Contrast enhanced ultrasound for the diagnosis of liver hemangiomas – results of a Romanian multicentre study

Abstract

Background and aim: Contrast enhanced ultrasound (CEUS) has been proven to be a reliable method for the characterization of focal liver lesions (FLL). The aim of this paper was to evaluate the performance of CEUS for the diagnosis of liver hemangiomas in a large cohort of patients. Material and method: We performed a multicentre prospective study which included successive CEUS examinations from fourteen centers from Romania. CEUS examinations were performed in de novo FLL, using low mechanical index ultrasound, following an intravenous bolus of 2.4 ml SonoVue. CEUS was considered conclusive for hemangioma if a typical pattern was present following contrast (centripetal fill in during the arterial phase, hyperenhanced lesion during venous and late phases). In all cases a reference method was available (contrast CT or MRI or biopsy). The trial was registered in clinicaltrials.gov (Identifier NCT01329458). Results: During February 2011 -May 2015, 1153 CEUS examinations were performed for the evaluation of de novo FLL. Out of the 1153 de novo FLL, 238 cases were diagnosed as hemangiomas by CEUS (typical enhancing pattern). Contrast CT/MRI and biopsy diagnosed additional 24 hemangiomas. From the 238 cases diagnosed as hemangiomas by CEUS, in 11 the final diagnosis was different. Considering contrast CT/MRI and biopsy as reference methods, CEUS had 90.4% sensitivity, 98.8% specificity, 95.4% positive predictive value, 97.4% negative predictive value, resulting in 96.9% diagnostic accuracy for the diagnosis of hemangiomas. Conclusion: CEUS is a sensitive and very specific method for the diagnosis of hemangiomas.

Differentiation of atypical hepatic hemangioma from liver metastases: Diagnostic performance of a novel type of color contrast enhanced ultrasound

“…On CEUS, the typical feature of liver hemangioma is peripheral nodular and centripetal enhancement during the arterial phase followed by hyper-or isoenhancement during the portal venous and late phases [4][5][6][7] . In contrast, the feature of liver metastases is complete or rim-like hyperenhancement during the arterial phase followed by hypoenhancement in the portal venous and late phase.…”

Atypical appearance of hepatic hemangiomas with contrast-enhanced ultrasound

“…However, when the features of the lesion are atypical at conventional ultrasound (US), further investigation is required. Contrast-enhanced ultrasound (CEUS) has been proven to be a reliable method for the characterization of the focal liver lesions [ 5 , 6 ], it is a sensitive and very specific method for the diagnosis of hemangiomas [ 7 ]. Based on the guidelines [ 8 ] and clinical experience, the typical CEUS features of hepatic hemangioma were peripheral nodular enhancement or circular enhancement in the arterial phase with centripedal filling, hyperechoic/ isoechoic change in the portal venous phase and late phase.…”

Contrast-Enhanced Ultrasound as a Main Radiological Diagnostic Method for Primary Liver Neoplasms and Hemangiomas

“…Ultrasound without contrast in most cases is not a reliable examination for focal liver lesions with the exception of simple liver cysts. A few years ago, the only other imaging methods were CT and MRI with contrast and Technetium-99m labeled studies [2]. In the study by Sirli et al involving 1153 patients with FLL, 238 cases of hemangioma were found using CEUS, and only 11 of them were misdiagnosed.…”

“…In contrast, focal fatty infiltrations of the liver can be seen in everyday practice [1]. Traditional ultrasound is not enough to diagnose focal liver lesions, except for cystic liver lesions, some hydatid cysts, and fatty liver lesions [2]. Contrast-enhanced ultrasound (CEUS), on the other hand, which is performed with sulfur hexafluoride microbubbles, is a real-time diagnostic method that helps make a reliable diagnosis for different liver lesions, based on contrast enhancement during arterial phase portal venous and late (sinusoidal) phase [3].…”