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Angiographic classification of hepatic hemangiomas in infants
Ara Kassarjian1, Josée Dubois, Patricia E Burrows
1Department of Radiology, Children's Hospital, Boston, MA, USA. akassarjian@hotmail.com
Insights
Infantile hepatic hemangiomas show varied angiographic appearances, leading to a proposed classification system. This research highlights the heterogeneity of these vascular liver lesions in infants.
Area of Science:
- Pediatric Radiology
- Vascular Malformations
- Medical Imaging
Background:
- Infantile hepatic hemangiomas are common benign vascular tumors in infants.
- Their variable presentation can complicate diagnosis and management.
- Angiographic findings are crucial for characterizing these lesions.
Purpose of the Study:
- To review angiograms of infants with hepatic hemangiomas.
- To identify variability in angiographic findings.
- To propose a classification system for hepatic hemangiomas based on these findings.
Main Methods:
- Retrospective review of angiograms from 15 infants with hepatic hemangiomas.
- Classification of hemangiomas based on features like high-flow nodules and direct shunts.
- Correlation of angiographic findings with clinical data.
Main Results:
- A five-type classification system was developed based on angiographic features.
- Type 1: Classic hemangioma (3 patients).
- Type 2: High-flow nodules (4 patients).
- Types 3-5: Direct shunts (arteriovenous, portovenous, or both) (8 patients).
Conclusions:
- Infantile hepatic hemangioma is a heterogeneous vascular lesion.
- Angiographic findings demonstrate a spectrum of angioarchitecture.
- A new classification system aids in understanding this variability.
Purpose:
To review the angiograms in patients with hepatic hemangiomas referred to two North American children's hospitals to determine the variability in angiographic findings and to propose a classification system that is based on these findings.
Materials And Methods:
Angiograms obtained in 15 infants with a diagnosis of hepatic hemangioma who were examined at or referred to two tertiary pediatric hospitals in North America from 1981 through 2000 were reviewed. The angiographic findings were then used to classify hemangiomas into types on the basis of a number of features, including high-flow nodules, early filling of veins, and the type of direct shunt present. Clinical data, including age at presentation, presence of cardiac insufficiency, and treatment, were also recorded.
Results:
Lesions were classified into five types on the basis of angiographic findings. In three of 15 patients, angiograms demonstrated the classic appearance of hepatic hemangiomas, with early filling of abnormal vascular channels, stagnation of contrast material, and no evidence of a direct shunt (type 1). In four patients, images showed high-flow nodules without direct shunts (type 2). In eight patients, direct shunts were demonstrated: arteriovenous shunts (type 3) in one, portovenous shunts (type 4) in three, and both arteriovenous and portovenous shunts (type 5) in four.
Conclusion:
Hepatic hemangioma in infants is a heterogeneous lesion with variable angioarchitecture and a spectrum of angiographic findings.