Ultrasonographic Correlations and Challenges in Liver Hemangiomas

Abstract

OBJECTIVES. Gray-scale ultrasonography (US) represents the first method of detecting focal liver lesions. The aims of our study were to establish in liver hemangiomas possible correlations between tumoral and liver echogenicity; tumoral size and presence of chronic liver diseases (CLD); presence of peritumoral rim- tumoral and liver echogenicity, tumoral size and presence of CLD. MATERIAL AND METHODS. The study involved 352 liver masses in 270 patients with the presumptive diagnosis of benign liver tumor masses, established by ambulatory US, hospitalized at the Emergency Hospital “Prof. Dr. Octavian Fodor” and 2nd Medical Clinic Cluj-Napoca between 2006-2015. The final diagnosis was established based on the results of investigations such as US (gray-scale and color Doppler), SPECT, liver angioscintigraphy, CT, MRI, laparoscopy, histology, corroborated with clinical and biological examinations. RESULTS. The typical image of well-defined (94.81% of cases), hyperechoic mass (81.48% of cases), without Doppler signal (54.07% of cases), was detected in most hemangiomas. Presence of steatosis/nonalcoholic steatohepatitis (NASH) in 69 images from our study revealed the following patterns of hemangiomas: hypo- (16/69 cases), isoechoic (2/69 cases) and heterogeneous (51/69 cases). Fisher ‘s exact test shows that there exists moderate association between hyperechoic rim and hypoechoic hemangiomas; there were no other statistically significant associations found between: tumor-liver echogenicity, hypoechoic rim and tumor size-liver echogenicity. CONCLUSION. Classic US criteria of hemangioma was found in 81.85%. Hypo- and isoechoic hemangiomas moderately correlate with the presence of a hyperechoic rim. No statistical correlation was found between the underlying CLD and the hemangioma’s echogenicity, nor with the presence of any tumoral rim.