How is hepatic angiosarcoma differentiated from hepatic hemangiomas on imaging?

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

Hepatic angiosarcoma is a rare tumor that tends to grow rapidly. Although hepatic angiosarcoma is classically associated with risk factors, including exposure to Thorotrast, vinyl chloride, or arsenic, many cases have occurred in which no discrete risk factor has been identified. Unfortunately, hepatic angiosarcoma may occasionally be mistaken for hepatic hemangioma on MRI, and vice versa. In the case of a suspected hemangioma with an atypical enhancement pattern, it is reasonable to perform a follow-up radiologic study in a few months to rule out rapid interval growth of the lesion. [39, 40]

Features of angiosarcoma on multiphasic CT scanning and MRI include the following [41] :

  • Rapidly progressive multifocal tumors
  • Arterial-phase foci of hypervascular enhancement without washout
  • Hypervascular foci with progressive expansion followed by blood pooling on multiphasic imaging
  • Enhancement pattern resembling that of cavernous hemangiomas or showing a "reverse hemangioma" centrifugal pattern

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