Contrast-enhanced ultrasound of histologically proven liver hemangiomas

Abstract

Differentiation of small and atypical hemangiomas from other hepatic masses using imaging methods can be difficult, especially in patients with underlying malignant disease. Therefore, contrast-enhanced ultrasound was assessed in patients with histologically confirmed hemangiomas with respect to contrast-enhancing kinetics and tumor characteristics. In 58 patients with indeterminate hepatic lesions demonstrated with at least 2 imaging methods (ultrasound/computed tomography/magnetic resonance imaging), ultrasound-guided liver biopsy revealed hemangioma. In all patients a hepatic neoplasm had been suspected because of underlying malignant disease (n ‫؍‬ 41), liver cirrhosis (n ‫؍‬ 15), or growth of the lesion (n ‫؍‬ 2). All patients underwent nonlinear, low mechanical index real-time contrast-enhanced ultrasound scanning with bolus injections of SonoVue. Peripheral nodular arterial enhancement was detected in 43 patients (74%), whereas the typical metastatic peripheral rim-like enhancement was not observed at all. Strong homogenous arterial enhancement was found in 9 of 58 (16%) patients. In 6 patients (10%), the arterial contrast enhancement pattern could not be determined because of the very small size of the lesions or fibrotic nodules. Forty-five (78%) of the hemangiomas showed homogenous centripetal filling within 180 seconds. Conclusion: Contrast-enhanced ultrasound demonstrates typical hemangioma imaging characteristics, that is, peripheral nodular contrast enhancement and iris-diaphragm sign in a high percentage of patients with undetermined lesions. This technique may therefore improve noninvasive functional characterization and differentiation of hemangiomas. (HEPATOLOGY 2007;45:1139-1145

Contrast‐enhanced ultrasound with SonoVue: Differentiation between benign and malignant focal liver lesions in 317 patients

“…This is in agreement with the results of other groups, who found peripheral globularnodular enhancement in 74-96% of hemangiomas. 32,35,36,39 The finding of early central starlike contrast enhancement is highly specific for FNH. Other groups found this type of enhancement in 88-100% of FNHs.…”

Cholangiocarcinoma in Cirrhosis: Value of Hepatocyte Specific Magnetic Resonance Imaging

“…Indeed, MRI is the imaging technique of choice to suggest ICC in cirrhosis by showing peripheral enhancement of the nodule during the arterial phase coupled with the absence of a global washout in the venous phase [2] , a finding however that increases the risk of misdiagnosis with such benign lesions, as hypervascular hemangioma and wash-in positive dysplastic hepatocellular macronodules [8,9] and that requires liver biopsy, whenever feasible, to obtain a conclusive diagnosis.…”

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

“…Considering all of the above, we can speculate that the 5 HCCs misdiagnosed by CEUS as hemangiomas, were well-differentiated and thus the wash-out was not visible during the 5 minutes of evaluation. Regarding the 4 hemangiomas misdiagnosed by CEUS as HCCs, we can speculate that a pseudo washout was observed due to hyperinsonation as showed in the German study [33,34], while the arterial inhomogeneous hyperenhancement observed in these cases can be explained by arterio-venous and/or portal venous shunts, known to be present in 10% of hemangiomas [37]. Also, rapidly filling hemangiomas, usually smaller than 3 cm can be encountered in patients with cirrhosis in up to 16-18% of cases [30,38,39] Previous studies demonstrated that CEUS accuracy for the characterization of FLL is comparable to that of contrast CT [40] and contrast MRI [41], and also that the use of CEUS as a first line imaging method when faced with a new FLL is cost-efficient [42,43].…”