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Diagnostic approach to hepatic hemangiomas detected by ultrasound.

Eighty cases of hepatic hemangioma were studied using ultrasound. In one group consisting of 28 subjects a final diagnosis of hepatic hemangioma was supported by arteriography (21 cases) or surgery (7 cases). In the remaining 52 cases, the diagnosis was uncertain and the normal clinical and biochemical findings with the ultrasound follow-up studies at intervals of 3, 6 and 12 months, made a diagnosis of hemangioma highly probable. Twenty-nine cases (9 cases of the first group and 20 of the second) were also evaluated by Tc-99m colloid and in vivo Tc-99m-labelled red blood cell scintigraphy. On the basis of ultrasound appearance and internal structure, hemangiomas may be divided into three groups: hyperechoic pattern (of which there were 16 cases in our study), cystic or anechoic pattern (5 cases), and complex pattern (7 cases). Fifty-two cases of uncertain diagnosis showed hyperechoic focal lesions with rounded, well-defined margins and no clinical or biological abnormalities. Differentiation from malignant forms must be approached according to the specific ultrasound pattern observed and the presence or absence of symptoms. Only in cases of hyperechoic, well-defined lesions detected in asymptomatic patients may a reliable diagnosis of hemangioma be made. The use of in vivo Tc-99m-labeled red blood cell scintigraphy (Tc-99m RBC scintigraphy) is useful in hyperechoic and cystic forms having a diameter greater than 3 cm. Complex forms invariably require additional studies, using complementary procedures (angiography, angio-CT) to confirm diagnosis.