Four branching patterns of intrahepatic biliary tree in cases with right sided ligamentum teres

Abstract

Introduction: Hepatic hemangioma has incidence of 0.4% e 20% in general population and conventional ultrasound is often the first diagnostic method, normally as an incidental finding. Second generation contrast-enhanced ultrasound (CEUS) has been used in several areas of hepatology, with similar results on computed tomography and magnetic resonance imaging (MRI) in the diagnosis of hepatic hemangiomas. Objective: Correlation between the perflutren CEUS and MRI in the diagnosis of hepatic hemangiomas. Method: A prospective analysis of 37 patients with 57 nodules identified as incidental findings of routine ultrasound. In 37 patients, was administered perflutren contrast with no adverse effects. The 37 patients underwent MRI. Results: Conventional ultrasound identified nodules in 15 patients with typical characteristics of hemangiomas and 22 patients with nodules with other characteristics. In 35 patients the perflutren CEUS characteristics were compatible with hemangiomas. Correlation between ultrasound and MRI with contrast was 94.5%, and in discordant cases the diagnosis was made by MRI. In nodules with indeterminate characteristics on perflutren CEUS, MRI was repeated in three months, confirming the diagnosis of hepatic hemangioma. In the case with nodule suggestive of malignancy on perflutren CEUS we performed biopsy and confirmed the diagnostic of hepatic hemangioma. The ultrasound contrast advantages of greater access to population and lower costs in relation to MRI. Conclusion:We suggest a new protocol for liver nodules identified incidentally on conventional ultrasound. In typical hemangiomas, conventional ultrasound would suffice. In cases of non-typical nodules, perflutren CEUS confirms the diagnosis of hepatic hemangioma and closes the diagnostic investigation.