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      Ressonância magnética dos hemangiomas hepáticos: avaliação das características morfológicas e quantitativas Translated title: Magnetic resonance imaging of hepatic hemangiomas: morphologic and quantitative characteristics

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          Abstract

          OBJETIVO: Estudar as características morfológicas e quantitativas dos hemangiomas hepáticos na ressonância magnética. MATERIAL E MÉTODOS: Foram estudados, prospectivamente, 57 hemangiomas hepáticos presentes em 27 pacientes, com ressonância magnética de alto campo (1,5 T) utilizando seqüência spin-eco, imagens ponderadas em T1 e T2, com tempos de eco de até 160 ms. Foram avaliadas as características morfológicas dos hemangiomas, classificando-os em típicos ou atípicos. Também foram avaliadas características quantitativas das lesões (relação intensidade de sinal lesão/fígado, valores de tempo de relaxação T2 e índice simplificado T2) e feitas comparações entre tais características nos hemangiomas morfologicamente típicos e atípicos, e naqueles com dimensões <FONT FACE=Symbol>£</FONT> 2,0 cm e > 2,0 cm. RESULTADOS: Do total de hemangiomas estudados, 78,9% apresentaram características morfológicas típicas. Não houve diferença significante entre as características quantitativas de hemangiomas morfologicamente típicos e atípicos. Hemangiomas com dimensões <FONT FACE=Symbol>£</FONT> 2,0 cm e > 2,0 cm apresentaram comportamento semelhante em relação ao tempo de relaxação T2 e ao índice simplificado T2. Valores da relação intensidade de sinal lesão/fígado apresentaram diferenças significantes entre esses dois grupos. Os valores do tempo de relaxação T2, do índice simplificado T2 e da relação intensidade de sinal lesão/fígado caracterizaram corretamente 96,5%, 93% e 89,5% de todos os hemangiomas, respectivamente. CONCLUSÃO: A avaliação quantitativa dos hemangiomas hepáticos nas imagens por ressonância magnética é um método simples e, conjuntamente com a análise morfológica, propicia maior confiança para o diagnóstico.

          Translated abstract

          OBJECTIVE: To evaluate the qualitative (morphological) and quantitative characteristics of hepatic hemangiomas with magnetic resonance imaging. MATERIAL AND METHODS: Twenty-seven patients with 57 hemangiomas were prospectively studied with magnetic resonance imaging using a system operating at 1.5 T. T1- and T2-weighted spin-echo images were obtained, including heavily T2-weighted images with TE of 160 ms. The morphological characteristics of the hemangiomas were studied and the lesions were classified as typical or atypical. Quantitative parameters (T2 relaxation time, simplified T2 index and lesion/liver signal intensity ratio) were also calculated. The values obtained for typical and atypical hemangiomas were compared as well as for the hemangiomas measuring <FONT FACE=Symbol>£</FONT> 2.0 cm and > 2.0 cm. RESULTS: 78.9% of hemangiomas showed typical morphological features. There was no difference between the quantitative values for typical and atypical hemangiomas. There was not significant difference in T2 relaxation times and values of simplified T2 index in hemangiomas measuring <FONT FACE=Symbol>£</FONT> 2.0 cm and > 2.0 cm. Lesion/liver signal intensity ratios showed significant differences between the two groups. T2 relaxation times, the simplified T2 index and the lesion/liver signal intensity ratios correctly characterized 96.5%, 93%, and 89.5% of the hemangiomas, respectively. CONCLUSION: Quantitative analysis of hepatic hemangiomas is a simple technique that in conjunction with morphological evaluation provides a more reliable characterization of these tumors.

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          Benign hepatic tumours and tumour like conditions in men.

          In a consecutive medicolegal necropsy series benign hepatic tumours and tumour like conditions occurred in 52% of the 95 men aged 35-69 years. The incidence increased with age, mainly due to small bile duct tumours (n = 26; mean age 56.7 years; p less than 0.01; mean size 1.3 mm). The next most common tumours were cavernous hemangiomas (n = 19; mean age 53.9 years; mean size 5.2 mm) that were not related to age. Focal nodular hyperplasia (n = 3; mean size 8.0 mm) tended to occur in a younger age group (mean age 40.3 years; p less than 0.001). Multiple bile duct tumours were present in 46% and hemangiomas in 50% of the men studied. Liver cell adenoma, nodular regenerative hyperplasia, and peliosis hepatis were incidental findings (one case of each). Nodular regenerative hyperplasia was associated with the consumption of alcohol and a total dose of 21.5 g of testosterone. These results indicate that benign hepatic tumours and tumour like conditions are not rare in men but may remain undetected because of their small size.
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            Hepatic metastases and cavernous hemangiomas: distinction with standard- and triple-dose gadoteridol-enhanced MR imaging.

            To determine if hepatic metastases can be distinguished from cavernous hemangiomas by pattern analysis of magnetic resonance (MR) images obtained prior to and following administration of gadoteridol at standard (0.1 mmol/kg) and triple (0.3 mmol/kg) doses. Ninety-five patients with proved hepatic metastases (n = 71) or cavernous hemangiomas (n = 24) underwent MR imaging at 16 different institutions. T2-weighted spin-echo and T1-weighted images were obtained before and after gadoteridol administration. Two independent blinded reviewers rated individual features of benignancy versus malignancy on a five-point confidence scale. The most useful diagnostic features, with 100% specificity, were nodular enhancement for hemangiomas and rim enhancement for metastases. Confident (definitely benign or definitely malignant) diagnoses were rendered in 80 of 95 cases (84%), with an accuracy of a confident diagnosis of 96%. The pattern of enhancement on T1-weighted images is highly accurate for distinction between hemangiomas and metastases in images obtained with both doses.
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              Hemangioma of the liver: heterogeneous appearance on T2-weighted images.

              We reviewed the gross photographs of 19 patients with hemangioma of the liver. On cut sections, all 19 tumors were inhomogeneous. In 17 cases (89%) there were areas of predominantly central fibrosis. Lobulations were present in 10 cases (53%). Areas of thrombosis (nine cases), calcification (four cases), and hemorrhage (four cases) were also present. We also reviewed 15 hemangiomas of the liver in 12 patients studied by MR imaging. Gross photographs and MR scans were available in three hemangiomas, thus allowing direct radiologic-pathologic correlation. Twelve (80%) of the hemangiomas were inhomogeneous on T2-weighted images and three (20%) were homogeneous. Other characteristics were sharp margins in all 15 cases (100%), lobulations in 11 cases (73%), peripheral location in 10 cases (67%), and internal septations in four cases (27%). We concluded that (1) hemangiomas of the liver are frequently inhomogeneous on cut sections; (2) heterogeneity in T2 images is commonly seen and should not exclude hemangioma; and (3) other signs, such as sharp margins, lobulated contour, and peripheral location, may be helpful in the MR diagnosis of hemangioma of the liver.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rb
                Radiologia Brasileira
                Radiol Bras
                Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (São Paulo )
                1678-7099
                January 2003
                : 36
                : 1
                : 01-09
                Affiliations
                [1 ] Universidade Federal de São Paulo Brazil
                Article
                S0100-39842003000100004
                10.1590/S0100-39842003000100004
                6c707612-88cb-469d-97f1-fde1d20857a3

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0100-3984&lng=en
                Categories
                RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

                Radiology & Imaging
                Liver,Hemangioma,Magnetic resonance imaging,Fígado,Ressonância magnética
                Radiology & Imaging
                Liver, Hemangioma, Magnetic resonance imaging, Fígado, Ressonância magnética

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