Diagnosis and Management of Giant Hepatic Hemangioma: The Usefulness of Contrast-Enhanced Ultrasonography

Abstract

Giant hepatic hemangiomas, though often asymptomatic, may require intervention if rapid growth occurs. The imaging studies including the computed tomography, magnetic resonance imaging, and ultrasonography, and so on are effective for the diagnosis and the management of this tumor; however, due to its size and various patterns of these studies, we need to carefully consider the therapeutic methods. Compared to the cost needed for these modalities, recently developed and approved Perflubutane- (Sonazoid-) based contrast agent enhanced ultrasonography is reasonable and safe. The major advantage is the real-time observation of the vascular structure and function of the Kupffer cells. By this procedure, we can carefully follow the tumor growth or character change in a hemangioma and decide the timing of therapeutic intervention, since abdominal pain, abdominal mass, consumptive coagulopathy, and hemangioma growth are the signs for the therapeutic intervention. We reviewed recent reports about Sonazoid-based enhancement and also showed the representative images collected in our department. This is the first review showing the detailed findings of the giant hemangiomas using Perflubutane (Sonazoid). This review will help the physician in making the decision, and we hope that Sonazoid will gain widespread acceptance in the near future.

Laparoscopic treatment of a large pedunculated hemangioma of the liver: a case report

“…A new contrast agent, the Perflubutane, has recently introduced in Japan, with the result of more detailed CEUS imaging compared to the conventional contrast agents currently in use in Europe. The Perflubutane CEUS seems to show real-time images more detailed compared to the CT or MRI images (13). The typical CT pattern is a hypodense, well bound lesion, showing peripheral enhancement during the arterial phase of the contrast injection and a progressive centripetal filling in the late phases.…”

Enhanced Ultrasonography Using a Nano/Microbubble Contrast Agent for Islet Transplantation

“…(E) The increase in the echogenicity in the Tx group was more prominent at POD 56 than at POD 14. was used to detect liver tumors in animal models (24,25) and in the clinic (26). Currently, the second-generation contrast agent, Sonazoid 1 (NC100100), is widely used to detect many types of gastroenterological tumor (27)(28)(29)(30).…”

Outcomes of ultrasound-guided percutaneous microwave ablation versus surgical resection for symptomatic large hepatic hemangiomas

“…On an enhanced CT, a hepatic hemangioma shows a characteristic pattern, and the presence of a tumor is represented clearly, showing a nodular peripheral puddling pattern in the early phase and a fill-in pattern subsequently. The MRI features involving hepatic hemangiomas have been reported to be typically of low signal intensity and are well defined on T1-weighted images, and of very high intensity in T2weighted images [24]. The number, size and location of the hemangiomas were determined prior to treatment.…”