Infantile Hepatic Hemangiomas: Clinical and Imaging Findings and Their Correlation with Therapy
Ara Kassarjian1,2,
David Zurakowski3,
Josée Dubois4,
Harriet J. Paltiel1,
Steven J. Fishman5 and
Patricia E. Burrows1
1 Department of Radiology, Children's Hospital, Harvard Medical School, 300
Longwood Ave., Boston, MA.
2 Department of Radiology, Division of Musculoskeletal Radiology, Massachusetts
General Hospital, Harvard Medical School, 15 Parkman St., Ste. 515, Boston, MA
02114.
3 Department of Biostatistics, Children's Hospital, Harvard Medical School,
Boston, MA.
4 Department of Medical Imaging, Hôpital Sainte Justine, Université
de Montréal, Montréal, QC, Canada.
5 Department of Surgery, Children's Hospital, Harvard Medical School, Boston,
MA.
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Fig. 1A. —1-month-old boy showing sonographic characteristics of
infantile hepatic hemangiomas. Transverse sonogram of liver shows multiple
well-defined hypoechoic spherical masses.
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Fig. 1B. —1-month-old boy showing sonographic characteristics of
infantile hepatic hemangiomas. Sonogram with Doppler interrogation of hepatic
vein shows arterial waveform as evidence of arteriovenous shunting.
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Fig. 2. —1-day-old boy with sonographic findings characteristic of
infantile hepatic hemangiomas. Transverse sonogram of liver shows two
hemangiomas with shadowing calcifications (arrow).
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Fig. 3A. —2-month-old girl with sonographic findings characteristic of
infantile hepatic hemangiomas. Sagittal sonogram of upper abdomen shows
tapering of aorta (arrow) distal to superior mesenteric artery,
typical of high-flow lesions.
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Fig. 3B. —2-month-old girl with sonographic findings characteristic of
infantile hepatic hemangiomas. Transverse sonogram of liver shows direct shunt
from portal vein (straight arrow) to hepatic vein (curved
arrow).
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Fig. 4A. —15-month-old girl with MRI characteristics of infantile
hepatic hemangiomas. Coronal T1-weighted image (TR/TE, 350/12) of liver shows
multiple well-defined spherical masses with flow voids in and adjacent to
lesions (arrow).
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Fig. 4B. —15-month-old girl with MRI characteristics of infantile
hepatic hemangiomas. Axial T2-weighted image (3,000/85) of upper abdomen shows
spherical strongly hyperintense masses in liver. Signal intensity of masses is
nearly as high as in cerebrospinal fluid.
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Fig. 4C. —15-month-old girl with MRI characteristics of infantile
hepatic hemangiomas. Coronal gadolinium-enhanced T1-weighted image (350/12)
shows homogeneous enhancement of hepatic masses.
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Fig. 5. —5-month-old girl with MRI findings characteristic of
infantile hepatic hemangiomas. Coronal T1-weighted image (TR/TE, 600/11) of
liver shows dilated hepatic veins (straight arrow) and large flow
voids (curved arrow) indicative of high-flow lesions adjacent to
spherical hypointense hepatic masses.
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Fig. 6A. —1-day-old boy showing central varix associated with infantile
hepatic hemangiomas. Coronal dynamic contrast-enhanced MR image (TR/TE,
50/3.1) of liver shows large enhancing varix with multiple draining veins.
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Fig. 6B. —1-day-old boy showing central varix associated with infantile
hepatic hemangiomas. Venous phase image from aortic angiogram shows large
varix in left lobe of liver with abnormally enlarged draining veins.
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Fig. 6C. —1-day-old boy showing central varix associated with infantile
hepatic hemangiomas. Sonogram of liver shows large anechoic vascular space
(straight arrow) with multiple draining veins (curved
arrow).
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Fig. 6D. —1-day-old boy showing central varix associated with infantile
hepatic hemangiomas. Coronal gadolinium-enhanced T1-weighted image (500/20) of
liver 10 weeks after embolization shows marked decrease in size of mass
(arrow) in left lobe of liver.
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Fig. 7. —2-day-old boy shows central varix associated with infantile
hepatic hemangiomas. Axial T2-weighted MR image (TR/TE, 6,194/60) shows
central varix that is seen as large flow void (straight arrow) with
associated enlarged draining vessel (curved arrow).
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Fig. 8. —3-month-old boy with hepatic hemangiomatosis and
hypothyroidism. Coronal gadolinium-enhanced T1-weighted image (TR/TE, 600/15)
of liver shows massively enlarged liver with multiple discrete homogeneously
enhancing masses.
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Fig. 9. —3-year-old girl with hepatic masses that may simulate
hemangiomas. Axial contrast-enhanced CT scan through upper abdomen shows
multiple hepatic masses with predominantly central enhancement
(arrow). Biopsy revealed angiosarcomas.
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Fig. 10. —4-month-old boy with hepatic masses that may simulate
hemangiomas. Axial T2-weighted image (TR/TE, 4,000/80) shows fluid–fluid
level (arrow) in one mass. Note that no mass is as hyperintense as
cerebrospinal fluid. Biopsy revealed metastatic neuroblastoma.
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Fig. 11. —Line drawing shows clinical course of 55 patients with
infantile hepatic hemangiomas. IFN = interferon alfa-2a.
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Copyright © 2004 by the American Roentgen Ray Society.
