Korean J Radiol.  2015 Jun;16(3):566-574. 10.3348/kjr.2015.16.3.566.

Computed Tomography and Magnetic Resonance Imaging Findings of Nasal Cavity Hemangiomas According to Histological Type

• Kim JH
• Park SW
• Kim SC
• Lim MK
• Jang TY
• Kim YJ
• Kang YH
• Lee HY

• KMID: 2155526
• DOI: http://doi.org/10.3348/kjr.2015.16.3.566

Abstract

OBJECTIVE
To compare computed tomography (CT) and magnetic resonance imaging (MRI) findings between two histological types of nasal hemangiomas (cavernous hemangioma and capillary or lobular capillary hemangioma).
MATERIALS AND METHODS
CT (n = 20; six pre-contrast; 20 post-enhancement) and MRI (n = 7) images from 23 patients (16 men and seven women; mean age, 43 years; range, 13-73 years) with a pathologically diagnosed nasal cavity hemangioma (17 capillary and lobular capillary hemangiomas and six cavernous hemangiomas) were reviewed, focusing on lesion location, size, origin, contour, enhancement pattern, attenuation or signal intensity (SI), and bony changes.
RESULTS
The 17 capillary and lobular hemangiomas averaged 13 mm (range, 4-37 mm) in size, and most (n = 13) were round. Fourteen capillary hemangiomas had marked or moderate early phase enhancement on CT, which dissipated during the delayed phase. Four capillary hemangiomas on MRI showed marked enhancement. Bony changes were usually not seen on CT or MRI (seen on five cases, 29.4%). Half of the lesions (2/4) had low SI on T1-weighted MRI images and heterogeneously high SI with signal voids on T2-weighted images. The six cavernous hemangiomas were larger than the capillary type (mean, 20.5 mm; range, 10-39 mm) and most had lobulating contours (n = 4), with characteristic enhancement patterns (three centripetal and three multifocal nodular), bony remodeling (n = 4, 66.7%), and mild to moderate heterogeneous enhancement during the early and delayed phases.
CONCLUSION
CT and MRI findings are different between the two histological types of nasal hemangiomas, particularly in the enhancement pattern and size, which can assist in preoperative diagnosis and planning of surgical tumor excision.

Keyword

Sinonasal hemangioma; Capillary hemangioma; Lobular capillary hemangioma; Pyogenic granuloma; Cavernous hemangioma; CT and MR

MeSH Terms

Adolescent
Adult
Aged
Female
Hemangioma, Capillary/*radiography
Hemangioma, Cavernous/diagnosis/*radiography
Humans
*Magnetic Resonance Imaging
Male
Middle Aged
Nasal Cavity/radiography
Paranasal Sinuses/*radiography
Retrospective Studies
*Tomography, X-Ray Computed
Young Adult

Figure

• 

  Fig. 1 Computed tomography (CT) image of 59-year-old woman who presented with nasal congestion. Right nasal tumor was diagnosed as lobular capillary hemangioma. A. Axial early-phase enhanced CT image reveals well-defined round mass with marked enhancement in right anterior nasal cavity (white arrow). B. Coronal delayed-phase enhanced CT image shows dissipation of tumor enhancement. Tumor reveals mild enhancement without adjacent bony changes (black arrow).

• 

  Fig. 2 Computed tomography (CT) and magnetic resonance images of 34-year-old man with right nasal tumor diagnosed as cavernous hemangioma. A. Early-phase CT image shows mild heterogeneous enhancing tumor (arrow) in right middle meatus. B. Tumor has mild heterogeneous enhancement on coronal delayed-phase image (arrow). Coronal CT image shows erosion of right middle turbinate and lateral nasal wall. C. Mass has heterogeneous high and low signal intensity on T2-weighted axial image (arrow). D. Mass appears with iso-signal intensity (arrow) on pre-contrast T1-weighted axial image. High signal intensity area on tumor margin of T1-weighted image suggests thrombus or thick mucus retention. E. Mass has partial heterogeneous mild enhancement (arrow) on post-contrast T1-weighted axial image.

• 

  Fig. 3 Magnetic resonance imaging (MRI) of 31-year-old woman who presented with recurrent right nasal hemorrhage and nasal congestion. Nasal tumor was histologically diagnosed as capillary hemangioma. A. Axial T1-weighted image reveals lobulating contoured mass in right anterior nasal cavity and middle meatus (white arrow). Mass has low signal intensity on T1-weighted image. Peritumoral cystic region in tumor periphery has low signal intensity on T1-weighted image (empty arrowhead). B. Right nasal mass has heterogeneously high signal intensity (large arrow) on axial T2-weighted image. There are irregular signal voids within mass (small arrows). Peritumoral cystic region has high signal intensity on T2-weighted image (empty arrowhead). C. Axial T1-weighted contrast-enhanced MRI shows markedly enhanced mass (white arrow) displacing right middle turbinate and deviating nasal septum leftward. Peritumoral cystic region exhibits no contrast enhancement (empty arrowhead).

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