Contrast Enhancement Pattern of Hepatic Haemangioma
A 44-year-old woman with mild right upper quadrant discomfort undergoes contrast-enhanced magnetic resonance imaging of the liver. A 3 cm lesion in the right lobe shows peripheral nodular discontinuous enhancement in the arterial phase with progressive centripetal filling on delayed images, remaining isointense to blood pool. Which is the most likely diagnosis?
- A.Hepatic metastasis
- B.Hydatid cyst
- C.Cavernous haemangiomaCorrect
- D.Hepatocellular carcinoma
Explanation
The described enhancement pattern is essentially pathognomonic for a cavernous haemangioma, the commonest benign tumour of the liver. A haemangioma is a tangle of large, endothelium-lined vascular channels fed by small feeding vessels, so contrast enters slowly at the periphery and pools in these channels. This produces peripheral nodular or beaded enhancement in the arterial phase, followed by progressive filling from outside inward, described as centripetal filling, on portal venous and delayed images. Because the enhancing nodules are pooled blood, the lesion stays isointense to the blood pool at every phase rather than washing out. Hepatocellular carcinoma behaves in the opposite way: neovascular arterial supply gives rapid intense arterial hyperenhancement followed by washout to hypointensity in the portal venous and delayed phases. Metastases classically show peripheral rim enhancement with a persistently dark centre because the viable growing rim is vascular while the core is necrotic, and they do not fill in centripetally. A hydatid cyst is a parasitic cyst whose contents do not enhance at all, though the pericyst wall may show a thin rim of enhancement. Recognising these phase-based signatures usually allows confident non-invasive diagnosis, and biopsy of a suspected haemangioma should be avoided because of bleeding risk.
Why each option
- A.
- Metastases typically enhance as a thin peripheral rim around a necrotic non-enhancing centre and do not progressively fill in from the periphery inward.
- B.
- A hydatid cyst is fluid filled with non-enhancing contents; at most its wall enhances, and daughter cysts or membranes rather than nodular filling are seen.
- C.
- Correct. Peripheral nodular arterial enhancement with progressive centripetal filling and persistent isointensity to blood pool is the classic signature of a cavernous haemangioma.
- D.
- Hepatocellular carcinoma shows brisk arterial hyperenhancement followed by washout on delayed images, the reverse of progressive filling, and usually arises in a cirrhotic liver.
Reference: UpToDate 2025, Hepatic haemangioma; Sabiston Textbook of Surgery, 21st ed., 2022, benign liver tumours
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