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A 78-year-old man with newly diagnosed high-risk prostate cancer underwent 68Ga-PSMA PET/CT for primary staging. This showed a single, very intense PSMA uptake in the vertebral body of Th2, without discrete morphological changes on low-dose CT. Thus, the patient was considered oligometastatic and underwent MRI of the spine for stereotactic radiotherapy planning. MRI demonstrated an atypical hemangioma in Th2. A bone algorithm CT scan confirmed the MRI findings. The treatment was changed, and the patient underwent a prostatectomy with no concomitant therapy. At three and six months after the prostatectomy, the patient had an unmeasurable PSA level, confirming the benign etiology of the lesion. [ABSTRACT FROM AUTHOR]

A 78-year-old man with newly diagnosed high-risk prostate cancer underwent 68Ga-PSMA PET/CT for primary staging. This showed a single, very intense PSMA uptake in the vertebral body of Th2, without discrete morphological changes on low-dose CT. Thus, the patient was considered oligometastatic and underwent MRI of the spine for stereotactic radiotherapy planning. MRI demonstrated an atypical hemangioma in Th2. A bone algorithm CT scan confirmed the MRI findings. The treatment was changed, and the patient underwent a prostatectomy with no concomitant therapy. At three and six months after the prostatectomy, the patient had an unmeasurable PSA level, confirming the benign etiology of the lesion.

Background and Aim: To derive lessons from the data of patients who were followed for various periods with the misdiagnosis of liver hemangioma and eventually found to have a malignancy.Material and Methods: The records of 23 patients treated between 2003 and 2018 were analyzed retrospectively.Results: Twelve patients were men and 11 were women; median (range) age was 55 (35–80). The principal diagnostic modality for the initial diagnosis was ultrasonography (n:8), magnetic resonance imaging (MRI) (n:13), and computed tomography (CT) (n:2). At our institution, MRI was performed in 16 patients; the diagnosis was made with the available MRI and CT studies in five and two patients, respectively. In other words, the ultrasonography interpretations were not confirmed on MRI; in others, the MRI or CT examinations were of low quality or they had not been interpreted properly. Fifteen patients underwent surgery; the other patients received chemotherapy (n:6) or chemoembolization (n:2). The misdiagnosis caused a median (range) 10 (0–96) months delay in treatment. The final diagnoses were hepatocellular carcinoma in 12 patients, cholangiocarcinoma in four patients, metastatic mesenchymal tumor, metastasis of colon cancer, metastatic neuroendocrine carcinoma, sarcomatoid hepatocellular carcinoma, angiosarcoma, thoracic wall tumor, and metastatic tumor of unknown primary in one patient each.Conclusions: High-quality MRI with proper interpretation and judicious follow up are vital for the accurate differential diagnosis of liver lesions.

Cavernous hemangiomas are among the most common liver lesions encountered in abdominal imaging. While classical imaging characteristics usually aid the radiologist in confidently arriving at its diagnosis, atypical hemangiomas can prove to be difficult to distinguish from other more worrisome hepatic lesions such as metastases and hepatocellular carcinoma. Furthermore, some malignant lesions can display features that simulate hemangiomas. The radiologist must be aware of these pitfalls to make an accurate diagnosis, when possible. • A diagnosis of hemangioma is established by classical imaging characteristics. • Hemangiomas with atypical imaging features may present a diagnostic dilemma. • Malignant liver lesions may display imaging features that overlap with hemangiomas. [ABSTRACT FROM AUTHOR]

Hemangiomas are the most common benign tumors of the liver. These lesions are typically asymptomatic, solitary and almost always discovered incidentally, and in recent years with advances in imaging technology these lesions are being detected more frequently. Although, in majority of the cases, the imaging diagnosis of a liver hemangioma is clearly and confidently established, not all hemangiomas present with their characteristic or typical appearance on imaging. Occasionally, these lesions do present with an atypical pattern, and can be confused with other malignant lesions such as hepatocellular carcinoma, intrahepatic cholangiocarcinoma, mixed hepatocellular-cholangiocarcinoma and angiosarcoma. In this article, we review with illustrations the diverse imaging appearances of hemangiomas on the commonly used imaging modalities, as well as provide a gamut of common and uncommonly encountered hemangioma mimickers. Knowledge of the various atypical avatars of this benign lesion is important and can help one circumvent diagnostic errors, thereby potentially avoiding unnecessary surgeries. [ABSTRACT FROM AUTHOR]

Objective: Most vertebral hemangiomas contain high signal intensity on T1-weighted MRI images. Atypical vertebral hemangiomas, which are defined as showing low-signal intensity on T1-weighted images, have been described as lesions which are prone to aggressive behavior. This study was performed to assess behavior of atypical hemangiomas.Materials and Methods: Thoracic and lumbar spine MRI reports for the year 2012 were reviewed for diagnosis of atypical hemangioma. Images were reviewed by two independent observers, and cases which showed atypical vertebral hemangioma, and had imaging or clinical follow-up, were included in our study.Results: Thirty atypical hemangiomas which had follow-up data were identified out of 2784 thoracic and lumbar MR examinations performed during 2012 at a single institution. Imaging follow-up was available for 23 lesions (mean follow-up 32 months), while there was clinical follow-up for the remaining seven lesions (mean 43.6 months). Twenty-two lesions were stable on imaging, while one demonstrated significant growth over approximately 6 years, developing MRI signal characteristics of a typical hemangioma. Eleven lesions had CT scans showing typical features of hemangioma. Two of the index lesions could not be identified on follow-up CT examinations, which showed normal-appearing spines. The remaining seven lesions were followed clinically; none of the patients reported symptoms in the region of the index lesions.Conclusions: Atypical hemangiomas are uncommon lesions. The cases in our population did not show aggressive behavior. A more appropriate designation for these lesions may be lipid-poor hemangioma, to distinguish them from aggressive hemangiomas. [ABSTRACT FROM AUTHOR]

Hepatic hemangioma is the most common benign liver lesion in the general population. It often exhibits a uniform pattern of characteristics, thus being called "typical". However, a certain number of hepatic hemangiomas have special or uncommon characteristics and are termed "atypical." We report on a 47-year-old patient with an atypical hepatic hemangioma. A 47-year-old female patient with a history of chronic hepatitis C was admitted to the Gastroenterology clinic for further paraclinic exams and imagistic investigations. The physical examination showed spider nevi in the superior vena cava trajectory, sharp liver edge with firm consistency and 1st grade splenomegaly. The biological panel in this case showed mild thrombocytopenia, moderate hepatic cytolysis syndrome, hyperbilirubinemia, and AFP in normal values. Abdominal US showed an irregular liver contour and inhomogeneous structure. In the right hepatic lobe was detected a hepatic lesion, oval form with diameter 6,9 cm, inhomogeneous, hypo-echoic, delineated, irregular contour with posterior acoustic shadow. Portal vein=14 mm, spleen=14cm with venous dilatation. In CEUS the liver lesion presented peripheral enhancement in arterial phase. It presents continued "filling in" of the lesion in the late phase. Regarding to CEUS LI-RADS categories is CEUS LI-RADS 1, definitely benign. Superior digestive endoscopy was performed which shown 1st grade esophageal varices and a portal-hypertensive gastropathy mild form. The MRI findings shows in T1: Hypointense, T2: hyperintense. After contrast administration the lesion showed peripheral enhancement which progresses centripetally, uncompleted, without wash out in portal phase. The diagnostic based on the imaging findings was Hepatic Hemangioma. The patient has been supervised with abdominal US and AFP every 6 months. The last evaluation showed a hepatic stable formation, without modifications of the US characteristics. An atypical hepatic hemangioma performing a standard US in a cirrhotic patient requires differentiation from hepatic malignancies. The confirmation of the diagnostics asks for an investigation with contrast enhancement which most frequently is CEUS [ABSTRACT FROM AUTHOR]

Aim: To be able to differentiate benign vertebral bone marrow lesions from malign lesions according to apparent diffusion coefficient (ADC) values, enabling quantitative assessment, and to determine the sensitivity and the specificity in differentiating benign and malign lesions according to the optimal cutoff ADC value. Materials and methods: In 99 patients, 133 lesions in total were included in the study, 59 of which were benign (acute vertebral compression fracture depending on osteoporosis or trauma, spondylitis, atypical hemangioma), and 74 malign (malign compression fracture, metastasis). Each of the benign lesions was compared to the malign lesions. In the statistical analysis, normality tests, variance analysis tests, and the Tukey HSD multi-discriminant analysis tests were performed for all measurable variables. The optimal cutoff ADC value was determined by ROC analysis in the differentiation of benign and malignant lesions. Results: The mean ADC value of the benign induced acute compression fractures was significantly higher than that of the malign induced compression fractures, and the mean ADC value of the spondylitis atypical hemangiomas was significantly higher than that of the malign lesions (P < 0.0001). According to the optimal cutoff value of 1.32 x 10-3 mm2/s, determined for the differentiation of benign and malignant vertebral bone-marrow lesions, sensitivity was 96.5%, specificity 95.2%, positive predictive value 96.5%, and negative predictive value 95.2%. Conclusion: Vertebral bone-marrow pathologies were differentiated as benign or malignant with high sensitivity and specificity with the aid of ADC values calculated from maps obtained by DWI. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of the work was directed to evaluate the value of diffusion weighted Magnetic Resonance Imaging in diagnosis, characterization and differentiation of atypical hemangioma and malignant lesions of spine. Materials and methods: This study included three groups: group (A) 8 (33%) patients with metastatic bony lesions of spine, group (B) 6 (25%) patients with atypical hemangioma and group (C) 10 (42%) patients with typical hemangioma. All patients were presented with different degrees of back pain. MRI was done for all patients (including T1, T2, T2 fat suppression and DWI with IV contrast administration when needed). Complementary non contrast CT was also done. Results: Atypical hemangioma and malignant lesions were low in T1 and high in T2 WI. Restricted diffusion and low ADC values were seen in metastasis compared with atypical hemangioma. Complementary CT revealed the lytic nature of malignant lesions while in hemangiomas, it showed their characteristic striated appearance. Conclusion: Diffusion weighted Magnetic Resonance Imaging is a useful tool in diagnosis, characterization and differentiation of atypical hemangioma and metastasis of spine. [Copyright &y& Elsevier]

Background and Aim: To derive lessons from the data of patients who were followed for various periods with the misdiagnosis of liver hemangioma and eventually found to have a malignancy. Material and Methods: The records of 23 patients treated between 2003 and 2018 were analyzed retrospectively. Results: Twelve patients were men and 11 were women; median (range) age was 55 (35-80). The principal diagnostic modality for the initial diagnosis was ultrasonography ( n :8), magnetic resonance imaging (MRI) ( n :13), and computed tomography (CT) ( n :2). At our institution, MRI was performed in 16 patients; the diagnosis was made with the available MRI and CT studies in five and two patients, respectively. In other words, the ultrasonography interpretations were not confirmed on MRI; in others, the MRI or CT examinations were of low quality or they had not been interpreted properly. Fifteen patients underwent surgery; the other patients received chemotherapy ( n :6) or chemoembolization ( n :2). The misdiagnosis caused a median (range) 10 (0-96) months delay in treatment. The final diagnoses were hepatocellular carcinoma in 12 patients, cholangiocarcinoma in four patients, metastatic mesenchymal tumor, metastasis of colon cancer, metastatic neuroendocrine carcinoma, sarcomatoid hepatocellular carcinoma, angiosarcoma, thoracic wall tumor, and metastatic tumor of unknown primary in one patient each. Conclusions: High-quality MRI with proper interpretation and judicious follow up are vital for the accurate differential diagnosis of liver lesions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Yıldırım, Şahiner, Poyanlı, Acunaş, Güllüoǧlu, İbiş, Tekant and Özden.)