Hemangiomas and Other Vascular Tumors

There are several benign and malignant neoplasms which may arise from the vascular elements of liver parenchyma. These lesions include hemangiomas, epithelioid hemangioendotheliomas, and angiosarcomas. Despite overlapping imaging features, each of these lesions behaves differently and they have vastly different prognoses. Cavernous hemangiomas are extremely common and have a classic imaging appearance, which allows for confident radiologic diagnosis in most cases; however, a minority of lesions demonstrate atypical features and may therefore mimic other processes. In the vast majority of cases, treatment is not indicated. Epithelioid hemangioendothelioma may show a concentric ring or “target” appearance on contrast-enhanced CT/MR and when numerous may be indistinguishable from angiosarcoma except for having slower growth and less frequent extrahepatic disease. Biopsy may be required for diagnosis, and liver transplant is the most effective treatment. Angiosarcomas are variably enhancing, very aggressive tumors, which frequently present with metastatic disease. Treatment options are limited.