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Magnetic resonance imaging features such as confluent peripheral nodules and capsular retraction suggest HEHE, whereas a large dominant mass with satellites and heterogeneity suggest PHA.
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Specific MRI features, including nodule characteristics, contrast enhancement patterns, and ADC values, can assist in the differential diagnosis of rare hepatic mesenchymal tumors.
BACKGROUND: Primary Hepatic Epithelioid Haemangioendothelioma (HEHE) and Primary Hepatic Angiosarcoma (PHA) are rare mesenchymal tumours with different malignant potential. Whereas HEHE demonstrates low to intermediate malignant potential, PHA is an aggressive malignancy with poor prognosis. The knowledge of typical imaging features of these lesions may facilitate correct diagnosis; however, the ultimate diagnosis of HEHE and PHA is based on histopathologic examination. DISCUSSION: The most typical findings helpful in diagnosing HEHE are: Presence of multiple, confluent nodules located at the liver periphery (in young to middle-aged woman), retraction of the liver capsule, marked hyperintensity on T2-weighted images, "target-sign" appearance, progressive centripetal contrast enhancement, and relatively high Apparent Diffusion Coefficient (ADC) values. More than ≥50% of nodules are hyper- or isointense on Hepatobiliary Phase (HBP) images. CONCLUSION: The imaging features suggestive of PHA are: Occurrence of metastases (lungs, spleen) at the time of diagnosis, presence of a large dominant mass with smaller satellites, heterogeneity and areas of haemorrhage in a dominant mass, progressive contrast enhancement, slightly elevated ADC values as compared to other malignant liver tumours.
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Cieszanowski et al. (2018) conducted a review in Primary Hepatic Epithelioid Haemangioendothelioma (HEHE) and Primary Hepatic Angiosarcoma (PHA). Magnetic Resonance Imaging was evaluated. Magnetic resonance imaging features such as confluent peripheral nodules and capsular retraction suggest HEHE, whereas a large dominant mass with satellites and heterogeneity suggest PHA.
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