hypervaskularisierte Leberläsionen
Riesenhämangiom
der Leber: Obere Reihe (axial, koronar, sagittal) arterielle Kontrastmittelphase, unten portalvenös. Man erkennt gut die zunehmende Auffüllung von peripher nach zentral. Daneben bzw. ventral davon noch eine ähnlich große Zyste ohne Kontrastmittelaufnahme. Koronar links eine weitere kleine Zyste.
Metastasen
eines Nierenzellkarzinoms im Magen und in der Leber. Die arterielle Kontrastmittelphase zeigt die Hyperperfusion. Es fanden sich multiple weitere Metastasen an anderen Stellen.
Teenager with
a liver lesion. The diagnosis was focal nodular hyperplasia.
Choriocarcinoma
• Choriocarcinoma liver metastases - Ganzer Fall bei Radiopaedia
Hypervascular
liver lesions • Liver metastases from lung primary - Ganzer Fall bei Radiopaedia
Hypervascular
liver lesions • Hepatocellular carcinoma - Ganzer Fall bei Radiopaedia
Hypervascular
liver lesions • Hepatic carcinoid - Ganzer Fall bei Radiopaedia
Hypervascular
liver lesions • Focal nodular hyperplasia - with embolization - Ganzer Fall bei Radiopaedia
Hypervascular
liver lesions • Hypervascular hepatic metastases of renal cell cancer (CEUS) - Ganzer Fall bei Radiopaedia
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)
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. hemangioma which does not show wash out). The primaries typically include:
- renal cell carcinoma (RCC)
- thyroid carcinoma
- neuroendocrine tumors
- leiomyosarcoma
- choriocarcinoma
- melanoma
- breast cancer
- colonic carcinoma
- ovarian cystadenocarcinoma
Other secondary lesions
- failing Fontan circulation
See also
Siehe auch:
- Leberhämangiom
- Regeneratknoten der Leber
- Schilddrüsenkarzinom
- Karzinoid
- hepatozelluläres Karzinom
- Leiomyosarkom
- Chorionkarzinom
- Phäochromozytom
- Lebermetastasen
- noduläre regenerative Hyperplasie
- Leberadenom
- Insulinom
- Fokale noduläre Hyperplasie
- Angiomyolipom der Leber
- liver lesions
- hypervascular hepatic metastases
- Lebermetastasen bei Mammakarzinom
- Lebermetastasen bei Nierenzellkarzinom
- Leber Primovist FNH
- hepatic carcinoid metastasis
- Lebermetastasen malignes Melanom
- bile duct adenoma
- hyperdense Leberläsionen
und weiter:
Assoziationen und Differentialdiagnosen zu hypervaskularisierte Leberläsionen: