One stop shop approach for the diagnosis of liver hemangioma

Objectives Contrast-enhanced ultrasound (CEUS) has similar performance to computed tomography (CT) or MRI in the diagnosis of hepatic hemangioma [1]. We propose an ultrasound-based diagnostic algorithm for hepatic hemangioma that is easy to use and is cost-effective [2,3]. Materials The study included 204 patients, examined between January 2019-January 2021 in the outpatient setting, diagnosed anteriorly or during the same examination with a focal liver mass. The patients were divided into three groups. Asymptomatic patients, without liver or oncological disease, in whom ultrasound identified a focal liver lesion below 3 cm with homogeneous hyperechoic appearance, with sharp margins and posterior enhancement, an absent halo sign, without intra-tumoral vessels at color Doppler, were assigned to the first group. These characteristics directed the diagnosis toward hepatic hemangioma and further investigations were unnecessary. If ultrasound showed a lesion with features other than those described or if a liver mass was detected in oncological patients or in those with underlying liver disease, CEUS was performed (second group). A typical aspect in contrast ultrasound (peripheral and globular enhancement on arterial phase followed by a central enhancement on delayed phases) guided the diagnosis to liver hemangioma. If the appearance in CEUS was atypical, the patient was referred for further investigations (CT, MRI) (third group). The first two groups were subject to follow-up one year after the diagnosis. Results From all the examined patients, 30 were assigned to the first group. At the 1-year follow-up, 25 presented no changes in lesion characteristics and did not require further investigations. For the 5 remaining patients in this group, ultrasound follow-up indicated tumor size progression and CEUS was performed. In all these cases, CEUS revealed the typical characteristics of hepatic hemangioma. The second group included 45 patients with typical hemangioma findings on CEUS. Due to the stationary appearance of the lesions at the 1-year follow-up, subsequent investigations were not pursued. 129 patients included in the third group required further imagistic evaluation. Conclusions The diagnostic algorithm of liver hemangioma is applicable to the adult patient in countries where the hepatologist has an ultrasonography system equipped with CEUS software in the consulting room.