THE USEFULNESS OF CEUS IN THE EVALUATION OF HEPATIC HEMANGIOMA – RETROSPECTIVE STUDY

• Published in: Ultrasound in medicine & biology Vol. 48; p. S22
• Main Authors: Domenco, Aurelia Stefania, Ionescu-Ciocalteu, Adriana, Sandulescu, Sarmis Marian, Urhut, Cristiana, Sandulescu, Larisa Daniela
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 2022
• Subjects: contrast-enhanced ultrasonography; hemangioma; liver; hemangioma; contrast-enhanced ultrasonography; liver
• ISSN: 0301-5629; 1879-291X
• DOI: 10.1016/j.ultrasmedbio.2022.04.076

Hemangiomas are among the most common benign solid lesions that can occur in the liver. Generally, they occur as a single lesion less than 3 cm diameter, but there are also described cases with multiple or bigger lesions (up to 20 cm). The diagnosis is confirmed by using imaging methods, thus their incidence has increased due to the recent improvement and widespread use of imaging. The aim of this study was to evaluate the usefulness of CEUS in clinical practice.
We performed a retrospective study for the year 2021 in the Gastroenterology Department of Emergency County Hospital of Craiova, Romania, including patients with diagnosed hepatic hemangioma. It is based on a group of 35 patients, 12 men and 18 women, ages ranged from 34 to 85 years. There were detected 65 focal liver lesions (21 patients with single lesion, 14 patients with 2 or more lesions) suspected as hemangiomas after performing standard abdominal US, which were further investigated by CEUS and/or contrast-enhanced CT or MRI and diagnosed as hepatic hemangiomas due to the typical enhancement pattern identified, consistent with EFSUMB guidelines.
Out of the 35 patients included in our study, 25 had no pre-existing liver damage, 8 had moderate diffuse steatosis and 2 had ethanolic liver cirrhosis. Within standard B-mode US of the 65 lesions, there were found 12 cases (18,5%) with a hypoechoic appearance, 52 cases (80%) with a hyperechoic appearance and 1 case (1,5%) with an isoechoic appearance. None of them showed intralesional vessels at color or power Doppler exam. Out of the 65 FLL, 47 cases (72,3%) were diagnosed as hepatic hemangiomas by CEUS, after presenting typical enhancing pattern: centripetal fill-in in the arterial phase (all 47 cases), partial (20 cases) or complete (27 cases) centripetal filling and sustained enhancement in portal and late phases; 1 case (1,6%) showed no enhancement in any on the vascular phases of CEUS, therefore it was also performed a contrast enhanced CT which confirmed the diagnosis of sclerosed hemangioma (atypical variant); 14 cases (21,5%) were investigated and diagnosed only by contrast-enhanced CT/MRI due to their associated pathology which required detailed investigations (without performing CEUS); 3 cases (4,6%) had typical aspect at standard B-mode US, being diagnosed without the necessity of any other investigations.
Contrast enhanced imaging has an unmatched value for HH diagnosis due to their typical enhancement pattern of the contrast agent, therefore CEUS could be considered the first-line investigation in all the patients with suspected hemangioma after performing a standard B-mode US.