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Angiographic Classification of Hepatic Hemangiomas in Infants¹

¹ From the Department of Radiology, Children’s Hospital, Boston, Mass (A.K., P.E.B.); and Department of Medical Imaging, Hôpital Sainte-Justine, Montreal, Quebec, Canada (J.D.). From the 2000 RSNA scientific assembly. Received November 27, 2000; revision requested January 11, 2001; final revision received June 29; accepted July 18. Address correspondence to A.K., Department of Radiology, Boston University School of Medicine, Boston Medical Center, One Boston Medical Center Pl, Boston, MA 02118 (e-mail: akassarjian@hotmail.com).

PURPOSE: To review the angiograms in patients with hepatic hemangiomas referred to two North American children’s hospitals to determine the variability in angiographic findings and to propose a classification system that is based on these findings.

MATERIALS AND METHODS: Angiograms obtained in 15 infants with a diagnosis of hepatic hemangioma who were examined at or referred to two tertiary pediatric hospitals in North America from 1981 through 2000 were reviewed. The angiographic findings were then used to classify hemangiomas into types on the basis of a number of features, including high-flow nodules, early filling of veins, and the type of direct shunt present. Clinical data, including age at presentation, presence of cardiac insufficiency, and treatment, were also recorded.

RESULTS: Lesions were classified into five types on the basis of angiographic findings. In three of 15 patients, angiograms demonstrated the classic appearance of hepatic hemangiomas, with early filling of abnormal vascular channels, stagnation of contrast material, and no evidence of a direct shunt (type 1). In four patients, images showed high-flow nodules without direct shunts (type 2). In eight patients, direct shunts were demonstrated: arteriovenous shunts (type 3) in one, portovenous shunts (type 4) in three, and both arteriovenous and portovenous shunts (type 5) in four.

CONCLUSION: Hepatic hemangioma in infants is a heterogeneous lesion with variable angioarchitecture and a spectrum of angiographic findings.

© RSNA, 2002

Index terms: Angioma, 761.3194 • Liver neoplasms, angiography, 761.124 • Liver neoplasms, in infants and children, 761.3194

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