Addition of Gadolinium Chelates to Heavily T2-Weighted MR Imaging
Limited Role in Differentiating Hepatic Hemangiomas from Metastases
Genevieve L. Bennett1,2,
Andrea Petersein3,
William W. Mayo-Smith1,
Peter F. Hahn3,
Wolfgang Schima3 and
Sanjay Saini3
1
Department of Diagnostic Imaging, Brown University School of Medicine, Rhode
Island Hospital, 593 Eddy St., Providence, RI 02903.
2
Present address: Department of Abdominal Imaging, New York University Medical
Center, 560 First Ave., New York, NY 10016.
3
Department of Radiology at the Massachusetts General Hospital and Harvard
Medical School, 55 Fruit St., Boston, MA 02114.
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Fig. 1. —Scatterplot of T2 relaxation times for hemangiomas
(diamonds) and metastases (circles) shows that highest T2
relaxation time observed among metastases was 193 msec, which was seen for
cystic metastasis from ovarian carcinoma. Highest observed T2 relaxation time
in other metastatic lesions was 98 msec. Only two hemangiomas had T2 values of
less than 98 msec.
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Fig. 2A. —60-year-old man with hemangioma in whom administration of gadolinium
did not alter diagnosis. T2-weighted MR images obtained with TE of 80 msec
(A) and 160 msec (B) show well-circumscribed lesion within
posterior right hepatic lobe (arrow, A). Signal intensity is
isointense to cerebrospinal fluid, which is consistent with hemangioma.
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Fig. 2B. —60-year-old man with hemangioma in whom administration of gadolinium
did not alter diagnosis. T2-weighted MR images obtained with TE of 80 msec
(A) and 160 msec (B) show well-circumscribed lesion within
posterior right hepatic lobe (arrow, A). Signal intensity is
isointense to cerebrospinal fluid, which is consistent with hemangioma.
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Fig. 2C. —60-year-old man with hemangioma in whom administration of gadolinium
did not alter diagnosis. T1-weighted MR images obtained before (C) and
after (D-F) gadolinium administration reveal nodular peripheral
enhancement with complete fill-in on equilibrium phase image (F), which
is consistent with hemangioma.
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Fig. 2D. —60-year-old man with hemangioma in whom administration of gadolinium
did not alter diagnosis. T1-weighted MR images obtained before (C) and
after (D-F) gadolinium administration reveal nodular peripheral
enhancement with complete fill-in on equilibrium phase image (F), which
is consistent with hemangioma.
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Fig. 2E. —60-year-old man with hemangioma in whom administration of gadolinium
did not alter diagnosis. T1-weighted MR images obtained before (C) and
after (D-F) gadolinium administration reveal nodular peripheral
enhancement with complete fill-in on equilibrium phase image (F), which
is consistent with hemangioma.
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Fig. 2F. —60-year-old man with hemangioma in whom administration of gadolinium
did not alter diagnosis. T1-weighted MR images obtained before (C) and
after (D-F) gadolinium administration reveal nodular peripheral
enhancement with complete fill-in on equilibrium phase image (F), which
is consistent with hemangioma.
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Fig. 3A. —53-year-old man with colonic cancer metastasis in whom
administration of gadolinium did not alter diagnosis. T2-weighted MR images
obtained with TE of 80 msec (A) and 160 msec (B) show large
lesion within posterior right hepatic lobe (arrow, A). Signal
intensity is heterogeneous, giving target appearance. This finding was
interpreted as metastasis.
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Fig. 3B. —53-year-old man with colonic cancer metastasis in whom
administration of gadolinium did not alter diagnosis. T2-weighted MR images
obtained with TE of 80 msec (A) and 160 msec (B) show large
lesion within posterior right hepatic lobe (arrow, A). Signal
intensity is heterogeneous, giving target appearance. This finding was
interpreted as metastasis.
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Fig. 3C. —53-year-old man with colonic cancer metastasis in whom
administration of gadolinium did not alter diagnosis. T1-weighted MR images
obtained during portal venous (C) and equilibrium (D) phases of
gadolinium administration reveal enhancement that is predominantly central,
thus confirming this lesion is not hemangioma.
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Fig. 3D. —53-year-old man with colonic cancer metastasis in whom
administration of gadolinium did not alter diagnosis. T1-weighted MR images
obtained during portal venous (C) and equilibrium (D) phases of
gadolinium administration reveal enhancement that is predominantly central,
thus confirming this lesion is not hemangioma.
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Fig. 4A. —43-year-old woman with hemangioma in whom administration of
gadolinium was helpful in establishing diagnosis of lesion that was initially
interpreted as indeterminate. T2-weighted MR images obtained with TE of 80
msec (A) and 160 msec (B) show large hepatic lesion with
heterogeneous signal intensity (arrow, A) that, overall, is
less than that of cerebrospinal fluid.
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Fig. 4B. —43-year-old woman with hemangioma in whom administration of
gadolinium was helpful in establishing diagnosis of lesion that was initially
interpreted as indeterminate. T2-weighted MR images obtained with TE of 80
msec (A) and 160 msec (B) show large hepatic lesion with
heterogeneous signal intensity (arrow, A) that, overall, is
less than that of cerebrospinal fluid.
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Fig. 4C. —43-year-old woman with hemangioma in whom administration of
gadolinium was helpful in establishing diagnosis of lesion that was initially
interpreted as indeterminate. T1-weighted MR images obtained during portal
venous (C) and equilibrium (D) phases of gadolinium enhancement
show peripheral nodular enhancement pattern with near-complete fill-in, which
is consistent with hemangioma.
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Fig. 4D. —43-year-old woman with hemangioma in whom administration of
gadolinium was helpful in establishing diagnosis of lesion that was initially
interpreted as indeterminate. T1-weighted MR images obtained during portal
venous (C) and equilibrium (D) phases of gadolinium enhancement
show peripheral nodular enhancement pattern with near-complete fill-in, which
is consistent with hemangioma.
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Fig. 5A. —37-year-old woman with ovarian carcinoma metastasis in whom
administration of gadolinium was helpful in establishing diagnosis of cystic
metastasis; lesion was initially interpreted as hemangioma. T2-weighted MR
images obtained with TE of 80 msec (A) and 160 msec (B) show
lesion in posterior right hepatic lobe (arrow, A) that appears
isointense to cerebrospinal fluid. This lesion was interpreted as
hemangioma.
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Fig. 5B. —37-year-old woman with ovarian carcinoma metastasis in whom
administration of gadolinium was helpful in establishing diagnosis of cystic
metastasis; lesion was initially interpreted as hemangioma. T2-weighted MR
images obtained with TE of 80 msec (A) and 160 msec (B) show
lesion in posterior right hepatic lobe (arrow, A) that appears
isointense to cerebrospinal fluid. This lesion was interpreted as
hemangioma.
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Fig. 5C. —37-year-old woman with ovarian carcinoma metastasis in whom
administration of gadolinium was helpful in establishing diagnosis of cystic
metastasis; lesion was initially interpreted as hemangioma. T1-weighted MR
image obtained after administration of gadolinium reveals irregular
enhancement pattern, which is not typical of hemangioma.
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Fig. 6A. —36-year-old woman with hemangioma in whom administration of
gadolinium led to incorrect interpretation after correct diagnosis had been
established from T2-weighted images. T2-weighted MR images obtained with TE of
80 msec (A) and 160 msec (B) show lesion within caudate lobe
(arrow, A) that is isointense to cerebrospinal fluid, which is
consistent with hemangioma.
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Fig. 6B. —36-year-old woman with hemangioma in whom administration of
gadolinium led to incorrect interpretation after correct diagnosis had been
established from T2-weighted images. T2-weighted MR images obtained with TE of
80 msec (A) and 160 msec (B) show lesion within caudate lobe
(arrow, A) that is isointense to cerebrospinal fluid, which is
consistent with hemangioma.
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Fig. 6C. —36-year-old woman with hemangioma in whom administration of
gadolinium led to incorrect interpretation after correct diagnosis had been
established from T2-weighted images. T1-weighted MR image obtained during
portal venous phase of gadolinium administration reveals irregular
enhancement, which is more typical for metastasis.
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