Scintigraphic evaluation of liver masses: cavernous hepatic hemangioma

Hepatic cavernous hemangioma must be included in the differential diagnosis of any hepatic solid mass. It is the second most common neoplasm of the liver, following intrahepatic metastases. With the exception of giant or symptomatic HCH, it does not require specific intervention. The ability to diagnose HCH radiologically (Table 2) has significant clinical importance. When confronted with clinical data and a preliminary radiologic study suggestive of HCH, serial planar blood-pool scintigraphy (with SPECT if the lesion is < 3-4 cm) should probably be the initial diagnostic examination. In comparison to MRI, it is safer, less expensive and easier for some patients to tolerate. For small, deep seated lesions or those adjacent to the heart or large vessels, MRI is the preferred test. Dynamic CT is probably most useful in patients with normal renal function in whom optimal imaging of the extrahepatic abdomen is desired. If the etiology of an incidental hepatic mass suspected to be an HCH is still not evident after these studies, angiography or biopsy are the remaining options. As described, angiography is sensitive and relatively specific for HCH. Although percutaneous biopsy may be associated with increased risk of bleeding, fine-needle biopsy has been shown to be safe for hemangiomas. However, fine-needle biopsy is more useful for confirming a suspected malignancy than for actually diagnosing hemangioma.