title: Changes in echogenicity of hepatic hemangiomas during the valsalva maneuver.
abstract: BACKGROUND
  We aimed to evaluate changes in echogenicity of hepatic hemangiomas during the Valsalva maneuver.
  
  
  METHODS
  We examined 16 liver hemangiomas in 12 patients with a mean diameter of 1.5 cm (range, 0.7-2.2 cm), which showed variations in echogenicity during the Valsalva maneuver. Two radiologists reviewed the sonographic (US) images of the hemangiomas at three different times: prior to the Valsalva maneuver, during the Valsalva maneuver, and on follow-up US examinations.
  
  
  RESULTS
  Prior to Valsalva maneuver, the 16 hemangiomas appeared as hypoechoic nodules with an echogenic rim (n = 7), homogeneously echogenic nodules (n = 5), one hypoechoic nodule with sound-through enhancement, one heterogeneous nodule with a hyperechoic rim, one heterogeneous nodule, and one echogenic nodule with a hyperechoic rim. During the Valsalva maneuver, increased echogenicity was observed in 11 cases, as a diffuse increase in 5 cases, and as a partial increase in 6. Prior to the Valsalva maneuver, 9 of 16 hemangiomas exhibited an echogenic rim. During the maneuver, all the rims were accentuated, and an additional five hemangiomas exhibited an echogenic rim. Throughout follow-up, 12 of 15 hemangiomas underwent some echogenicity change.
  
  
  CONCLUSIONS
  Use of the Valsalva maneuver during US examination of the liver can increase the echogenicity of hepatic hemangiomas and accentuate the echogenic rim, which could enhance the operator's confidence in the diagnosis of hemangioma. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:328-331, 2017.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea.
authors.forename: Hyung Jin
authors.initials: HJ
authors.lastname: Won
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea.
authors.forename: Pyo Nyun
authors.initials: PN
authors.lastname: Kim
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea.
authors.forename: Jong Seok
authors.initials: JS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006391:Hemangioma / Q000000981:diagnostic imaging*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography / Q000379:methods*; D014636:Valsalva Maneuver / Q000502:physiology*; D055815:Young Adult
keywords: Valsalva maneuver; hemangioma; liver; ultrasonography