title: Contrast enhanced ultrasound for the diagnosis of liver hemangiomas in clinical practice.
abstract: OBJECTIVE
  Contrast enhanced ultrasound (CEUS) has a well established place in the characterization of focal liver lesions (FLL). The aim of this paper was to evaluate the usefulness of CEUS in the assessment of liver hemangiomas.
  
  
  METHODS
  We included in a prospective study all the CEUS examinations performed during a 13 months period for the evaluation of de novo FLL, using a Siemens Acuson S2000™ Ultrasound System, following an intravenous bolus of 2.4 ml SonoVue® CEUS was considered conclusive for hemangioma if a typical pattern was present following contrast (centripetal fill in during the arterial phase, hyperenhanced lesion during venous and late phases).
  
  
  RESULTS
  During September 2009 - October 2010, 413 CEUS examinations were performed in our department for the evaluation of de novo FLL. Out of the 413 cases, based on standard ultrasound, 43 were suspected hemangiomas, 125 were uncharacteristic lesions and 245 were suspected for other types of lesions (metastases, focal nodular hyperplasias, hepatocellular carcinomas etc). Out of the 413 de novo FLL, 64 cases (15.5%) were diagnosed as hemangiomas by CEUS (typical CEUS pattern). MRI diagnosed 7 additional hemangiomas in inconclusive CEUS cases, so 90.1% (64/71) of the hemangiomas were diagnosed by CEUS alone. Out of the 125 uncharacteristic lesions on standard ultrasound, 29 cases were diagnosed after CEUS as hemangiomas. Thus, CEUS diagnosed additional 40.8% (29/71) hemangiomas as compared to standard ultrasound, without the need of more expensive imaging methods.
  
  
  CONCLUSIONS
  CEUS is a reliable method for the diagnosis of hemangiomas, also allowing a precise characterization of FLL. This method diagnosed additional 40% hemangiomas in comparison with standard ultrasound (for atypical ultrasound hemangiomas) and finally, CEUS diagnosed correctly 90% of this type of lesions, all with typical enhancement pattern according to the EFSUMB guidelines.
authors.affiliation: Department of Gastroenterology and Hepatology, Victor Babeş University of Medicine and Pharmacy, Timisoara, Romania. roxanasirli@gmail.com
authors.forename: Roxana
authors.initials: R
authors.lastname: Sirli
authors.forename: Ioan
authors.initials: I
authors.lastname: Sporea
authors.forename: Alina
authors.initials: A
authors.lastname: Popescu
authors.forename: Mirela
authors.initials: M
authors.lastname: Dănilă
authors.forename: Alina
authors.initials: A
authors.lastname: Martie
authors.forename: Simona
authors.initials: S
authors.lastname: Bota
authors.forename: Ana
authors.initials: A
authors.lastname: Jurchis
authors.forename: Mădălina
authors.initials: M
authors.lastname: Sendroiu
mesh_terms: D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006391:Hemangioma / Q000000981:diagnostic imaging*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; 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