A

Fig. 4.5a-f. Autosomal recessive polycystic kidney disease (ARPKD). a Pre-natal depiction of ARPKD. b Gross pathology of microcysts in ARPKD. c Hepatomegaly with ascites suggested on neonatal abdominal radiograph with overall deformity suggesting ARPKD. d Echogenic liver with a few cysts (arrows). e Longtitudinal left, f transverse bilaterally midpole. Echogenic, massively enlarged kidneys with "pepper and salt" pattern

Hemangiomas usually show as echogenic lesions on US; however, sometimes a lesion with heterogenous echogenicity or a hypoechoic lesion may correspond with a hemangioma (Fig. 4.6b,c). This variable echogenicity depends on the extent of vessels and thrombi inside the structure (Siegel 2001a). Besides the hepatic mass, a decrease in the aortic diameter distal to the hepatic artery with an increase in the diameter of the hepatic and celiac arteries will support the diagnosis. On color Doppler the lesion will show mixed arterial and venous flow with a high-frequency peak of systolic shift and high diastolic flow (Swischuk 2005).

On CT, a typical hemangioma will be seen as a mass with lower attenuation than the adjacent liver. After contrast injection it will show a peripheral enhancement followed by centripetal filling on late images. Some necrotic areas or calcifications might not enhance. More than 50% of hemangiomas will contain calcifications on CT.

On MRI hemangiomas will have low signal intensity on Tl-weighted sequences, and high signal intensity on T2-weighted sequences (Fig. 4.6d). Hemorrhage and hemosiderin deposition may be responsible for a heterogeneous signal pattern. Acute hemorrhage will have high signal intensity on Tl-weighted images while hemosiderin will depict low signal intensity. After contrast injection an enhancement pattern similar to that seen on enhanced CT occurs with central enhancement and uniform distribution to the periphery on delay images (Fig. 4.6e,f). Other findings include a small infrahepatic aorta with increase caliber of the celiac and hepatic arteries (Siegel 2001b; Fulcher and Sterling 2002; Mortele et al. 1998).

Angiographic evaluation can be performed if embolization is a consideration. On angiography the hepatic arteries will show an increased diameter with early fill of hepatic veins (Mortele 2002).

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