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Published on: August 31, 2022
Peliosis hepatis presenting as a multifocal hepatic pseudotumor: MR findings in two cases
G Verswijvel1, F Janssens, P Colla
1Department of Radiology, Ziekenhuis Oost Limburg, Campus St. Jan, Schiepse Bos 6, 3600 Genk, Belgium. geert_verswijvel@hotmail.com
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.
Insights
This study highlights MRI findings in two pseudotumoral peliosis hepatis cases, noting unique lesion characteristics and contrast enhancement patterns. One case showed spontaneous regression on follow-up MRI.
Area of Science:
- Radiology and Medical Imaging
- Hepatology and Gastroenterology
Background:
- Peliosis hepatis is a rare vascular liver condition characterized by blood-filled cystic spaces.
- Pseudotumoral peliosis hepatis presents as focal lesions mimicking tumors, posing diagnostic challenges.
Observation:
- Two cases of pseudotumoral peliosis hepatis were analyzed using magnetic resonance imaging (MRI).
- Lesions exhibited heterogeneous signal intensity on T1-weighted images (T1WI) and T2-weighted images (T2WI).
- Distinctive findings included numerous intralesional hyperintense areas with hypointense borders on T2WI.
Findings:
- MRI revealed heterogeneic signal intensities on T1WI and T2WI, with areas of varying signal.
- Enhancement patterns included peripheral border enhancement in the arterial phase and enhancement in portovenous and late phases.
- The use of hepatobiliary contrast agents (Gd-BOPTA, iron oxides) demonstrated enhancement, suggesting the presence of hepatocytes and Kupffer cells.
Implications:
- MRI is crucial for characterizing pseudotumoral peliosis hepatis, differentiating it from other liver lesions.
- The study reports the first use of hepatobiliary contrast agents in peliosis hepatis, aiding in cellular component assessment.
- Spontaneous regression observed in one case suggests a dynamic nature of the condition, potentially impacting management strategies.
