Abstract
BackgroundCavernous hemangiomas are the most frequent neoplasms of the liver and in routine clinical practice they often need to be differentiated from malignant tumors and other benign focal lesions. The purpose of this study is to evaluate whether diagnostic accuracy of magnetic resonance imaging (MRI) of hepatic hemangiomas, showing atypical pattern on US, improves with the use of Gd-BOPTA in comparison with contrast-enhanced multi-phase computed tomography (CT).Methods178 consecutive patients with ambiguous hepatic masses showing atypical hyperechoic pattern on grey-scale US, underwent unenhanced and contrast-enhanced multi-phase multi-detector CT and MR (1.5T) with the use of liver-specific contrast medium gadobenate dimeglumine (Gd-BOPTA). After intravenous contrast administration arterial (HAP), venous-portal (PVP), equilibrium phases (EP) both in CT and MR and additionally hepatobiliary phase (HBP) in MR were obtained. 398 lesions have been detected including 99 hemangiomas and 299 other lesions.ResultsIn non-enhanced MDCT examination detection of hemangiomas was characterized by sensitivity of 76%, specificity of 90%, PPV of 71%, NPV of 92% and accuracy of 86%.Non-enhanced MR examination showed sensitivity of 98%, specificity of 99%, PPV of 99%, NPV of 99% and accuracy of 99%.After intravenous administration of contrast medium in MR the mentioned above parameters did not increase significantly.ConclusionGd-BOPTA-enhanced MR in comparison with unenhanced MRI does not improve diagnostic accuracy in discriminating hemangiomas that show non-specific appearance in ultrasound examination. Unenhanced MR as a method of choice should directly follow US in course of diagnostic algorithm in differentiation of hemangiomas from other liver tumors.
Highlights
Cavernous hemangiomas are the most frequent neoplasms of the liver and in routine clinical practice they often need to be differentiated from malignant tumors and other benign focal lesions
The purpose of this study is to evaluate whether assessment by means of magnetic resonance imaging (MRI) of hepatic hemangiomas, showing atypical appearance on gray-scale US, improves with the use of Gd-BOBTA in comparison with contrast-enhanced multiphase computed tomography (CT)
In 100 patients the final diagnosis was based upon histopathological examination results (66 cases by the means of surgery and 34 cases with biopsy) which disclosed: 41 cases of HCC, 21 focal nodular hyperplasia (FNH), 28 cases of liver metastases, 4 cavernous hemangiomas, 4 solitary adenomas and 2 cases of peripheral cholangiocarcinoma
Summary
Cavernous hemangiomas are the most frequent neoplasms of the liver and in routine clinical practice they often need to be differentiated from malignant tumors and other benign focal lesions. The purpose of this study is to evaluate whether diagnostic accuracy of magnetic resonance imaging (MRI) of hepatic hemangiomas, showing atypical pattern on US, improves with the use of Gd-BOPTA in comparison with contrastenhanced multi-phase computed tomography (CT). Cavernous hemangiomas are the most frequent benign neoplasms of the liver, found in autopsy examinations within 0.4% to 20% of population [1,2]. Such frequent occurrence of hepatic hemangiomas (HH) rises a need for differential diagnosis between those benign lesions pattern or may contain calcifications or appear as large lesion [5]. Most hemangiomas show typical enhancement pattern: nodular or globular peripheral enhancement in arterial phase with a progressive fill-in in portal venous and equilibrium phases.
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