Soft Tissue Hemangiomas: High-resolution Grayscale and Color Doppler Ultrasonographic Features in 43 Patients

Background High-resolution ultrasonography (HRUS) is the first-line imaging modality for the assessment of soft tissue tumors. The reported HRUS features of soft tissue hemangiomas vary greatly. We reviewed 43 histologically proven soft tissue hemangiomas and describe the HRUS and color Doppler ultrasound (CDUS) features, and propose a convenient CDUS sign for diagnosis. Materials and Methods HRUS data of 43 proven soft tissue hemangiomas were included in this study. Data assessment included tumor margin, tumor echogenicity and echotexture, presence of phleboliths, fluid–fluid level in the masses, and CDUS features. In masses with weak or no color Doppler signal, color Doppler enhancing maneuver (CDEM) was applied, which was carried out using light compression on the masses or on the soft tissues adjacent to the masses. CDEM was considered positive when the color Doppler signal in a mass was more prominent and/or extensive. Results Twenty-three hemangiomas were ill-defined and 20 were well-defined. Twenty-six hemangiomas were hypoechoic and 17 were hyperechoic. Thirty-seven masses were heterogeneous in echotexture. Phleboliths were found in only nine hemangiomas. Thirty-seven hemangiomas had multiple cystic spaces and fluid–fluid levels were noted in 12. Color Doppler signals were detected in 37 hemangiomas, i.e. 33 masses had weak signals and four masses had strong signals. CDEM was positive in all 33 hemangiomas with weak color Doppler signals and was positive in four of six hemangiomas with no detectable color Doppler signal. Conclusion Typical HRUS features of a soft tissue hemangioma were an ill-defined or well-defined hypoechoic mass of heterogeneous echotexture with multiple cystic spaces. On CDUS, there may be no detectable or only weak color Doppler signals. CDEM was helpful in the diagnosis of soft tissue hemangiomas, especially in masses with no detectable color Doppler signal.