Sonographic characterization of 271 hepatic hemangiomas with typical appearance on CT imaging.
OBJECTIVE
Hepatic hemangioma is the most frequent benign solid tumor that requires differentiation from hepatic malignancy on ultrasonography. Useful ultrasound findings are therefore required for diagnosis.


METHODS
The following factors were investigated for 271 masses diagnosed as hepatic hemangioma by contrast-enhanced computed tomography (CT) in 188 patients: hepatic subsegment location, shape, maximum diameter, internal echo level, hyperechoic rim, posterior echoes, marginal hypoechoic band (halo), lateral shadow, blood flow signal in the central portion of the mass, and underlying liver disease.


RESULTS
Hepatic masses were classified by internal echo pattern as homogeneous hyperechoic (35.0%), homogeneous hypoechoic (22.9%), isoechoic (5.2%), mixed hyperechoic (22.1%), or mixed hypoechoic (14.8%) masses. Twelve masses were isoechoic, and could be recognized by the hyperechoic rim. Posterior echo enhancement was present in 66 masses. There were no cases of posterior echo attenuation. A halo was present in six masses, with the underlying condition being fatty infiltrated liver in two masses; a hypoechoic region with a small amount of fat deposit was present around the mass, and this resembled a halo. This finding was termed a "pseudohalo." There were no masses in which a lateral shadow was observed. In terms of blood flow signals in the central portion of the mass, pulsatile flow was present in only one mass.


CONCLUSIONS
Important ultrasonographic findings of hepatic hemangioma are characterized as the absence of lateral shadow (100%) and no attenuation of posterior echoes (100%), while the presence of a hyperechoic rim is useful for detecting isoechoic hemangioma.
Department of Gastroenterology and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan. h2ito@marianna-u.ac.jp.
Hiroaki
H
Ito
Department of Laboratory Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.
Fumio
F
Tsujimoto
Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.
Yasuo
Y
Nakajima
Department of Laboratory Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.
Gaku
G
Igarashi
Department of Ultrasonography Center, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.
Takanori
T
Okamura
Department of Ultrasonography Center, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.
Masaru
M
Sakurai
Department of Laboratory Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.
Sachihiko
S
Nobuoka
Department of Gastroenterology and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.
Takehito
T
Otsubo
CT; Hepatic hemangioma; Hyperechoic rim; Pseudohalo; Ultrasonography