Atypically enhancing hepatic cavernous hemangiomas: high-spatial-resolution gadolinium-enhanced triphasic dynamic gradient-recalled-echo imaging findings

We retrospectively investigated the appearance and frequency of atypically enhancing cavernous hemangiomas with high-spatial-resolution (512x224 matrix) gadolinium-enhanced triphasic dynamic gradient-recalled-echo (GRE) MR images. Images of 132 hepatic cavernous hemangiomas (ranging in size from 4 to 72 mm; mean size 17.2 mm) in 95 patients (42 men and 53 women; age range 25-85 years; mean age 54 years) were retrospectively reviewed by two independent radiologists. Forty (30%) of 132 lesions atypically enhanced. Smaller hemangiomas (< or =15 mm) more frequently (29%) showed early entire enhancement with or without arterio-portal shunting in the hepatic arterial-dominant phase ( p<0.001); most of them showed hyperintense complete fill-in in the equilibrium phase and were readily characterized. "Bright dot" or minimal peripheral enhancement in the equilibrium phase was seen in a small number of lesions (6% each). With T2-weighted images, 130 (98%) lesions showed moderately to very high signal intensity and only 2 (2%) with minimal peripheral enhancement showed hyperintensity of slight degree. The high-spatial-resolution dynamic GRE images clearly revealed minute enhancement characteristics of hemangiomas. Although moderately to very high signal intensity with T2-weighted MR images is informative for the diagnosis of most cavernous hemangiomas, when a lesion shows minimal peripheral enhancement in the equilibrium phase and hyperintensity of slight degree with T2-weighted images, further follow-up or biopsy may be warranted to discriminate hypovascular metastases.