Contrast Enhanced Ultrasound (CEUS) in hemangiomas – atypical behavior

Hemangioma is the most common benign liver tumor with typical behavior in CEUS. Sometimes, washout can be noted in the late phase of CEUS examination, posing problems of differential diagnosis with hypervascular malignant tumors.

The aim of this paper is assessing the incidence of atypical behavior of hemangiomas in CEUS examination.

Material and methods: We studied a group of 103 patients (62 women and 41 men, average age 54.7 ± 10.3 years), where CEUS was performed starting from the suspicion in standard ultrasound of liver hemangioma (typical/atypical aspect) between January 2014 – December 2015. We followed the behavior of the lesion in the three phases of CEUS examination (arterial, venous and late phase) and also the presence of central vascular thrombosis. For characterization and diagnosis of hemangiomas we used the EFSUMB criterias (peripheral nodular enhancement progressing in a centripetal direction in the arterial phase, hyperenhacement in the portal and late phase).

Results: Typical appearance in CEUS was recorded in 90.2% of cases. In 9.8% of cases, the result was unconclusive due to the washout described in the late phase. In all cases with unconclusive result, a second imaging technique was performed (CT/MRI), which confirmed the diagnosis.

Central thrombosis, defined as the lack of enhancement of the lesion was found in 15 cases (14.5%).

CEUS sensitivity in the diagnosis of hemangioma was 91.1% and specificity of 98.8%.

Hemangiomas were more frequent in the female population (F/B = 1.5/1).

Conclusions: In 90.2% of cases, the hemangioma has typical loading pattern in CEUS.

The presence of late washout may cause difficulties in diagnosis of hemangiomas (in our group in 9.8% of cases).

Central thrombosis is common in hemangiomas (14.5% in the studied group).

The sensitivity of contrast enhanced ultrasound in diagnosing hepatic hemangioma was 91.1%.