What is the role of an MRI scan in the diagnosis of hepatic hemangiomas?

Updated: Jun 17, 2019
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Answer

MRI is highly sensitive and specific for the diagnosis of hepatic hemangioma. [29, 30] Typically, hemangiomas have low signal intensity on T1-weighted images and high signal intensity on T2-weighted images (see the image below). When gadolinium is used as an intravenous contrast agent, hemangiomas enhance in a fashion similar to that seen on dynamic CT scanning. Typically, hemangiomas follow the signal intensity of blood. However, hemangiomas smaller than 2 cm may exhibit homogeneous enhancement in late arterial-phase imaging and can be mistaken for hepatocellular carcinoma or a hypervascular metastasis. [31] The sensitivity for detection of hepatic hemangioma is upwards of 90%. [32]

Hepatic hemangioma. Moderately (a) and heavily (b) Hepatic hemangioma. Moderately (a) and heavily (b) T2-weighted magnetic resonance images show typical bright lesions. Courtesy of BMC Gastroenterology https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-11-43).

Giant cavernous hemangiomas (ie, >5 cm in diameter) may exhibit internal fluid levels on MRI and CT scan images. [33] This finding is attributed to the separation of the blood cells and serous fluid because of extremely slow blood flow through the tumor.

In the setting of hepatic fibrosis and cirrhosis, MRI features of hepatic hemangioma appear similar to those of normal livers. [34]

In the authors' opinions, MRI with arterial phase and delayed contrast is the test of choice for investigating a liver mass of unclear origin. This is particularly the case when hepatic hemangioma is suspected.


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