Liver Hemangiomas: When to Seek Further Imaging - Gastroenterology and Hepatology

Hepatic hemangioma

Hello, Dr.
Lin.
I would like to ask the following question.
I was diagnosed as a carrier of hepatitis B over a decade ago.
Therefore, I have been getting checked every six months to a year.
Currently, my AST and ALT levels, as well as alpha-fetoprotein, are all normal, but an ultrasound revealed a vascular tumor about one centimeter in size (the doctor mentioned it is not easy to detect).
I was advised to return for another check in three months.
However, I understand that it is difficult to differentiate between a vascular tumor and cancer through ultrasound.
Should I consider getting a CT scan instead, or does the doctor have other recommendations? Thank you.
A new father.

Pa ren sheng hei bai de ren, 30~39 year old female. Ask Date: 2005/09/18

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, this issue should be discussed with your physician.
Tumors can present in very typical ways, resembling hepatocellular carcinoma or hemangiomas.
If the distinction is not clear and there is a possibility of liver cancer, further imaging studies are necessary.
In cases of suspected liver tumors, if a CT scan does not provide a clear differentiation, angiography or a liver biopsy may be required for diagnosis.
This is aimed at achieving early diagnosis and early treatment.
Sincerely, Dr.
Lin Ming-Hui, Internal Medicine.

Reply Date: 2005/09/18

More Info

Hello! Thank you for your question regarding liver hemangiomas and the need for further imaging. It’s understandable to have concerns, especially given your history of hepatitis B and the recent discovery of a liver hemangioma.

Understanding Liver Hemangiomas
Liver hemangiomas are the most common benign tumors of the liver. They are composed of a mass of blood vessels and are often asymptomatic, meaning many people may not even know they have one unless it is discovered incidentally during imaging for another reason. The size of hemangiomas can vary, and while many remain stable over time, some may grow.

Diagnostic Imaging and Protocols
You mentioned that your ultrasound detected a 1 cm hemangioma, and your doctor recommended a follow-up in three months. This is a standard approach, as most hemangiomas do not require immediate intervention unless they are symptomatic or show significant growth.
Regarding your question about the dynamic liver triphasic imaging protocol, this is a specialized CT scan technique that captures images of the liver in three phases: the arterial phase, the portal venous phase, and the delayed phase. This method provides detailed information about the vascularity of liver lesions, which can help differentiate between hemangiomas, focal nodular hyperplasia (FNH), and malignant tumors. If your CT scan was not performed using this protocol, it may limit the ability to definitively characterize the lesion.

When to Seek Further Imaging
Given that your ultrasound indicated a hemangioma, and considering your normal liver function tests (GOT, GPT) and alpha-fetoprotein levels, it is likely that the hemangioma is benign. However, if there is any uncertainty or if the hemangioma grows significantly during your follow-up, further imaging such as a CT scan or MRI may be warranted.
MRI is particularly useful for characterizing liver lesions because it provides excellent soft tissue contrast and can help distinguish between different types of liver tumors. If your doctor feels that the ultrasound findings are inconclusive or if there are any changes in your condition, they may recommend an MRI for better visualization.

Growth Rate of Hemangiomas
As for the growth rate of hemangiomas, they can vary significantly from person to person. Some hemangiomas remain stable for years, while others may grow slowly over time. It is not uncommon for a hemangioma to be present for many years before it is detected. If you have had this hemangioma for a while without any changes, it is likely to remain stable.

Conclusion
In summary, while your current follow-up plan seems appropriate, it is essential to maintain open communication with your healthcare provider. If you have concerns about the accuracy of the ultrasound or the need for further imaging, do not hesitate to discuss this with your doctor. They can provide personalized advice based on your medical history and the specifics of your case. Regular monitoring is crucial, especially for individuals with a history of liver disease, and your proactive approach to your health is commendable.
If you have any further questions or need clarification, feel free to ask. Wishing you the best of health!

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