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Epithelioid hemangioendothelioma of the liver: The role of hepatobiliary phase imaging for the preoperative diagnosis and qualification of patients for liver transplantation – preliminary experience

Andrzej Cieszanowski, Ryszard Pacho, Agnieszka Anysz-Grodzicka, Barbara Gornicka, Piotr Remiszewski, Edyta Maj, Ireneusz P. Grudzinski, Krzysztof Zieniewicz, Urszula Oldakowska-Jedynak, Olgierd Rowinski, Marek Krawczyk

Ann Transplant 2013; 18:424-433

DOI: 10.12659/AOT.883997

Background: The aim of this study was to determine if the appearance of hepatic epithelioid hemangioendothelioma (HEHE) on state-of-the-art MRI including hepatocyte phase after administration of hepatobiliary contrast agent can facilitate preoperative diagnosis and identification of potential candidates for liver transplantation.
Material and Methods: The study group comprised 6 patients with pathologically confirmed HEHE. Analysis included signal characteristics of 55 tumor nodules (maximum of 10 lesions per patient) on T2-weighted images, dynamic contrast-enhanced, 5-minute delayed, and hepatobiliary phase images.
Results: The most common feature of HEHE, observed in 84% of lesions, was progressive contrast-enhancement, followed by subcapsular location (66%), confluent appearance (60%) and hyper- or isointensity on hepatobiliary phase images (53%). In 5 of 6 patients, capsular retraction was observed.
Conclusions: The appearance of HEHE on hepatobiliary phase images was variable, but examined tumors often demonstrated hyper- or isointensity, most probably due to prolonged retention of contrast material. These features, along with typical morphology (subcapsular, confluent nodules, with progressive enhancement and capsular retraction), may contribute to correct diagnosis and recognition of potential candidates for liver transplantation.

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