Changes in echogenicity of hepatic hemangiomas during the valsalva maneuver

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.