Hypervascular liver lesions

Hypervascular liver lesions may be caused by primary liver pathology or metastatic disease.

Differential diagnosis

Primary lesions
  • hepatocellular carcinoma (HCC)
    • most common hypervascular primary liver malignancy
    • early arterial phase enhancement and then rapid wash out
    • rim enhancement of capsule may persist
  • hemangioma
    • benign; most common liver tumor overall
    • discontinuous, nodular, peripheral enhancement starting in arterial phase
    • gradual central filling in
    • enhancement must match blood pool in each phase, or not a hemangioma (i.e. similar to aorta in arterial, portal vein in portal phase, etc)
    • small hemangiomas (<1.5 cm) may demonstrate "flash filling" - complete homogeneous enhancement in arterial phase (no gradual filling in)
  • focal nodular hyperplasia (FNH)
    • bright arterial phase enhancement except central scar
    • isodense/isointense to liver on portal venous phase
    • central scar enhancement on delayed phase
  • hepatic adenoma
    • arterial phase: transient homogeneous enhancement
    • returns to near isodensity on portal venous and delayed phase image
  • primary hepatic carcinoid
  • background liver disease (cirrhosis) 6

Although the majority of liver metastases are hypodense and enhance less than the surrounding liver, metastases from certain primaries demonstrate an increase in the number of vessels, resulting in a hyperechoic ultrasound appearance, and arterial phase hyperenhancement on CT or MRI which washes out on delayed scan (c.f. hemangioma which does not show wash out). The primaries typically include:

Other secondary lesions

See also

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Article information

rID: 1480
Section: Gamuts
Synonyms or Alternate Spellings:
  • Hypervascular hepatic lesions

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Cases and figures

  • Liver metastases ...
    Case 1: metastasis from lung cancer
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  • t = 0
    Case 2: hepatocellular carcinoma
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  • Case 3: hepatic carcinoid
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  • Case 4: FNH - embolization
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  • Case 5: FNH - embolization
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  • Case 6: focal nodular hyperplasia
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