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Byung Ihn Choi’ Ten giant cavernous hemangiomas of the liver in eight patients were examined with
Man Chung Han both MR imaging and dynamic bolus CT. The maximal diameters of the tumors were
Jae Hyung Park 6.5-19 cm (mean, 10.8 cm). MR imaging was done with a 2.0-T superconducting magnet
and spin-echo imaging. CT was done with single-bolus dynamic scans. On MR images,
American Journal of Roentgenology 1989.152:1221-1226.
in all eight patients. The giant hemangiomas were 6.5-19 cm (mean, differentiated from the cleftlike areas. The contours of the
1 0.8 cm) in the largest diameter. Seven tumors were located in the internal septa were linear or curvilinear in all five cases.
right lobe, two in the left lobe, and one in the caudate lobe. On T2-weighted MR images, the main part of the tumor
MR spin-echo (SE) images were obtained by using a supercon-
was of high intensity with an increasing intensity ratio with
ducting Spectro-20000 (Goldstar, Seoul, Korea) operated at 2.0 T.
prolongation of TR and TE in all 1 0 cases (Fig. 2B). On heavily
Images were constructed by using two-dimensional Fourier transform
T2-weighted images, 2000/i 20, seven of 1 0 tumors were of
technique. A body coil with a field of view of 35 cm was used. The
image matrix of 1 80 x 256 elements yielded an in-plane spatial higher intensity than fat (Fig. 2C), while all 1 0 tumors were of
resolution of 1 .9 x 1 .4 mm. Two or four data acquisitions were higher intensity on SE 2000/i 50, 1 80 images (Figs. 1 B and
averaged for each image. A multisection/multiecho technique was 2D). Intensity ratios of the main tumor were 3.00 ± 1 .02 (SE
used to make axial sections with a section thickness of 8 mm and 2000/60), 7.1 3 ± 2.55 (SE 2000/i 20), i 1 .67 ± 3.91 (SE
intersection gap of 2 mm. Relatively Ti -weighted images, 500/30 2000/i 50), and 1 2.71 ± 3.3i (SE 2000/i 80). Cleftlike areas
(TR/TE), were obtained, as were T2-weighted images, 2000/60, i20, were of high intensity on T2-weighted images, 2000/60, in all
1 50, 1 80 (TR/TE). Neither respiratory nor ECG gating was used.
1 0 cases and could not be differentiated from the main part
CT scans were obtained by using a CT 9800 scanner (General
ofthe tumor. However, on heavily T2-weighted images, 2000/
Electric, Milwaukee, WI) with a scan speed of 2 sec. In all eight
1 50, 1 80, cleftlike areas showed higher intensity than the
patients, single-level bolus dynamic scans were obtained. Nonen-
hanced CT scans of the liver were obtained at 1 0-mm intervals to
main tumor did, and the two could be differentiated from each
localize the lesions. Single-level bolus dynamic CT scans were then other in all i 0 cases (Figs. 1 B and 2D). Internal septa had low
obtained at the level that contained the largest lesion. Contrast- intensity on all T2-weighted images (Figs. 2B-2D) and could
enhanced CT scans of the liver were obtained after IV bolus injection be differentiated from cleftlike areas, which showed high
of 60 ml of 60% iodinated contrast agent (Telebrix 30, Guerbet, intensity in all five cases.
Aulnay-Sous-Bois, France). The contrast agent was injected by hand
American Journal of Roentgenology 1989.152:1221-1226.
. . :1-’l
had tumors that fulfilled the criteria used by Freeny and Marks septa of hemangiomas could be explained as poorly cellular
[8] for a typical hemangioma. However, all would have been fibrous tissue. The areas of internal septa were of low intensity
acceptable under the conditions proposed by Ashida et al. on MR images on all pulse sequences. Fibrosis decreases
[9]. Our results are similar to those reported by Scatarige the water content and shows low intensity. The low-density
et al. [i5]. areas of hemangiomas with the most recent enhancement on
The cleftlike areas of hemangiomas noted on MR images delayed scans corresponded exactly to the areas of low
or CT scans may be due to areas of cystic degeneration or intensity on MR images. On the basis of an MR-pathologic
liquefaction, rather than fibrosis, thrombosis, or hemorrhage, correlation in three resected hemangiomas, Ros et al. [i 4]
as was postulated by several authors [4, i 5]. The reason for reported that nodular areas and septations of decreased
this is because the attenuation numbers of the cleftlike areas intensity within a hyperintense tumor on T2-weighted images
in all cases were less than +30 H, all of the cleftlike areas did corresponded to fibrotic nodular areas and fibrotic strands,
not show contrast enhancement on delayed scans, and the respectively. Muramatsu et al. [20] described the CT-patho-
cleftlike areas with lower density on dynamic bolus CT scans logic correlation of the fibrotic part of a hepatic tumor. On
corresponded to the areas with lower intensity than the main late-enhancing CT scans obtained more than 5 mm after
part of the tumor on Ti -weighted images and with higher administration of contrast material, the fibrotic part showed
intensity than the main part on heavily T2-weighted images. contrast enhancement because fibrous stromas retained con-
Takayasu et al. [i 91 also reported one case of giant heman- trast material longer than tumor tissue did. However, on CT
gioma of the liver with a central cavity that contained trans- scans in the early phase after a bolus administration of
parent serous fluid. Ros et al. [i 4] reported that some he- contrast material, it was difficult to differentiate tumor tissue
mangiomas contained cystic cavities filled with gelatinous from fibrotic connective tissue. Further studies with histologic
material on pathologic examination. The areas of internal correlation are needed because none of the hemangiomas in
AJR:152, June 1989 GIANT CAVERNOUS LIVER HEMANGIOMAS 1225
our series were surgically resected and available for patho- large, well-defined, heterogeneous masses that contain areas
logic study. with an increasing intensity ratio with prolongation of TA and
Giant cavernous hemangiomas have a heterogeneous ap- TE, cleftlike areas of low intensity on Ti -weighted images
pearance on MR images. Therefore, there is sometimes con- and of higher intensity on heavily T2-weighted images, and
fusion between giant hemangiomas and malignant tumors. low-intensity internal septa on all pulse sequences.
Necrotic metastatic tumor and hepatoma are included in the
differential diagnosis of giant hemangiomas [i i]. The char- ACKNOWLEDGMENTS
acteristic MR findings of giant hemangiomas, such as well-
We thank Z. H. Cho and H. W. Park for assistance in manuscript
defined, high-intensity areas on T2-weighted images with
preparation.
increasing intensity ratios with prolongation of TR and TE,
are useful in differentiating these tumors from necrotic metas-
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