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AJR Teaching File: Hypervascular Metastasis or Hepatic Hemangioma?

Kimberly J. Burkholz1 and Alvin C. Silva1

1 Both authors: Department of Diagnostic Radiology, Mayo Clinic, 13400 Shea Blvd., Scottsdale, AZ 85259.


Figure 1
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  		Fig. 1A —67-year-old man with chemotherapy-treated hepatic metastases mimicking hemangiomas. Unenhanced axial T1 in-phase image shows 2.3-cm hypointense mass (arrow) in liver segment VIII.

 

Figure 2
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  		Fig. 1B —67-year-old man with chemotherapy-treated hepatic metastases mimicking hemangiomas. T2-weighted images show high signal equal to that of CSF in lesion on both intermediate-echo (B, arrow) and long-echo (C, arrow) sequences. Note additional smaller hyperintense metastases (arrowheads).

 

Figure 3
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  		Fig. 1C —67-year-old man with chemotherapy-treated hepatic metastases mimicking hemangiomas. T2-weighted images show high signal equal to that of CSF in lesion on both intermediate-echo (B, arrow) and long-echo (C, arrow) sequences. Note additional smaller hyperintense metastases (arrowheads).

 

Figure 4
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  		Fig. 1D —67-year-old man with chemotherapy-treated hepatic metastases mimicking hemangiomas. Steady-state free precession sequence shows high signal intensity in lesion (arrow) that is equal to that in left portal vein.

 

Figure 5
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  		Fig. 1E —67-year-old man with chemotherapy-treated hepatic metastases mimicking hemangiomas. T1-weighted dynamic gadolinium-enhanced sequences. During arterial phase, mass shows peripheral nodular enhancement in continuous ringlike pattern (E, arrow). Note progressive centripetal enhancement during portal venous and delayed phase (F, arrow). Additional metastases show variable enhancement (arrowheads).

 

Figure 6
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  		Fig. 1F —67-year-old man with chemotherapy-treated hepatic metastases mimicking hemangiomas. T1-weighted dynamic gadolinium-enhanced sequences. During arterial phase, mass shows peripheral nodular enhancement in continuous ringlike pattern (E, arrow). Note progressive centripetal enhancement during portal venous and delayed phase (F, arrow). Additional metastases show variable enhancement (arrowheads).

 

Figure 7
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  		Fig. 1G —67-year-old man with chemotherapy-treated hepatic metastases mimicking hemangiomas. Axial T2-weighted (G) and portal venous phase (H) images obtained 8 months after initiation of chemotherapy treatment show significant decrease in size and number of hepatic metastases (compare with B and F). Dominant segment VIII lesion (arrows) has decreased from 2.3 to 0.9 cm, indicating favorable response to treatment.

 

Figure 8
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  		Fig. 1H —67-year-old man with chemotherapy-treated hepatic metastases mimicking hemangiomas. Axial T2-weighted (G) and portal venous phase (H) images obtained 8 months after initiation of chemotherapy treatment show significant decrease in size and number of hepatic metastases (compare with B and F). Dominant segment VIII lesion (arrows) has decreased from 2.3 to 0.9 cm, indicating favorable response to treatment.

 

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