title: Prospective study of ultrasound with perflutrene contrast compared to magnetic resonance imaging in the diagnosis of hepatic hemangiomas.
abstract: BACKGROUND
  The incidence of hepatic hemangiomas ranges from 0.4% to 20% in the general population. Conventional ultrasound is usually the first diagnostic method to identify these hemangiomas, typically as an incidental finding. Ultrasonography with second generation contrast materials is being used in various areas of hepatology, yielding similar results to those obtained with computerized tomography and magnetic resonance imaging in the diagnosis of hepatic hemangiomas.
  
  
  OBJECTIVE
  To evaluate the agreement between ultrasound with perflutrene contrast and magnetic resonance imaging in the diagnosis of hepatic hemangiomas.
  
  
  METHODS
  A total of 37 patients were prospectively examined between January 2006 and August 2008. A total of 57 hepatic nodules were documented in this group as incidental findings on routine ultrasound exams. The 37 patients were administered perflutrene contrast without adverse reactions, and were all submitted to magnetic resonance exams.
  
  
  RESULTS
  Conventional ultrasound identified 15 patients with nodules typical of hemangiomas and 22 patients with other nodules. In 35 patients, the contrast characteristics were consistent with hepatic hemangiomas.
  
  
  CONCLUSIONS
  Agreement between the data obtained from ultrasound with contrast and magnetic resonance was 94.5%. In discordant cases, the magnetic resonance diagnosis prevailed. In the case which presented indeterminate findings on contrast ultrasonography, magnetic resonance was repeated after 3 months, confirming the diagnosis of a hepatic hemangioma. A biopsy was performed on the suspected malignant nodule which also confirmed the presence of a hepatic hemangioma. Ultrasonography with contrast has the advantages of being more accessible to the public at large and lower cost than magnetic resonance. The results of our study highlight the need for a new protocol in hepatic nodules incidentally identified on conventional ultrasonography. In the case of typical hemangiomas, conventional ultrasound is sufficient for diagnosis. However, for poorly defined nodules, ultrasonography with contrast is indicated. After confirming the presence of a hepatic hemangioma on contrast ultrasonography, no further exams are needed to finalize the diagnosis.
authors.affiliation: Department of Surgery, Faculty of Medical Sciences, Santa Casa of São Paulo, São Paulo, SP, Brasil. joel@schmillevitch.com.br
authors.forename: Joel
authors.initials: J
authors.lastname: Schmillevitch
authors.forename: Luiz Arnaldo
authors.initials: LA
authors.lastname: Szutan
authors.forename: Fábio Gonçalves
authors.initials: FG
authors.lastname: Ferreira
authors.forename: Maria de Fátima
authors.initials: Mde F
authors.lastname: Santos
authors.forename: Ricardo
authors.initials: R
authors.lastname: Mincis
authors.forename: Ana
authors.initials: A
authors.lastname: Gorski
mesh_terms: D000328:Adult; D003287:Contrast Media; D005260:Female; D005466:Fluorocarbons; D006391:Hemangioma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D014463:Ultrasonography / Q000379:methods
chemical_list: D003287:Contrast Media; D005466:Fluorocarbons; C042852:perflutren