Hepatic Hemangioma Research Articles

Prognostic utility of gamma-glutamyl transpeptidase to platelet ratio in patients with solitary hepatitis B virus-related hepatocellular carcinoma after hepatectomy

BACKGROUND The prognostic impact of preoperative gamma-glutamyl transpeptidase to platelet ratio (GPR) levels in patients with solitary hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) following radical resection has not been established. AIM To examine the clinical utility of GPR for prognosis prediction in solitary HBV-related HCC patients. METHODS A total of 1167 solitary HBV-related HCC patients were retrospectively analyzed. GPR levels were compared with 908 non-HCC individuals. Overall survival (OS) and recurrence-free survival (RFS) were evaluated, and cox proportional hazard model analyses were performed to identify independent risk factors. Differences in characteristics were adjusted by propensity score matching (PSM). Subgroup and stratified survival analyses for HCC risks were performed, and a linear trend of the hazard ratio (HR) according to GPR levels was constructed. RESULTS GPR levels of patients with solitary HBV-related HCC were higher than those with hepatic hemangiomas, chronic hepatitis B and healthy control (adjusted P < 0.05). Variable bias was diminished after the PSM balance test. The low GPR group had improved OS (P < 0.001) and RFS (P < 0.001) in the PSM analysis and when combined with other variables. Multivariate cox analyses suggested that low GPR levels were associated with a better OS (HR = 0.5, 95%CI: 0.36-0.7, P < 0.001) and RFS (HR = 0.57, 95%CI: 0.44-0.73, P < 0.001). This same trend was confirmed in subgroup analyses. Prognostic nomograms were constructed and the calibration curves showed that GPR had good survival prediction. Moreover, stratified survival analyses found that GPR > 0.6 was associated with a worse OS and higher recurrence rate (P for trend < 0.001). CONCLUSION Preoperative GPR can serve as a noninvasive indicator to predict the prognosis of patients with solitary HBV-related HCC.

Clinical characteristics and managements of congenital hepatic hemangioma: a cohort study of 211 cases.

Hepatic hemangiomas can be classified into three morphologic patterns: focal (congenital hepatic hemangiomas [CHHs]), multifocal, and diffuse. We aimed to identify the clinical characteristics of CHH and evaluate the changes in CHH management at our institution over the last 2 decades. This was a retrospective cohort study of children diagnosed with CHH who were managed at 8 investigation sites. The primary outcome was changes in CHH size in patients at the last follow-up. The primary exposure of interest was management modality in 2 study periods (2003-2012 versus 2013-2022). Two hundred and eleven patients were analyzed. Four different subtypes of CHH were identified. Rapidly involuting CHH patients had complete involution/nearly complete involution, with a median age of 12.0months. Noninvoluting CHH presented no change in CHH size. Partially involuting CHH patients presented with partial involution and had a stable tumor size at a median age of 16.0months. Postnatally proliferating CHHs had an initial postnatal increase in CHH lesion size and underwent involution at a median age of 27.0months. Further analysis revealed that management strategies for CHHs have shifted over time, with the proportion of patients receiving expectant management increasing from 35.4% before 2013 to 77.7% after 2013 (difference, 42.3%; 95% confidence interval 29.3-53.3%). The survival rate of patients with CHH was high (98.6%). We documented 4 subtypes of CHHs. We found that expectant management strategies have increasingly replaced invasive interventions in patients with CHH over the past 2 decades. We have already registered at Clinicaltrials.gov. The UIN number is NCT03331744.

Reconsideration of the clinical management of hepatic hemangioma

In this letter, we comment on the article by Zhou et al that was published in the recent issue of the World Journal of Gastrointestinal Surgery . This article proposes a new clinical grading system based on a multidisciplinary team, which prompts us to rethink the clinical management of hepatic hemangioma. Hepatic hemangioma is the most common benign solid liver tumor. In general, follow-up and observation for the vast majority of hepatic hemangioma is reasonable. For those patients with symptoms and severe complications, surgical intervention is necessary. Specific surgical indications, however, are still not clear. An effective grading system is helpful in further guiding the clinical management of hepatic hemangioma. In this article, we review the recent literature, summarize the surgical indications and treatment of hepatic hemangioma, and evaluate the potential of this new clinical grading system.

Radiomics-based automated machine learning for differentiating focal liver lesions on unenhanced computed tomography.

Enhanced computed tomography (CT) is the primary method for focal liver lesion diagnosis. We aimed to use automated machine learning (AutoML) algorithms to differentiate between benign and malignant focal liver lesions on the basis of radiomics from unenhanced CT images. We enrolled 260 patients from 2 medical centers who underwent CT examinations between January 2017 and March 2023. This included 60 cases of hepatic malignancies, 93 cases of hepatic hemangiomas, 48 cases of hepatic abscesses, and 84 cases of hepatic cysts. The Pyradiomics method was used to extract radiomics features from unenhanced CT images. By using the mljar-supervised (MLJAR) AutoML framework, clinical, radiomics, and fusion models combining clinical and radiomics features were established. In the training and validation sets, the area under the curve (AUC) values for the clinical, radiomics, and fusion models exceeded 0.900. In the external testing set, the respective AUC values for the clinical, radiomics, and fusion models were as follows: 0.88, 1.00, and 1.00 for hepatic cysts; 0.81, 0.90, and 0.97 for hepatic hemangiomas; 0.89, 0.98, and 0.92 for hepatic abscesses; and 0.23, 0.80, and 0.93 for hepatic malignancies. The diagnostic accuracy rates for hepatic cysts, hemangiomas, malignancies, and abscesses by radiologists in the external testing cohort were 0.96, 0.60, 0.79, and 0.66, respectively. The fusion model based on noninvasive radiomics and clinical features of unenhanced CT images has high clinical value for distinguishing focal hepatic lesions.

Long-Term Outcomes of Transarterial Chemoembolization of Giant Liver Hemangiomas with Lipiodol-Bleomycin Emulsion.

To evaluate the safety, efficacy, and long-term outcomes of transarterial chemoembolization (TACE) with bleomycin-Lipiodol for giant liver hemangiomas. Single-center retrospective study from 1998 to January 2020, including patients with giant liver hemangiomas treated with bleomycin-Lipiodol TACE and followed up >36months. The exclusion criteria were defined as patients who had been treated but had no available follow-up above 3years and patients who had previously been treated with any other treatment method. Clinical success was defined as the disappearance of symptoms and radiological success (responded vs. non-responded groups) as a more than 50% decrease in the volume of the giant hemangioma in follow-up CT or MRI compared to the baseline images. A total of 121 patients were included. The mean maximum diameter of the hemangiomas decreased from 122 (range: 40-300) to 73mm (range: 15-240), and the mean volume reduced from 984.4 (range: 30-7312) to 286.6cm3 (range: 1-3835). There were 106 patients in the responded group, while only 15 patients were in the non-responded group. No significant difference was found in size and volume change percentages across these two groups based on gender, age, lesion size, lesion volume, lesion number, and second TACE. When the follow-up period was stratified in 5-year periods, the maximum volume decrease was observed in the first 5-year period and then remained constant up to > 15years. TACE with bleomycin-Lipiodol is safe, reducing the size and volume of giant liver hemangiomas with stable results in the long-term follow-up.

Mildly Increased 68 Ga-Pentixafor Uptake in Hepatic Hemangioma.

68 Ga-pentixafor uptake in hemangioma is rare. We report 68 Ga-pentixafor PET/MRI findings of a hepatic hemangioma in a 54-year-old woman. The images revealed a hyperintense lesion in the right posterior liver on T2-weighted images, with mild pentixafor uptake. The lesion was consistent with typical presentations of a hemangioma on MRI and contrast-enhanced CT.

Giant ruptured hepatic hemangioma in pregnancy managed with a mixed approach: case report

Giant ruptured hepatic hemangioma in pregnancy managed with a mixed approach: case report

S3072 Metastatic Colorectal Cancer Masquerading as a Hepatic Hemangioma: A Case Report

S3072 Metastatic Colorectal Cancer Masquerading as a Hepatic Hemangioma: A Case Report

A combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound in the Kupffer phase for the diagnosis of well-differentiated hepatocellular carcinoma and atypical focal liver lesions: a prospective, multicenter study.

The objective of this study was to develop a combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound (CEUS) during the Kupffer phase and to evaluate its value in differentiating well-differentiated hepatocellular carcinoma (w-HCC) from atypical benign focal liver lesions (FLLs). A total of 116 patients with preoperatively Sonazoid-CEUS confirmed w-HCC or benign FLL were selected from a prospective multiple study on the clinical application of Sonazoid in FLLs conducted from August 2020 to March 2021. According to the randomization principle, the patients were divided into a training cohort and a test cohort in a 7:3 ratio. Seventy-nine patients were used for establishing and training the radiomics model and combined model. In comparison, 37 patients were used for validating and comparing the performance of the models. The diagnostic efficacy of the models for w-HCC and atypical benign FLLs was evaluated using ROCs curves and decision curves. A combined model nomogram was created to assess its value in reducing unnecessary biopsies. Among the patients, there were 55 cases of w-HCC and 61 cases of atypical benign FLLs, including 28 cases of early liver abscess, 16 cases of atypical hepatic hemangioma, 8 cases of hepatocellular dysplastic nodules (DN), and 9 cases of focal nodular hyperplasia (FNH). The radiomics model and combined model we established had AUCs of 0.905 and 0.951, respectively, in the training cohort, and the AUCs of the two models in the test cohort were 0.826 and 0.912, respectively. The combined model outperformed the radiomics feature model significantly. Decision curve analysis demonstrated that the combined model achieved a higher net benefit within a specific threshold probability range (0.25 to 1.00). A nomogram of the combined model was developed. The combined model based on the radiomics features of Sonazoid-CEUS in the Kupffer phase showed satisfactory performance in diagnosing w-HCC and atypical benign FLLs. It can assist clinicians in timely detecting malignant FLLs and reducing unnecessary biopsies for benign diseases.

Case series multilocular cystic hemangioma of the liver: Three cases and literature review.

Multilocular cystic hemangioma is a rare benign tumor classified as an atypical hemangioma. Currently, there are limited imaging reports available, and the imaging characteristics can be challenging to distinguish from other malignant multilocular cystic liver diseases such as cystadenocarcinoma, necessitating confirmation through pathological diagnosis. Here, we discuss the imaging features of 3 cases of multilocular cystic hemangiomas. Case 1 was a 24-year-old young female, and Case 2 involved a 60-year-old elderly male. Both patients were asymptomatic and physical examination revealed hepatic space-occupying lesions. Imaging findings revealed multilocular cystic lesions in the left liver with septa, calcification, a high diffusion-weighted magnetic resonance imaging (DWI) signal at the edge of the lesion, and progressive enhancement of the cyst wall and septa. Case 3 involved a 50-year-old male patient with epigastric distending pain for 1 month and sudden severe abdominal pain for 14 hours. Imaging results revealed a multilocular cystic lesion in the left liver with septa and tumor bleeding, a high DWI signal, and an enhanced cyst wall and septa. The pathological diagnosis confirmed a hepatic hemangioma. All 3 patients underwent liver tumor resection. All 3 patients recovered successfully without any intraoperative or postoperative complications during the follow-up periods of 5 years, 6 months, and 5 months. There were no signs of recurrence. Liver imaging revealed multilocular cystic lesions with features, such as compartmentalization, calcification, or bleeding. Multilocular cystic hemangiomas should be considered in imaging diagnosis. Enhancing our understanding of multilocular cystic hemangiomas can aid in improving the differential diagnosis of other malignant multilocular cystic liver diseases, ultimately reducing unnecessary liver resection.

Spontaneous rupture of hepatic hemangioma: case report and literature review

Hepatic lesions represent a potential etiology of spontaneous hemoperitoneum. Among these, hepatic hemangiomas, characterized by congenital vascular malformations, stand out as the most likely benign liver neoplasms, frequently presenting as asymptomatic entities. However, spontaneous rupture constitutes the gravest complication associated with these lesions, underscoring the imperative of prompt diagnosis. Notably, the global mortality rate attributed to spontaneous rupture of hepatic hemangiomas remains elevated. Hence, achieving an accurate diagnosis of this condition is paramount for informing. Hepatic hemangioma stands as the prevailing benign hepatic neoplasm, with autopsy studies indicating a prevalence ranging between 3% and 20%. In a clinical scenario, a 64-year-old patient presented at Sant’Anna and S. Sebastian Hospital with severe abdominal pain, hypotension (blood pressure 70/40 mm Hg), tachycardia (heart rate 120 bpm), and abdominal muscle guarding upon physical examination. Ultrasound assessment revealed the presence of free intraperitoneal fluid. However, the ultrasound examination could not be completed due to the patient’s deteriorating hemodynamic status and manifestation of instability. Consequently, an urgent exploratory laparotomy was deemed necessary and promptly undertaken in the operating theater.

Retrospective analysis based on a clinical grading system for patients with hepatic hemangioma: A single center experience.

The optimal approach for managing hepatic hemangioma is controversial. To evaluate a clinical grading system for management of hepatic hemangioma based on our 17-year of single institution experience. A clinical grading system was retrospectively applied to 1171 patients with hepatic hemangioma from January 2002 to December 2018. Patients were classified into four groups based on the clinical grading system and treatment: (1) Observation group with score < 4 (Obs score < 4); (2) Surgical group with score < 4 (Sur score < 4); (3) Observation group with score ≥ 4 (Obs score ≥ 4); and (4) Surgical group with score ≥ 4 (Sur score ≥ 4). The clinico-pathological index and outcomes were evaluated. There were significantly fewer symptomatic patients in surgical groups (Sur score ≥ 4 vs Obs score ≥ 4, P < 0.001; Sur score < 4 vs Obs score < 4, χ² = 8.60, P = 0.004; Sur score ≥ 4 vs Obs score < 4, P < 0.001). The patients in Sur score ≥ 4 had a lower rate of in need for intervention and total patients with adverse event than in Obs score ≥ 4 (P < 0.001; P < 0.001). Nevertheless, there was no significant difference in need for intervention and total patients with adverse event between the Sur score < 4 and Obs score < 4 (P > 0.05; χ² = 1.68, P > 0.05). This clinical grading system appeared as a practical tool for hepatic hemangioma. Surgery can be suggested for patients with a score ≥ 4. For those with < 4, follow-up should be proposed.

LIVER ULTRASOUND IMAGING LESION DETECTION BASED ON YOLO

The liver is a silent organ with no pain-sensing nerves. When the body's functions begin to appear abnormal, it may have entered the trilogy of liver diseases: "hepatitis, cirrhosis, and liver cancer." An abdominal ultrasound is a powerful tool for checking liver health. With the rapid development of ultrasound technology, ultrasound machines are gradually developing in the direction of miniaturization and cheapness, transforming from hospital-specific equipment to home medical equipment. However, ultrasound diagnosis requires professional knowledge, which has also become the threshold for the popularization of ultrasound diagnosis. This article uses artificial intelligence and machine learning technology to take the liver ultrasound images marked by professional doctors as a data set. After training of image object detection model YOLO, it can be used to detect tumors, hepatic hemangioma, radiofrequency cautery, abscess and metastatic, the accuracy can reach 98%.

Congenital hepatic hemangioma: a review

Congenital hepatic hemangioma (CHH) is a benign vascular malformation of the liver observed in newborns. Despite its rarity, it is crucial to understand its clinical presentation, diagnosis, and management due to potential complications. This extensive bibliographic review compiles key references to provide a detailed overview of the epidemiology, pathogenesis, clinical manifestations, diagnostic methods, and therapeutic options for CHH, aiming to offer a comprehensive insight into this condition.

Is the identification of multiple infantile cutaneous haemangiomas always a definitive diagnosis? A case report of an infant with multifocal hepatic haemangioma

Multifocal hepatic haemangiomas are the most common benign vascular tumours of the liver that are detected in children with concomitant multiple infantile haemangiomas. Reported lesions are usually undetectable at birth, which presents a diagnostic problem for general practitioners. Ultrasound should be the imaging examination performed in the first instance in search for vascular anomalies in children. In pharmacotherapy, the first-choice treatment is propranolol, administered orally. In the described case, a boy with multiple hepatic and skin haemangiomas, after treatment with propranolol, achieved a significant improvement in the ultrasound image of the liver. Skin lesions were also reduced. The importance of the physical examination should be emphasised in the context of detecting cutaneous haemangiomas, which usually accompany multifocal hepatic haemangiomas and should prompt the physician to regularly observe and repeat abdominal ultrasound examinations of the diagnosed and/or treated child.

Multiple intraductal papillary neoplasms of bile duct diagnosed based on endoscopic ultrasonography and peroral cholangioscopy findings

A man in his 30s was referred to our department for evaluation of bile duct stricture and removal of an intrahepatic bile duct stone. Five years before his presentation, he underwent left hepatectomy for a giant hepatic hemangioma. There were no abnormalities in blood biochemical tests. Magnetic resonance cholangiopancreatography showed one 5 mm oval defect in region B6 and two 8 mm semicircular defects in the hilar bile duct. Endoscopic ultrasound revealed a 3.5 mm hypoechoic focal raised lesion in the hilar bile duct. Oral cholangioscopy revealed his two lesions in the hilar bile duct as white papillary elevations with mucus production. The pathological diagnosis of intraductal papillary neoplasm was determined (low-grade dysplasia, type 1, gastric type). After 1 and a half years, no expansion of the bile duct lesion was observed. Initially, it was thought to be a benign stenosis after liver resection, but based on the results of endoscopic ultrasound, we suspected a tumorous lesion, and we were able to make an accurate diagnosis, including histological type, using transoral cholangioscopy.

Diagnostic approach to hepatic vascular lesions: a paediatric perspective.

The pathological evaluation of hepatic vascular lesions in children requires special consideration. Inconsistent terminology, rarity of pathology specimens and overlapping pathological features between various lesions may pose a serious diagnostic challenge. In this review, we highlight the importance of using the International Society for the Study of Vascular Anomalies (ISSVA) classification scheme to characterise these lesions. Selected entities are discussed, including hepatic vascular tumours exclusively seen in the paediatric age group, hepatic infantile haemangioma and hepatic congenital haemangioma. Vascular malformations, with emphasis on their syndromic associations (venous malformation in blue rubber bleb naevus syndrome) and complications (hepatocellular nodules in Abernethy malformation) are also covered.

Definitive Diagnosis of Hepatic Hemangioma by 99mTc Labeled Red Blood Cell SPECT and Comparative Analysis with Ultrasound

Definitive Diagnosis of Hepatic Hemangioma by 99mTc Labeled Red Blood Cell SPECT and Comparative Analysis with Ultrasound

Clinical experience of infantile hepatic hemangioma

PurposeTo describe the clinical presentation, treatment preference, and relevant complications of infantile hepatic hemangioma (IHH) in propranolol era. MethodsThe National Taiwan University Hospital integrated Medical Database (NTUH-iMD) was used to enroll twenty-one cases of IHH diagnosed from 2006 to 2020. Medical charts were retrospectively reviewed. ResultsIn nine patients (42.9%), IHH was found incidentally, and in seven patients (33%), it was detected during postnatal self-paid ultrasonography. Focal disease was determined in 17 patients, multifocal disease in 1 patient, and diffuse disease in 3 patients. Patients with diffuse disease had a lower hemoglobulin level than patients with focal IHH (9.38 vs. 12.6 mg/dL, p = 0.045). Two patients had Kasabach-Merritt phenomenon (KMP), one had hypothyroidism, and one had both. All patients with KMP had focal hepatic hemangiomas. Among the 17 patients with focal IHH, nine were prescribed propranolol, one was treated by surgical resection of the tumor, and the others had expectant management. All patients with multifocal and diffuse IHH were administered propranolol. One infant (7.7%) treated with propranolol had bradycardia initially but it subsided after dose adjustment. ConclusionsMost IHH is found incidentally or detected during postnatal ultrasonography screening. Patients with large focal lesions should also be screened for associated complications. Propranolol is the drug of choice and a safe therapeutic option for IHH, especially for focal tumors >5 cm as well as multifocal and diffuse lesions.

Clinical impact and role of major vessels involvement in laparoscopic resection for hepatic hemangioma.

Severe bleeding remains a significant concern in laparoscopic resection for hepatic hemangioma. It is rarely reported that how the degree of major vessels involvement impacts on severe bleeding. The present study primarily aimed to analyze the impacts of the number of involved major vessels (NIMV) during laparoscopic surgery for hepatic hemangioma and evaluate the risk factors associated with increased bleeding. A database search was carried out for consecutive patients who underwent laparoscopic resection for liver hemangiomas at our department from January 2018 to December 2023. The collected data included demographics, characteristics of the hemangiomas, laboratory data, operation method, surgical and postoperative variables. A total of 72 patients were enrolled in the study. 42 patients were categorized into the group with NIMV < 2, while 30 patients were divided into the group with NIMV ≥ 2. The group with NIMV ≥ 2 demonstrated a significant correlation with special segments, involved multiple segments and diameter of the hemangiomas (P < 0.01). And the perioperative variables including the extent of resection, operative time, blood loss, Pringle maneuver times, postoperative stay, drainage tube duration, and postoperative liver function (ALT, AST) also showed significant differences between the two groups (P < 0.05). Notably, NIMV ≥ 2 was identified as the most important independent risk factor for intraoperative blood loss ≥ 500ml in laparoscopic surgery for hepatic hemangioma (P = 0.011). For NIMV ≥ 2, the independent risk factor was special segments in multivariate analysis (P = 0.000). The involvement of multiple major vessels (NIMV ≥ 2) was significantly associated with special segments, resulting in increased intraoperative blood loss, operation difficulty, and delayed postoperative recovery. Moreover, it was identified as the single independent risk factor with a considerable risk for increased blood loss during laparoscopic resection for hepatic hemangioma.