Atypical liver hemangiomas: contrast-enhancement patterns with SH U 508A and pulse-inversion US.
OBJECTIVE
To describe the enhancement patterns of atypical hepatic haemangiomas with Pulse Inversion Harmonic Imaging (PIHI) using SH U 508A (Levovist).


METHODS
Twenty-five patients (15 women, 10 men; age range: 29-65 years, mean: 48.2 years) with 28 hepatic haemangiomas (size: 1.5 - 11.5 cm; mean: 4.6 cm) underwent PIHI before and after i.v. administration of Levovist. Selected images obtained at baseline and 25-30s, 55-60s and 240s after Levovist injection were sequentially reviewed to determine the changes in echogenicity of haemangiomas in comparison to surrounding liver parenchyma.


RESULTS
At the baseline US study, 22/28 (79%) haemangiomas revealed highly inhomogeneous echotexture; 5/28 (18%) were homogeneously hypoechoic and 1/28 (3%) was isoechoic with respect to hepatic parenchyma. After Levovist administration, 16/28 (57%) haemangiomas showed peripheral hyperechoic nodules in the arterial phase with progressive centripetal fill-in in portal and late phases; such fill-in was complete in 14/16 cases and incomplete in 2/16. Four of twenty-eight (14%) haemangiomas revealed a rapid and complete homogeneous fill-in on arterial phase that lasted throughout the portal and late phases. Finally, 8/28 (29%) showed a rim-like enhancement with progressive and complete centripetal fill-in on portal and late phases.


CONCLUSIONS
According to our results, PIHI with Levovist allows demonstration of typical enhancement patterns in most of atypical haemangiomas, thus providing useful diagnostic information for their characterization.
Bartolotta
Tommaso Vincenzo
TV
Dipartimento di Biotecnologie Mediche e Medicina Legale, Sezione di Diagnostica per Immagini, Policlinico Universitario, Palermo, Italy. tv_bartolotta@yahoo.com
Midiri
Massimo
M
Galia
Massimo
M
Iovane
Angelo
A
Runza
Giuseppe
G
Carcione
Aldo
A
Lagalla
Roberto
R
D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006391:Hemangioma / Q000000981:diagnostic imaging*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides; D014463:Ultrasonography / Q000379:methods
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508