Abstract: Objective To explore and analyze the imaging and clinical features of hepatic angiosarcoma (HA), so as to improve the understanding of this disease and accumulate diagnostic experience. Methods A retrospective analysis was performed on the imaging and clinical data of 23 patients with hepatic angiosarcoma who were hospitalized in Fifth Medical Center of Chinese PLA General Hospital from March 2018 to October 2025, with the diagnosis confirmed by surgical pathology and liver biopsy. The chief complaints, gender and age, laboratory test results, imaging findings and other clinical information of the patients were summarized and sorted out. Results Among the 23 patients with HA, 14 were male and 9 were female, aged from 20 to 88 years old. Their chief complaints at admission included a detection of liver lesions during physical examination, abdominal distension or abdominal pain, and abnormal liver function. Most of the laboratory test results showed no obvious abnormalities or only mild abnormalities. The majority of patients had no concurrent viral hepatitis, with only 2 cases being positive for hepatitis B. In addition, 6 cases presented with mild elevation of CA199, and 10 cases had elevated CA125. Of the 23 lesions, 1 was cystic-solid, 1 was cystic, and the rest were solid. Only 2 patients had a single intrahepatic lesion located in the right lobe of the liver, while the remaining 21 patients had multiple intrahepatic lesions. The maximum diameter of the intrahepatic lesions ranged from 1.2 cm to 17.7 cm, with an average of approximately 7.9 cm. On ultrasonography, the lesions were predominantly characterized by heterogeneous echoes, with visible peripheral vascular signals. Liver MRI revealed that only 2 cases had solitary intrahepatic lesions located in the right hepatic lobe, whereas the remaining 21 cases presented with multiple intrahepatic lesions. Contrast-enhanced scans mostly showed progressive enhancement: the lesions exhibited mild to moderate heterogeneous enhancement or rim enhancement in the arterial phase, and in both the portal venous phase and delayed phase, the lesions presented as isointense or slightly hyperintense signals. Conclusion HA predominantly occurs in middle-aged and elderly males. Its clinical manifestations and laboratory test results are mostly non-specific. The main imaging feature is multiple intrahepatic lesions, presenting heterogeneous echoes and progressive enhancement. The diagnosis of this disease needs to be made by combining imaging findings with clinical data. When the diagnosis is difficult, pathological results are required for confirmation.

Key words: Liver, Magnetic resonance imaging, Hepatic angiosarcoma, Ultrasound, Tomography