Which of the following is the best enhancement pattern description for an infantile hepatic hemangioma?

Question:

	1. Rapidly enhancing dysplastic blood vessels with early filling of hepatic and portal veins.
	2. Predominately cystic mass with enhancing septa and stromal components.
	3. Heterogeneous enhancement pattern.
	4. Tends to hypoenhance relative to adjacent normal liver.
	5. Early peripheral nodular enhancement with progressive centripetal fill-in on delayed images.

Answer:

The correct answer for the question "Which of the following is the best enhancement pattern description for an infantile hepatic hemangioma?" is:

5. Early peripheral nodular enhancement with progressive centripetal fill-in on delayed images.

Explanation
A. This description best fits an arteriovenous malformation (AVM). [AVMs appear as a tangle of abnormal blood vessels on CT and MR with rapid arterial enhancement and early draining veins on postcontrast imaging.]
B. This description best fits a mesenchymal hamartoma. [It has a distinctly different imaging appearance to that of a hepatic AVM, in that it is a relatively avascular lesion comprised of numerous cysts and solid stromal components. Stromal components will enhance following contrast administration.]
C. This description best fits a hepatoblastoma. [Heterogeneous enhancement is also typical by both CT and MRI.]
D. This description best fits hepatic neuroblastoma metastases. [Post contrast CT and MR imaging appearance is variable, but neuroblastoma metastases tend to hypoenhance relative to adjacent liver in a heterogeneous fashion.]
E. This is the typical enhancement pattern of an infantile hepatic hemangioma. [Enhanced CT and MR images show distinctive early peripheral nodular enhancement with progressive centripetal fill-in on delayed images.]

From the manuscript:
Transarterial Embolization of a Hepatic Arteriovenous Malformation in an Infant Using Onyx: A Case Report and Review of the Differential Diagnosis Imaging Findings
Radiology Case. 2014 Aug; 8(8):33-42

This article belongs to the Interventional section.

From the manuscript

Transarterial Embolization of a Hepatic Arteriovenous Malformation in an Infant Using Onyx: A Case Report and Review of the Differential Diagnosis Imaging Findings

Free full text article: Transarterial Embolization of a Hepatic Arteriovenous Malformation in an Infant Using Onyx: A Case Report and Review of the Differential Diagnosis Imaging Findings

Abstract
Hepatic arteriovenous malformations are rare congenital lesions associated with significant morbidity and mortality, most commonly from high output cardiac failure. Efficient diagnosis and treatment demands an interdisciplinary approach, and the interventional radiologist plays a pivotal role in both. Imaging is important for diagnostic accuracy and treatment planning, and transcatheter embolization has become an established primary therapy. We report the clinical and imaging findings of a rare hepatic arteriovenous malformation in an infant presenting with high-output cardiac failure and pulmonary artery hypertension that was successfully treated by transarterial embolization using Onyx.

References

1. Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg 1982; 69:412-422