Hemangioma in the cirrhotic liver: Diagnosis and natural history

PURPOSE: To investigate the natural history and diagnosis of cavernous hemangioma in the cirrhotic liver with computed tomography (CT) and magnetic resonance (MR) imaging. MATERIALS AND METHODS: Imaging and pathologic findings of 21 hemangiomas in 17 patients were retrospectively reviewed. CT of the liver was performed in all patients; MR imaging, in four. Cirrhosis was confirmed histologically in all patients, and the diagnosis of hemangioma was based on histopathologic findings (15 patients, 18 hemangiomas) or strict imaging criteria (two patients, three hemangiomas). Ten patients underwent imaging follow-up. The number, sizes, location, attenuation, pattern of enhancement, exophytic growth, presence of capsular retraction, and size stability were evaluated. RESULTS: Of the 21 hemangiomas, five were not detected at CT or MR imaging. Twelve (75%) of 16 hemangiomas were subcapsular, two (12%) of 16 demonstrated exophytic growth, 14 (87%) of 16 demonstrated nodular peripheral enhancement, and 16 (100%) of 16 were isoattenuating to blood vessels. At MR imaging, all five hemangiomas demonstrated nodular peripheral enhancement and hyperintensity on T2-weighted images. Seven lesions were smaller at follow-up, and five lesions developed retraction of the hepatic capsule. CONCLUSION: Even within the cirrhotic liver, larger hemangiomas can usually be diagnosed confidently with CT or MR imaging. With progressive cirrhosis, however, hemangiomas are likely to decrease in size, become more fibrotic, and are difficult to diagnose radiologically and pathologically.