From the Guidelines
Contrast-enhanced MRI is the recommended imaging modality for diagnosing hemangiomas, particularly for hepatic hemangiomas, due to its high sensitivity and specificity, as well as its ability to provide excellent characterization of these benign vascular tumors. The use of MRI with extracellular gadolinium contrast has been shown to have a sensitivity of 93%, specificity of 99%, accuracy of 98%, PPV of 96%, and NPV of 99% for the diagnosis of hemangioma 1. This makes it a highly effective tool for diagnosing hemangiomas, especially when compared to other imaging modalities such as CT or ultrasound.
Key Points to Consider
- MRI with gadolinium contrast provides excellent characterization of hemangiomas by demonstrating their typical enhancement pattern: peripheral nodular enhancement in the arterial phase with progressive centripetal fill-in during later phases 1.
- Ultrasound can serve as an initial screening tool, where hemangiomas typically appear as well-defined hyperechoic lesions, but lacks the specificity of MRI.
- CT with contrast is an alternative when MRI is contraindicated, showing similar enhancement patterns but with less sensitivity and specificity.
- For cutaneous hemangiomas, clinical examination is often sufficient, but Doppler ultrasound may be used to confirm the diagnosis and assess blood flow.
- MRI is preferred over CT when possible because it avoids radiation exposure and provides superior soft tissue contrast, allowing better characterization of the lesion's vascular nature and relationship to surrounding structures.
Additional Considerations
- The American College of Radiology (ACR) Appropriateness Criteria recommend MRI as the initial imaging modality for characterizing liver lesions, including hemangiomas 1.
- The use of diffusion-weighted imaging (DWI) and hepatobiliary phase (HBP) imaging can also aid in the diagnosis of hemangiomas, with a reported accuracy of 95% to 99% for gadoxetate-enhanced MRI 1.
- In patients with uncertain diagnosis, ultrasonography may be used as an initial imaging modality, but MRI is often required for further characterization and diagnosis 1.
From the Research
Imaging Modalities for Diagnosing Hemangiomas
The diagnosis of hemangiomas, which are benign vascular tumors, can be facilitated by various imaging modalities. The choice of imaging technique depends on the location and size of the hemangioma, as well as the patient's overall health.
- For soft-tissue hemangiomas of the extremities, plain radiography is recommended as the initial imaging modality, followed by MRI if a deep hemangioma is suspected 2.
- Ultrasonography (US) may be useful in confirming the presence of a mass in doubtful cases or if MRI is unavailable 2.
- Computed Tomography (CT) offers no distinct advantage over the combined use of plain radiography and MRI for diagnosing soft-tissue hemangiomas 2.
- Angiography can demonstrate the pathognomonic features of soft-tissue hemangioma, but its invasiveness limits its use to patients undergoing surgical resection 2.
Hepatic Hemangiomas
For hepatic hemangiomas, which are the most common benign liver tumors, various imaging methods are used for diagnosis, including:
- MRI
- CT
- Ultrasonography (US)
- Tagged red blood cell scanning
These imaging modalities can help identify the typical and atypical features of hepatic hemangiomas, allowing for a correct diagnosis and avoiding diagnostic errors 3, 4.
Breast Hemangiomas
Breast hemangiomas are rare benign vascular tumors that can be diagnosed incidentally during imaging examinations. Mammography and sonography are useful in diagnosing breast hemangiomas, and core needle biopsy can be used to confirm the diagnosis 5.
Limitations of Color and Power Doppler Sonography
Color and power Doppler sonography have limited utility in diagnosing hepatic cavernous hemangiomas, as they often show no internal blood flow or only a peripheral flow pattern 6.