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Prevalence of Hepatic Hemangioma in Patients with Focal Nodular Hyperplasia: MR Imaging Analysis¹

¹ From the Department of Radiology, Hôpital Beaujon, Clichy, France (V.V., F.U., G.B., M.Z., Y.M.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.P.F.). Received October 4, 2002; revision requested December 12; revision received January 10, 2003; accepted February 28. Address correspondence to G.B., Department of Radiology, University of Palermo, Via Villaermosa 29, Palermo 90139, Italy (e-mail: gbranca@yahoo.com).

View larger version (145K): [in a new window]   Figure 1a. Transverse MR images show hemangioma associated with FNH in a 49-year-old woman. (a) T2-weighted fast spin-echo MR image (3,250/110) shows mildly hyperintense FNH lesion (long arrow) in the right hepatic lobe. Hemangioma (short arrow) with signal intensity almost as strong as that of the gallbladder (g) is seen posteriorly. (b) T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) shows hepatic hemangioma (arrow) to be hypointense to surrounding liver parenchyma. FNH lesion is isointense to adjacent liver parenchyma and is not easily seen. (c) Gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during arterial phase shows strong hyperintensity of FNH lesion (long arrow) to normal liver. Hemangioma (short arrow) shows nodular peripheral enhancement. (d) Gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during portal venous phase shows centripetal filling of hemangioma (short arrow) except for the central region, while FNH lesion (long arrow) is isointense to normal liver. (e) Delayed-phase (5 minutes) gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) shows isointensity of FNH lesion (long arrow) with enhancement of central scar (arrowhead) and pseudocapsule. Hemangioma (short arrow) is now almost completely filled with contrast material.

View larger version (136K): [in a new window]   Figure 1b. Transverse MR images show hemangioma associated with FNH in a 49-year-old woman. (a) T2-weighted fast spin-echo MR image (3,250/110) shows mildly hyperintense FNH lesion (long arrow) in the right hepatic lobe. Hemangioma (short arrow) with signal intensity almost as strong as that of the gallbladder (g) is seen posteriorly. (b) T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) shows hepatic hemangioma (arrow) to be hypointense to surrounding liver parenchyma. FNH lesion is isointense to adjacent liver parenchyma and is not easily seen. (c) Gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during arterial phase shows strong hyperintensity of FNH lesion (long arrow) to normal liver. Hemangioma (short arrow) shows nodular peripheral enhancement. (d) Gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during portal venous phase shows centripetal filling of hemangioma (short arrow) except for the central region, while FNH lesion (long arrow) is isointense to normal liver. (e) Delayed-phase (5 minutes) gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) shows isointensity of FNH lesion (long arrow) with enhancement of central scar (arrowhead) and pseudocapsule. Hemangioma (short arrow) is now almost completely filled with contrast material.

View larger version (143K): [in a new window]   Figure 1c. Transverse MR images show hemangioma associated with FNH in a 49-year-old woman. (a) T2-weighted fast spin-echo MR image (3,250/110) shows mildly hyperintense FNH lesion (long arrow) in the right hepatic lobe. Hemangioma (short arrow) with signal intensity almost as strong as that of the gallbladder (g) is seen posteriorly. (b) T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) shows hepatic hemangioma (arrow) to be hypointense to surrounding liver parenchyma. FNH lesion is isointense to adjacent liver parenchyma and is not easily seen. (c) Gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during arterial phase shows strong hyperintensity of FNH lesion (long arrow) to normal liver. Hemangioma (short arrow) shows nodular peripheral enhancement. (d) Gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during portal venous phase shows centripetal filling of hemangioma (short arrow) except for the central region, while FNH lesion (long arrow) is isointense to normal liver. (e) Delayed-phase (5 minutes) gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) shows isointensity of FNH lesion (long arrow) with enhancement of central scar (arrowhead) and pseudocapsule. Hemangioma (short arrow) is now almost completely filled with contrast material.

View larger version (140K): [in a new window]   Figure 1d. Transverse MR images show hemangioma associated with FNH in a 49-year-old woman. (a) T2-weighted fast spin-echo MR image (3,250/110) shows mildly hyperintense FNH lesion (long arrow) in the right hepatic lobe. Hemangioma (short arrow) with signal intensity almost as strong as that of the gallbladder (g) is seen posteriorly. (b) T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) shows hepatic hemangioma (arrow) to be hypointense to surrounding liver parenchyma. FNH lesion is isointense to adjacent liver parenchyma and is not easily seen. (c) Gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during arterial phase shows strong hyperintensity of FNH lesion (long arrow) to normal liver. Hemangioma (short arrow) shows nodular peripheral enhancement. (d) Gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during portal venous phase shows centripetal filling of hemangioma (short arrow) except for the central region, while FNH lesion (long arrow) is isointense to normal liver. (e) Delayed-phase (5 minutes) gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) shows isointensity of FNH lesion (long arrow) with enhancement of central scar (arrowhead) and pseudocapsule. Hemangioma (short arrow) is now almost completely filled with contrast material.

View larger version (136K): [in a new window]   Figure 1e. Transverse MR images show hemangioma associated with FNH in a 49-year-old woman. (a) T2-weighted fast spin-echo MR image (3,250/110) shows mildly hyperintense FNH lesion (long arrow) in the right hepatic lobe. Hemangioma (short arrow) with signal intensity almost as strong as that of the gallbladder (g) is seen posteriorly. (b) T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) shows hepatic hemangioma (arrow) to be hypointense to surrounding liver parenchyma. FNH lesion is isointense to adjacent liver parenchyma and is not easily seen. (c) Gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during arterial phase shows strong hyperintensity of FNH lesion (long arrow) to normal liver. Hemangioma (short arrow) shows nodular peripheral enhancement. (d) Gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during portal venous phase shows centripetal filling of hemangioma (short arrow) except for the central region, while FNH lesion (long arrow) is isointense to normal liver. (e) Delayed-phase (5 minutes) gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) shows isointensity of FNH lesion (long arrow) with enhancement of central scar (arrowhead) and pseudocapsule. Hemangioma (short arrow) is now almost completely filled with contrast material.

View larger version (154K): [in a new window]   Figure 2a. Transverse MR images show hemangioma associated with FNH in a 34-year-old woman. (a) Fat-suppressed T2-weighted fast spin-echo MR image (3,250/110) shows mildly hyperintense FNH lesion (long arrow). Hemangioma (short arrow) with signal intensity as strong as that of cerebrospinal fluid is seen posteriorly. (b) Fat-suppressed T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) shows hepatic hemangioma (short arrow) to be hypointense to surrounding liver parenchyma. FNH lesion (long arrow) is isointense to liver parenchyma. (c) Fat-suppressed gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during arterial phase shows enhancement of FNH lesion (long arrow) to normal liver. Hemangioma (short arrow) shows nodular peripheral enhancement. (d) Fat-suppressed gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during portal venous phase shows centripetal filling of hemangioma (short arrow), while FNH lesion (long arrow) is almost isointense to normal liver. Note numerous draining veins around FNH lesion. (e) Fat-suppressed gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during delayed-phase (5 minutes) imaging shows isointensity of FNH lesion to liver parenchyma. Hemangioma (short arrow) is partially filled with contrast material.

View larger version (134K): [in a new window]   Figure 2b. Transverse MR images show hemangioma associated with FNH in a 34-year-old woman. (a) Fat-suppressed T2-weighted fast spin-echo MR image (3,250/110) shows mildly hyperintense FNH lesion (long arrow). Hemangioma (short arrow) with signal intensity as strong as that of cerebrospinal fluid is seen posteriorly. (b) Fat-suppressed T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) shows hepatic hemangioma (short arrow) to be hypointense to surrounding liver parenchyma. FNH lesion (long arrow) is isointense to liver parenchyma. (c) Fat-suppressed gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during arterial phase shows enhancement of FNH lesion (long arrow) to normal liver. Hemangioma (short arrow) shows nodular peripheral enhancement. (d) Fat-suppressed gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during portal venous phase shows centripetal filling of hemangioma (short arrow), while FNH lesion (long arrow) is almost isointense to normal liver. Note numerous draining veins around FNH lesion. (e) Fat-suppressed gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during delayed-phase (5 minutes) imaging shows isointensity of FNH lesion to liver parenchyma. Hemangioma (short arrow) is partially filled with contrast material.

View larger version (142K): [in a new window]   Figure 2c. Transverse MR images show hemangioma associated with FNH in a 34-year-old woman. (a) Fat-suppressed T2-weighted fast spin-echo MR image (3,250/110) shows mildly hyperintense FNH lesion (long arrow). Hemangioma (short arrow) with signal intensity as strong as that of cerebrospinal fluid is seen posteriorly. (b) Fat-suppressed T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) shows hepatic hemangioma (short arrow) to be hypointense to surrounding liver parenchyma. FNH lesion (long arrow) is isointense to liver parenchyma. (c) Fat-suppressed gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during arterial phase shows enhancement of FNH lesion (long arrow) to normal liver. Hemangioma (short arrow) shows nodular peripheral enhancement. (d) Fat-suppressed gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during portal venous phase shows centripetal filling of hemangioma (short arrow), while FNH lesion (long arrow) is almost isointense to normal liver. Note numerous draining veins around FNH lesion. (e) Fat-suppressed gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during delayed-phase (5 minutes) imaging shows isointensity of FNH lesion to liver parenchyma. Hemangioma (short arrow) is partially filled with contrast material.

View larger version (142K): [in a new window]   Figure 2d. Transverse MR images show hemangioma associated with FNH in a 34-year-old woman. (a) Fat-suppressed T2-weighted fast spin-echo MR image (3,250/110) shows mildly hyperintense FNH lesion (long arrow). Hemangioma (short arrow) with signal intensity as strong as that of cerebrospinal fluid is seen posteriorly. (b) Fat-suppressed T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) shows hepatic hemangioma (short arrow) to be hypointense to surrounding liver parenchyma. FNH lesion (long arrow) is isointense to liver parenchyma. (c) Fat-suppressed gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during arterial phase shows enhancement of FNH lesion (long arrow) to normal liver. Hemangioma (short arrow) shows nodular peripheral enhancement. (d) Fat-suppressed gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during portal venous phase shows centripetal filling of hemangioma (short arrow), while FNH lesion (long arrow) is almost isointense to normal liver. Note numerous draining veins around FNH lesion. (e) Fat-suppressed gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during delayed-phase (5 minutes) imaging shows isointensity of FNH lesion to liver parenchyma. Hemangioma (short arrow) is partially filled with contrast material.

View larger version (143K): [in a new window]   Figure 2e. Transverse MR images show hemangioma associated with FNH in a 34-year-old woman. (a) Fat-suppressed T2-weighted fast spin-echo MR image (3,250/110) shows mildly hyperintense FNH lesion (long arrow). Hemangioma (short arrow) with signal intensity as strong as that of cerebrospinal fluid is seen posteriorly. (b) Fat-suppressed T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) shows hepatic hemangioma (short arrow) to be hypointense to surrounding liver parenchyma. FNH lesion (long arrow) is isointense to liver parenchyma. (c) Fat-suppressed gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during arterial phase shows enhancement of FNH lesion (long arrow) to normal liver. Hemangioma (short arrow) shows nodular peripheral enhancement. (d) Fat-suppressed gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during portal venous phase shows centripetal filling of hemangioma (short arrow), while FNH lesion (long arrow) is almost isointense to normal liver. Note numerous draining veins around FNH lesion. (e) Fat-suppressed gadolinium-enhanced T1-weighted gradient-echo MR image (160/4.9, 80° flip angle) obtained during delayed-phase (5 minutes) imaging shows isointensity of FNH lesion to liver parenchyma. Hemangioma (short arrow) is partially filled with contrast material.