title: Contrast-enhanced ultrasound of histologically proven hepatic epithelioid hemangioendothelioma.
abstract: OBJECTIVE
  To analyze contrast-enhanced ultrasound (CEUS) features of histologically proven hepatic epithelioid hemangioendothelioma (HEHE) in comparison to other multilocular benign focal liver lesions (FLL).
  
  
  METHODS
  Twenty-five patients with histologically proven HEHE and 45 patients with histologically proven multilocular benign FLL were retrospectively reviewed. Four radiologists assessed the CEUS enhancement pattern in consensus.
  
  
  RESULTS
  HEHE manifested as a single (n = 3) or multinodular (n = 22) FLL. On CEUS, HEHE showed rim-like (18/25, 72%) or heterogeneous hyperenhancement (7/25, 28%) in the arterial phase and hypoenhancement (25/25, 100%) in the portal venous and late phases (PVLP), a sign of malignancy. Eighteen patients showed central unenhanced areas (18/25, 72%); in seven patients (7/25, 28%), more lesions were detected in the PVLP. In contrast, all patients with hemangioma and focal nodular hyperplasia showed hyperenhancement as the most distinctive feature (P < 0.01).
  
  
  CONCLUSIONS
  CEUS allows for characterization of unequivocal FLL. By analyzing the hypoenhancement in the PVLP, CEUS can determine the malignant nature of HEHE.
authors.affiliation: Yi Dong, Wen-Ping Wang, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Yi Dong, Wen-Ping Wang, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Wen-Ping
authors.initials: WP
authors.lastname: Wang
authors.affiliation: Yi Dong, Wen-Ping Wang, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Vito
authors.initials: V
authors.lastname: Cantisani
authors.affiliation: Yi Dong, Wen-Ping Wang, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Mirko
authors.initials: M
authors.lastname: D'Onofrio
authors.affiliation: Yi Dong, Wen-Ping Wang, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Andre
authors.initials: A
authors.lastname: Ignee
authors.affiliation: Yi Dong, Wen-Ping Wang, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Mulazzani
authors.affiliation: Yi Dong, Wen-Ping Wang, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Adrian
authors.initials: A
authors.lastname: Saftoiu
authors.affiliation: Yi Dong, Wen-Ping Wang, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Zeno
authors.initials: Z
authors.lastname: Sparchez
authors.affiliation: Yi Dong, Wen-Ping Wang, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Ioan
authors.initials: I
authors.lastname: Sporea
authors.affiliation: Yi Dong, Wen-Ping Wang, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Christoph F
authors.initials: CF
authors.lastname: Dietrich
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D018323:Hemangioendothelioma, Epithelioid / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010743:Phospholipids / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride / Q000008:administration & dosage*; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: Biopsy; Guidelines; Liver transplantation Contrast enhanced ultrasound; Liver tumor; Recommendations