Atypical appearance of hepatic hemangiomas with contrast-enhanced ultrasound.

Min Huang,Fen Chen,Tian’An Jiang,Qiyu Zhao,Qihan You

doi:10.18632/oncotarget.24185

Abstract

To describe the atypical enhancement pattern of hepatic hemangiomas on contrast-enhanced sonography. 22 patients with hepatic hemangiomas that were atypical on contrast-enhanced ultrasound were included in the study, all of them were confirmd by biopsy or surgery pathology. Atypical appearance of hepatic hemangiomas on contrast-enhanced ultrasound were divided into seven subtypes: (i) peripheral nodular enhancement in the arterial phase with centripedal filling, hypoechoic change in the delayed phase; (ii) peripheral circular enhancement; (iii) peripheral nodular enhancement; (iv) none enhancement; (v) septal enhancement; (vi) a central enhancing focus in the arterial phase, followed by a centrifugal enhancement in the portal venous phase, hypoechoic change in the delayed phase; (vii) slowly spoke wheel enhancement. Atypical appearance of hepatic hemangiomas were various. Radiologists should be aware. Establishing knowledge of the entire spectrum of atypical hepatic hemangiomas may benefit the rational approach to future cases.

Highlights

Hemangioma is the most common benign tumor in liver, the prevalence varing from 1–2% [1] to 20% [2]
Establishing knowledge of the entire spectrum of atypical hepatic hemangiomas may benefit the rational approach to future cases
Atypical appearance of hepatic hemangiomas on Contrast-enhanced ultrasound (CEUS) were divided into seven subtypes: (i) peripheral nodular enhancement in the arterial phase with centripedal filling, hypoechoic change in the delayed phase (Figure 1); (ii) peripheral nodular enhancement throughout the whole enhancement period (Figure 2); (iii) peripheral circular enhancement throughout the whole enhancement period (Figure 3); (iv) none enhancement throughout the whole enhancement period (Figure 4); (v) septal enhancement throughout the whole enhancement period (Figure 5); (vi) a central enhancing focus in the arterial phase, followed by a centrifugal enhancement in the portal venous phase, hypoechoic change in the delayed phase (Figure 6); (vii) slowly spoke wheel enhancement throughout the whole enhancement period (Figure 7) (Table 1)

Summary

Introduction

Hemangioma is the most common benign tumor in liver, the prevalence varing from 1–2% [1] to 20% [2]. Hemangiomas typically appear as hyperechoic, well defined lesions, or hypoechoic masses with hyperechoic periphery [3, 4]. 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. Additional CEUS features were rapid centripetal enhancement in the arterial phase, hyperechoic/isoechoic change in the portal venous phase and late phase, usually seen in small lesions [8]. Atypical imaging findings of hemangiomas may occur even when contrast agents are administered, here we analyzed retrospectively the imaging features of 22 patients with hepatic hemangiomas that were atypical on CEUS

Methods

Results

Conclusion