Hepatic Hemangiomas with Arterioportal Shunt: Sonographic Appearances with CT and MRI Correlation
Kyoung Won Kim1,
Ah Young Kim1,
Tae Kyoung Kim1,2,
So Yeon Kim1,
Min-Jeong Kim1,
Mi-Suk Park1,3,
Seong Ho Park1,
Kyung Ho Lee4,
Jeong Kon Kim1,
Pyo-Nyun Kim1,
Hyun Kwon Ha1 and
Moon-Gyu Lee1
1 Department of Radiology, Asan Medical Center, University of Ulsan College of
Medicine, 388-1, Pungnap-2 dong, Songpa-ku, Seoul, South Korea 138-736.
2 Department of Medical Imaging, Toronto General Hospital, Toronto, ON,
Canada.
3 Department of Radiology, YongDong Severance Hospital, Seoul, South
Korea.
4 Department of Radiology, Seoul National University Bundang Hospital, Seong
Nam, South Korea.
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Fig. 1A —48-year-old woman with high-flow hemangioma with
arterioportal shunt in right lobe of liver. Oblique coronal sonogram shows
well-defined hypoechoic mass (arrowheads) in right lobe of liver.
There is otherwise no remarkable abnormality in hepatic parenchyma.
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Fig. 1B —48-year-old woman with high-flow hemangioma with
arterioportal shunt in right lobe of liver. Dynamic T1-weighted image during
hepatic artery phase after gadopentetate dimeglumine administration shows
rapid homogeneous enhancement of tumor (arrow) with peritumoral
wedge-shaped parenchymal enhancement (arrowheads), which suggests
high-flow hemangioma with arterioportal shunt.
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Fig. 1C —48-year-old woman with high-flow hemangioma with
arterioportal shunt in right lobe of liver. Dynamic T1-weighted image during
the equilibrium phase shows persistent homogeneous enhancement of tumor
(arrow). However, wedge-shaped hyperintense peritumoral enhancement
during hepatic artery phase is no longer seen.
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Fig. 2A —51-year-old man with slow-flow hemangioma in right lobe of
liver. Transverse sonogram shows slightly hyperechoic mass with well-defined
margin in right lobe of liver (arrowheads).
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Fig. 2B —51-year-old man with slow-flow hemangioma in right lobe of
liver. Contrast-enhanced CT scan of liver during portal venous phase shows
dotlike enhancement (arrowhead) in periphery of lesion, suggesting
diagnosis of slow-flow hemangioma.
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Fig. 3A —44-year-old woman with hepatic steatosis. Peritumoral sparing
of fatty infiltration around high-flow hemangioma is seen with arterioportal
shunt. Transverse sonogram shows increased liver echogenicity, suggestive of
hepatic steatosis, and also shows well-defined mass with echo-poor appearance
(arrow) and small geographic peritumoral hypoechoic area
(arrowheads) in lateral segment of left hepatic lobe.
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Fig. 3B —44-year-old woman with hepatic steatosis. Peritumoral sparing
of fatty infiltration around high-flow hemangioma is seen with arterioportal
shunt. Contrast-enhanced CT during hepatic artery phase shows strong
homogeneous enhancement of tumor (long arrow), peritumoral
wedge-shaped parenchymal enhancement (arrowheads), and early
opacification of portal vein branch (short arrow) in that area,
suggestive of high-flow hemangioma with arterioportal shunt.
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Fig. 3C —44-year-old woman with hepatic steatosis. Peritumoral sparing
of fatty infiltration around high-flow hemangioma is seen with arterioportal
shunt. Contrast-enhanced CT during portal venous phase shows persistent
homogeneous enhancement of tumor (arrow) and faint wedge-shaped
peritumoral enhancement.
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Fig. 3D —44-year-old woman with hepatic steatosis. Peritumoral sparing
of fatty infiltration around high-flow hemangioma is seen with arterioportal
shunt. Unenhanced CT scan shows decrease of hepatic attenuation, suggestive of
hepatic steatosis, and also shows thin hyperdense peritumoral rim
(arrowheads), which corresponds to geographic peritumoral hypoechoic
area at sonography, suggesting peritumoral sparing of fatty infiltration.
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Fig. 4A —24-year-old woman with hepatic steatosis. Peritumoral sparing
of fatty infiltration around high-flow hemangioma with arterioportal shunt is
seen. Oblique sagittal sonogram shows slightly increased liver echogenicity,
suggestive of mild hepatic steatosis, and also shows well-defined hypoechoic
mass with hyperechoic rim (arrow) and peritumoral hypoechoic area
(arrowheads) in posterior segment of right hepatic lobe.
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Fig. 4B —24-year-old woman with hepatic steatosis. Peritumoral sparing
of fatty infiltration around high-flow hemangioma with arterioportal shunt is
seen. Contrast-enhanced CT scan during hepatic arterial phase shows strong
homogenous enhancement of tumor (arrow) and peritumoral wedge-shaped
parenchymal enhancement (arrowheads), suggestive of high-flow
hemangioma with arterioportal shunt.
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Fig. 4C —24-year-old woman with hepatic steatosis. Peritumoral sparing
of fatty infiltration around high-flow hemangioma with arterioportal shunt is
seen. Contrast-enhanced CT during portal venous phase shows persistent
homogeneous enhancement of tumor (arrow). Also, wedge-shaped
peritumoral enhancement during hepatic arterial phase is still seen as
hyperattenuation (arrowheads).
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Fig. 4D —24-year-old woman with hepatic steatosis. Peritumoral sparing
of fatty infiltration around high-flow hemangioma with arterioportal shunt is
seen. Unenhanced CT scan shows decrease of hepatic attenuation, suggestive of
hepatic steatosis, and also shows geographic hyperdense area
(arrowheads) around tumor (arrow), which corresponds to
geographic peritumoral hypoechoic area at sonography, suggesting peritumoral
sparing of fatty infiltration.
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Fig. 5A —31-year-old woman with hepatic steatosis. Peritumoral sparing
of fatty infiltration around high-flow hemangioma with arterioportal shunt is
seen. Oblique sagittal sonogram shows slightly increased liver echogenicity,
suggestive of mild hepatic steatosis, and also shows well-defined hypoechoic
mass with hyperechoic rim (arrow) and peritumoral hypoechoic area
(arrowheads) in right lobe of liver.
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Fig. 5B —31-year-old woman with hepatic steatosis. Peritumoral sparing
of fatty infiltration around high-flow hemangioma with arterioportal shunt is
seen. Contrast-enhanced CT scan during hepatic arterial phase shows strong
globular enhancement of tumor (arrow) and small peritumoral
wedge-shaped parenchymal enhancement (arrowheads), suggestive of
high-flow hemangioma with arterioportal shunt.
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Fig. 5C —31-year-old woman with hepatic steatosis. Peritumoral sparing
of fatty infiltration around high-flow hemangioma with arterioportal shunt is
seen. Contrast-enhanced CT during portal venous phase shows centripetal
fill-in enhancement of tumor (arrow). However, wedge-shaped
peritumoral enhancement during hepatic arterial phase is no longer seen.
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Fig. 5D —31-year-old woman with hepatic steatosis. Peritumoral sparing
of fatty infiltration around high-flow hemangioma with arterioportal shunt is
seen. In-phase gradient-echo T1-weighted image shows mass with hypointensity
(arrow).
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Fig. 5E —31-year-old woman with hepatic steatosis. Peritumoral sparing
of fatty infiltration around high-flow hemangioma with arterioportal shunt is
seen. Out-of-phase gradient-echo T1-weighted image shows signal decrease of
hepatic parenchyma, suggesting hepatic steatosis. It also shows thin
peritumoral hyperintense rim (arrowheads), which corresponds to
geographic peritumoral hypoechoic area at sonography, suggesting peritumoral
sparing of fatty infiltration.
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Fig. 6A —58-year-old man with hepatic steatosis. Peritumoral sparing
of fatty infiltration around hepatocellular carcinoma is seen. Oblique
sagittal sonogram shows increased liver echogenicity, suggestive of hepatic
steatosis, and also shows large hypoechoic mass (arrows) surrounded
by peritumoral hypoechoic area (arrowheads) in posterior segment of
right hepatic lobe.
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Fig. 6B —58-year-old man with hepatic steatosis. Peritumoral sparing
of fatty infiltration around hepatocellular carcinoma is seen. In-phase
gradient-echo T1-weighted image shows large mass with hypointensity
(arrows).
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Fig. 6C —58-year-old man with hepatic steatosis. Peritumoral sparing
of fatty infiltration around hepatocellular carcinoma is seen. Out-of-phase
gradient-echo T1-weighted image shows signal decrease of hepatic parenchyma,
suggesting hepatic steatosis. It also shows large mass with hypointensity
(arrows) and peritumoral hyperintense area (arrowheads),
which corresponds to peritumoral hypoechoic area at sonography, suggesting
peritumoral sparing of fatty infiltration.
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Fig. 6D —58-year-old man with hepatic steatosis. Peritumoral sparing
of fatty infiltration around hepatocellular carcinoma is seen. Dynamic
T1-weighted image during hepatic arterial phase after gadopentetate
dimeglumine administration shows intense peripheral enhancement of tumor.
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Fig. 6E —58-year-old man with hepatic steatosis. Peritumoral sparing
of fatty infiltration around hepatocellular carcinoma is seen. Dynamic
T1-weighted image during the equilibrium phase shows isointense enhancement of
tumor periphery compared with hepatic parenchyma, irregular necrotic cavity in
center, and thin peritumoral enhancement (arrowheads), suggesting
encapsulated hepatocellular carcinoma. Diagnosis of hepatocellular carcinoma
was made by histopathologic examination of percutaneous biopsy specimen.
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Fig. 7A —67-year-old man with hepatic steatosis. Peritumoral sparing
of fatty infiltration around hepatic metastasis from rectal cancer is seen.
Oblique sagittal sonogram shows increased liver echogenicity, suggestive of
hepatic steatosis. It also shows hypoechoic mass (arrows) surrounded
by peritumoral hypoechoic area (arrowheads).
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Fig. 7B —67-year-old man with hepatic steatosis. Peritumoral sparing
of fatty infiltration around hepatic metastasis from rectal cancer is seen.
Contrast-enhanced CT scan during hepatic arterial phase shows thin peripheral
rimlike enhancement (arrowheads).
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Fig. 7C —67-year-old man with hepatic steatosis. Peritumoral sparing
of fatty infiltration around hepatic metastasis from rectal cancer is seen.
Tumor is seen as hypoattenuation on contrast-enhanced CT scan during portal
venous phase.
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Fig. 7D —67-year-old man with hepatic steatosis. Peritumoral sparing
of fatty infiltration around hepatic metastasis from rectal cancer is seen.
In-phase gradient-echo T1-weighted image shows mass with hypointensity
(arrow).
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Fig. 7E —67-year-old man with hepatic steatosis. Peritumoral sparing
of fatty infiltration around hepatic metastasis from rectal cancer is seen.
Out-of-phase gradient-echo T1-weighted image shows signal decrease of hepatic
parenchyma, suggesting hepatic steatosis. It also shows thin peritumoral
hyperintense rim (arrowheads), which corresponds to geographic
peritumoral hypoechoic area at sonography, suggesting peritumoral sparing of
fatty infiltration. Hepatic metastasis was proven by histopathologic
examination of percutaneous biopsy specimen.
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Fig. 8A —34-year-old man with hepatic steatosis. High-flow hemangioma
with arterioportal shunt is seen. Oblique sagittal sonogram shows increased
liver echogenicity, suggestive of hepatic steatosis. It also shows hypoechoic
mass (arrow) with hyperechoic rim surrounded by geographic
peritumoral hypoechoic area (arrowheads).
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Fig. 8B —34-year-old man with hepatic steatosis. High-flow hemangioma
with arterioportal shunt is seen. Color Doppler sonogram shows presence of
intratumoral flows (arrowheads).
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Fig. 8C —34-year-old man with hepatic steatosis. High-flow hemangioma
with arterioportal shunt is seen. Color Doppler sonogram shows large feeding
artery (arrow) and reversal of portal flow (arrowheads),
seen as blue color, in proximity of tumor.
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Fig. 8D —34-year-old man with hepatic steatosis. High-flow hemangioma
with arterioportal shunt is seen. Spectral Doppler waveform at portal vein
reveals retrograde portal flow.
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Fig. 8E —34-year-old man with hepatic steatosis. High-flow hemangioma
with arterioportal shunt is seen. Contrast-enhanced CT during hepatic artery
phase shows strong enhancement of tumor (large arrow), peritumoral
wedge-shaped parenchymal enhancement (arrowheads), and early
opacification of portal vein branch (short arrow) in that area,
suggestive of high-flow hemangioma with arterioportal shunt.
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Fig. 8F —34-year-old man with hepatic steatosis. High-flow hemangioma
with arterioportal shunt is seen. Contrast-enhanced CT during portal venous
phase shows persistent homogeneous enhancement of tumor (arrow).
However, wedge-shaped peritumoral enhancement during hepatic artery phase is
no longer seen.
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Fig. 8G —34-year-old man with hepatic steatosis. High-flow hemangioma
with arterioportal shunt is seen. Unenhanced CT scan shows decrease of hepatic
attenuation, suggestive of hepatic steatosis. It also shows hyperdense area
(arrowheads) around tumor (arrow), which corresponds to
geographic peritumoral hypoechoic area at sonography, suggesting peritumoral
sparing of fatty infiltration.
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Copyright © 2006 by the American Roentgen Ray Society.
