title: Contrast-enhanced ultrasound of histologically proven liver hemangiomas.
abstract: Differentiation of small and atypical hemangiomas from other hepatic masses using imaging methods can be difficult, especially in patients with underlying malignant disease. Therefore, contrast-enhanced ultrasound was assessed in patients with histologically confirmed hemangiomas with respect to contrast-enhancing kinetics and tumor characteristics. In 58 patients with indeterminate hepatic lesions demonstrated with at least 2 imaging methods (ultrasound/computed tomography/magnetic resonance imaging), ultrasound-guided liver biopsy revealed hemangioma. In all patients a hepatic neoplasm had been suspected because of underlying malignant disease (n=41), liver cirrhosis (n=15), or growth of the lesion (n=2). All patients underwent nonlinear, low mechanical index real-time contrast-enhanced ultrasound scanning with bolus injections of SonoVue. Peripheral nodular arterial enhancement was detected in 43 patients (74%), whereas the typical metastatic peripheral rim-like enhancement was not observed at all. Strong homogenous arterial enhancement was found in 9 of 58 (16%) patients. In 6 patients (10%), the arterial contrast enhancement pattern could not be determined because of the very small size of the lesions or fibrotic nodules. Forty-five (78%) of the hemangiomas showed homogenous centripetal filling within 180 seconds.
  
  
  CONCLUSIONS
  Contrast-enhanced ultrasound demonstrates typical hemangioma imaging characteristics, that is, peripheral nodular contrast enhancement and iris-diaphragm sign in a high percentage of patients with undetermined lesions. This technique may therefore improve noninvasive functional characterization and differentiation of hemangiomas.
authors.affiliation: Second Department of Internal Medicine, Caritas Hospital Bad Mergentheim, Bad Mergentheim, Germany. christoph.dietrich@ckbm.de
authors.forename: Christoph F
authors.initials: CF
authors.lastname: Dietrich
authors.forename: Joachim C
authors.initials: JC
authors.lastname: Mertens
authors.forename: Barbara
authors.initials: B
authors.lastname: Braden
authors.forename: Gudrun
authors.initials: G
authors.lastname: Schuessler
authors.forename: Michaela
authors.initials: M
authors.lastname: Ott
authors.forename: Andre
authors.initials: A
authors.lastname: Ignee
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006391:Hemangioma / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D011446:Prospective Studies; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride