Atypical hepatic hemangiomas with intense arterial enhancement and early fading.

Background: Our purpose is to analyze the prevalence and characteristics of the enhancement patterns of hemangiomas. Methods: Fifty-five proven hemangiomas studied with a dynamic single-slice T1-weighted spoiled gradient echo sequence (50/13/65°) were retrospectively selected. Fifteen images of the tumor in 5 min were obtained after a bolus of gadolinium. A temporal planar reconstruction image was generated to analyze the dynamic evolution of a line of interest through the tumor. Results: Most hemangiomas (60%) had a typical progressive pattern with hyperintensity on late images. Of these, 34.6% had an intense enhancement pattern with the highest slope close to the arterial or portal phases of perfusion and 25.5% had a less intense enhancement with a more constant rate. In 10.9% of cases, the enhancement was slowly progressive with late isointensity and 7.3% had a very slow progressive pattern with late hypointensity; all had a globular peripheral initial enhancement pattern. There were 12 hemangiomas (21.8%) with intense arterial enhancement and early fading; eight of 12 (66.7%) showed peripheral globular enhancement, with all 12 hemangiomas remaining hyperintense to the liver at the end of the dynamic study. In four cases, the initial enhancement was diffuse throughout the entire lesion. Conclusions: Hemangiomas can have early intense enhancement with early fading and diffuse intense enhancement.