The radiology of cavernous hemangioma of the liver

This article reviews the epidemiology, pathology, and diagnosis of cavernous hemangioma of the liver. This lesion is very common; it is the most common benign tumor of the liver. While small hemangiomas (less than 3 cm) have a characteristic ultrasonographic appearance, lesions larger than 3 cm in diameter may have a whole host of ultrasonic findings and this technique becomes less reliable in making the diagnosis. Initial experience with dynamic CT has shown it to be reliable in differentiating hemangiomas from other lesions. Later, some metastatic lesions were described to mimic hemangiomas on CT. Furthermore, a diagnostic CT is hard to get in small lesions because of the difficulty in getting a small lesion in the scanning plane repeatedly. Blood pool scintigraphy with planar imaging has been shown to be very sensitive and specific for that lesion. This technique is not very reliable for small (less than 2 cm) or deeply seated lesions. We have shown that blood scintigraphy is more reliable for those situations. Recent reports have shown that MRI is highly reliable for the detection and characterization of liver hemangiomas. This technology is very expensive and is unlikely to be used in evaluating all patients suspected of having cavernous hemangiomas; it should be reserved for cases with uncharacteristic ultrasound or blood pool scan findings.