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Imaging findings of hemorrhagic hepatic cysts with enhancing mural nodules

Shigeshi Kohno1, Shigeki Arizono2, Hiroyoshi Isoda2

  • 1Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan. shigeshi@kuhp.kyoto-u.ac.jp.

Abdominal Radiology (New York)
|January 22, 2019
PubMed

Insights

Radiological findings like decreasing cyst size, centrifugal enhancement, T2 hypointense rim, and wall calcification suggest hemorrhagic hepatic cysts with mural nodules.

Area of Science:

  • Radiology
  • Hepatology
  • Pathology

Background:

  • Hemorrhagic hepatic cysts can present with complex imaging features.
  • Distinguishing these from other cystic liver lesions is clinically important.

Purpose of the Study:

  • To evaluate the clinical and radiological characteristics of hemorrhagic hepatic cysts featuring enhancing mural nodules.

Main Methods:

  • Retrospective review of radiology databases from five institutions.
  • Identification and analysis of cases with hemorrhagic hepatic cysts and enhancing mural nodules, confirmed by imaging or pathology.

Main Results:

  • 14 cases (11 female, 3 male; mean age 72.6 years) were analyzed.
  • Cysts decreased in size over >3 years prior to nodule detection in 10 cases.
  • Enhancing mural nodules (≥10 mm) showed focal early and progressive centrifugal enhancement on CT/MRI.
  • MRI revealed hypointense rim/central hyperintensity on T2-weighted images in 13/14 nodules.
  • All cases had cyst wall calcification; no intense FDG uptake on PET/CT.
  • Histopathology of nodules showed neovascularization within organized hematoma, including hemangioma-like lesions.

Conclusions:

  • A combination of decreasing cyst size, centrifugal enhancement patterns, specific MRI signal characteristics (T2 hypointense rim), and cyst wall calcification can suggest hemorrhagic hepatic cysts.
  • These findings aid in differentiating these lesions from other hepatic cystic tumors.
Abstract

Keywords:
Computed tomographyCystic liver lesionHemorrhagic hepatic cystIntracystic hemorrhageMagnetic resonance imagingOrganized hematoma

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