|
1
|
Rosselli M, Popescu A, Bende F, Al Refaie A, Lim A. Imaging in Vascular Liver Diseases. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1955. [PMID: 39768837 PMCID: PMC11677191 DOI: 10.3390/medicina60121955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Revised: 11/10/2024] [Accepted: 11/13/2024] [Indexed: 01/11/2025]
Abstract
Vascular liver diseases (VLDs) include different pathological conditions that affect the liver vasculature at the level of the portal venous system, hepatic artery, or venous outflow system. Although serological investigations and sometimes histology might be required to clarify the underlying diagnosis, imaging has a crucial role in highlighting liver inflow or outflow obstructions and their potential causes. Cross-sectional imaging provides a panoramic view of liver vascular anatomy and parenchymal patterns of enhancement, making it extremely useful for the diagnosis and follow-up of VLDs. Nevertheless, multiparametric ultrasound analysis provides information useful for differentiating acute from chronic portal vein thrombosis, distinguishing neoplastic invasion of the portal vein from bland thrombus, and clarifying the causes of venous outflow obstruction. Color Doppler analysis measures blood flow velocity and direction, which are very important in the assessment of VLDs. Finally, liver and spleen elastography complete the assessment by providing intrahepatic and intrasplenic stiffness measurements, offering further diagnostic information.
Collapse
Affiliation(s)
- Matteo Rosselli
- Department of Internal Medicine, San Giuseppe Hospital, USL Toscana Centro, 50053 Empoli, Italy;
- Division of Medicine, Institute for Liver and Digestive Health, University College London, London NW3 2PF, UK
| | - Alina Popescu
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy Timișoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Felix Bende
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy Timișoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Antonella Al Refaie
- Department of Internal Medicine, San Giuseppe Hospital, USL Toscana Centro, 50053 Empoli, Italy;
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London SW 2AZ, UK
| |
Collapse
|
|
2
|
Calistri L, Nardi C, Rastrelli V, Maraghelli D, Grazioli L, Messerini L, Colagrande S. MRI of Peliosis Hepatis: A Case Series Presentation With a 2022 Systematic Literature Update. J Magn Reson Imaging 2023; 58:1386-1405. [PMID: 36988385 DOI: 10.1002/jmri.28673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Peliosis hepatis (PH) is a rare benign condition, characterized by hepatic sinusoidal dilatation and blood-filled cystic cavities, often found incidentally, with still challenging diagnosis by imaging due to polymorphic appearance. PURPOSE Based on a retrospective analysis of our series (12 patients) and systematic literature review (1990-2022), to organize data about PH and identify features to improve characterization. STUDY TYPE Retrospective case series and systematic review. POPULATION Twelve patients (mean age 48 years, 55% female) with pathology-proven PH and 49 patients (mean age 52 years, 67% female) identified in 33 studies from the literature (1990-2022). FIELD STRENGTH/SEQUENCE 1,5-T; T1-weighted (T1W), T2-weighted (T2W), diffusion-weighted (DW), contrast-enhanced (CE) T1W imaging. ASSESSMENT We compared our series and literature data in terms of demographic (gender/age/ethnicity), clinical characteristics (symptoms/physical examination/liver test), associated conditions (malignancies/infectious/hematologic/genetic or chronic disorders/drugs or toxic exposure) percentage. On magnetic resonance imaging lesion numbers/shape/mean maximum diameter/location/mass effect/signal intensity were compared. PH pathological type/proposed imaging diagnosis/patient follow-up were also considered. STATISTICAL TESTS Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports/Series quality assessment. Intraclass correlation and Cohen's kappa coefficients for levels of inter/intrareader agreement in our experience. RESULTS Patients were mainly asymptomatic (92% vs. 70% in our study and literature) with associated conditions (83% vs. 80%). Lesions showed homogeneous T1W-hypointensity (58% vs. 65%) and T2W-hyperintensity (58% vs. 66%). Heterogeneous nonspecific (25% vs. 51%), centrifugal (34% vs. 8%), or rim-like centripetal (25% vs. 23%) patterns of enhancement were most frequent, with hypointensity on the hepatobiliary phase (HBP), without restricted diffusivity. Good inter- and intrareader agreement was observed in our experience. Concerning JBI Checklist, 19 out of 31 case reports met at least 7 out of 8 criteria, whereas 2 case series fulfilled 5 and 6 out of 10 items respectively. DATA CONCLUSION A homogeneous, not well-demarcated T1W-hypointense and T2W-hyperintense mass, with heterogeneous nonspecific or rim-like centripetal or centrifugal pattern of enhancement, and hypointensity on HBP, may be helpful for PH diagnosis. Among associated conditions, malignancies and drug exposures were the most frequent. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Vieri Rastrelli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Luigi Grazioli
- Department of Radiology, University of Brescia "Spedali Civili", Brescia, Italy
| | - Luca Messerini
- Department of Human Pathology and Oncology, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| |
Collapse
|
|
3
|
Calistri L, Rastrelli V, Nardi C, Maraghelli D, Vidali S, Pietragalla M, Colagrande S. Imaging of the chemotherapy-induced hepatic damage: Yellow liver, blue liver, and pseudocirrhosis. World J Gastroenterol 2021; 27:7866-7893. [PMID: 35046618 PMCID: PMC8678821 DOI: 10.3748/wjg.v27.i46.7866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/15/2021] [Accepted: 11/29/2021] [Indexed: 02/06/2023] Open
Abstract
The liver is the major drug-metabolizing and drug-detoxifying organ. Many drugs can cause liver damage through various mechanisms; however, the liver response to injury includes a relatively narrow spectrum of alterations that, regardless of the cause, are represented by phlogosis, oxidative stress and necrosis. The combination of these alterations mainly results in three radiological findings: vascular alterations, structural changes and metabolic function reduction. Chemotherapy has changed in recent decades in terms of the drugs, protocols and duration, allowing patients a longer life expectancy. As a consequence, we are currently observing an increase in chemotherapy-associated liver injury patterns once considered unusual. Recognizing this form of damage in an early stage is crucial for reconsidering the therapy regimen and thus avoiding severe complications. In this frontier article, we analyze the role of imaging in detecting some of these pathological patterns, such as pseudocirrhosis, "yellow liver" due to chemotherapy-associated steatosis-steatohepatitis, and "blue liver", including sinusoidal obstruction syndrome, veno-occlusive disease and peliosis.
Collapse
Affiliation(s)
- Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Vieri Rastrelli
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Sofia Vidali
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Michele Pietragalla
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| |
Collapse
|
|
4
|
Dong Y, Wang WP, Lim A, Lee WJ, Clevert DA, Höpfner M, Tannapfel A, Dietrich CF. Ultrasound findings in peliosis hepatis. Ultrasonography 2021; 40:546-554. [PMID: 34399044 PMCID: PMC8446485 DOI: 10.14366/usg.20162] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The aim of this study was to retrospectively evaluate contrast-enhanced ultrasound (CEUS) findings in patients with peliosis hepatis (PH). METHODS A retrospective analysis was conducted of CEUS features in 24 patients with histopathologically confirmed PH (11 men and 13 women; mean age, 32.4±7.1 years; range, 28 to 41 years). All lesions were histologically proven, either by core needle biopsy (n=10) or by hepatic surgery (n=14). RESULTS The mean size was 36.8±12.4 mm (range, 10 to 80 mm). On B-mode ultrasonography (BMUS), all PH lesions were heterogeneously hypoechoic, with well-defined margins but irregular shapes. No mass effect was observed. During the arterial phase of CEUS, all lesions displayed mild heterogeneous hyperenhancement (83.3%, 20/24) or isoenhancement (16.7%, 4/24). Furthermore, 87.5% of the PH lesions showed mild washout after 1 minute in the portal venous phase (30-120 seconds) and mild washout in the late phase (>120 seconds). CONCLUSION The lack of a mass effect on BMUS, mild heterogeneous arterial hyperenhancement, and washout in the very late portal venous phase (after 1 minute) on CEUS are characteristic of PH. Although it is a histological diagnosis, PH should be considered in the differential diagnosis when the clinical context does not favor a malignancy or infection.
Collapse
Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London, UK
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Dirk-Andre Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Michael Höpfner
- Department Gastroenterologie, Klinik für Innere Medizin, Agaplesion Diakonie Kliniken Kassel, Kassel, Germany
| | | | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Hirslanden, Bern, Switzerland
| |
Collapse
|
|
5
|
Ren SX, Li PP, Shi HP, Chen JH, Deng ZP, Zhang XE. Imaging presentation and postoperative recurrence of peliosis hepatis: A case report. World J Clin Cases 2021; 9:5197-5202. [PMID: 34307567 PMCID: PMC8283614 DOI: 10.12998/wjcc.v9.i19.5197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/02/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Peliosis hepatis (PH) is a rare benign lesion of vascular origin with a pathological characteristic of multiple blood-filled cavities in the liver parenchyma. It is commonly misdiagnosed due to its lack of specificity in clinical presentation and laboratory test results. Herein, a case of a patient with PH who was misdiagnosed with hepatic echinococcosis before operation to remove the lesions was analyzed, with an emphasis on the computed tomography and magnetic resonance imaging characteristics of PH.
CASE SUMMARY We outline the case of a 40-year-old Chinese female who was admitted with aggravated abdominal pain with fever for 1 wk. Ultrasound examination at the local hospital indicated hepatic echinococcosis. However, discordance between imaging diagnosis, clinical history and laboratory examinations in our hospital. Subsequently, the patient was pathologically confirmed as having PH-like changes, which recurred 1 year after operation removal of the lesion.
CONCLUSION Our objective is to highlight the imaging diagnostic value of PH.
Collapse
Affiliation(s)
- Si-Xie Ren
- Department of Radiology, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Pan-Pan Li
- Department of Radiology, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Hai-Peng Shi
- Pathology Center, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Jun-Hui Chen
- Department of Radiology, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Zhen-Ping Deng
- Department of Radiology, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Xi-E Zhang
- Department of Radiology, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| |
Collapse
|
|
6
|
Maruyama H, Takahashi K, Ishikawa N, Hosaka K, Kumaki D, Aruga Y, Yamakawa M, Hirano M, Funakoshi K, Terai S. A rare case of peliosis hepatis in a patient with chronic renal failure and renal cell carcinoma. Clin J Gastroenterol 2019; 13:403-407. [PMID: 31713159 DOI: 10.1007/s12328-019-01068-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/01/2019] [Indexed: 11/27/2022]
Abstract
Peliosis hepatis (PH) is a rare disease characterized by the presence of sinusoidal dilation and blood-filled cysts throughout the hepatic parenchyma. We report a case of PH in a 49-year-old woman with chronic renal failure (CRF) on hemodialysis and with renal cell carcinoma (RCC). Dynamic contrast-enhanced computed tomography (CT) showed a 35-mm-diameter, hypervascular tumor in the liver and RCC in the right renal cyst. Ultrasound and superparamagnetic iron oxide-enhanced magnetic resonance imaging were also performed; however, the liver tumor could not be distinguished from the metastasis of RCC. Therefore, echo-guided biopsy of the liver tumor using an 18-G Majima needle was performed. Histological evaluation of the specimen showed irregular sinusoidal dilatation and blood-filled cavities without malignant cells. She was ultimately diagnosed with PH. Subsequently, she underwent total right nephrectomy for RCC and was diagnosed with RCC stage 1 (pT1N0M0). A follow-up CT performed 4 months after nephrectomy showed no growth of PH. Although the development of PH in patients with CRF or RCC who do not undergo renal transplantation is extremely rare, it should be considered in the differential diagnosis to distinguish PH from the metastasis of RCC.
Collapse
Affiliation(s)
- Hiroki Maruyama
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Kazuya Takahashi
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan.
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Niigata, Japan.
| | - Natsuki Ishikawa
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Kazunori Hosaka
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Daisuke Kumaki
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Yukio Aruga
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Masashi Yamakawa
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Masaaki Hirano
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Kazuhiro Funakoshi
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Niigata, Japan
| |
Collapse
|
|
7
|
Abstract
OBJECTIVE To describe the MRI findings of the effects of exogenous sex steroids on the liver. FINDINGS Estrogens, progesterone and synthetic testosterone are exogenous sex steroids that may result in a variety of liver diseases, including tumour formation and vascular disorders. These hormones are mainly administered in the form of the oral contraceptive pill (OCP) and anabolic steroids. Both are implicated in hepatic adenoma formation. The HNF-1α-mutated and inflammatory adenoma subgroups are more commonly seen in association with the OCP whereas there is an increased incidence of the β-catenin positive subtype with anabolic steroid use. Furthermore, anabolic steroids are associated with hepatocellular carcinoma resulting from malignant transformation of β-catenin positive adenomas. The oral contraceptive pill may also induce vascular disorders within the liver, some of which are related to the prothrombotic effect of the hormones, such as hepatic and portal vein thrombosis. Other hepatic vascular abnormalities resulting from exogenous sex steroids include veno-occlusive disease and peliosis hepatis.
Collapse
|
|
8
|
Bleeding Liver Masses: Imaging Features With Pathologic Correlation and Impact on Management. AJR Am J Roentgenol 2019; 213:8-16. [PMID: 30973778 DOI: 10.2214/ajr.19.21240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE. The purposes of this article are to discuss a variety of liver masses that can present with hemorrhage, including their characteristic imaging features, and to propose a diagnostic approach. CONCLUSION. A broad spectrum of pathologic conditions can present as spontaneous hemorrhage within or surrounding the liver and may present acutely or as a chronic or incidental finding. Imaging characteristics and clinical history can often narrow the differential diagnosis and guide management.
Collapse
|
|
9
|
Tan CHN, Soon GST, Kow WCA. Liver lesions detected in a hepatitis B core total antibody-positive patient masquerading as hepatocellular carcinoma: a rare case of peliosis hepatis and a review of the literature. Ann Hepatobiliary Pancreat Surg 2017; 21:157-162. [PMID: 28990003 PMCID: PMC5620477 DOI: 10.14701/ahbps.2017.21.3.157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/01/2017] [Accepted: 03/04/2017] [Indexed: 12/24/2022] Open
Abstract
Peliosis Hepatis (PH) is a rare vascular disorder of the liver, characterized by the presence of cystic blood-filled cavities distributed throughout the hepatic parenchyma. The pathogenesis of PH remains controversial. The preoperative diagnosis of PH is difficult, due to the non-specific imaging characteristics of PH and almost all cases are diagnosed on histology post resection. This study presents a case of PH masquerading as hepatocellular carcinoma (HCC). The patient is a 45-year old Chinese lady, who presented with transaminitis. She was found to be hepatitis B virus core total antibody-positive with an alpha-fetoprotein (AFP) of 29.4 ng/ml. Triphasic liver computed tomography showed several arterial hypervascular lesions and hypoenhancing lesions on the venous phase, particularly in the segments 6/7. Subsequently, a magnetic resonance imaging scan showed multiple lesions in the right hemiliver with an indeterminate enhancement patterns. Subsequently, she decided to undergo a resection procedure. Histopathology revealed findings consistent with PH with some unusual features. This case demonstrates a clinical conundrum, in which PH presented with a raised AFP, in a patient with risk factors for the development of HCC. The clinical suspicion of PH should be high in patients, who present with multiple hepatic lesions with variable enhancement patterns.
Collapse
Affiliation(s)
- Chun Han Nigel Tan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | | | - Wei Chieh Alfred Kow
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| |
Collapse
|
|
10
|
Elsayes KM, Shaaban AM, Rothan SM, Javadi S, Madrazo BL, Castillo RP, Casillas VJ, Menias CO. A Comprehensive Approach to Hepatic Vascular Disease. Radiographics 2017; 37:813-836. [DOI: 10.1148/rg.2017160161] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Khaled M. Elsayes
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
| | - Akram M. Shaaban
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
| | - Sarah M. Rothan
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
| | - Sanaz Javadi
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
| | - Beatrice L. Madrazo
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
| | - Rosa P. Castillo
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
| | - Victor J. Casillas
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
| | - Christine O. Menias
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
| |
Collapse
|
|
11
|
Crocetti D, Palmieri A, Pedullà G, Pasta V, D’Orazi V, Grazi GL. Peliosis hepatis: Personal experience and literature review. World J Gastroenterol 2015; 21:13188-13194. [PMID: 26675327 PMCID: PMC4674738 DOI: 10.3748/wjg.v21.i46.13188] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 05/22/2015] [Accepted: 08/29/2015] [Indexed: 02/06/2023] Open
Abstract
Peliosis hepatis (PH) is a disease characterized by multiple and small, blood-filled cysts within the parenchymatous organs. PH is a very rare disease, more common in adults, and when it affects the liver, it comes to the surgeon's attention only in an extremely urgent situation after the lesion's rupture with the resulting hemoperitoneum. This report describes the case of a 29-year-old woman affected by recurring abdominal pain. Computed tomography scans showed a hepatic lesion formed by multiple hypodense areas, which showed an early acquisition of the contrast during the arterial phase. Furthermore, it remained isodense with the remaining parenchyma during the late venous phase. We decided on performing a liver resection of segment VII while avoiding a biopsy for safety reasons. The histopathologic examination confirmed the diagnosis of focal PH. PH should always be considered in the differential diagnosis of hepatic lesions. Clinicians should discuss the possible causes and issues related to the differential diagnosis in addition to the appropriate therapeutic approach. The fortuitous finding of a lesion, potentially compatible with PH, requires elective surgery with diagnostic and therapeutic intents. The main aim is to prevent the risk of a sudden bleeding that, in absence of properly equipped structures, may have a fatal outcome.
Collapse
|
|
12
|
Alessandrino F, Felisaz PF, La Fianza A. Peliosis hepatis associated with hereditary haemorrhagic telangiectasia. Gastroenterol Rep (Oxf) 2013; 1:203-6. [PMID: 24759967 PMCID: PMC3938001 DOI: 10.1093/gastro/got021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hereditary haemorrhagic telangiectasia (HHT) is an autosomal, predominantly inherited disease characterized by diffuse telangiectases involving the skin, mucous membranes, lung, brain, gastrointestinal tract and liver. Peliosis hepatis is a rare, benign disorder causing sinusoidal dilatation and the presence of multiple blood-filled lacunar spaces within the liver. We report a case of an HHT patient with incidental magnetic resonance findings of focal hepatic peliosis.
Collapse
Affiliation(s)
- F Alessandrino
- Foundation IRCCS, Policlinico San Matteo, Institute of Radiology, University of Pavia, Pavia, Italy
| | | | | |
Collapse
|
|
13
|
Duigenan S, Anupindi SA, Nimkin K. Imaging of multifocal hepatic lesions in pediatric patients. Pediatr Radiol 2012; 42:1155-68; quiz 1285. [PMID: 22565297 DOI: 10.1007/s00247-012-2400-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 02/25/2012] [Accepted: 03/05/2012] [Indexed: 02/08/2023]
Abstract
Imaging plays a vital role in detection and characterization of multifocal liver lesions in children. Numerous causes for these lesions exist, including benign and malignant neoplasms, infectious lesions, and congenital and inflammatory conditions. The imaging spectrum of multifocal liver lesions in children is presented with emphasis on key imaging features, differential diagnoses and helpful relevant clinical features.
Collapse
Affiliation(s)
- Shauna Duigenan
- Division of Pediatric Radiology, Massachusetts General Hospital, Boston, MA, USA.
| | | | | |
Collapse
|
|
14
|
[Solution to case 31. Peliosis hepatis]. RADIOLOGIA 2011; 53:376-8. [PMID: 21784237 DOI: 10.1016/j.rx.2010.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 05/12/2010] [Indexed: 12/30/2022]
|
|
15
|
Battal B, Kocaoglu M, Atay AA, Bulakbasi N. Multifocal peliosis hepatis: MR and diffusion-weighted MR-imaging findings of an atypical case. Ups J Med Sci 2010. [PMID: 20095924 PMCID: PMC2853794 DOI: 10.3109/03009730903262118] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Peliosis is a rare benign disorder that is characterized by the presence of diffuse blood-filled cystic spaces and can occur in the liver, spleen, bone-marrow, and lungs. We present a 10-year-old boy with Fanconi anemia who presented with peliosis hepatis due to androgen treatment. Magnetic resonance (MR) imaging revealed multiple non-enhancing masses. Some of the lesions revealed fluid-fluid levels and extrahepatic extension on MR images. Diffusion-weighted (DW) imaging showed restricted diffusion. Fluid-fluid levels and extrahepatic extensions are unusual findings for hepatic peliotic lesions. In addition, DW imaging findings of peliosis hepatis have not been reported previously.
Collapse
Affiliation(s)
- Bilal Battal
- Sarikamis Military Hospital, Department of Radiology, Sarikamis, Kars, Turkey.
| | | | | | | |
Collapse
|
|
16
|
Battal B, Kocaoglu M, Atay AA, Bulakbasi N. Multifocal peliosis hepatis: MR and diffusion-weighted MR-imaging findings of an atypical case. Ups J Med Sci 2010; 115:153-6. [PMID: 20095924 PMCID: PMC2853794 DOI: 10.1080/03009730903262118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Peliosis is a rare benign disorder that is characterized by the presence of diffuse blood-filled cystic spaces and can occur in the liver, spleen, bone-marrow, and lungs. We present a 10-year-old boy with Fanconi anemia who presented with peliosis hepatis due to androgen treatment. Magnetic resonance (MR) imaging revealed multiple non-enhancing masses. Some of the lesions revealed fluid-fluid levels and extrahepatic extension on MR images. Diffusion-weighted (DW) imaging showed restricted diffusion. Fluid-fluid levels and extrahepatic extensions are unusual findings for hepatic peliotic lesions. In addition, DW imaging findings of peliosis hepatis have not been reported previously.
Collapse
Affiliation(s)
- Bilal Battal
- Sarikamis Military Hospital, Department of Radiology, Sarikamis, Kars, Turkey.
| | | | | | | |
Collapse
|
|
17
|
Nougaret S, Aufort S, Ramos J, Pierredon MA, Delhom E, Colleau J, Ragu N, Gallix B, Bruel JM. [Hepatic peliosis: an entity to remember]. JOURNAL DE RADIOLOGIE 2009; 90:1745-1749. [PMID: 19953064 DOI: 10.1016/s0221-0363(09)73275-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- S Nougaret
- Service d'Imagerie Médicale, Hôpital St Eloi, CHU de Montpellier, Montpellier Cedex 5, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
18
|
Anderson SW, Kruskal JB, Kane RA. Benign hepatic tumors and iatrogenic pseudotumors. Radiographics 2009; 29:211-29. [PMID: 19168846 DOI: 10.1148/rg.291085099] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Myriad benign tumors may be found in the liver; they can be classified according to their cell of origin into tumors of hepatocellular, cholangiocellular, or mesenchymal origin. Common benign hepatic tumors may pose a diagnostic dilemma when they manifest with atypical imaging features. Less frequently encountered benign hepatic tumors such as inflammatory pseudotumor or biliary cystadenoma demonstrate less specific imaging features; however, awareness of their findings is useful in narrowing differential diagnostic considerations. In addition, certain iatrogenically induced abnormalities of the liver may be confused with more ominous findings such as infection or neoplasia. However, knowledge of their common imaging appearances, in addition to the clinical history, is critical in correctly diagnosing and characterizing iatrogenic abnormalities of the liver. Familiarity with both expected and unexpected imaging appearances of common benign hepatic tumors, less commonly encountered benign hepatic tumors, and iatrogenic abnormalities potentially masquerading as hepatic tumors allows the radiologist to achieve an informed differential diagnosis.
Collapse
Affiliation(s)
- Stephan W Anderson
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
| | | | | |
Collapse
|
|
19
|
Kim SH, Lee JM, Kim WH, Han JK, Lee JY, Choi BI. Focal peliosis hepatis as a mimicker of hepatic tumors: radiological-pathological correlation. J Comput Assist Tomogr 2007; 31:79-85. [PMID: 17259837 DOI: 10.1097/01.rct.0000232919.22287.20] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To retrospectively evaluate the radiological findings in patients with focal peliosis hepatis and to correlate them with pathological findings. METHODS Eight patients with pathologically proven peliosis hepatis underwent ultrasonography (n = 6), computed tomography (CT; n =8), and/or magnetic resonance imaging (MRI; n = 3). Two radiologists analyzed the images for the size, margin, echogenicity, presence of posterior acoustic enhancement, and enhancement pattern of the lesion. The enhancement patterns on CT or MRI were correlated with the pathological findings. RESULTS The average lesion size was 1.9 cm. On ultrasonography, 4 lesions were ill defined and low echoic compared with the hepatic parenchyma. Two lesions showed posterior acoustic enhancement. In 4 lesions, centripetal enhancement was observed on dynamic CT images. Two lesions showed homogeneously high and 2 showed persistently low enhancement patterns. On dynamic MR phases, 2 lesions showed strong and persistent enhancement. In 1 lesion, MR showed slow centripetal enhancement. In the 3 patients who showed a homogeneously high enhancement pattern on dynamic CT or MRI, microscopic examination demonstrated that the dilated sinusoids were filled with fresh blood cells. On the contrary, in 5 patients who showed a centripetal or persistently low enhancement pattern, their dilated sinusoids were filled with old stagnated blood. CONCLUSIONS Focal peliosis hepatis showed various enhancement patterns on contrast-enhanced CT and MRI, depending on the histopathologic findings.
Collapse
Affiliation(s)
- Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | | | | | | | | | | |
Collapse
|
|
20
|
Iannaccone R, Federle MP, Brancatelli G, Matsui O, Fishman EK, Narra VR, Grazioli L, McCarthy SM, Piacentini F, Maruzzelli L, Passariello R, Vilgrain V. Peliosis hepatis: spectrum of imaging findings. AJR Am J Roentgenol 2006; 187:W43-52. [PMID: 16794138 DOI: 10.2214/ajr.05.0167] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE It is important to recognize the imaging characteristics of peliosis hepatis because peliotic lesions may mimic several different types of focal hepatic lesions CONCLUSION We illustrate the spectrum of imaging findings of peliosis hepatis, including sonography, CT, MR, and angiography.
Collapse
Affiliation(s)
- Riccardo Iannaccone
- Department of Radiological Sciences, University of Rome, La Sapienza, 324 Viale Regina Elena, Rome, Italy 00161.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
21
|
Sandrasegaran K, Hawes DR, Matthew G. Hepatic peliosis (bacillary angiomatosis) in AIDS: CT findings. ACTA ACUST UNITED AC 2006; 30:738-40. [PMID: 16245016 DOI: 10.1007/s00261-005-0341-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Patients with acquired immunodeficiency syndrome are at risk of developing opportunistic infections and aggressive tumors. Computed tomographic examination is the usual method of evaluating the abdomen and pelvis in these patients. Although this technique is reasonably sensitive in detecting pathology, findings are often nonspecific. A case of hepatic peliosis (bacillary angiomatosis) in a patient with acquired immunodeficiency syndrome is presented.
Collapse
Affiliation(s)
- K Sandrasegaran
- Department of Radiology, Indiana University School of Medicine, 46202, USA.
| | | | | |
Collapse
|
|
22
|
Alobaidi M, Shirkhoda A. Benign focal liver lesions: discrimination from malignant mimickers. Curr Probl Diagn Radiol 2005; 33:239-53. [PMID: 15549050 DOI: 10.1067/j.cpradiol.2004.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Focal lesions of the liver often have various imaging characteristics which may be interpreted as either benign or malignant. Understanding the underlying pathophysiology of these liver lesions may lead to characteristic imaging manifestations, which direct the radiologist to the diagnosis. Benign lesions include congenital hepatic cyst, autosomal dominant polycystic disease, hemangioma, focal nodular hyperplasia (FNH), hepatic adenoma, inflammatory pseudotumor, peliosis hepatis, focal fatty infiltration, hamartoma, and infectious processes such as hepatic abscess, echinococcal cyst, and candidiasis. Characteristic imaging features, clinical symptoms, and treatment/prognosis will be discussed. Emphasis will be placed on key reliable features of each disease to develop a method of discriminating these lesions from other benign and malignant disorders.
Collapse
|
|
23
|
Hiorns MP, Rossi UG, Roebuck DJ. Peliosis hepatis causing inferior vena cava compression in a 3-year-old child. Pediatr Radiol 2005; 35:209-11. [PMID: 15448948 DOI: 10.1007/s00247-004-1311-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Accepted: 07/20/2004] [Indexed: 12/20/2022]
Abstract
Peliosis hepatis is a rare benign condition characterized by oval or irregular, multiple blood-filled spaces within the liver parenchyma. It is most commonly seen in adults and may be idiopathic, but has various associations including malignancy, infection and drugs. The imaging findings are often non-specific and the condition may be mistaken for multiple abscesses, metastases or vascular malformations. Peliosis hepatis is an especially rare condition in children and to our knowledge only six cases have been described in the literature. Our case describes and illustrates peliosis in a 3-year-old girl and is the first described in any age group to cause complete IVC obstruction. The patient subsequently made a full recovery.
Collapse
Affiliation(s)
- Melanie P Hiorns
- Department of Radiology, Great Ormond Street Children's NHS Trust, London, WC1N 3JH, UK.
| | | | | |
Collapse
|
|
24
|
Abstract
Although medical literature and differential diagnoses discussions tend to be organ specific, systemic diseases more commonly manifest with multi-organ involvement. Detection of dual organ involvement combined with clinical history narrows the differential to provide a more specific diagnosis. Two organs closely linked are the liver and the spleen. Many processes affect both of these organs through their common denominator, the reticuloendothelial system (RES). This pictorial essay reviews the wide spectrum of benign and malignant pathologies to be considered when computed tomography (CT) demonstrates concurrent focal disease in the liver and spleen.
Collapse
Affiliation(s)
- Marchelle J Bean
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 601 North Caroline Street, Room 3140 A, Baltimore, MD 21287, USA.
| | | | | |
Collapse
|
|
25
|
Abstract
Benign lesions of the liver represent diagnostic dilemmas, clinically and radiographically; however, certain clues can help the extensive differential diagnosis of both benign and malignant processes. Hemangiomas and simple cysts have very distinct and very specific radiographic characteristics, and if diagnosed, no further work-up is necessary. The remaining benign lesions have significant overlap, even though there are some more common characteristics to each of the entities. Still, differentiation of any particular lesion outside simple cysts or hemangioma may be difficult. It is reasonable and relatively simple, with minimal invasiveness, to perform US- or CT-guided, percutaneous core-needle biopsies. It is recommended that core biopsies be performed, because many of the benign entities have some overlapping histologic features, and if fine-needle aspirations are performed, a definitive diagnosis may be difficult to obtain. A definitive pathological diagnosis still cannot be made in some cases, even after needle biopsy. Therefore, a surgical resection or wedge resection may be necessary if a benign process cannot be definitively ruled out.
Collapse
Affiliation(s)
- John F Gibbs
- Department of Surgery, State University of New York at Buffalo, NY, USA.
| | | | | |
Collapse
|
|
26
|
Kleinig P, Davies RP, Maddern G, Kew J. Peliosis Hepatis: Central “Fast Surge” Ultrasound Enhancement and Multislice CT Appearances. Clin Radiol 2003; 58:995-8. [PMID: 14654034 DOI: 10.1016/s0009-9260(03)00141-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- P Kleinig
- Department of Radiology, North Western Adelaide Health Service, University of Adelaide, The Queen Elizabeth Hospital, South, Woodville South, Australia
| | | | | | | |
Collapse
|
|
27
|
Verswijvel G, Janssens F, Colla P, Mampaey S, Verhelst H, Van Eycken P, Erven W. Peliosis hepatis presenting as a multifocal hepatic pseudotumor: MR findings in two cases. Eur Radiol 2003; 13 Suppl 4:L40-4. [PMID: 15018164 DOI: 10.1007/s00330-003-1852-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Two cases of pseudotumoral peliosis hepatis are presented with emphasis on MRI findings. One patient had four individual lesions, the other had two. Image characteristics in both were: heterogeneic signal intensity on T1-weighted images (T1WI) with areas of high-, intermediate, and low signal intensity; heterogeneic signal intensity on T2WI with presence of numerous intralesional "cystic" hyperintense areas with a hypointense border. Signal intensities on T1WI were iso- to hypointense in one case and mild central hyperintensities were demonstrated in the other case, probably due to intra-lesional hemorrhage or diffuse accumulation of fresh clotting within the sinusoids. One case demonstrated early enhancement of the peripheral borders in the arterial phase, and both demonstrated enhancement in the portovenous and late phases. One case was studied with Gd-BOPTA and iron oxides and demonstrated enhancement with both products, suggestive for the presence of hepatocytes and Kupffer cells. This is the first report of the use of hepato-specific contrast agents in this entity. Spontaneous regression of the lesions was demonstrated on a follow-up MR examination in one case.
Collapse
Affiliation(s)
- G Verswijvel
- Department of Radiology, Ziekenhuis Oost Limburg, Campus St. Jan, Schiepse Bos 6, 3600 Genk, Belgium.
| | | | | | | | | | | | | |
Collapse
|
|
28
|
|