Correlation of the real-time ultrasonographic appearance of hepatic hemangiomas with angiography

Duplex pulsed Doppler sonography in the differential diagnosis of hepatocellular carcinoma and other common hepatic tumours

180 previously untreated consecutive patients with liver tumours (308 lesions), including 104 hepatocellular carcinomas (148 lesions), 43 metastases (116 lesions) and 33 haemangiomas (44 lesions), were studied to determine the value of duplex sonography in the differentiation of hepatocellular carcinoma from other tumours. For lesions measuring less than or equal to 5 cm in diameter, hepatocellular carcinoma demonstrated the highest rate and haemangioma demonstrated the lowest rate of Doppler signals from within the lesions. To differentiate malignancy from haemangioma, the presence or absence of Doppler signals from these lesions were used as criteria. The specificity and positive predictive value were very high (100%, 100%), but the sensitivity, negative predictive value and accuracy were low (61.5%, 48.3%, 71.7%, respectively). With one exception, all lesions measuring less than 3 cm in diameter with detectable Doppler signals were hepatocellular carcinoma. Using these results it is possible to differentiate hepatocellular carcinoma from metastases and haemangioma with high sensitivity, specificity, positive and negative predictive value, and accuracy (80.8%, 96.4%, 95.5%, 84.4%, 88.9%, respectively, for metastases; 80.8%, 100%. 100%, 81.5%, 89.6%, respectively, for haemangioma). We conclude that Doppler signals from within a lesion in combination with its size can aid differentiation of hepatocellular carcinoma from two other kinds of common hepatic tumour.

Cystic cavernous hemangioma of the liver

We report an unusual case of multilocular cystic cavernous hemangioma of the liver. The patient was a 61-year-old woman without liver disfunction but who had multicystic mass lesions in the liver. Although cavernous hemangiomas are usually accurately diagnosed by the various imaging modalities, our case showed atypical features.

Clinical significance of focal echogenic liver lesions

During a 4-year period, 53 focal echogenic liver lesions were demonstrated by sonography in 41 patients, in whom there was no evidence of metastatic origin. Most of the lesions were hemangiomas. One of the purposes of this study was to determine the characteristic ultrasound features for liver hemangioma. Small (less than 2 cm), homogeneous, echogenic, well-circumscribed, subcapsular lesions almost prove their hemangiomatous nature. Lesions with a diameter of more than 2 cm are usually more lobulated and heterogeneous. They are located more centrally in the liver and nearly all show a close anatomical relation with 1 of the hepatic veins. Very large lesions (greater than 5 cm) with a heterogeneous and irregular aspect suggest focal nodular hyperplasia, which must be proven by a Tc-isotopic liver scan.