Small hepatocellular carcinoma and cavernous hemangioma: differentiation with dynamic FLASH MR imaging with Gd-DTPA

Forty patients with hepatocellular carcinoma (HCC) (n = 22) or cavernous hemangioma (diameter, 3 cm or less) (n = 18) were examined with serial magnetic resonance (MR) imaging at 1.5 T with the fast low-angle shot (FLASH) technique and an intravenously administered bolus injection of 0.05 mmol/kg Gd-DTPA. Two images per minute were obtained for 5 minutes, and one per minute thereafter until about 10 minutes. Dynamic MR studies revealed five criteria for differentiating these tumors. With HCC there was a hyperintense mass before contrast material enhancement (32%), peak contrast enhancement at about 10 seconds after injection (55%), slight to moderate peak contrast enhancement (73%), absent or minimal delayed enhancement (100%), and, at morphologic study, a capsule or nodules-in-nodule appearance (59%). With hemangioma there was a hypointense mass before contrast enhancement (72%), peak contrast enhancement more than 2 minutes after injection (72%), marked peak contrast enhancement (83%), moderate to marked delayed enhancement (100%), and, at morphologic study, spreading phenomenon (39%). Seventy-seven percent of HCCs and 83% of hemangiomas satisfied three or more criteria and thus could be differentiated from each other with certainty.