Imaging of atypical hemangiomas of the liver with pathologic correlation, Atypical hepatic hemangioma; a suggestive sonographic morphology. In CEUS three patterns may be observed: no enhancement, persistent irregular ring enhancement and lack of early enhancement with slight peripheral enhancement in the late phase[33,38,39] (Figure (Figure14).14). Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Hepatic haemangioma: common and uncommon imaging features. Note the non-enhancement of the central scar, In approximately 20% of patients, a central hypoattenuating scar may be seen.38 A central scar in FNH represents fibrous connective tissue radiating from its centre. It's made up of clumped, malformed blood vessels that are fed by the hepatic artery. Sugimoto K, Moriyasu F, Saito K, Yoshiara H, Imai Y. Kupffer-phase findings of hepatic hemangiomas in contrast-enhanced ultrasound with sonazoid. Ichikawa T, Federle MP, Grazioli L, et al. Liver function tests are usually normal. Hemangiomatosis, also called diffuse hepatic hemangiomatosis (DHH), is a rare condition characterized by innumerable HHs distributed in the liver parenchyma[13]. Fortunately, in CEUS HH in fatty liver show a typical enhancement pattern of cavernous or flash-filling hemangioma[52-54] (Figure (Figure2121). On CEUS, cystic metastases appear as solitary or, more commonly, multifocal lesions with complex features, such as thick, irregular, enhancing walls, thick or nodular enhancing septations, enhancing mural nodularity or internal debris. Hanazaki K, Koide N, Kajikawa S, Ushiyama T, Watanabe T, Adachi W, Amano J. Cavernous hemangioma of the liver with giant cyst formation: degeneration by apoptosis? The phenomenon of transient hyperenhanced liver parenchyma may be due to the loss of the balance between arterial and portal blood supply because of perilesional hyperemia and portal venous obstruction.58, Hepatic abscess on: (a) CEUS and (b) grey scale demonstrating peripheral enhancement in the portovenous phase. Detection, Characterization, Ablation. In less than 15% of patients CEUS does not provide a conclusive appearance; thus, CT scan or MRI becomes mandatory and liver biopsy is rarely required. Moreover, there are studies that demonstrate CEUS to be approximately equal to the computed tomography (CT)-scan or magnetic resonance imaging (MRI) regarding to assessment of tumor differentiation and specification of newly discovered liver tumors in clinical practice, including for HH[26,27]. On B-mode ultrasound appears as inhomogeneous lesion with a large central cavity that contains fluid and possible septa[13,46]. Contrast-enhanced ultrasonography to identify the two major subtypes of hepatocellular adenoma. Differentiation remains difficult between small and well-differentiated HH and HCC, which do not show wash-out in the late phase[34]. A difficult diagnosis in a case of a flash-filling hemangioma in a woman with hepatitis C liver cirrhosis. Hemangioma, Liver, Ultrasound, Contrast media, Diagnosis, Algorithm. Biliary cystadenoma and biliary cystadenocarcinoma are premalignant and malignant cystic biliary ductal neoplasms, respectively, that account for fewer than 5% of intrahepatic cystic lesions of biliary origin. Larisa Daniela Sandulescu, Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania. In: Cioni LL, Bartolozzi C. Focal Liver Lesions. A: B-mode ultrasound; B: Doppler ultrasound mode. See: Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania. Have you used hormone replacement therapy? US demonstrates a hyperechoic contour with a cone-shaped acoustic shadow.31 When the cyst wall is heavily calcified, only the anterior portion of the wall is visualised and appears as a thick arch with a posterior concavity.31 Partial calcification of the cyst does not always indicate the death of the parasite; nevertheless, densely calcified cysts may be assumed to be inactive.27,32 There is little data in the published literature on the CEUS appearances of hydatid disease. A: Two hyperechoic lesions; B: Four small well delimited lesions; C: One large hepatic hemangioma besides two small hyperechoic lesions. Note peripheral feeding vessel (white arrow) and homogenous enhancement with centripetal filling (i.e. von Meyenburg complex on: (a) grey scale and (b) CEUS (white arrow), CT studies have demonstrated variable patterns of enhancement. The differential diagnosis includes other hyperechoic hepatic lesions, such as hyperechoic metastases, haemangioma, FNH and adenoma. Vilgrain V, Brancatelli G. Liver hemangioma. In the arterial phase there is usually complete hyper-enhancement, although in some cases areas of non-enhancement may be present. FOIA Focal fatty sparing is isoechoic to background liver on administration of ultrasound contrast (c). It can appear at any age but are detected more frequently between 30-50 years[6]. Currently, four contrast agents are used in the imaging assessment of FLLs[15,16]. Hypoechoic hemangioma in 57-yr-old woman with liver steatosis. Focal fatty sparing on: (a) grey scale, (b) colour Doppler and (c) CEUS (arrow = focal fatty sparing, star = gallbladder fossa). Because ultrasonography systems are becoming more and more efficient, smaller and smaller masses are detected, from 2-3 mm, especially if a linear probe with a frequency higher than 8 MHz is used (Figure (Figure11). However, during the venous and delayed phases, the progressive centripetal enhancement of the lesion is present but does not lead to complete filling[13,42] (Figure (Figure1616). Specialty type: Gastroenterology and hepatology, Peer-review reports scientific quality classification, P-Reviewer: Shi GQ S-Editor: Gao CC L-Editor: A P-Editor: Gao CC. In recent years, ultrasound examination is the main method of detecting HH due to the fact that it is widely available, inexpensive, rapidly performed without exposing the patient to radiation. Types of Ultrasound Images Certain words are used to describe areas imaged with ultrasound. Lack of internal enhancement on CEUS is a characteristic enhancement pattern of pyogenic hepatic abscesses, whereas hepatic malignancies manifest as diffuse or peripheral intratumoural enhancement, with peripheral enhancement. As a library, NLM provides access to scientific literature. Kamyab AA, Rezaei-Kalantari K. Hepatic Hemangioma in a Cluster of Iranian Population. Soussan M, Aub C, Bahrami S, Boursier J, Valla DC, Vilgrain V. Incidental focal solid liver lesions: diagnostic performance of contrast-enhanced ultrasound and MR imaging. DHH is more frequently seen in newborns where the entire liver is usually involved but uncommon cases of isolated DHH without extrahepatic involvement may be seen in the adult population (about 17 cases in the literature)[14,50]. As the years passed, the equipment evolved, and the examiners gained more experience. hepatic hemangioma : commonest hyperechoic liver lesion by far . At contrast-enhanced US, HNF-1-mutated hepatocellular adenomas show isovascularity to moderately increased vascularity, with mixed filling in the arterial phase after contrast material administration, and are isoechoic in the portal venous and delayed phases.47 Among all hepatocellular adenomas, the HNF-1-mutated hepatocellular adenomas are the least aggressive subtype: Tumours less than 5cm in maximum dimension show minimal risk of bleeding and subsequent rupture and carry minimal or no risk for the development of malignancy. Note retained contrast on the portovenous phase relative to the background liver and (c) relative wash out on the delayed image (inflammatory subtype), On the basis of the genetic and pathologic features, hepatocellular adenomas are categorised into three subtypes: (a) inflammatory hepatocellular adenomas, (b) hepatocyte nuclear factor 1 -mutated hepatocellular adenomas and (c) -catenin-mutated hepatocellular adenomas. A: Hyperechoic mass with sharp margins; B-D: After contrast agent administration the mass shows peripheral nodular enhancement in arterial phase (B and C) with partial centripetal filling in the late phase (D). Liu LP, Dong BW, Yu XL, Liang P, Zhang DK, An LC. Romanini L, Passamonti M, Aiani L, Cabassa P, Raieli G, Montermini I, Martegani A, Grazioli L, Calliada F. Economic assessment of contrast-enhanced ultrasonography for evaluation of focal liver lesions: a multicentre Italian experience. Differentiation of focal nodular hyperplasia and hepatocellular adenoma by contrast-enhanced ultrasound. Your doctor may schedule follow-up exams to check your liver hemangioma periodically for growth if the hemangioma is large. HHs does not have a peritumoral halo and pushes the hepatic vessels without their invasion or thrombosis (Figure (Figure4).4). Batista A, Matos AP, Neta JO, Ramalho M. Diffuse Hepatic Hemangiomatosis in the Adult without Extra-hepatic Involvement: An Extremely Rare Occurrence. Malignant lesions were more likely than benign lesions to have noncircumscribed margins (9/9 vs 7/16; p = 0.008) and nonparallel orientation (6/9 vs 1/16; p = 0.003). The liver is a large, football-shaped organ found in the upper right portion of your abdomen. Schwarze V, Lindner F, Marschner C, Negro de Figueiredo G, Rbenthaler J, Clevert DA. Peripheral pools in arterial phase (B and C) and centripetal progression (D) followed by complete fill-in (E); F: In the late phase phenomenon of pseudo-washout is observed due to hyperinsonation determined by the proximity of the linear probe. Typical hepatic hemangioma. This diagnostic algorithm is applicable to the adult patient in countries where the hepatologist has an ultrasonography system equipped with CEUS software in the consulting room. In the vast majority of cases does not require treatment or monitoring. The ability to rapidly diagnose benign lesions in the ultrasound department will ensure compliance with the NICE guidelines and help to decrease patient and clinician anxiety when an incidental liver lesion has been detected. Ultrasound images using linear probe in a case of small, hyperechoic, subcapsular hepatic hemangioma. Yamashita Y, Hatanaka Y, Yamamoto H, et al. Benign developmental hepatic cyst is the second most common benign hepatic lesion (after cavernous haemangioma), present in 2.5% of the population,15 more commonly found in women than men and usually asymptomatic.15,17 Benign hepatic cyst is a congenital lesion derived from biliary endothelium that does not communicate with the biliary tree. arterial phase: peripheral nodular discontinuous enhancement HHs belong to the group of non-epithelial lesions, consisting of a blood-filled space, fed by hepatic arterial circulation. Benign and solid tumors of the liver: relationship to sex, age, size of tumors, and outcome. A high-performance ultrasonographic system equipped with contrast-enhanced ultrasound software, allows the experienced examinator to orient the diagnosis quickly, cost-effectively and non-invasively in most cases.