Hepatic sclerosed hemangioma and sclerosing cavernous hemangioma: a radiological study

Diagnostic Pitfalls of Hepatic Sclerosed Hemangiomas: A Case Report

An 81-year-old man was found to have a liver mass on an annual medical checkup. Enhanced CT of the mass, 3.8 cm in size, showed weak enhancement with a small non-enhanced oval area near the mass borders. Ultrasound showed an oval mass with internal iso-echoes. Magnetic resonance imaging (MRI) showed that the mass had low and slightly high signal intensities on T1- and T2-weighted images, respectively. MRI of the small non-enhanced area on CT showed high signal intensity both on T1- and T2-weighted images, suggesting focal subacute bleeding. In addition to these image findings, elevated serum α-fetoprotein (AFP) and lectin-reactive fraction of AFP levels made us resect the liver mass without performing a biopsy to the tumor under the tentative diagnosis of possible hepatic malignancy. A postoperative pathological study showed that the mass had massive scar tissue with hemorrhage, lymphocytes, hemosiderin-laden macrophages, and multiple vascular structures, leading to the diagnosis of a hepatic sclerosed hemangioma (HSH). Why this case showed high tumor marker levels remains uncertain. The patient showed normal tumor marker levels shortly after surgery and has been well for 40 months without any problems. Diagnostic physicians should note that HSHs can present very similar image findings to those of intra-hepatic cholangiocarcinomas.

Current State of Artificial Intelligence in Clinical Applications for Head and Neck MR Imaging

Due primarily to the excellent soft tissue contrast depictions provided by MRI, the widespread application of head and neck MRI in clinical practice serves to assess various diseases. Artificial intelligence (AI)-based methodologies, particularly deep learning analyses using convolutional neural networks, have recently gained global recognition and have been extensively investigated in clinical research for their applicability across a range of categories within medical imaging, including head and neck MRI. Analytical approaches using AI have shown potential for addressing the clinical limitations associated with head and neck MRI. In this review, we focus primarily on the technical advancements in deep-learning-based methodologies and their clinical utility within the field of head and neck MRI, encompassing aspects such as image acquisition and reconstruction, lesion segmentation, disease classification and diagnosis, and prognostic prediction for patients presenting with head and neck diseases. We then discuss the limitations of current deep-learning-based approaches and offer insights regarding future challenges in this field.

Solitary hypovascular hepatic nodules: comparison and differentiation between peripheral nodular cholangiocarcinoma and atypical liver hemangioma with MRI

Background

Peripheral nodular cholangiocarcinoma (PCC) and hepatic hemangioma (HG) significantly differ in treatment strategies and prognosis. However, they can present similar imaging characteristics, making them difficult to distinguish. The distinction between PCC and atypical HG using pre-operative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) holds substantial significance.

Methods

Fifty-four cases of solitary hypovascular hepatic nodules (nodules ≤3 cm in diameter and enhancement not exceeding the hepatic parenchyma) confirmed pathologically were collected, including 25 cases of PCC and 29 cases of HG. The clinical and DCE-MRI features were observed, and the apparent diffusion coefficient (ADC) values were compared. The t-test or Fisher's exact test was used to compare the differences between the two groups. Receiver operating characteristic (ROC) curve analysis was performed on the diagnostic results of the two readings before and after the study by three diagnostic physicians.

Results

The signal of PCC was more heterogeneous and could be shown as a ring hyperintensity signal on diffusion weighted imaging (DWI). The T2-weighted imaging (T2WI) signal of HG lesions showed a more homogeneous high-intense signal. The ADC value of PCC patients was lower than that of HG patients. Most of the patients in the two groups presented marginal enhancement in the arterial phase with infrequent abnormal perfusion around. The intratumoral vascular traversal signs in the PCC group showed a diagnostic significance. Among the lesions with marginal enhancement at arterial stage, the enhancement in PCC group was more likely to have annular enhancement with the main manifestation of delay reduction and nebulous or separated/astral center. On the other hand, HG tended to be more likely to have nodular enhancement in the arterial phase with delayed invariance at the margins and with no significant enhancement at the center. The area under the curves (AUC) of the three radiologists before and after the two readings were 0.645 and 0.888, respectively.

Conclusions

In the differentiation of PCC and atypical liver hemangioma, the presence of a circular hyper-intense signal in DWI, the ADC values, and the pattern and extent of enhancement of marginal and central lesions were of diagnostic significance.

Multiple sclerosing hemangiomas mimicking hepatocellular carcinoma: A case report

Hepatocellular carcinoma is a prevalent malignant tumor affecting the liver, and surgical resection and liver transplantation are the primary treatment options for early-stage HCC patients. However, the presence of benign hepatic tumors with similar imaging characteristics to HCC poses challenges in diagnosing and treating the disease, often resulting in misdiagnosis and inappropriate treatment. This case report presents a 52-year-old female patient who exhibited space-occupying liver lesions on abdominal CT and MRI scans. Based on pathological sections from other hospitals, liver malignancy was highly suspected, and hepatocellular tumor was diagnosed preoperatively. But the tumor markers of the patient were all within the normal range. After evaluating the overall condition of the patient, we finally chose the diagnosis and treatment of dissection and partial hepatectomy. Surprisingly, the final diagnosis of postoperative pathology was sclerosing hemangioma. The patient recovered well and was discharged 2 weeks later. Hepatic sclerosing hemangioma is an extremely rare disease that can be easily mistaken for malignant liver tumors due to absence of typical imaging presentations. The diagnosis also needs to be differentiated from other benign tumors, such as liver adenoma and liver abscess, according to the medical history, symptoms, and auxiliary examinations. Therefore, special attention should be given to the diagnosis and treatment of sclerosing hemangioma.

Case report: Sclerosed hemangioma of the liver: A diagnostic challenge

Hemangiomas are the most common noncystic benign hepatic tumors and are usually incidentally discovered during routine radiological examinations. The diagnosis of hepatic hemangiomas with a typical presentation is generally easy with plain and cross-sectional imaging; however, it can be complicated when hemangiomas undergo histological changes such as fibrosis. Sclerosed hepatic hemangioma (SHH) is the extreme presentation of this fibrotic process. These atypical lesions can be misdiagnosed as primary hepatic malignancies or metastasis. Their diagnosis is established by histological examination. We report the case of a patient with an SHH, which was misdiagnosed as an intrahepatic cholangiocarcinoma. This article's aim is to draw attention to this infrequent pathology and underline the features of this benign tumor that could suggest its diagnosis prior to surgery to avoid unnecessary hepatic resections.

Added Value of Ultrasound-Based Multimodal Imaging to Diagnose Hepatic Sclerosed Hemangioma before Biopsy and Resection

Imaging methods have the overwhelming advantage of being non-invasive in the diagnosis of hepatic lesions and, thanks to technical developments in the field of ultrasound (US), radiation exposure can also be avoided in many clinical situations. In particular, contrast-enhanced US (CEUS) outperforms other radiological methods in regard to real-time images, repeatability, and prompt reporting and demonstrates relatively few contraindications and adverse reactions. In this study, we reported in detail a rare benign tumor: hepatic sclerosed hemangioma (HSH). We described US-based multimodal imaging (B-flow imaging, US elastography, and Sonazoid CEUS) features of this HSH case. Furthermore, by summarizing the recently published literature on the imaging diagnosis of HSH, we offered readers comprehensive knowledge of conventional imaging methods (CT, MRI) and CEUS in the diagnosis of HSH and preliminarily discussed their mechanism of pathology-based diagnosis. Our multimodal imaging approach may provide a diagnostic strategy for HSH, thus avoiding unnecessary biopsy or resection.

Hepatic sclerosing haemangioma showing restricted diffusion: A case report with histopathologic correlation

Hepatic sclerosing haemangiomas are rare benign tumours that are often difficult to distinguish from malignant tumours because these tumours do not show the typical imaging features of cavernous haemangiomas. We report a case of a sclerosing haemangioma that showed restricted diffusion and was difficult to differentiate from a malignancy.

A 60-year-old female was referred to our hospital for evaluation of a hepatic mass that was incidentally diagnosed after a CT scan for right lower quadrant abdominal pain.

Contrast-enhanced dynamic CT showed hepatic capsular retraction, with a small peripheral enhancement of the mass. The lesion appeared homogeneously hypointense on T1-weighted images, heterogeneously hyperintense on T2-weighted images, hyperintense on diffusion-weighted images, and hypointense on apparent diffusion coefficient (ADC) map. The lesion was suspected to be a cholangiocellular carcinoma and was surgically resected, but a final diagnosis of hepatic sclerosing haemangioma was made.

Hepatic sclerosing/sclerosed haemangiomas are usually considered to show an increased ADC, which is useful for distinguishing them from malignant tumours. However, in this particular case, most of the lesion contained many obliterated or narrowed vascular channels, which might have acted as septa restricting the diffusion of water molecules in the intervening fibrous and/or hyalinized tissue. Hepatic sclerosing haemangiomas in the process of becoming completely fibrotic may show restricted diffusion, similar to malignant tumours.