability.

• #3 Hepatic hemangioma Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/hepatic-hemangioma

  A hepatic hemangioma is a liver mass made of widened (dilated) blood vessels. It is not cancerous. […] In most cases, the condition is not found until liver images are taken for some other reason. If the hemangioma ruptures, the only sign may be an enlarged liver. […] The following tests may be performed: Blood tests, CT scan of the liver, Hepatic angiogram, MRI, Single-photon emission computed tomography (SPECT), Ultrasound of the abdomen.

• #4 Liver hemangioma – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/liver-hemangioma/symptoms-causes/syc-20354234

  Most cases of liver hemangiomas are discovered during an imaging study done for some other condition. […] A liver hemangioma usually occurs as a single abnormal collection of blood vessels that is less than about 1.5 inches (about 4 centimeters) wide. […] In most people, a liver hemangioma will never grow and never cause any signs and symptoms. But in a small number of people, a liver hemangioma will grow to cause symptoms and require treatment. It’s not clear why this happens. […] Make an appointment with your doctor if you experience any persistent signs and symptoms that worry you. […] Women who have been diagnosed with liver hemangiomas face a risk of complications if they become pregnant. […] Very rarely, a growing hemangioma can cause signs and symptoms that may require treatment, including pain in the upper right quadrant of the abdomen, abdominal bloating or nausea. […] Medications that affect hormone levels in your body, such as birth control pills, could cause an increase in size and complications if you’ve been diagnosed with a liver hemangioma.

• #5 Liver hemangioma – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/liver-hemangioma/symptoms-causes/syc-20354234

  Most cases of liver hemangiomas are discovered during an imaging study done for some other condition. […] A liver hemangioma usually occurs as a single abnormal collection of blood vessels that is less than about 1.5 inches (about 4 centimeters) wide. […] In most people, a liver hemangioma will never grow and never cause any signs and symptoms. But in a small number of people, a liver hemangioma will grow to cause symptoms and require treatment. It’s not clear why this happens. […] Make an appointment with your doctor if you experience any persistent signs and symptoms that worry you. […] Women who have been diagnosed with liver hemangiomas face a risk of complications if they become pregnant. […] Very rarely, a growing hemangioma can cause signs and symptoms that may require treatment, including pain in the upper right quadrant of the abdomen, abdominal bloating or nausea. […] Medications that affect hormone levels in your body, such as birth control pills, could cause an increase in size and complications if you’ve been diagnosed with a liver hemangioma.

• #6 One stop shop approach for the diagnosis of liver hemangioma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8727199/

  Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation. […] An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance [ultrasound/ computed tomography/or magnetic resonance imaging (MRI)]. For a clinician who practices ultrasound and has an ultrasound system in the room, the easiest, fastest, non-invasive and cost-effective method is contrast enhanced ultrasound (CEUS). Approximately 85% of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography (CT)/MRI appointment.

• #7 One stop shop approach for the diagnosis of liver hemangioma

  https://www.wjgnet.com/1948-5182/full/v13/i12/1892.htm

  Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation. […] An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance [ultrasound/ computed tomography/or magnetic resonance imaging (MRI)]. For a clinician who practices ultrasound and has an ultrasound system in the room, the easiest, fastest, non-invasive and cost-effective method is contrast enhanced ultrasound (CEUS). Approximately 85% of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography (CT)/MRI appointment.

• #8 One stop shop approach for the diagnosis of liver hemangioma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8727199/

  Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation. […] An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance [ultrasound/ computed tomography/or magnetic resonance imaging (MRI)]. For a clinician who practices ultrasound and has an ultrasound system in the room, the easiest, fastest, non-invasive and cost-effective method is contrast enhanced ultrasound (CEUS). Approximately 85% of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography (CT)/MRI appointment.

• #9 Liver Hemangioma | Liver Cancer | UPMC Center for Liver Care

  https://www.upmc.com/services/digestive-disorders-center/services/liver-diseases/conditions/liver-cancer/liver-hemangioma

  Most people with liver hemangiomas don’t have any symptoms. […] Doctors often find liver hemangiomas during imaging tests for other health issues, such as: CT scans, MRI, Ultrasound. […] Doctors may also order these tests if they suspect you have liver hemangioma. […] There’s usually no need for a liver biopsy to test a sample of liver tissue sample.

• #10 What is a Liver Hemangioma and What Are the Symptoms and Causes? – Ezra

  https://ezra.com/blog/what-is-a-liver-hemangioma

  Liver hemangiomas (also referred to as hepatic hemangiomas) are a common type of growth within the liver. […] Various imaging technologies can be used to identify liver hemangiomas, though some are better at diagnosing them than others. […] If you experience persistent pain, particularly in the upper right abdomen, or other worrying symptoms, you should contact a healthcare professional immediately. […] Since liver hemangiomas are usually asymptomatic, they are commonly found incidentally during imaging tests like ultrasounds, computed tomography (CT), and magnetic resonance imaging (MRI) scans. […] Early detection and diagnosis through imaging techniques like CT or MRI are essential for differentiating these benign tumors from more serious liver conditions.

• #11 Liver hemangioma – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/liver-hemangioma/diagnosis-treatment/drc-20354239

  Tests used to diagnose liver hemangiomas include: […] Ultrasound, an imaging method that uses high-frequency sound waves to produce images of the liver […] Computerized tomography (CT) scanning, which combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images (slices) of the liver […] Magnetic resonance imaging (MRI), a technique that uses a magnetic field and radio waves to create detailed images of the liver […] Scintigraphy, a type of nuclear imaging that uses a radioactive tracer material to produce images of the liver. […] Other tests may be used depending on your situation.

• #12 Liver hemangioma | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/liver-hemangioma?content_id=CON-20198825

  Most cases of liver hemangiomas are discovered during an imaging study done for some other condition. […] Tests used to diagnose liver hemangiomas include: Ultrasound, an imaging method that uses high-frequency sound waves to produce images of the liver; Computerized tomography (CT) scanning, which combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images (slices) of the liver; Magnetic resonance imaging (MRI), a technique that uses a magnetic field and radio waves to create detailed images of the liver; Scintigraphy, a type of nuclear imaging that uses a radioactive tracer material to produce images of the liver. […] Other tests may be used depending on your situation.

• #13 Hepatic hemangioma: What internists need to know

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6952297/

  Hepatic hemangioma (HH) is the most common benign liver tumor and it is usually found incidentally during radiological studies. […] The diagnosis can be established by the identification of HH hallmarks in several imaging studies. […] In asymptomatic patients treatment is not required and follow up is usually reserved for HH of more than 5 cm. […] The natural progression of HH varies, previously these lesions were considered to remain stable. However, multiple studies have shown progression and increase in size when followed throughout the years. […] HH unique features by imaging are the presence of peripheral nodular enhancement and a progressive centripetal fill-in. Ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are the most common imaging tests. […] US is usually the first diagnostic imaging test due to its availability.

• #14 Hepatic Hemangiomas Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/177106-workup

  Radiologic imaging is the key to making a diagnosis of hepatic hemangioma. The key modalities include ultrasonography, dynamic contrast-enhanced computed tomography (CT) scanning, and magnetic resonance imaging (MRI). Less commonly used imaging modalities include nuclear medicine studies using technetium-99m (99mTc)labeled red blood cells (RBCs), hepatic arteriography, and digital subtraction angiography (DSA) […] Ultrasound has a sensitivity as high as 97% and a specificity as high as 60% in the diagnosis of hepatic hemangioma. The American College of Gastroenterology (ACG) and the European Association for the Study of the Liver (EASL) both state that the finding of a small lesion ( 2 cm for ACG; 3 cm for EASL) with classic imaging characteristics in a patient without chronic liver disease or without an oncologic diagnosis can be considered to be diagnostic for hepatic hemangioma. Additional contrast-enhanced studies are not necessary in such patients.

• #15 Hepatic hemangioma: What internists need to know

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6952297/

  CT has a sensitivity of 98.3% and a specificity of 55%. […] MRI has been considered the best imaging method for HH with a sensitivity of 90%-100% and a specificity of 91%-99%. […] Angiography is the best option for atypical HH that are difficult to diagnose with other imaging test. […] Needle aspiration biopsy is not recommended because of the high risk of hemorrhage and a low diagnostic yield.

• #16 Hepatic hemangioma: What internists need to know

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6952297/

  CT has a sensitivity of 98.3% and a specificity of 55%. […] MRI has been considered the best imaging method for HH with a sensitivity of 90%-100% and a specificity of 91%-99%. […] Angiography is the best option for atypical HH that are difficult to diagnose with other imaging test. […] Needle aspiration biopsy is not recommended because of the high risk of hemorrhage and a low diagnostic yield.

• #17 Hepatic Hemangiomas Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/177106-workup

  MRI is highly sensitive and specific for the diagnosis of hepatic hemangioma. Classical imaging characteristics of hepatic hemangiomas on MRI include: On T1-weighted sequences: The hemangioma is hypointense. On T2-weighted sequences: The lesion is strongly hyperintense (ie, light bulb bright). When gadolinium is used as an intravenous contrast agent, hemangiomas enhance in a fashion similar to that seen on dynamic CT scanning. […] In the authors’ opinions, MRI with arterial phase and delayed contrast medium is the test of choice for investigating a liver mass of unclear origin. This is particularly the case when hepatic hemangioma is suspected.

• #18 Liver hemangioma – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/liver-hemangioma/diagnosis-treatment/drc-20354239

  Tests used to diagnose liver hemangiomas include: […] Ultrasound, an imaging method that uses high-frequency sound waves to produce images of the liver […] Computerized tomography (CT) scanning, which combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images (slices) of the liver […] Magnetic resonance imaging (MRI), a technique that uses a magnetic field and radio waves to create detailed images of the liver […] Scintigraphy, a type of nuclear imaging that uses a radioactive tracer material to produce images of the liver. […] Other tests may be used depending on your situation.

• #19 Hepatic Hemangioma: Review of Imaging and Therapeutic Strategies

  https://www.mdpi.com/1648-9144/60/3/449

  Hepatic hemangiomas are the most common benign liver tumors. Typically, small- to medium-sized hemangiomas are asymptomatic and discovered incidentally through the widespread use of imaging techniques. A variety of imaging methods are used for diagnosis. The diagnosis of hepatic hemangiomas utilizes a spectrum of imaging modalities, including conventional ultrasound (US, including B-mode and Doppler), contrast-enhanced ultrasound (CEUS), contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), angiography, and nuclear imaging (specifically, scintigraphic studies utilizing Technetium-99m-labeled red blood cells). The specificity and sensitivity of these diagnostic techniques are delineated in Table 1. These diagnostic modalities offer considerable specificity in differentiating hepatic hemangiomas from other vascular neoplasms, benign entities such as adenomas, or malignant lesions including hepatocellular carcinoma (HCC), metastases, and dysplastic nodules. Ultrasound (US) frequently serves as the initial diagnostic modality for hepatic hemangiomas, favored for its wide availability, non-ionizing nature, and repeatability. The characteristic imaging feature of a hepatic hemangioma on computed tomography (CT) scans is a well-circumscribed, hypodense lesion. In magnetic resonance imaging (MRI), hepatic hemangiomas are typically characterized by a well-defined, homogenous morphology, manifesting as hypointense on T1-weighted sequences and hyperintense on T2-weighted sequences. Technetium-99m-labeled red blood cell (Tc-99m RBC) scintigraphy is a noninvasive diagnostic technique offering high specificity for identifying hepatic hemangiomas. The sensitivity of this modality is contingent upon the lesion’s size: it is 17–20% for lesions under 1 cm, increases to 65–80% for lesions between 1 and 2 cm, and reaches nearly 100% for those exceeding 2 cm in diameter. The management strategy for hepatic hemangiomas depends on various factors, including the size, location, symptoms, and potential complications of the lesion. Asymptomatic and small lesions often do not require intervention and can be monitored conservatively with regular imaging. When treatment is necessary for liver hemangiomas, surgical approaches like hepatic resection or enucleation, performed through open, laparoscopic, or robotic methods, have been historically deemed the first choice. However, in recent years, alternative therapies such as liver transplantation, radiofrequency ablation, transarterial embolization, and transarterial chemoembolization have also been gaining in importance.

• #20 One stop shop approach for the diagnosis of liver hemangioma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8727199/

  The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast, non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma. […] The classic sonographic appearance of hemangioma is that of a homogeneous hyperechoic mass, measuring less than 3 cm in diameter with acoustic enhancement and sharp margins. […] The typical CEUS feature of a hemangioma, regardless of the injected contrast agent, is peripheral nodular enhancement in the arterial phase with progressive centripetal partial or complete fill-in in portal venous phase and complete enhancement in late phase. […] The described appearance is highly suggestive of hemangioma. When the two hallmarks of haemangioma, peripheral pools and centripetal progression, are present the diagnosis of HH is most likely, the specificity of the method approaching 100% in most studies.

• #21 One stop shop approach for the diagnosis of liver hemangioma

  https://www.wjgnet.com/1948-5182/full/v13/i12/1892.htm

  The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast, non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma. […] A high-performance ultrasonographic system equipped with contrast-enhanced ultrasound software allows the experienced examinator to orient the diagnosis quickly, cost-effectively and non-invasively in most cases. […] This article reviews the typical and atypical ultrasound features of hepatic hemangioma and proposes a diagnostic algorithm for liver hemangiomas in patients referred to the hepatologist. […] In an asymptomatic adult patient, without liver or oncological disease, the detection on standard ultrasound of a FLL below 3 cm with homogeneous hyperechoic appearance, sharp margin, posterior enhancement, absence of halo sign, without intra-tumoral vessels at colour Doppler directs the diagnosis to HH and does not require further investigation.

• #22 One stop shop approach for the diagnosis of liver hemangioma

  https://www.wjgnet.com/1948-5182/full/v13/i12/1892.htm

  However, if ultrasound shows a lesion with features other than those described, measures over 3 cm or has been detected in oncology patients or those with underlying liver disease, contrast enhanced imaging (CEUS, CT or MRI) is required. […] CEUS can be performed immediately after standard ultrasound in the consulting room, without the need to assess renal function as needed in the administration of contrast agents for CT/MRI. Studies to date have shown that CEUS has similar performance to computed tomography or MRI in the diagnosis of HH. […] A typical aspect of hemangioma in contrast ultrasound (peripheral and globular enhancement on arterial phase followed by a central enhancement on delayed phases) guides the diagnosis in a maximum of 30 min, stops further investigations and provides mental comfort to the patient. […] According to studies, this strategy includes approximately 85%-90% of patients.

• #23 One stop shop approach for the diagnosis of liver hemangioma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8727199/

  The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast, non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma. […] The classic sonographic appearance of hemangioma is that of a homogeneous hyperechoic mass, measuring less than 3 cm in diameter with acoustic enhancement and sharp margins. […] The typical CEUS feature of a hemangioma, regardless of the injected contrast agent, is peripheral nodular enhancement in the arterial phase with progressive centripetal partial or complete fill-in in portal venous phase and complete enhancement in late phase. […] The described appearance is highly suggestive of hemangioma. When the two hallmarks of haemangioma, peripheral pools and centripetal progression, are present the diagnosis of HH is most likely, the specificity of the method approaching 100% in most studies.

• #24 One stop shop approach for the diagnosis of liver hemangioma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8727199/

  The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast, non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma. […] The classic sonographic appearance of hemangioma is that of a homogeneous hyperechoic mass, measuring less than 3 cm in diameter with acoustic enhancement and sharp margins. […] The typical CEUS feature of a hemangioma, regardless of the injected contrast agent, is peripheral nodular enhancement in the arterial phase with progressive centripetal partial or complete fill-in in portal venous phase and complete enhancement in late phase. […] The described appearance is highly suggestive of hemangioma. When the two hallmarks of haemangioma, peripheral pools and centripetal progression, are present the diagnosis of HH is most likely, the specificity of the method approaching 100% in most studies.

• #25 One stop shop approach for the diagnosis of liver hemangioma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8727199/

  CEUS can be performed immediately after standard ultrasound in the consulting room, without the need to assess renal function as needed in the administration of contrast agents for CT/MRI. Studies to date have shown that CEUS has similar performance to computed tomography or MRI in the diagnosis of HH. […] A typical aspect of hemangioma in contrast ultrasound (peripheral and globular enhancement on arterial phase followed by a central enhancement on delayed phases) guides the diagnosis in a maximum of 30 min, stops further investigations and provides mental comfort to the patient. […] In conclusion, standard and contrast-enhanced ultrasound examination in a clinical context guides the diagnosis of HH in most patients.

• #26 One stop shop approach for the diagnosis of liver hemangioma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8727199/

  CEUS can be performed immediately after standard ultrasound in the consulting room, without the need to assess renal function as needed in the administration of contrast agents for CT/MRI. Studies to date have shown that CEUS has similar performance to computed tomography or MRI in the diagnosis of HH. […] A typical aspect of hemangioma in contrast ultrasound (peripheral and globular enhancement on arterial phase followed by a central enhancement on delayed phases) guides the diagnosis in a maximum of 30 min, stops further investigations and provides mental comfort to the patient. […] In conclusion, standard and contrast-enhanced ultrasound examination in a clinical context guides the diagnosis of HH in most patients.

• #27 The Radiology Assistant : Common Liver Tumors

  https://radiologyassistant.nl/abdomen/liver/common-liver-tumors

  Hemangioma is the most common benign liver tumor. It is composed of multiple vascular channels lined by endothelial cells. In 60% of cases more than one hemangioma is present. The size varies from a few millimeters to more than 10 cm (giant hemangiomas). Calcification is rare and seen in less than 10%, usually in the central scar of giant hemangioma. […] CT will show hemangiomas as sharply defined masses with the same density as the vessels on NECT and CECT. The enhancement pattern is characterized by sequential contrast opacification beginning at the periphery as one or more nodular areas of enhancement. All these areas of enhancement must have the same density as the bloodpool. This means that in the arterial phase the areas of enhancement must have almost the density of the aorta, while in the portal venous phase the enhancement must be of the same density as the portal vein. Even on delayed images the density of a hemangioma must be of the same density as the vessels. Finally most hemangiomas show complete fill in with contrast.

• #28 Liver Hemangioma – Symptoms, Causes and TreatmentLPC

  https://liverandpancreasclinic.com/blog/2018/03/23/liver-hemangioma/

  Most patients with liver hemangioma come with the diagnosis on a routine ultrasonography as said before rarely other form of imaging like CT or MRI. […] The modalities used to aid in the diagnosis of hepatic hemangiomas include ultrasonography, dynamic contrast-enhanced computed tomography (CT) scanning, nuclear medicine studies using technetium-99m (99m Tc) labeled RBCs, magnetic resonance imaging (MRI), hepatic arteriography, and digital subtraction angiography. […] Ultrasonography is the most commonly used initial diagnostic tool. Serial ultrasonographic examinations are done to monitor any increase in size of the hemangioma over time. […] The finding on ultrasonography of a suspected hemangioma should be diagnostically correlated with CT scan or MRI to ensure a correct diagnosis.

• #29 The Radiology Assistant : Common Liver Tumors

  https://radiologyassistant.nl/abdomen/liver/common-liver-tumors

  Small hemangiomas may show fast homogeneous enhancement (’flash filling’). Small HCC and hypervascular metastases may mimic small hemangiomas because they all show homogeneous enhancement in the arterial phase. By looking at the other phases to see if the enhancing areas match the bloodpool, it is usually possible to differentiate these lesions. […] Large hemangiomas can have an atypical appearance. Complete fill in is sometimes prevented by central fibrous scarring. These lesions need to be differentiated from other lesions with a scar like FLC, FNH and Cholangiocarcinoma. Again looking at the bloodpool will help you. […] Hemangiomas must be differentiated from other lesions that are hypervascular or lesions that show peripheral enhancement and progressive fill in.

• #30 Hepatic Hemangiomas Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/177106-workup

  MRI is highly sensitive and specific for the diagnosis of hepatic hemangioma. Classical imaging characteristics of hepatic hemangiomas on MRI include: On T1-weighted sequences: The hemangioma is hypointense. On T2-weighted sequences: The lesion is strongly hyperintense (ie, light bulb bright). When gadolinium is used as an intravenous contrast agent, hemangiomas enhance in a fashion similar to that seen on dynamic CT scanning. […] In the authors’ opinions, MRI with arterial phase and delayed contrast medium is the test of choice for investigating a liver mass of unclear origin. This is particularly the case when hepatic hemangioma is suspected.

• #31 Hepatic Hemangiomas Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/177106-workup

  MRI is highly sensitive and specific for the diagnosis of hepatic hemangioma. Classical imaging characteristics of hepatic hemangiomas on MRI include: On T1-weighted sequences: The hemangioma is hypointense. On T2-weighted sequences: The lesion is strongly hyperintense (ie, light bulb bright). When gadolinium is used as an intravenous contrast agent, hemangiomas enhance in a fashion similar to that seen on dynamic CT scanning. […] In the authors’ opinions, MRI with arterial phase and delayed contrast medium is the test of choice for investigating a liver mass of unclear origin. This is particularly the case when hepatic hemangioma is suspected.

• #32 Hepatic Hemangiomas Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/177106-workup

  MRI is highly sensitive and specific for the diagnosis of hepatic hemangioma. Classical imaging characteristics of hepatic hemangiomas on MRI include: On T1-weighted sequences: The hemangioma is hypointense. On T2-weighted sequences: The lesion is strongly hyperintense (ie, light bulb bright). When gadolinium is used as an intravenous contrast agent, hemangiomas enhance in a fashion similar to that seen on dynamic CT scanning. […] In the authors’ opinions, MRI with arterial phase and delayed contrast medium is the test of choice for investigating a liver mass of unclear origin. This is particularly the case when hepatic hemangioma is suspected.

• #33 Hepatic Hemangiomas Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/177106-workup

  Radiologic imaging is the key to making a diagnosis of hepatic hemangioma. The key modalities include ultrasonography, dynamic contrast-enhanced computed tomography (CT) scanning, and magnetic resonance imaging (MRI). Less commonly used imaging modalities include nuclear medicine studies using technetium-99m (99mTc)labeled red blood cells (RBCs), hepatic arteriography, and digital subtraction angiography (DSA) […] Ultrasound has a sensitivity as high as 97% and a specificity as high as 60% in the diagnosis of hepatic hemangioma. The American College of Gastroenterology (ACG) and the European Association for the Study of the Liver (EASL) both state that the finding of a small lesion ( 2 cm for ACG; 3 cm for EASL) with classic imaging characteristics in a patient without chronic liver disease or without an oncologic diagnosis can be considered to be diagnostic for hepatic hemangioma. Additional contrast-enhanced studies are not necessary in such patients.

• #34 Hepatic hemangioma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/hepatic-haemangioma-3?lang=us

  Hepatic hemangiomas are frequently diagnosed as an incidental finding on imaging, and most patients are asymptomatic. From a radiologic perspective, it is important to differentiate hemangiomas from hepatic malignancy. […] The diagnosis of hemangioma can usually be made with high specificity if the imaging characteristics are typical. General imaging differential considerations for a hemangioma depend on the imaging modality and the patient’s history, but may include: […] Recommendations for patients with no known risk factors for hepatic malignancy can range from center to center from performing confirmatory examinations (MRI, triphasic CT or scintigraphy) to considering follow-up ultrasound in 6 months to confirm stability, to performing no further imaging evaluation.

• #35 One stop shop approach for the diagnosis of liver hemangioma

  https://www.wjgnet.com/1948-5182/full/v13/i12/1892.htm

  Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation. […] An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance [ultrasound/ computed tomography/or magnetic resonance imaging (MRI)]. For a clinician who practices ultrasound and has an ultrasound system in the room, the easiest, fastest, non-invasive and cost-effective method is contrast enhanced ultrasound (CEUS). Approximately 85% of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography (CT)/MRI appointment.

• #36 Atypical appearance of hepatic hemangiomas with contrast-enhanced ultrasound | Oncotarget

  https://www.oncotarget.com/article/24185/text/

  Contrast-enhanced ultrasound (CEUS) has been proven to be a reliable method for the characterization of the focal liver lesions, it is a sensitive and very specific method for the diagnosis of hemangiomas. […] However, atypical imaging findings of hemangiomas may also occur even when contrast agents are administered, here we analyzed retrospectively the imaging features of 22 patients with hepatic hemangiomas that were atypical on CEUS. […] Familiarity with the atypical appearance of hepatic hemangiomas on US and CEUS will increase the rate of correct primary diagnosis before surgery and histologic examination. […] Atypical appearance of hepatic hemangiomas were various, including: washout in the late phase; just peripheral enhancement; no enhancement; septal enhancement; centrifugal enhancement and slow spoke-wheel enhancement. Radiologists should be aware of these rare atypical appearance. Establishing knowledge of the entire spectrum of atypical hepatic hemangiomas may benefit the rational approach to future cases.

• #37 Liver Hemangioma – Symptoms, Causes and TreatmentLPC

  https://liverandpancreasclinic.com/blog/2018/03/23/liver-hemangioma/

  Dynamic contrast-enhanced CT scanning is preferred to routine CT scanning. […] MRI is highly sensitive and specific in the diagnosis of differentiating liver tumors especially hepatic hemangioma. […] Diagnostic accuracy diminishes for all imaging modalities when assessing a liver lesion that is less than 2 cm in diameter. MRI is the most accurate radiologic study to establish the diagnosis of a small hepatic tumor. […] Liver biopsy is not done in most circumstances where a hemangioma is high in the differential diagnosis of a hepatic mass. […] Most hepatic hemangiomas are small and asymptomatic at the time of diagnosis, and they are likely to remain that way. […] Once the diagnosis of hepatic hemangioma is confirmed by radiologic studies, there will not be any further follow up if it is a small hemangioma.

• #38 Hepatic hemangioma: What internists need to know

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6952297/

  CT has a sensitivity of 98.3% and a specificity of 55%. […] MRI has been considered the best imaging method for HH with a sensitivity of 90%-100% and a specificity of 91%-99%. […] Angiography is the best option for atypical HH that are difficult to diagnose with other imaging test. […] Needle aspiration biopsy is not recommended because of the high risk of hemorrhage and a low diagnostic yield.

• #39 Hemangioma – Hepatic Tumors – Liver Diseases – Gastroenterology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.7.30.4.2.

  Liver hemangioma is the most common benign neoplasm of the liver (it occurs in 2%-5% of the population and is several times more frequent in women). […] If the lesion is larger or it is found in a person with liver disease or a malignant tumor, then contrast-enhanced ultrasonography, CT, or MRI is required to confirm the diagnosis. A suspicion of hemangioma is a contraindication to lesion biopsy given the low diagnostic yield and bleeding risk. […] In the case of lesions 3 cm in diameter and a typical ultrasound image found in a person without liver disease, ultrasonography is sufficient to establish the diagnosis.

• #40 Liver Hemangioma – Symptoms, Causes and TreatmentLPC

  https://liverandpancreasclinic.com/blog/2018/03/23/liver-hemangioma/

  Dynamic contrast-enhanced CT scanning is preferred to routine CT scanning. […] MRI is highly sensitive and specific in the diagnosis of differentiating liver tumors especially hepatic hemangioma. […] Diagnostic accuracy diminishes for all imaging modalities when assessing a liver lesion that is less than 2 cm in diameter. MRI is the most accurate radiologic study to establish the diagnosis of a small hepatic tumor. […] Liver biopsy is not done in most circumstances where a hemangioma is high in the differential diagnosis of a hepatic mass. […] Most hepatic hemangiomas are small and asymptomatic at the time of diagnosis, and they are likely to remain that way. […] Once the diagnosis of hepatic hemangioma is confirmed by radiologic studies, there will not be any further follow up if it is a small hemangioma.

• #41 Liver Hemangioma – Symptoms, Causes and TreatmentLPC

  https://liverandpancreasclinic.com/blog/2018/03/23/liver-hemangioma/

  Dynamic contrast-enhanced CT scanning is preferred to routine CT scanning. […] MRI is highly sensitive and specific in the diagnosis of differentiating liver tumors especially hepatic hemangioma. […] Diagnostic accuracy diminishes for all imaging modalities when assessing a liver lesion that is less than 2 cm in diameter. MRI is the most accurate radiologic study to establish the diagnosis of a small hepatic tumor. […] Liver biopsy is not done in most circumstances where a hemangioma is high in the differential diagnosis of a hepatic mass. […] Most hepatic hemangiomas are small and asymptomatic at the time of diagnosis, and they are likely to remain that way. […] Once the diagnosis of hepatic hemangioma is confirmed by radiologic studies, there will not be any further follow up if it is a small hemangioma.

• #42 Liver Hemangioma – Symptoms, Causes and TreatmentLPC

  https://liverandpancreasclinic.com/blog/2018/03/23/liver-hemangioma/

  For larger hemangioma you will be advised to undergo ultrasonography at 6 months and at 12 months after the initial diagnosis. […] Surgical treatment may be appropriate in cases of rapidly growing tumors. Surgery may also be warranted in cases where a hepatic hemangioma cannot be differentiated from hepatic malignancy on imaging studies. […] Size actually does not matter in most cases and as said above it is the symptoms that decide the requirement of treatment. […] Surgical resection and surgical enucleation are the treatments of choice. […] In general, both surgical resection and enucleation are safe and are well tolerated by patients. […] In the absence of tumor-promoting factors, such as estrogen therapy, hemangiomas rarely recur after successful resection. […] Spontaneously ruptured hemangioma is an emergency life-threatening situation.

• #43 Real-world data on the clinicopathological traits and outcomes of hospitalized liver hemangioma patients: a multicenter study

  https://atm.amegroups.org/article/view/70525/html

  In recent years, research on the etiology, pathogenesis, clinical and imaging characteristics, diagnosis, and treatment of hepatic hemangioma has made progress globally, but there is still a lack of evidence from high-quality clinical trials. […] It is necessary to determine which types of hepatic hemangioma need to be treated. […] As a benign tumor, most hepatic hemangiomas are asymptomatic and are not typically malignant, and significant liver function abnormalities have not been observed in asymptomatic hepatic hemangioma patients. […] Surveillance is often recommended for patients presenting with this type of hepatic hemangioma, and this course of action is generally accepted worldwide. […] Spontaneous or traumatic rupture of hepatic hemangioma and Kasabach-Merritt syndrome are absolute indications for treatment because of their fatal consequences.

• #44 Hepatic Hemangiomas Differential Diagnoses

  https://emedicine.medscape.com/article/177106-differential

  Hepatic hemangiomas should be differentiated from other benign and malignant space-occupying liver lesions. […] The malignant lesions need to ruled out using multiparameteric MRI, including the use of T1 and T2-weighted images, diffusion-weighted images, and dynamic contrast-enhanced images.

• #45 Hepatic Hemangiomas Differential Diagnoses

  https://emedicine.medscape.com/article/177106-differential

  Hepatic hemangiomas should be differentiated from other benign and malignant space-occupying liver lesions. […] The malignant lesions need to ruled out using multiparameteric MRI, including the use of T1 and T2-weighted images, diffusion-weighted images, and dynamic contrast-enhanced images.

• #46 What is changing in indications and treatment of hepatic hemangiomas. A review | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-what-is-changing-in-indications-S1665268119308397

  Hepatic cavernous hemangioma accounts for 73% of all benign liver tumors with a frequency of 0.4-7.3% at autopsy and is the second most common tumor seen in the liver after metastases. Patients affected by hemangioma usually have their tumor diagnosed by ultrasound abdominal examination for a not well defined pain, but pain persist after treatment of the hemangioma. […] Different imaging modalities are used to diagnosis liver hemangioma including ultrasonography, computed tomography (CT), magnetic resonance (MR) imaging, and less frequently scintigraphy, positron-emission tomography combined with CT (PET/CT) and angiography. Imaging-guided biopsy of hemangioma is usually not resorted to except in extremely atypical cases. […] The importance of hemangioma, from the point of view of medical imaging comes from its relatively high incidence in comparison to other focal liver lesions, its occurrence as an incidental finding, and the need to differentiate it from other more serious focal liver lesions. The latter consideration is particularly important in two types of patients: patients with primary malignant neoplasm and patients with liver cirrhosis. In the patients with primary liver neoplasm, it is important to differentiate hemangioma from liver metastasis. In the patients with cirrhosis, it is important to differentiate it from hepatocellular carcinoma.

• #47 One stop shop approach for the diagnosis of liver hemangioma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8727199/

  CEUS can be performed immediately after standard ultrasound in the consulting room, without the need to assess renal function as needed in the administration of contrast agents for CT/MRI. Studies to date have shown that CEUS has similar performance to computed tomography or MRI in the diagnosis of HH. […] A typical aspect of hemangioma in contrast ultrasound (peripheral and globular enhancement on arterial phase followed by a central enhancement on delayed phases) guides the diagnosis in a maximum of 30 min, stops further investigations and provides mental comfort to the patient. […] In conclusion, standard and contrast-enhanced ultrasound examination in a clinical context guides the diagnosis of HH in most patients.

• #48 Liver Hemangioma – Symptoms, Causes and TreatmentLPC

  https://liverandpancreasclinic.com/blog/2018/03/23/liver-hemangioma/

  Dynamic contrast-enhanced CT scanning is preferred to routine CT scanning. […] MRI is highly sensitive and specific in the diagnosis of differentiating liver tumors especially hepatic hemangioma. […] Diagnostic accuracy diminishes for all imaging modalities when assessing a liver lesion that is less than 2 cm in diameter. MRI is the most accurate radiologic study to establish the diagnosis of a small hepatic tumor. […] Liver biopsy is not done in most circumstances where a hemangioma is high in the differential diagnosis of a hepatic mass. […] Most hepatic hemangiomas are small and asymptomatic at the time of diagnosis, and they are likely to remain that way. […] Once the diagnosis of hepatic hemangioma is confirmed by radiologic studies, there will not be any further follow up if it is a small hemangioma.

• #49 Hepatic hemangiomas: Typical and atypical imaging findings, pitfalls and differential diagnosis.

  https://epos.myesr.org/poster/esr/ecr2017/C-1754

  Hemangiomas are common focal liver lesions, usually detected in the work up of asymptomatic patients. […] We illustrate the spectrum of imaging findings of liver hemangioma emphasizing key diagnostic features in ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) and theirs histopathological correlation. […] Their imaging features are well known, as their pathological examination reveals a characteristic focal tender mass formed by multiple vascular channels limited by a single… […] The most common sonographic pattern of hemangiomas consists of homogeneous hyperechoic liver nodule, with discrete posterior acoustic enhancement, devoided of Doppler signal both on colour-coded and spectral examination. […] Atypical US features are frequently seen in… […] Hemangiomas are a radiologists dream lesions because they often allow a confident diagnosis. […] Knowledge of atypical features and pitfalls can limit diagnostic error. […] However if diagnostic criteria are not reunited or doubtful, a biopsy study should be recommended.

• #50 I thought it was a hemangioma! A pictorial essay about common and uncommon liver hemangiomas’ mimickers | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-024-01745-1

  Focal liver lesions are frequently encountered during imaging studies, and hemangiomas represent the most common solid liver lesion. Liver hemangiomas usually show characteristic imaging features that enable characterization without the need for biopsy or follow-up. […] The knowledge of imaging features of potential liver hemangiomas mimickers is fundamental to avoid misinterpretation. […] Liver hemangiomas typically show imaging features that enable avoiding a biopsy. […] Many benign and malignant liver lesions show imaging features resembling hemangiomas. […] Radiologists must know the potentially misleading imaging features of hemangiomas mimickers. […] Hemangiomas have peculiar imaging features that enable accurate diagnosis using contrast-enhanced imaging modalities. […] No percutaneous biopsy or surgical resection is needed in cases of lesions with typical US appearance in nononcological patients with healthy liver, as well as in lesions with a typical enhancement pattern.

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