AJR 2004; 183:1075-1077
© American Roentgen Ray Society
Imaging Findings of Hepatic Sinusoidal Dilatation
Dal Mo Yang1,
Dong Hae Jung2,
Chul Hi Park1,
Jee Eun Kim1 and
Soo Jin Choi1
1 Department of Radiology, Gachon Medical School, Gil Medical Center, 1198
Guwol-Dong, Namdong-Gu, Incheon 405-760, South Korea.
2 Department of Pathology, Gachon Medical School, Gil Medical Center, Incheon,
South Korea.
Received December 18, 2003;
accepted after revision January 20, 2004.
Address correspondence to D. M. Yang
(dmyang{at}ghil.com).
Introduction
Hepatic sinusoidal dilatation is a vascular lesion that has been described
as a complication of oral contraceptive therapy
[1]. It may also be associated
with several other conditions such as pregnancy, granulomatous disease,
neoplasm, rheumatoid arthritis, HIV infection, and Hodgkin's disease
[2–4].
Although several reports have described the pathologic features of hepatic
sinusoidal dilatation, information is scarce regarding its imaging features.
To our knowledge, the enhancement characteristics of hepatic sinusoidal
dilatation on helical CT and MRI have not been described. We describe the
imaging findings in a case of hepatic sinusoidal dilatation that mimicked
hepatic tumor.
Case Report
A 19-year-old woman who had undergone vaginal delivery a month before
admission was transferred to our hospital for lower abdominal pain. A
sonographic examination at the other hospital disclosed a large pelvic cystic
mass. She had no pertinent medical history. A physical examination showed low
abdominal tenderness and rebound tenderness. Laboratory findings revealed an
elevated WBC (13.6 x 103/µL) and alkaline phosphatase
level (649 U/L). Results of the remaining liver function tests were
normal.
Abdominal helical CT (Somatom Plus 4, Siemens) was performed after the IV
administration of 120 mL of iopromide (Ultravist 300, Schering).
Contrast-enhanced CT of the liver was performed with 8-mm collimation, 1:1
table pitch, and 8-mm reconstruction during the portal phase (60 sec after
start of the injection) and during the delayed phase (3 min after injection).
Portal phase CT scans showed a heterogeneously hypodense lesion in the right
hepatic lobe (Fig. 1A), and
delayed phase CT scans showed that the lesion was isodense with respect to the
liver parenchyma (Fig. 1B). In
the pelvis, a 14 x 4 cm cystic mass with a thick wall was found. Because
of a diagnosis of a pelvic abscess, percutaneous drainage was performed with
sonographic guidance, and 90 mL of yellow pus was aspirated.
Abdominal MRI was then performed with a 1.5-T scanner (Magnetom Vision,
Siemens). On T1-weighted images (fast low-angle shot [FLASH] technique; TR/TE,
187/4.8; flip angle, 75°), the hepatic lesion was isointense to the
adjacent liver parenchyma (Fig.
1C). On T2-weighted images (HASTE; infinite/90; flip angle,
150°), the hepatic lesion was slightly hyperintense and vessellike
structures were observed within the lesion
(Fig. 1D). T1-weighted dynamic
images using a multisection FLASH sequence (105/2.2; flip angle, 70°) were
obtained 10 sec, 40 sec, and 2 min after the administration of 0.1 mmol/kg of
gadopentetate dimeglumine. The hepatic lesion showed an enhancement pattern
resembling that of CT. The lesion was heterogeneously hypointense on arterial
phase images and isointense relative to the liver parenchyma on delayed phase
images. A core biopsy of the hepatic lesion was performed under sonographic
guidance. On sonography, the hepatic lesion was hypoechoic relative to the
surrounding liver (Fig. 1E). A
microscopic examination showed hepatic sinusoidal dilatation
(Fig. 1F).
View larger version (121K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1D. —19-year-old woman with hepatic sinusoidal dilatation.
T2-weighted MR image shows lesion is slightly hyperintense (large
arrow). Healthy vascular structures (small arrows) are seen
within lesion.
|
|
Discussion
Hepatic sinusoidal dilatation usually occurs in young women with a history
of longterm oral contraceptive use. It is manifested by right upper quadrant
abdominal pain, hepatomegaly, and minimal elevation of liver function tests
[1]. Hepatic sinusoidal
dilatation induced by oral contraceptive use, with involvement of the
periportal zone (Rappaport classification I), is characteristic of this
condition [1]. High estrogen
doses associated with oral contraceptive use have been linked with this
adverse hepatic reaction, and the discontinuation of the oral contraceptives
results in regression of the liver disease
[1]. Periportal sinusoidal
dilatation may occur during pregnancy and induces the secretion of estrogen
and progesterone [2]. We
believe that the hepatic sinusoidal dilatation in our patient was related to
her pregnancy.
Microscopically, hepatic sinusoidal dilatation is characterized by focal
dilatation of the sinusoidal spaces associated with hepatocyte atrophy and
necrosis [5]. Anoxic hepatocyte
necrosis results in acute inflammatory reaction and subsequent early
intrasinusoidal fibrosis
[5].
Imaging findings of hepatic sinusoidal dilatation have been reported
sporadically [1,
2]; the condition has been
found to be echogenic compared with the surrounding the liver on sonography
[1]. On angiography, hepatic
sinusoidal dilatation is revealed as multiple ill-defined focal collections of
contrast material along the liver that are visualized during the late arterial
phase and become more prominent during the parenchymal and venous phases
[2]. However, to our knowledge,
the CT and MRI findings of hepatic sinusoidal dilatation have not been
previously reported. In our patient, hepatic sinusoidal dilatation was
revealed as heterogeneously hypodense during the portal phase and as isodense
to the surrounding liver during the delayed phase. On MR images, hepatic
sinusoidal dilatation was isointense to the surrounding liver on the
T1-weighted image and slightly hyperintense on the T2-weighted image.
Enhancement characteristics on MR images were similar to those on CT
scans.
Before the biopsy, we believed that this lesion was a hepatic tumor or an
inflammatory mass. In a retrospective review, however, we noted an interesting
MRI finding—namely, the crossing vascular structures within the lesion.
Large hepatic neoplasms usually show a hepatic vascular distortion or
compression, but an extension of the healthy hepatic vessels through hepatic
neoplasm is quite rare [6].
Therefore, the crossing vascular structure within the lesion is a useful
finding that distinguishes hepatic sinusoidal dilatation from hepatic
neoplasm.
Peliosis hepatis is another consideration in the differential diagnosis.
Peliosis hepatis is an unusual disorder characterized by multiple blood-filled
spaces within the liver [7]. It
is important to differentiate between hepatic sinusoidal dilatation and
peliosis hepatis because the morbidity rate is higher for the latter
[2]. In addition, peliosis
hepatis may cause intrahepatic and peritoneal hemorrhage. Hepatic sinusoidal
dilatation can be differentiated from peliosis hepatis by contrast-enhancement
patterns on CT, MRI, and angiography. In peliosis hepatis, the enhancement
characteristics are variable in size. Small peliosis hepatis usually produces
normal CT findings, but large peliosis hepatis shows early vessellike
enhancement on CT, MRI, and angiography
[2,
7,
8]. In comparison, hepatic
sinusoidal dilatation shows delayed enhancement, unlike peliosis hepatis.
In conclusion, although rare, a diagnosis of hepatic sinusoidal dilatation
should be considered when dynamic CT shows a hypodense lesion during arterial
and portal phase imaging and a lesion that is isodense to the adjacent liver
parenchyma on delayed phase images. MRI shows isointensity on T1-weighted
images, hyperintensity on T2-weighted images, and enhancement characteristics
resembling those of CT. Both dynamic CT scans and MR images show the healthy
hepatic vascular structures crossing the lesion.
References
- Weinberger M, Garty M, Cohen M, Russo Y, Rosenfeld JB.
Ultrasonography in the diagnosis and follow-up of hepatic sinusoidal
dilatation. Arch Intern Med1985; 145:927
-929[Abstract]
- Fisher MR, Neiman HL. Periportal sinusoidal dilatation associated
with pregnancy. Cardiovasc Intervent Radiol1984; 7:299
-302[Medline]
- Curciarello J, Castelletto R, Barbero R, et al. Hepatic sinusoidal
dilatation associated to giant lymph node hyperplasia (Castleman's): a new
case in a patient with periorbital xanthelasmas and history of celiac disease.
J Clin Gastroenterol1998; 27:76
-78[Medline]
- Laffon A, Moreno A, Gutierrez-Bucero A, Ossorio C, Sabando P,
Moreno-Otero R. Hepatic sinusoidal dilatation in rheumatoid arthritis.
J Clin Gastroenterol1989; 11:653
-657[Medline]
- Oligny LL, Lough J. Hepatic sinusoidal ectasia. Hum
Pathol 1992;23:953
-956[Medline]
- Apicella PL, Mirowitz SA, Weinreb JC. Extension of vessels through
hepatic neoplasm: MR and CT findings. Radiology1994; 191:135
-136[Abstract/Free Full Text]
- Gouya H, Vignaux O, Legmann P, de Pigneux G, Bonnin A. Peliosis of
hepatis: triphasic helical CT and dynamic MRI findings. Abdom
Imaging 2001;26:507
-509[Medline]
- Marves CK, Caron KH, Bisset GS III, Agarwal R. Splenic and hepatic
peliosis: MR findings. AJR1992; 158:75
-76[Free Full Text]
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
J. Ward, J. A. Guthrie, M. B. Sheridan, S. Boyes, J. T. Smith, D. Wilson, J. I. Wyatt, D. Treanor, and P. J. Robinson
Sinusoidal Obstructive Syndrome Diagnosed With Superparamagnetic Iron Oxide-Enhanced Magnetic Resonance Imaging in Patients With Chemotherapy-Treated Colorectal Liver Metastases
J. Clin. Oncol.,
September 10, 2008;
26(26):
4304 - 4310.
[Abstract]
[Full Text]
[PDF]
|
|
|
Top
Introduction
Case Report
