Author: Serge Sicular
| Ultrasound | NECT | CECT, arterial | CECT, venous | CECT, delayed (5-20min) | T1 | T2 | Post-contrast T1, arterial | Post-contrast T1, venous | Post-contrast T1, delayed (5-20min) | Radionuclide | Gross Pathology | Histology | Additional comments |
Hemangioma
 | Echogenic with posterior acoustic enhancement
 | Hypodense (~blood attenuation)
| Progressive centripetal enhancement with initial discontinuous rim formation
| Progressive centripetal enhancement with initial discontinuous rim formation
| Progressive centripetal enhancement with initial discontinuous rim formation
| Hypo- or Isointense
| Very hyperintense
| Progressive centripetal enhancement with initial discontinuous rim formation
| Progressive centripetal enhancement with initial discontinuous rim formation
| Progressive centripetal enhancement with initial discontinuous rim formation
| RBC scan: prolonged ↑activity on delayed images
| vascular cystic spaces (arrows)
| vascular cystic spaces (arrows)
| Single or multiple; usually 2-10cm |
Flash-filling hemangioma
| Echogenic with posterior acoustic enhancement
| Hypodense (~blood attenuation)
| Homogenous enhancement
| Homogenous enhancement
| Homogenous enhancement
| Hypo- or Isointense
| Hyperintense
| Homogenous enhancement
| Homogenous enhancement
| Homogenous enhancement
| RBC scan: prolonged ↑activity on delayed images
| vascular cystic spaces (arrows)
| vascular cystic spaces (arrows)
| Single or multiple; usually <2cm |
Giant hemangioma
| Lobulated heterogenous mass with echogenic border
| Heterogenously hypodense (~blood attenuation) w/central hypodense scar; +/- calcifications
| Progressive centripetal enhancement with initial discontinuous rim formation
| Incomplete centripetal filling (fibrous scar does not enhance)
| Incomplete centripetal filling (fibrous scar does not enhance)
| Heterogenously hypointense with hypointense central scar
| Hyperintense mass with hyperintense central scar
| Progressive centripetal enhancement with initial discontinuous rim formation and hypointense scar
| Incomplete centripetal filling (fibrous scar remains hypointense)
| Incomplete centripetal filling (fibrous scar remains hypointense)
| RBC scan: prolonged ↑activity on delayed images; photon deficient regions represent areas of degeneration | Central fibrous tissue represents scar
| Multiple vascular channels
| Usually >10cm |
Focal Nodular Hyperplasia (FNH)
| Typically inconspicuous or hypoechoic
| Typically isodense
| Homogenous hyperenhancement
| Isodense
| Enhancement of central scar
| Iso- or slightly hypointense
| Iso- or slightly hyperintense
| Homogenous bright enhancement
| Increased homogenous enhancement
| Enhancement of central scar w/typical agents. W/Eovist: FNH retains enhancement
| Sulfur-colloid liver-spleen: Normal/↑ activity (due to Kupfer cells)
| yellowish nodules (straight black arrows) surrounded by multiple septa (arrowhead) and a central scar (*) with large vessels (curved black arrow). Note no fibrous capsule between lesion and normal liver (white arrow)
| Multiple nodules and septa; image also displays large vessels (straight arrow) and portal vein tracts with inflammatory infiltrates (curved arrow)
| Typically <5cm; Central scar in 60% only. |
Adenoma
| Hyperechoic
| Hypodense; +/- cal (15%); +/- hemorrhage
| ↑↑Homogenous hyperenhancement
| Isodense to liver, or slight persistent enhancement
| Isodense to liver, or slight persistent enhancement
| Heterogenously increased signal (Heterogeneity due to fat or hemorrhage)
| Heterogenously increased signal
| Fairly homogenous enhancement
| Iso- to slightly hypointense to liver
| Iso- to slightly hypointense to liver
| Sulfur-colloid liver-spleen: cold (due to non-functional Kupfer cells)
| Individual cells resemble normal hepatocytes but contain large amounts of lipid and glycogen (= pale cytoplasm)
| Well-circumscribed mass with extensive hemorrhage (open arrow), a partial capsule (curved arrow), and foci of yellow-tan tissue (straight solid arrow)
| Usually single; Typically 8-30cm. |
Solitary HCC
| Highly variable
| Typically vaguely hypodense; +/- necrosis, fat, calcification
| Enhancement; occasional ring-like enhancement of capsule
| Washout +/- heterogeneous areas of enhancement (i.e. capsule)
| Washout
| Variable
| Typically increased signal
| Typically heterogeneously enhances
| Washout
| Isointense to liver or persistent washout
| Gallium: ↑ (90%). Hepatobiliary: ↑ (50%). Sulfur-colloid: HCC w/cirrhosis ↓; HCC w/o cirrhosis hetgen ↑.
| Typically cirrhotic liver with numerous regenerative nodules and a larger dominant nodule
| Vascular invasion (arrows). Note the central necrosis within one of the tumor thrombi (*).
| HCC may also be diffuse in the liver or multinodular. Often demonstrates restricted diffusion on MR. |
Fibrolamellar carcinoma
| Large, lobulated, well-defined with mixed echogenicity; +/- echogenic scar
| low attenuation mass +/- calcification (to differentiate from FNH)
| irregular heterogenous enhancement
| irregular heterogenous enhancement
| Increasing homogeneity with prominent scar Enhancement
| Slightly hypointense with hypointense scar
| Slightly hyperintense with hypointense scar
| Heterogenous enhancement
| Heterogenous enhancement
| Increasingly Homogenous enhancement
| Sulfur colloid (image 1): cold defect. RBC (image 2): increased uptake in dynamic phase (2c), with washout in delayed phase (2d)
| lobulated mass with central scar
| nests of malignant tumor cells (arrowhead) separated by fibrotic strands (arrow)
| Mean age 23yrs; normal aFP; look for adenopathy; single > multiple |
THID
| Unremarkable (no image shown) | Unremarkable (no image shown) | May be associated with THAD (see THAD for images) | Unremarkable (no image shown) | Unremarkable (no image shown) | Unremarkable (no image shown) | Unremarkable (no image shown) | Focal region of hyperenhancement; typically peripheral and wedge-shaped
| No abnormal enhancement
| Unremarkable (no image shown) | Unremarkable (no image shown) | Unremarkable (no image shown) | Unremarkable (no image shown) | Important to check for underlying lesions that may be causing the perfusional problem |
THAD
| Unremarkable (no image shown) | Unremarkable
| Focal region of hyperenhancement; typically peripheral and wedge-shaped
| No abnormal enhancement
| Unremarkable (no image shown) | Unremarkable (no image shown) | Unremarkable (no image shown) | May be more likely to demonstrate THID (see THID for images) | Unremarkable (no image shown) | Unremarkable (no image shown) | Unremarkable (no image shown) | Unremarkable (no image shown) | Unremarkable (no image shown) | Important to check for underlying lesions that may be causing the perfusional problem |
Infantile Hemangioendothelioma AKA Infantile hemangioma
| Variably echotextured mass w/multiple prominent vessels; +/- calcifications
| Hepatomegaly; highly variable, though predominantly hypodense; +/- calcifications
| Variable; typically early peripheral or nodular enhancement followed by nodular puddling of contrast on later phases
| Variable; typically early peripheral or nodular enhancement followed by nodular puddling of contrast on later phases
| Variable; typically early peripheral or nodular enhancement followed by nodular puddling of contrast on later phases
| Can be hypointense but also hyperintense (due to hemorrhage)
| Heterogenously increased w/flow voids
| Variable; this example demonstrates peripheral uptake with early filling of draining veins
| Variable; no image available | Variable; no image available | This scan demonstrates a large varix within the tumor
| Hepatomegaly with multiple small purplish masses
| Expresses GLUT1 on special staining
| <6 mos; large (1-20cm). Associated w/cutaneous hemangiomas (~50%), cardiomegaly secondary to high-output failure. |
Mesenchymal Hamartoma
| Cystic and solid tumor
| Cystic and solid tumor
| Mixed cystic and solid tumor with enhancing septations (no image available) | Mixed cystic and solid tumor with enhancing septations
| Mixed cystic and solid tumor with enhancing septations (no image available) | Predominantly hypointense
| Markedly hyperintense cystic mass; septations
| Mixed cystic and solid tumor with enhancing septations
| Mixed cystic and solid tumor with enhancing septations
| Mixed cystic and solid tumor with enhancing septations
| No image available | Partially cystic and partially solid tumor
| Compressed, branching ductules surrounded by loose mesenchyme
| N/A |