Authors: Emilio Quaia Michele Bertolotto Ludovico Dalla Palma
Publish Date: 2014/02/03
Volume: 12, Issue: 3, Pages: 537-544
Abstract
The purpose of this study was to determine if pulse inversion harmonic imaging PIHI can characterize liver hemangiomas We retrospectively evaluated 39 consecutive patients with liver hemangiomas 20 typical on conventional US hyperechoic homogeneous or slightly inhomogeneous and with sharp margins and 19 atypical 11 inhomogeneous with different echogenicity larger than 3 cm 6 hypoechoic and 2 isoechoic smaller than 3 cm Each liver hemangioma was firstly evaluated by PIHI and then confirmed by dynamic helical CT 28 patients or by 6 months of US followup 11 patients The PIHI was performed by two distinct sweeps on a marker lesion 30 s vascular phase and from 3 to 5 min late phase after bolus injection of Levovist 25 g 300 mg/ml Scans were digitally stored and reviewed using a dedicated software Contrast enhancement features of marker lesion were subjectively evaluated Typical hemangiomas on conventional US revealed on PIHI a characteristic rimlike or peripheral globular enhancement on 30s scan in 4 of 20 cases 20 and a characteristic isoechoic pattern on late phase in 16 of 20 cases 80 On PIHI all 11 of 11 atypical hemangiomas larger than 3 cm and 4 of 8 atypical liver hemangiomas smaller than 3 cm revealed a characteristic rimlike or peripheral globular enhancement on vascular phase with a characteristic centripetal fillin on late phase In 4 of 8 atypical liver hemangiomas smaller than 3 cm no characteristic pattern was revealed by PIHI Pulse inversion harmonic imaging revealed a typical pattern in the majority of liver hemangiomas typical and atypical on conventional US In few liver hemangiomas atypical on conventional US PIHI did not identify a characteristic pattern and helical CT was necessary for final characterization
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