case studies

Liver Haemangioma

Patient History
A patient was referred for four phase CT Scan (spiral) of the liver to assess a large focal lesion in the right lobe of the liver detected by ultra-sound.

Methodology
10mm thick slices from the diaphragm through the liver pre contrast (fig 1). Then 10mm thick slices post contrast media at:

Arterial Phase (30 sec delay from start of injection).
Portal Venous Phase (70 sec delay from start of injection).
Equilibrium Phase (3 min delay from start of injection).
200mA, 120kVp, pitch of 1.5, with a 1 second scan time per rotation.

The patient was hyper-ventilated between and before scans for breath hold during spiral acquisition.
100mls of omnipaque 300 was pump injected using a pump injector at 3mls/second.

Result
There is a large well defined low density mass involving segments 5,6 and 7 of the right lobe of the liver. This mass shows peripheral enhancement by a large peripheral feeder vessel. In the later scans the lesion fills in a central fashion. There is a central non-enhancing region representing fibrotic scarring. The radiological features are those of a haemangioma of the liver.

Conclusion
A 4 phase CT scan is used to demonstrate whether a mass is a haemangioma. A haemangioma fills within contrast in a set manner. After 30 seconds the contrast media enhances the edges of the mass (fig 2), at 70secs this is more defined (fig 3), and at equilibrium the centre of the mass is highlighted (fig 4). Spiral CT scanning is fast and low invasive, allowing the liver to be scanned repeatedly in a short space of time to demonstrate the different contrast media phases within the liver.

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