title: Hyperechoic and hypoechoic hepatic hemangiomas smaller than 3 cm seldom coexist.
abstract: OBJECTIVE
  The purpose of this study was to determine whether hyperechoic and hypoechoic hepatic hemangiomas coexist.
  
  
  METHODS
  Archives of 456 patients with multiple smaller (≤3 cm) hepatic hemangiomas were reviewed, including sex, age, imaging study (ultrasound [US], computed tomography [CT], and magnetic resonance imaging [MRI]), follow-up, and laboratory test. Patients with chronic liver disease or other malignancy and diameter of lesion larger than 3 cm were excluded. The mean age of the patients was 41.8 ± 13.9 years (range, 18-78 years). The liver was observed with US; undetermined cases were evaluated by using CT and/or MRI. The follow-up time was from 35 to 39 months (mean, 36.3 months). Echo patterns, patterns of enhancement on CT and MRI, and associated findings of the hepatic hemangiomas were studied.
  
  
  RESULTS
  The number of hemangiomas was from 2 to 6, including 154 patients with 2 lesions, 196 patients with 3 lesions, 78 patients with 4 lesions, 18 patients with 5 lesions, and 10 patients with 6 lesions. Among them, hyperechoic accounts for 71.93% (328/456), hypoechoic 27.85% (127/456), and hyperechoic and hypoechoic coexistence 0.22% (1/456). There were significant differences of distribution between the hyperechoic and hypoechoic coexistence and other echo patterns (all P < 0.001). Diameter of the hemangioma was from 8.6 and 30.0 mm (15.5 ± 4.9 mm).
  
  
  CONCLUSIONS
  Hyperechoic and hypoechoic hemangiomas rarely coexist in the liver. In the event that hypoechoic and hyperechoic lesions are simultaneously found in the liver, CT, MRI, or contrast-enhanced US should be performed for a definitive diagnosis.
authors.affiliation: Department of Medical Imaging, Affiliated Hospital of Hainan Medical College, Haikou, China.
authors.forename: Size
authors.initials: S
authors.lastname: Wu
authors.forename: Rong
authors.initials: R
authors.lastname: Tu
authors.forename: Guangqing
authors.initials: G
authors.lastname: Liu
authors.forename: Ying
authors.initials: Y
authors.lastname: Guan
authors.forename: Yanyan
authors.initials: Y
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006391:Hemangioma / Q000145:classification* / Q000000981:diagnostic imaging*; D006801:Humans; D008113:Liver Neoplasms / Q000145:classification* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000145:classification / Q000000981:diagnostic imaging*; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D047368:Tumor Burden; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult