Table 3 MR imaging of vascular tumors of different malignancy
Vascular tumors | ||||
|---|---|---|---|---|
Hemangioma (infantile/congenital) | Tufted angioma/kaposiform hemangioendothelioma | Epitheloid hemangioendothelioma | Angiosarcoma | |
MRI morphology | Solid, frequently homogeneous well-defined mass | Diffuse infiltrating mass permeating all soft tissue structures | Solid mass with ill-defined margins | Diffuse inhomogeneous mass, infiltrating all tissue types |
MRI signal | ||||
T1 pre-contrast | Isointense to muscle | Isointense to muscle | Isointense to muscle | Isointense to muscle |
T2 (to be performed with fat saturation) | Hyperintense to muscle | Hyperintense to muscle, septal architecture perpendicular to the skin, often with edema | Moderate hyperintense to muscle | Hyperintense to muscle |
Fat-saturated T1 post-contrast | Hyperintense to muscle and flow-voids | Hyperintense to muscle, septal enhancement | Moderate hyperintense to muscle | Hyperintense to muscle (central necrosis frequent) |
MRI flow-characteristics | ||||
MR-angiography | Fast-flow, tumor blush | Fast flow, tumor blush | Slow flow | Slow-flow |
Imaging differential diagnosis | Venous (in case of slow flow hemangioma) or arteriovenous malformation (in case of fast-flow), KHE, macular stains/capillary malformation, soft tissue sarcoma | Hemangioma, soft tissue sarcoma, extraosseus Ewing sarcoma, kaposiform lymphangiomatosis | Hemangioma (such as epitheloid hemangioma), HCC (in case of liver manifestation), lymphoma (in case of lymphatic manifestation), sarcoma | Can mimic any malignant highly vascularized tumor (breast, soft tissue, bone, visceral, head, and neck), intravascular angiosarcoma can resemble thrombosis or atheroma |