Hemangiomas: Key Questions and Diagnostic Approaches

Q: Hemangiomas: Key Questions and Diagnostic Approaches

(1) The normal value for alpha-fetoprotein (AFP) varies depending on the reagents used by different machines, with early values being less than 20. <br>Currently, our hospital's normal value is less than 10, so there is no standardized data. <br>(2) Angiography is quite helpful i

Hemangioma

Dear Dr.
Yang,
Thank you for your previous response, which has greatly reassured me.
I would like to ask for your assistance once again regarding the following questions:
1.
My recent Alpha-Fetoprotein (AFP) level was 8.31, with a normal range being <6.
Could you clarify what this means?
2.
Is it appropriate to undergo an invasive procedure like angiography at this time?
3.
I have heard that Magnetic Resonance Imaging (MRI) is more effective than a CT scan in distinguishing between a benign hemangioma and other malignant tumors.
When would a physician typically arrange for an MRI? Would this be out-of-pocket, and is it advisable? (I understand that no imaging test can provide a definitive diagnosis, but I would appreciate your guidance.)
4.
How does a CT scan differentiate a hemangioma? Is it solely based on the presence of a single blood vessel, or are there other distinguishing features?
5.
If I wait three months for a follow-up examination, could a 2.5 cm benign hemangioma potentially worsen during that time?
Thank you for your assistance.

LL, 30~39 year old female. Ask Date: 2002/07/29

Dr. Yang Peizhen reply Gastroenterology and Hepatology

(1) The normal value for alpha-fetoprotein (AFP) varies depending on the reagents used by different machines, with early values being less than 20.
Currently, our hospital's normal value is less than 10, so there is no standardized data.
(2) Angiography is quite helpful in differentiating between benign and malignant tumors, but it is not 100% accurate.
Unless the typical characteristics of various tumor types are observed, a definitive diagnosis cannot be made, only a suspicion.
The principle behind this is that malignant tumors require a higher blood flow to supply the nutrients necessary for their growth, leading to the formation of many small new blood vessels.
As the tumor grows larger, these vessels become more apparent and can be seen supplying the malignant tumor during angiography.
In contrast, benign liver tumors (such as hemangiomas) typically do not exhibit such imaging characteristics.
(3) Magnetic resonance imaging (MRI) is often very sensitive and accurate for diagnosing benign hemangiomas.
Therefore, if a computed tomography (CT) scan cannot confirm whether it is a liver hemangioma, the next step may be to consider an MRI, as MRI does not involve radiation like CT scans and is less painful than angiography.
If the physician deems it necessary, the National Health Insurance will cover the costs.
(4) The tissue structure of liver hemangiomas consists of many small blood vessel tissues, mostly small veins, unlike malignant liver tumors, which primarily contain small arteries.
Therefore, during a CT scan, once the contrast agent is injected into the blood vessels and delivered to the liver via the hepatic artery, malignant tumors quickly eliminate this contrast agent, resulting in a dark shadow on the imaging.
In contrast, benign hemangiomas retain the contrast agent for a longer duration, creating a bright shadow on the imaging, which is a typical representation of liver hemangiomas.
However, some liver hemangiomas do not present such typical imaging characteristics, making precise diagnosis challenging.
(5) Benign hemangiomas typically do not grow, while malignant liver tumors do grow, but the rate varies from person to person.
Therefore, there is no definitive conclusion on how often to follow up; it mainly depends on whether the initial diagnosis leans more towards benign or malignant.
If the likelihood of benignity is higher, a follow-up every three months is usually sufficient.
However, if benignity cannot be confirmed, close monitoring is necessary, generally every 1 to 2 months, and if any changes occur, further examination or surgical intervention should be promptly undertaken.

Reply Date: 2002/07/29

More Info

Understanding hemangiomas, particularly in the context of your recent medical evaluations, involves a few key aspects that can help clarify your concerns. Hemangiomas are benign tumors made up of blood vessels, and while they are generally not harmful, monitoring and diagnostic approaches are crucial to ensure they do not pose any health risks.

1. Alpha-fetoprotein (AFP) Levels: Your AFP level of 8.31 is slightly elevated, as the normal range is typically considered to be less than 6. Elevated AFP can be associated with liver conditions, including hepatocellular carcinoma, but it can also be elevated in benign conditions such as liver hemangiomas. It’s important to interpret these results in conjunction with imaging studies and clinical findings.

2. Invasive Imaging Techniques: The suggestion to undergo blood vessel imaging (angiography) can be appropriate, especially if there is uncertainty regarding the nature of the lesion. Angiography can provide detailed information about the blood supply to the tumor, which can help differentiate between benign and malignant lesions. However, it is an invasive procedure, and the decision to proceed should consider the risks versus the potential benefits. If your physician believes that the imaging will significantly alter management or provide clarity, it may be warranted.

3. MRI vs. CT Scans: Magnetic Resonance Imaging (MRI) is indeed more sensitive than CT scans for characterizing liver lesions, including hemangiomas. MRI can provide clearer images of soft tissue and vascular structures without the exposure to ionizing radiation that comes with CT scans. If your doctor feels that an MRI is necessary, it is often covered by insurance if deemed medically necessary. Discuss with your physician when they would consider scheduling an MRI based on your clinical situation.

4. Differentiating Hemangiomas on CT: On a CT scan, hemangiomas typically appear as well-defined lesions that enhance with contrast due to their vascular nature. They often show a characteristic "light" appearance because they retain contrast longer than surrounding liver tissue. The presence of multiple small blood vessels can be seen, but it is not solely about the number of vessels; the pattern of enhancement and the lesion's morphology are crucial for diagnosis.

5. Monitoring and Follow-Up: The recommendation to follow up in three months is standard for benign lesions like hemangiomas, especially if they are small and asymptomatic. While it is understandable to be concerned about potential delays in diagnosis, most benign hemangiomas do not grow rapidly or transform into malignant tumors. However, if there are any changes in symptoms or if the lesion appears to grow significantly, earlier follow-up may be warranted. Regular monitoring is essential to ensure that any changes are detected promptly.

In conclusion, while your current situation regarding the hemangioma and elevated AFP levels may seem concerning, it is important to remember that many hemangiomas remain stable and do not require aggressive treatment. Regular follow-up with imaging and clinical evaluation is key to managing your health. Always feel free to discuss any concerns or questions with your healthcare provider, as they can provide personalized advice based on your specific medical history and current findings.

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