Focal peliosis hepatis as a mimicker of hepatic tumors: Radiological-pathological correlation

Objective: To retrospectively evaluate the radiological findings in patients with focal peliosis hepatis and to correlate them with pathological findings. Methods: Eight patients with pathologically proven peliosis hepatis underwent ultrasonography (n = 6), computed tomography (CT; n = 8), and/or magnetic resonance imaging (MRI; n = 3). Two radiologists analyzed the images for the size, margin, echogenicity, presence of posterior acoustic enhancement, and enhancement pattern of the lesion. The enhancement patterns on CT or MRI were correlated with the pathological findings. Results: The average lesion size was 1.9 cm. On ultrasonography, 4 lesions were ill defined and low echoic compared with the hepatic parenchyma. Two lesions showed posterior acoustic enhancement. In 4 lesions, centripetal enhancement was observed on dynamic CT images. Two lesions showed homogeneously high and 2 showed persistently low enhancement patterns. On dynamic MR phases, 2 lesions showed strong and persistent enhancement. In I lesion, MR showed slow centripetal enhancement. In the 3 patients who showed a homogeneously high enhancement pattern on dynamic CT or MRI, microscopic examination demonstrated that the dilated sinusoids were filled with fresh blood cells. On the contrary, in 5 patients who showed a centripetal or persistently low enhancement pattern, their dilated sinusoids were filled with old stagnated blood. Conclusions: Focal peliosis hepatis showed various enhancement patterns on contrast-enhanced CT and MRI, depending on the histopathologic findings.