Application of Contrast-enhanced Ultrasound on Diagnosis of Liver Atypical Hypoechoic Hemangiomas

Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) in diagnosing liver atypical hypoechoic hemangiomas. Methods Forty-nine cases with 58 liver hemangiomas were examined with CEUS. The accuracy rate of CEUS was compared with baseline ultrasound, and the enhancement patterns of hypoechoic hemangiomas were analyzed. Results The accuracy rate of CEUS (86.2%) for diagnosing liver hypoechoic hemangiomas was significantly higher than that of baseline ultrasound (20.7%) (P0.05). The hypoechonic hemangiomas presented 4 enhancement patterns with CEUS: Type I, thick-ring enhancement with peripheral nodular and progressive centripetal fill-in; Type Ⅱ, thin-ring enhancement with progressive centripetal fill-in; Type Ⅲ, rapid and complete centripetal fill-in in the arterial phase, which persisted in portal phase and delayed phase; and Type Ⅳ, thick-ring enhancement with peripheral nodular but without interior enhancement. The enhanced patterns were dependent with the tumor size. TypeⅡ and Type Ⅲ usually showed in 3 cm lesions, whereas TypeⅠ and Type Ⅳusually showed in 3 cm lesions. Conclusions CEUS is helpful to improve the accuracy in diagnosis of liver atypical hypoechoic hemangiomas. The enhancement patterns are correlated with the lesion size and pathologic characters.