Hepatic cavernous hemangiomas: simple diagnostic sign with dynamic bolus CT

Many hepatic hemangiomas are discovered incidentally during incremental dynamic bolus computed tomography (CT). To meet the established criteria for diagnosis with CT, however, a second CT examination with single-level dynamic bolus imaging is necessary. A prospective evaluation was performed to examine a simple sign that may be used to diagnose cavernous hemangiomas during incremental dynamic bolus CT. This sign is the visualization of foci of globular enhancement within the hemangioma, analogous to areas of puddling of contrast material seen at angiography. A total of 34 lesions in 21 patients demonstrated foci of globular enhancement. Of the 34 lesions, 32 (94%) proved to be hemangiomas. All 21 patients underwent confirmatory evaluation. Foci of globular enhancement seen during dynamic bolus CT are a strong indication that the lesion is a cavernous hemangioma. This diagnostic sign may obviate further, more expensive imaging studies.