Richard C Semelka1, Nadesan Nimojan1, Saman Chandana1, Miguel Ramalho2, Suzanne L Palmer3, Danielle DeMulder4, Carolina Parada Villavicencio5, John Woosley6, Bonnie L Garon3, Reena C Jha4, Frank H Miller5, Ersan Altun7. 1. Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA. 2. Department of Radiology, Hospital Garcia de Orta, EPE, Almada, Portugal. 3. Department of Radiology, University of South California, Los Angeles, CA, USA. 4. Department of Radiology, Georgetown University, Washington, DC, USA. 5. Department of Radiology, Northwestern University, Chicago, IL, USA. 6. Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 7. Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA. ersan_altun@med.unc.edu.
Abstract
PURPOSE: To determine if rare primary malignancies of the liver may have consistent features on magnetic resonance imaging (MRI). MATERIALS AND METHODS: This IRB-compliant retrospective study reviewed the records from the pathology departments of four university centres over an 11-year period from 2005-2016 to identify rare primary malignant tumours, which were cross-referenced with MRI records. MRI studies of these patients were reviewed to determine if these tumours exhibited consistent and distinctive features. RESULTS: Sixty patients were identified with rare primary liver tumours. The following distinctive features and frequency of occurrence were observed: mixed hepatocellular carcinoma-cholangiocarcinoma showed regions of wash-out in 7/19 of patients; 6/6 of fibrolamellar carcinomas demonstrated large heterogeneous lesions with large heterogeneous central scars; epithelioid haemangioendothelioma larger than 2 cm showed target-like enhancement in late-phase enhancement in 9/13; sarcomas excluding angiosarcoma had central necrosis in 3/9 and haemorrhage in 5/9; angiosarcomas showed centripedal progressive nodular enhancement in 3/6 and showed regions of haemorrhage in 3/6; and 7/7 of primary hepatic lymphomas showed encasement of vessels. CONCLUSION: Although helpful features for the differentiation of rare primary malignancies of the liver are identified, no MRI features appear to be specific and therefore histopathological confirmation is usually required for definitive diagnosis. KEY POINTS: • No MRI features appear to be specific for rare primary liver malignancies. • Haemorrhage is a helpful sign in diagnosis of primary hepatic sarcomas. • Angiosarcomas may show progressive nodular enhancement towards the centre mimicking haemangioma. • Vessel encasement is a helpful sign in diagnosis of primary hepatic lymphoma.
PURPOSE: To determine if rare primary malignancies of the liver may have consistent features on magnetic resonance imaging (MRI). MATERIALS AND METHODS: This IRB-compliant retrospective study reviewed the records from the pathology departments of four university centres over an 11-year period from 2005-2016 to identify rare primary malignant tumours, which were cross-referenced with MRI records. MRI studies of these patients were reviewed to determine if these tumours exhibited consistent and distinctive features. RESULTS: Sixty patients were identified with rare primary liver tumours. The following distinctive features and frequency of occurrence were observed: mixed hepatocellular carcinoma-cholangiocarcinoma showed regions of wash-out in 7/19 of patients; 6/6 of fibrolamellar carcinomas demonstrated large heterogeneous lesions with large heterogeneous central scars; epithelioid haemangioendothelioma larger than 2 cm showed target-like enhancement in late-phase enhancement in 9/13; sarcomas excluding angiosarcoma had central necrosis in 3/9 and haemorrhage in 5/9; angiosarcomas showed centripedal progressive nodular enhancement in 3/6 and showed regions of haemorrhage in 3/6; and 7/7 of primary hepatic lymphomas showed encasement of vessels. CONCLUSION: Although helpful features for the differentiation of rare primary malignancies of the liver are identified, no MRI features appear to be specific and therefore histopathological confirmation is usually required for definitive diagnosis. KEY POINTS: • No MRI features appear to be specific for rare primary liver malignancies. • Haemorrhage is a helpful sign in diagnosis of primary hepatic sarcomas. • Angiosarcomas may show progressive nodular enhancement towards the centre mimicking haemangioma. • Vessel encasement is a helpful sign in diagnosis of primary hepatic lymphoma.
Authors: Kathryn J Fowler; Arman Sheybani; Rex A Parker; Sean Doherty; Elizabeth M Brunt; William C Chapman; Christine O Menias Journal: AJR Am J Roentgenol Date: 2013-08 Impact factor: 3.959
Authors: Theodora A Potretzke; Benjamin R Tan; Maria B Doyle; Elizabeth M Brunt; Jay P Heiken; Kathryn J Fowler Journal: AJR Am J Roentgenol Date: 2016-02-11 Impact factor: 3.959
Authors: Basrull N Bhaludin; Khin Thway; Margaret Adejolu; Alexandra Renn; Christian Kelly-Morland; Cyril Fisher; Robin L Jones; Christina Messiou; Eleanor Moskovic Journal: Insights Imaging Date: 2021-12-18