Diagnosis Of Hepatic Hemangioma Research Articles

Evaluation of Tc-99m Labeled Erythrocyte Scintigraphy with SPECT/CT in the Diagnosis of Hepatic Hemangioma

Amaç: Günümüzde görüntüleme yöntemlerindeki gelişmeyle birlikte karaciğer hemanjiomlarının saptanması da artmıştır. Genellikle asemptomatik olan karaciğer hemanjiomlarının, karaciğerin diğer primer ve metastatik malign tümörlerinden ayırıcı tanısının konulması gerekmektedir. Özellikle boyutu küçük olan ve ana vasküler yapılara yakın olan lezyonların tanısını koymak önemlidir. Bu tip lezyonlar Tc-99m işaretli eritrosit sintigrafisi ile doğru olarak tanımlanabilir. Bu çalışmanın amacı karaciğer hemanjiomlarının Tc-99m işaretli eritrosit sintigrafisinin SPECT/BT ile değerlendirilmesi ve tanıya olan katkısını araştırmaktır. Yöntem: Hemanjiom ön tanısı ile kliniğimize gönderilen 36 olgudaki 40 lezyon retrospektif olarak değerlendirildi. Modifiye in vivo yöntemle Tc-99m işaretli eritrosit sintigrafisi yapılan 36 hasta SPECT/BT ile görüntülendi. Hastalar 12-24 aylık klinik bulgu ve diğer görüntüleme yöntemleri (USG, BT ve MRG) ile takip edildi. Yapılan takiplerle lezyonların boyut ve morfolojisinde değişiklikler değerlendirilerek tanıları doğrulandı. Bulgular: SPECT/BT ile görüntülemede 36 olgunun 29’unda aktivite artışı saptandı ve bu olguların hepsi gerçek pozitif olarak değerlendirildi. 7 olguda aktivite tutulumu olmadı. 2 olgu kist hidatik, 4 olgu metastaz (1 kolon kanseri, 3 meme kanseri) olarak belirlendi. 1 olgu ise yanlış negatif olarak saptandı. Bu olguda lezyon boyutu 1 cm idi. Tc-99m işaretli eritrosit sintigrafisi-SPECT/BT ile sensitivite:%100; spesifite: %96,7; pozitif prediktif değer: %100; negatif prediktif değer: % 85,7 ve toplam tanı değeri: %97,3 olarak belirlendi. Ayrıca SPECT/BT’de 9 (%25) olguda lezyonlar ana vasküler yapılara yakın yerleşimli idi. Lezyonların 1’i kalbe, 3’ü vena kava inferiora, 5’i ise büyük hepatik damarlara yakın yerleşimli idi. BT sayesinde radyoaktivite akümülasyonunun olduğu odağın doğru anatomik lokalizasyonu yapılarak hastalara hemanjiom tanısı kondu. Sonuç: Tc-99m işaretli eritrosit sintigrafisi SPECT/BT sayesinde karaciğer hemanjiomlarının tespitinde sensitivitesi, spesifitesi ve doğruluğu yüksek olan, fonksiyonel ve anatomik görüntülemenin bir arada yapılmasına sağlayan noninvaziv bir görüntüleme yöntemidir.

A Retrospective Analysis of Clinical Characteristics, Treatment Modalities and Outcome of the Patients With Infantile Hepatic Hemangiomas: Single-center Experience From Turkey.

Hepatic hemangiomas (HH) are the most common vascular tumors of the liver. It is important to distinguish hemangiomas from malignant liver tumors. The patients 0 to 1 years old, were diagnosed with HH and followed up in the oncology outpatient clinic between 2009 and 2020 were included in the study. A total of 127 patients with the diagnosis of HH were included in the study. Of the patients, 99 (78%) had focal, 20 (15.7%) had multifocal, and 8 (6.3%) had diffuse HHs. Surgery was performed and the diagnosis was confirmed histopathologically in 6 patients (4.7%). During the follow-up, 16 (12.5%) patients received medical treatment. Thirteen (10.2%) were treated with propranolol, 2 (1.5%) with corticosteroids, and 1 (0.8%) with propranolol and corticosteroids. Complete response was obtained in 9 (9/16) patients and partial response was obtained in 6 (6/16) patients with medical treatment. Although HH is a benign tumor, it is important to make its differential diagnosis with malignant tumors of the liver. Over the years, the need for histopathologic examination for diagnosis has decreased. The success rate of propranolol is high, and the need for other treatment options with a high side-effect profile has decreased significantly since 2008.

A sonographic software program, Fluctuational Imaging, for diagnosis of hepatic hemangioma

Hepatic hemangioma is the most common benign solid lesion of the liver. Contrast-enhanced computed tomography or magnetic resonance imaging is recommended for definitive diagnosis of hepatic hemangioma. However, these modalities have drawbacks in terms of radiation exposure, invasiveness, and high cost for examination. “Fluttering sign” is one of the candidate findings considered specific for hepatic hemangioma that can be useful for diagnosis of hepatic hemangioma using grayscale US alone. However, the assessment is subjective and the findings are weak and likely to be overlooked in some cases. We developed a software program, Fluctuational Imaging, for objective detection and depiction of “fluttering sign”. Here, we evaluated the ability of Fluctuational Imaging software to depict “fluttering sign” in hepatic hemangioma. Presence or absence of “fluttering sign” was evaluated in the grayscale US videos and Fluctuational Imaging software analysis results of patients with hepatic hemangioma. The Cohen’s kappa test showed very good agreement (0.95). Fluctuational Imaging software can detect and depict the phenomenon of “fluttering sign” well and may be a useful tool for diagnosis of hepatic hemangioma.

Роль однофотонной эмиссионной компьютерной томографии в диагностике гемангиом печени

Роль однофотонной эмиссионной компьютерной томографии в диагностике гемангиом печени

Value of gadoxetic acid-enhanced MR imaging and DWI in classification, characterization and confidence in diagnosis of solid focal liver lesions

Objective To assess gadoxetic acid (Gd-EOB-DTPA) and diffusion-weighted imaging (DWI) value in classification (benign vs. malignant) and characterization of solid focal liver lesions (SFLLs) and impact on confidence in diagnosis. Methods A total of 195 lesions (46 hepatocellular carcinomas [HCCs], 45 metastases, 32 adenomas, 37 focal nodular hyperplasias [FNHs] and 35 hemangiomas) were retrospectively evaluated in 93 patients. Three imaging datasets were compared: DWI/ apparent diffusion coefficient (ADC) (set A), Gd-EOB-DTPA (set B) and combination of both (set C). Two radiologists (R) independently classified (on a five-point ordinal scale) and characterized each lesion. The accuracy in classification and characterization was compared, and the diagnostic confidence was assessed. Results The classification accuracy on set A, B and C was 86.2%, 91.3% and 91.8% (R1), and 84.6%, 91.8% and 93.3% (R2); and characterization accuracy was 67.2%, 88.2% and 87.7% (R1), and 60.5%, 88.2% and 85.6% (R2). Classification by reader 1 showed no significant difference between set A and B (p=.09). For both readers, there was a significant difference between set A and C in both classification and characterization (all p < .05), but no significant difference between set B and C in neither classification nor characterization. No significant difference between the three datasets in classification and characterization of hemangiomas (all p > .05). The diagnostic confidence of the readers has increased progressively from set A to Set C (all p < .01). Conclusions DWI may suggest benignity or malignancy of solid liver lesions, while Gd-EOB-DTPA-enhanced imaging remains superior in lesions characterization and the combination of both increases the diagnostic confidence. DWI is very helpful in the diagnosis of hepatic hemangiomas.

Sensitivity of Pre-Contrast Multiphase versus Conventional Liver MRI in Diagnosing Hepatic Hemangioma

Hepatic hemangioma (HH) can be diagnosed noninvasively via dynamic contrast enhancement computed tomography, magnetic resonance imaging (MRI) or ultrasonography. Diagnosis HH is based on imaging features such as early arterial phase enhancement and persistence enhancement on portal or delayed phase. However, differentiating small or atypical hemangiomas from other hepatic masses using these imaging methods maybe be difficult, especially in patients with a medical history of malignant disease. Another challenge in clinical practice is when patients with acute or chronic renal insufficiency, use MRI contrast agent gadolinium (Gd) with the risk of nephrogenic systemic fibrosis. Differentiating hemangioma from its mimickers on preoperative imaging studies is of critical importance. Our study compared the diagnostic sensitivity of pre-contrast multiphase and conventional liver MRI. Total 80 patients with HH were participate to our study retrospectively. Imaging was performed using pre-contrast multiphase and conventional liver MRI methods. The size of the nodule/mass to be evaluated was ≥1 cm. All patients MRI images were obtained and classified into two groups based on the acquisition parameters. The first group with pre-contrast multiphase MRI sequences, and the second group of conventional liver MRI methods included pre-contrast multiphase MRI sequences, contrast-enhanced tri-phase sequences. The study was reviewed and analyzed by two independence gastrointestinal radiologists, who were blinded to the examination and follow-up study results. The diagnostic sensitivity was compared between pre-contrast multiphase MRI sequences only and conventional liver MRI sequences methods. Based on the observation of two gastrointestinal radiologists, our results showed mean sensitivity of 90.0% and 97.5% for pre-contrast multiphase MRI and conventional liver MRI, respectively. Pre-contrast multiphase MRI sequence methods may be reliably applied in the diagnosis of HH.

Diagnosis and Treatment of Hepatic Hemangioma

The clinical manifestations of hepatic hemangioma are not specific. At present, the diagnosis of hepatic hemangioma mainly depends on imaging examination, and the treatments are based on surgery. However, the current indications and timing for surgical treatments and surgical options for hepatic hemangioma remain controversial. This article introduces our current understanding of hepatic hemangioma and the current status of diagnosis and treatment of hepatic hemangioma, providing a basis for the standardization of diagnosis and treatment of hepatic hemangioma. Treatments of hepatic hemangioma include surgery, hepatic artery embolization, radiofrequency ablation, radiation therapy, intraoperative microwave coagulation, cryotherapy, and sclerotherapy. Surgical treatment is the preferred option for patients without surgical contraindications.

TO RESEARCH MORPHOLOGIC FEATURES, SIGNAL CHARACTERISTICS ON SONOGRAPHY AND DYNAMIC COMPUTED TOMOGRAPHY OF HEPATIC HEMANGIOMAS

Objectives: To assess morphologic features, signal characteristics on sonography and dynamic computed tomography of hepatic hemangiomas. To compare the agreement degree of diagnosis of hepatic hemangiomas between sonography and computed tomography. Material and methods: We researched the sonography and computed tomography findings in 50 patients including 82 lesions hepatic hemangiomas at Hue university hospital and Hue central hospital from march 2012 to june 2013, 21 men and 29 women, mean age 51.7 ± 13.9 (range 30 – 89). Results: Mean mass diameter was 3.7 ± 1.9 cm. Sonography revealed hyperechonic pattern in 97.6% and hypoechonic pattern in 2.4%. On nonenhanced computed tomography, almost tumors (70.8%) showed hypodense, 26.8% had cleftlike areas of lower density than the main mass and 2.4% showed hyperdense lesions in a hypodense fatty liver. Almost tumors were periperally hyperdense on early contrast - enhanced computed tomography, progressive centripetal enhancement and in the delayed phase 85.4% displayed isodense and 14.6% displayed hyperdense fill-in. Conclusions: Triphasic helical computed tomography has additional values for sonography in diagnosis of hepatic hemangioma with typical characteristics: hypodense lesion on nonenhanced computed tomography, periperally hyperdense on early contrast - enhanced computed tomography, progressive centripetal enhancement and complete isodense fill-in of the lesion in the delayed phase. For tiny lesion smaller than 15mm (especially smaller than 10 mm), computed tomography plays a less important role. Key words: Hepatic hemangiomas, signal characteristics, sonography, computed tomography, research.

Contrast‐enhanced sonography in the diagnosis of hepatic hemangiomas: Atypical appearance due to the washout of microbubbles

Contrast-enhanced sonography (CEUS) examination permits identification of hemangioma of the liver in most cases. This method is particularly useful when the ultrasound pattern is atypical on standard grayscale examination. CEUS appearances suggestive of hemangioma are peripheral globular enhancement, progression of enhancement toward the center of the nodule, and persistence of enhancement in the late phase. We present seven cases of hemangioma, which were atypical on CEUS examination due to washout during the portal and late phases, resulting in a hypoenhanced appearance compared with the adjacent liver parenchyma.

Effect of Lesion Size in the Diagnosis of Hepatic Hemangioma with Tc-99m Erythrocyte Scintigraphy

Effect of Lesion Size in the Diagnosis of Hepatic Hemangioma with Tc-99m Erythrocyte Scintigraphy

Diagnosis of Hepatic Hemangioma by Parametric Imaging Using Sonazoid-Enhanced US

Comparison of Parametric Imaging (PI) using Sonazoid-enhanced ultrasonography (US) and microflow imaging (MFI) to determine the possibility of hepatic hemangioma diagnosis using PI. Twenty-two hepatic hemangioma nodules (mean±SD diameter: 31.6±19.1mm) undergoing Sonazoid-enhanced US between February 2008 and March 2009. After Sonazoid-enhanced US, COMMUNE ultrasonographic image analysis software was used for analysis of tumor imaging dynamics in the vascular phase using PI and MFI. In PI, 0s was set as the time contrast agent reached the tumor. Imaging within the tumor after 0s was color-coded according to time, and the images were displayed in color. In MFI, 0s was set as the time contrast agent reached the tumor. The path of microbubbles as it flowed through blood vessels was superimposed on the original B-mode images. Three trained physicians used these methods to analyze tumor imaging dynamics. All physicians concluded all cases were hepatic hemangioma regardless of method used. However, compared to MFI, PI allowed determination of more detailed blood flow dynamics in high-flow hepatic hemangioma, where blood flow speed was faster than in normal hepatic hemangioma. It is possible to diagnose hepatic hemangioma using PI using sonazoid-enhanced US.

Prospective study of ultrasound with perflutrene contrast compared to magnetic resonance imaging in the diagnosis of hepatic hemangiomas

The incidence of hepatic hemangiomas ranges from 0.4% to 20% in the general population. Conventional ultrasound is usually the first diagnostic method to identify these hemangiomas, typically as an incidental finding. Ultrasonography with second generation contrast materials is being used in various areas of hepatology, yielding similar results to those obtained with computerized tomography and magnetic resonance imaging in the diagnosis of hepatic hemangiomas. To evaluate the agreement between ultrasound with perflutrene contrast and magnetic resonance imaging in the diagnosis of hepatic hemangiomas. A total of 37 patients were prospectively examined between January 2006 and August 2008. A total of 57 hepatic nodules were documented in this group as incidental findings on routine ultrasound exams. The 37 patients were administered perflutrene contrast without adverse reactions, and were all submitted to magnetic resonance exams. Conventional ultrasound identified 15 patients with nodules typical of hemangiomas and 22 patients with other nodules. In 35 patients, the contrast characteristics were consistent with hepatic hemangiomas. Agreement between the data obtained from ultrasound with contrast and magnetic resonance was 94.5%. In discordant cases, the magnetic resonance diagnosis prevailed. In the case which presented indeterminate findings on contrast ultrasonography, magnetic resonance was repeated after 3 months, confirming the diagnosis of a hepatic hemangioma. A biopsy was performed on the suspected malignant nodule which also confirmed the presence of a hepatic hemangioma. Ultrasonography with contrast has the advantages of being more accessible to the public at large and lower cost than magnetic resonance. The results of our study highlight the need for a new protocol in hepatic nodules incidentally identified on conventional ultrasonography. In the case of typical hemangiomas, conventional ultrasound is sufficient for diagnosis. However, for poorly defined nodules, ultrasonography with contrast is indicated. After confirming the presence of a hepatic hemangioma on contrast ultrasonography, no further exams are needed to finalize the diagnosis.

Comparative diagnostic value of contrast-enhanced ultrasonography, computed tomography, and magnetic resonance imaging in diagnosis of hepatic hemangiomas

To compare the value of intravenous contrast-enhanced ultrasonography (US), intravenous contrast-enhanced computed tomography (CT), and magnetic resonance imaging (MRI) in the diagnosis of hepatic hemangiomas. The study enrolled 48 patients, aged between 20 and 79 years (35 [72.9%] women, 13 [27.1%] men; mean age, 53.5+/-12.855 years), who were examined and treated in the Departments of Gastroenterology, Surgery, and Oncology, Hospital of Kaunas University of Medicine, in the year 2007. All patients underwent intravenous contrast-enhanced US, intravenous contrast-enhanced CT, and MRI and were diagnosed with hepatic hemangioma according to the findings of these examinations. The size of hemangiomas was < or =2.0 cm in 20 cases (41.7%) and >2.0 cm in 28 (58.3%). No association between hepatic hemangioma and patient's age was found (chi(2)=0.547, df=2, P=0.761). Nearly one-third of hemangiomas were located in the segment IV of the left hepatic lobe. There were a few complicated hemangiomas in the study sample: 2 with calcification and 1 with necrosis. The sensitivity of CT in the diagnosis of hepatic hemangioma was 76.92%; specificity, 33.3%; positive prognostic value, 83.3%; and negative prognostic value, 25.0%. The sensitivity of intravenous contrast-enhanced US in the diagnosis of hepatic hemangioma was 77.8%; specificity, 100%; positive prognostic value, 100%; and negative prognostic value, 23.1%. Intravenous contrast-enhanced US is more specific than intravenous contrast-enhanced CT in the diagnosis of hepatic hemangioma (P=0.0005) and has a higher positive prognostic value (P=0.001).

A case of high-flow hepatic hemangioma: analysis by parametoric imaging using sonazoid-enhanced ultrasonography.

Hepatic hemangioma is the most prevalent type of benign primary tumor of the liver, and it occurs three times more frequently in females than in males. Patients with hepatic hemangioma are often encountered in unrelated clinical settings [1, 2]. On contrast-enhanced ultrasonography, hepatic hemangioma is characterized by slow flow in the tissue surrounding the lesion and slow filling inside the tumor. In fact, it has been reported that diagnosis of hepatic hemangioma could be made based on the fill-in pattern during the vascular phase of ultrasonography (US) using a contrast agent [3]. The data presented in this study were acquired from a tumor that showed faster than usual filling on US, a socalled high-flow hepatic hemangioma. Parametric imaging was used to analyze the imaging kinetics. Case report

Painful hepatic hemangioma: report of a case with an emphasis on sonographic findings.

Hepatic hemangiomas are usually asymptomatic and very rarely produce abdominal symptoms. We report a painful 10×9cm hemangioma situated at the hepatic surface of segment6. The lesion showed a heterogeneous internal structure, composed irregularly of hyperechoic and hypoechoic areas, and it also showed weak posterior echo enhancement. Contrast-enhanced US showed the so-called fill-in pattern, leading to the diagnosis of hepatic hemangioma. The patient's abdomen showed no other abnormal findings, which stressed the relationship between the hemangioma and the patient's symptoms. When the diagnosis of hepatic hemangioma is conclusive, surgical therapy is indicated only in patients with severe symptoms. Our patient was considered to be a candidate for enucleation of the lesion. Histopathologically, the lesion included no areas of hemorrhage or necrosis, and the patient's abdominal pain was likely due to distension of the liver capsule. After surgery, the patient was completely free of symptoms, and enucleation was considered to be appropriate.

Conservative management of neonatal hepatic hemangioma: a report from one institute

To summarize the conservative treatment of neonatal hepatic hemangioma at one institute. Fifteen cases of neonatal hepatic hemangioma were managed in our hospital during the previous 5 years. Initial symptoms, combination symptoms, diagnosis, and treatment were analyzed. Initial symptoms were abdominal mass, hepatomegaly, jaundice, and pneumonia. Combination symptoms were multiple skin hemangiomas, pneumonia, and cardiac insufficiency. Ultrasound and CT showed the typical characteristics of the liver hemangioma. There were three types of hepatic hemangioma: nine cases had a single focus, four cases were multiple foci, and two had diffuse changes in the liver. The diameter of a single focus in this group was about 53-99 mm. Four cases of single focus received resection and two received biopsy. Six cases received corticosteroid treatment. The other five cases were kept under observation only. Those with cardiac insufficiency and pneumonia received diuretics and antibiotic treatment. One neonate with cardiac insufficiency and pneumonia had postoperative MODS and died. One patient having multi-focus in the liver gave up the treatment after biopsy. Other patients were followed-up at 5-17 months. Two cases that received total tumor resection did not have recurrence. In those who received conservative therapy, all hemangiomas disappeared within 1 year. The diagnosis of hepatic hemangioma can be made from symptomology, ultrasound, and CT; pathologic samples are not necessary. Corticosteroid therapy is the widely used therapy. Proactive therapy for congestive heart failure is helpful for those endangering liver hemangioma. Surgery can increase the risk of complications and is not advised for treatment of neonatal hepatic hemangioma.

Positive diagnosis of hepatic hemangioma in hyperechoic masses of the liver

Positive diagnosis of hepatic hemangioma in hyperechoic masses of the liver

Ultraschallgeführte Feinnadelbiopsie herdförmiger Lebererkrankungen - Teil II: Benigne herdförmige Lebererkrankungen

Sixty patients with benign focal liver disease underwent sonography-guided percutaneous fine needle biopsy for definitive diagnosis. The benignancy of all lesions was determined accurately by cytohistologic evaluation. All 44 liquid space-occupying lesions (30 hepatic cysts, 9 abscesses, 3 hematomas, 2 serous residual cavities after surgery) could be classified by cytological, biochemical and bacterial examination. The diagnosis of hepatic hemangiomas by fine needle puncture is problematic, because the cytological identification of benign endothelial cells is difficult. The histological examination of tissue cylinders of 4 small echogenic lesions revealed focal fatty change of the liver. Tissue fragments of focal nodular hyperplasias and liver cell adenomas showed histologically typical liver cells arranged in trabecular structure. The additional identification of bile ducts supplies proof of focal nodular hyperplasia and excludes liver cell adenoma. Percutaneous puncture of liver abscesses and cysts afforded effective therapeutic decompression. Eight out of 9 liver abscesses were cured by evacuating fine needle puncture. More than 50% of the liver cysts showed long-term growth shrinkage subsequent to puncture. The histological confirmation of benign and malignant liver tumors by sonographyguided fine needle biopsy is considered a decisive step forward in the diagnostic possibilities of update imaging methods.

99mTc-red blood cells SPECT and planar scintigraphy in the diagnosis of hepatic hemangiomas

The aim of the study is the assessment of the value of SPECT (single photon emission computerized tomography) using 99mTc-labeled red blood cells in the detection of liver hemangioma, in comparison to planar imaging. With planar red blood cell scintigraphy, sensitivity of the method was 76%, specificity 98%, positive predictive value 98% and negative predictive value 79%. With SPECT, sensitivity of the method was 95%, specificity 98%, positive predictive value 98% and negative predictive value 94%. The smallest lesion detected by planar red blood cell scintigraphy was 1.2 cm, and with SPECT red blood cell scintigraphy 0.8 cm. The use of 99mTc-labeled red blood cells SPECT improved the sensitivity much more in smaller lesions (0.8 to 2 cm), than in bigger ones (2-5 cm). SPECT with radiolabeled red blood cells significantlyy improves the results of scintigraphic findings, especially in the small lesions.

Role of SPECT/CT in diagnosis of hepatic hemangiomas

To investigate the role of SPECT/CT in the diagnosis of hepatic hemangiomas whose anatomical positions are not ideal, situated adjacent to the heart, the inferior cava, hepatic vessels or abdominal aorta, etc. The hepatic perfusion, blood pool, and fusion imaging were carried out using SPECT/CT in 54 patients, who were suspected for hepatic hemangiomas. When the anatomical positions were not ideal, the diagnosis was difficult by SPECT only. So the information of computed tomography (CT) was applied to help in diagnosing. The results were recorded as hemangiomas or not. Of the 54 patients, 31 patients were diagnosed as suffering from hepatic hemangiomas. The anatomical positions of eight patients' hepatic hemangiomas (25.81%) were not ideal. Among these lesions of the eight patients, three patients' hepatic lesions were located near to the abdominal aorta, one to the heart, and four to the inferior cava. In addition, six abnormal radioactivity accumulation regions, adjacent to the heart and inferior cava, with the help of CT, were confirmed to be the imaging of inferior cava other than hepatic hemangiomas. When the anatomical positions of hepatic hemangiomas are not good enough for diagnosis, the fusion imaging of SPECT/CT is a simple and efficient method for differential diagnosis.