Ultrasonography.  2021 Oct;40(4):538-545. 10.14366/usg.20177.

Superb microvascular imaging technology of ultrasound examinations for the evaluation of tumor vascularity in hepatic hemangiomas

• Jeon SK
• Lee JY
• Han JK

• KMID: 2520313
• DOI: http://doi.org/10.14366/usg.20177

Abstract

Purpose
This study aimed to investigate and categorize the diverse features of hepatic hemangiomas on superb microvascular imaging (SMI) in a relatively large prospective study.
Methods
In this prospective study, 70 patients with 92 hepatic hemangiomas were consecutively enrolled. All nodules were radiologically confirmed with the typical imaging features of hepatic hemangiomas on dynamic computed tomography (CT) or magnetic resonance imaging (MRI). Using SMI, all lesions were evaluated and categorized into subgroups according to the flow pattern on SMI. Differences in the frequencies of SMI patterns according to lesion size and enhancement patterns on dynamic CT or MRI were also compared.
Results
In 67.4% (62/92) of hemangiomas, tumor vascularity was detected using SMI, while 32.6% (30/92) did not show any signal on the SMI examination, and the absence of an SMI signal was not shown in rapidly enhancing hemangiomas (0% [0/30] vs. 100% [30/30], P=0.002) and was more frequent in lesions <2 cm than in lesions ≥2 cm (44.0% [22/50] vs. 2.7% [8/42], P=0.011). In hepatic hemangiomas in which vascularity was detected (n=62), the strip rim pattern was the most common SMI pattern of hepatic hemangiomas (48.4%, 30/62), followed by the nodular rim pattern involving spotty dot-like engorged vessels (37.1%, 23/62).
Conclusion
The evaluation of the inner vascularity of hepatic hemangiomas with SMI was feasible for most hemangiomas, especially in larger (≥2 cm) or rapidly enhancing hemangiomas. The most frequent SMI patterns of hepatic hemangiomas were the strip rim pattern and nodular rim pattern.

Keyword

Hemangioma; Ultrasonography; Doppler ultrasonography; Microvessels

Figure

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  Fig. 1. Flowchart of the study population.

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  Fig. 2. A classification of the superb microvascular imaging features.A diagram of the superb microvascular imaging features of hepatic nodules is shown: strip rim pattern (A), nodular rim pattern (B), peripheral dot-like pattern (C), central dot-like pattern (D), nonspecific vascular pattern (E), and staining pattern (F).

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  Fig. 3. A 2.2-cm hemangioma in a 47-year-old woman.A, B. On contrast-enhanced computed tomography, a nodular lesion (arrow) exhibits peripheral globular enhancement in the arterial phase (A) and centripetal fill-in in the delayed phase (B), consistent with a hepatic hemangioma. C. B-mode ultrasonography reveals a 2.2-cm isoechoic nodular lesion with a hyperechoic rim (arrow). D. Superb microvascular imaging reveals a well-visualized strip rim pattern of vascularity (arrow).

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  Fig. 4. A 1.8-cm hemangioma in a 35-year-old woman.A, B. Contrast-enhanced computed tomography reveals a 1.8-cm nodule (arrow) with peripheral globular enhancement in the arterial phase (A) and centripetal fill-in in the delayed phase (B), which suggests a hepatic hemangioma. C. B-mode ultrasonography reveals a 1.8-cm hypoechoic nodule with a hyperechoic rim (arrow). D. On superb microvascular imaging, the lesion shows the nodular rim pattern of vascularity (arrow), which is defined as a prominent nodular dot-like structure (arrowhead) with strip rim vascularity.

Reference

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