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Hepatic hemangioendothelioma: CT, MR, and FDG-PET-CT in 67 patients-a bi-institutional comprehensive cancer center review.

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Title: Hepatic hemangioendothelioma: CT, MR, and FDG-PET-CT in 67 patients-a bi-institutional comprehensive cancer center review.
Authors: Ganeshan, Dhakshinamoorthy1 (AUTHOR) dganeshan@mdanderson.org, Pickhardt, Perry J.2 (AUTHOR), Morani, Ajaykumar C.3 (AUTHOR), Javadi, Sanaz3 (AUTHOR), Lubner, Meghan G.2 (AUTHOR), Elmohr, Mohab M.4 (AUTHOR), Duran, Cihan1,4 (AUTHOR), Elsayes, Khaled M.1,4 (AUTHOR)
Source: European Radiology. May2020, Vol. 30 Issue 5, p2435-2442. 8p. 1 Color Photograph, 5 Black and White Photographs.
Subjects: Cross-sectional imaging, Research, Liver tumors, Research methodology, Magnetic resonance imaging, Retrospective studies, Evaluation research, Medical cooperation, Comparative studies, Radiopharmaceuticals, Research funding, Deoxy sugars, Hemangiomas, Pharmacodynamics
Abstract: Objective: To evaluate the imaging features of hepatic epithelioid hemangioendothelioma (HEH) on multiphasic CT, MR, and FDG-PET-CT.Methods: Bi-institutional review identified 67 adults (mean age, 47 years; 23 M/44 F) with pathologically proven HEH and pretreatment multiphasic CT (n = 67) and/or MR (n = 30) and/or FDG-PET-CT (n = 13).Results: HEHs were multifocal in 88% (59/67). Mean size of the dominant mass was 4.1 cm (range, 1.4-19 cm). The tumors were located in the peripheral, subcapsular regions of the liver in 96% (64/67). Capsular retraction was present in 81% (54/67 cases) and tumors were coalescent in 61% (41/67). HEH demonstrated peripheral ring enhancement on arterial phase imaging in 33% (21/64) and target appearance on the portal venous phase in 69% (46/67). Persistent peripheral enhancement on the delayed phase was seen in 49% (31/63). On MR, multilayered target appearance was seen on the T2-weighted sequences in 67% (20/30) and on the diffusion-weighted sequences in 61% (11/18). Target appearance on hepatobiliary phase of MRI was seen in 57% (4/7). On pre-therapy FDG-PET-CT, increased FDG uptake above the background liver parenchyma was seen in 62% (8/13).Conclusion: HEHs typically manifest as multifocal, coalescent hepatic nodules in peripheral subcapsular location, with associated capsular retraction. Peripheral arterial ring enhancement and target appearance on portal venous phase are commonly seen on CT. Similarly, multilayered target appearance correlating with its histopathological composition is typically seen on multiple sequences of MR including T2-weighted, diffusion-weighted, and dynamic contrast-enhanced multiphasic MR.Key Points: • Hepatic epithelioid hemangioendotheliomas manifest on CT and MR as multifocal, coalescent hepatic nodules in peripheral subcapsular location, with associated capsular retraction. • Enhancement pattern on contrast-enhanced CT and MR can vary but peripheral ring enhancement on arterial phase and target appearance on portal venous phase are commonly seen. • Retrospective two-center study showed that cross-sectional imaging may help in the diagnosis. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Hepatic hemangioendothelioma: CT, MR, and FDG-PET-CT in 67 patients-a bi-institutional comprehensive cancer center review.
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  Data: <searchLink fieldCode="AR" term="%22Ganeshan%2C+Dhakshinamoorthy%22">Ganeshan, Dhakshinamoorthy</searchLink><relatesTo>1</relatesTo> (AUTHOR)<i> dganeshan@mdanderson.org</i><br /><searchLink fieldCode="AR" term="%22Pickhardt%2C+Perry+J%2E%22">Pickhardt, Perry J.</searchLink><relatesTo>2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Morani%2C+Ajaykumar+C%2E%22">Morani, Ajaykumar C.</searchLink><relatesTo>3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Javadi%2C+Sanaz%22">Javadi, Sanaz</searchLink><relatesTo>3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lubner%2C+Meghan+G%2E%22">Lubner, Meghan G.</searchLink><relatesTo>2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Elmohr%2C+Mohab+M%2E%22">Elmohr, Mohab M.</searchLink><relatesTo>4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Duran%2C+Cihan%22">Duran, Cihan</searchLink><relatesTo>1,4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Elsayes%2C+Khaled+M%2E%22">Elsayes, Khaled M.</searchLink><relatesTo>1,4</relatesTo> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22European+Radiology%22">European Radiology</searchLink>. May2020, Vol. 30 Issue 5, p2435-2442. 8p. 1 Color Photograph, 5 Black and White Photographs.
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  Data: <searchLink fieldCode="DE" term="%22Cross-sectional+imaging%22">Cross-sectional imaging</searchLink><br /><searchLink fieldCode="DE" term="%22Research%22">Research</searchLink><br /><searchLink fieldCode="DE" term="%22Liver+tumors%22">Liver tumors</searchLink><br /><searchLink fieldCode="DE" term="%22Research+methodology%22">Research methodology</searchLink><br /><searchLink fieldCode="DE" term="%22Magnetic+resonance+imaging%22">Magnetic resonance imaging</searchLink><br /><searchLink fieldCode="DE" term="%22Retrospective+studies%22">Retrospective studies</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation+research%22">Evaluation research</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+cooperation%22">Medical cooperation</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+studies%22">Comparative studies</searchLink><br /><searchLink fieldCode="DE" term="%22Radiopharmaceuticals%22">Radiopharmaceuticals</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Deoxy+sugars%22">Deoxy sugars</searchLink><br /><searchLink fieldCode="DE" term="%22Hemangiomas%22">Hemangiomas</searchLink><br /><searchLink fieldCode="DE" term="%22Pharmacodynamics%22">Pharmacodynamics</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: <bold>Objective: </bold>To evaluate the imaging features of hepatic epithelioid hemangioendothelioma (HEH) on multiphasic CT, MR, and FDG-PET-CT.<bold>Methods: </bold>Bi-institutional review identified 67 adults (mean age, 47 years; 23 M/44 F) with pathologically proven HEH and pretreatment multiphasic CT (n = 67) and/or MR (n = 30) and/or FDG-PET-CT (n = 13).<bold>Results: </bold>HEHs were multifocal in 88% (59/67). Mean size of the dominant mass was 4.1 cm (range, 1.4-19 cm). The tumors were located in the peripheral, subcapsular regions of the liver in 96% (64/67). Capsular retraction was present in 81% (54/67 cases) and tumors were coalescent in 61% (41/67). HEH demonstrated peripheral ring enhancement on arterial phase imaging in 33% (21/64) and target appearance on the portal venous phase in 69% (46/67). Persistent peripheral enhancement on the delayed phase was seen in 49% (31/63). On MR, multilayered target appearance was seen on the T2-weighted sequences in 67% (20/30) and on the diffusion-weighted sequences in 61% (11/18). Target appearance on hepatobiliary phase of MRI was seen in 57% (4/7). On pre-therapy FDG-PET-CT, increased FDG uptake above the background liver parenchyma was seen in 62% (8/13).<bold>Conclusion: </bold>HEHs typically manifest as multifocal, coalescent hepatic nodules in peripheral subcapsular location, with associated capsular retraction. Peripheral arterial ring enhancement and target appearance on portal venous phase are commonly seen on CT. Similarly, multilayered target appearance correlating with its histopathological composition is typically seen on multiple sequences of MR including T2-weighted, diffusion-weighted, and dynamic contrast-enhanced multiphasic MR.<bold>Key Points: </bold>• Hepatic epithelioid hemangioendotheliomas manifest on CT and MR as multifocal, coalescent hepatic nodules in peripheral subcapsular location, with associated capsular retraction. • Enhancement pattern on contrast-enhanced CT and MR can vary but peripheral ring enhancement on arterial phase and target appearance on portal venous phase are commonly seen. • Retrospective two-center study showed that cross-sectional imaging may help in the diagnosis. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1007/s00330-019-06637-3
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        Text: English
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      – SubjectFull: Cross-sectional imaging
        Type: general
      – SubjectFull: Research
        Type: general
      – SubjectFull: Liver tumors
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      – SubjectFull: Research methodology
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      – SubjectFull: Magnetic resonance imaging
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      – SubjectFull: Deoxy sugars
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      – SubjectFull: Hemangiomas
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      – SubjectFull: Pharmacodynamics
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              Text: May2020
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