Hypervascular liver lesions

Changed by Yahya Baba, 14 Jan 2021

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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
haemangioma
- benign; most common liver tumour overall
- discontinuous, nodular, peripheral enhancement starting in arterial phase
- gradual central filling in
- enhancement must match blood pool in each phase, or not a haemangioma (i.e. similar to aorta in arterial, portal vein in portal phase, etc)
- small haemangiomas (<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
- vascular shunts
  - intrahepatic arterioportal shunt
  - intrahepatic arteriovenous shunt
- regenerative nodules
- dysplastic nodules
- hepatocellular carcinoma

Metastases

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. haemangioma which does not show wash out). The primaries typically include:

Other secondary lesions

failing Fontan circulation ³

~~-<li>vascular shunts</li>~~
+<li>vascular shunts<ul>
+<li><a title="Intrahepatic arterioportal shunt" href="/articles/intrahepatic-arterioportal-shunt">intrahepatic arterioportal shunt</a></li>
+<li><a title="Intrahepatic arteriovenous shunt" href="/articles/intrahepatic-arteriovenous-shunt">intrahepatic arteriovenous shunt</a></li>
+</ul>
+</li>

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