Centrifugal (inside-out) enhancement of liver hemangiomas: A possible atypical appearance on contrast-enhanced US

Bartolotta, Tommaso Vincenzo; Taibbi, Adele; Galia, Massimo; Lo Re, Giuseppe; La Grutta, Ludovico; Grassi, Roberto; Midiri, Massimo

doi:10.1016/j.ejrad.2007.02.038

« Previous Next »European Journal of Radiology
Volume 64, Issue 3 , Pages 447-455, December 2007

Centrifugal (inside-out) enhancement of liver hemangiomas: A possible atypical appearance on contrast-enhanced US

Tommaso Vincenzo Bartolotta
- Department of Radiology, University of Palermo, Via Del Vespro 127, 90127 Palermo, Italy
- Corresponding author. Tel.: +39 091 6552330; fax: +39 091 6552337.
Adele Taibbi
- Department of Radiology, University of Palermo, Via Del Vespro 127, 90127 Palermo, Italy
- Tel.: +39 091 6552330; fax: +39 091 6552337.
Massimo Galia
- Department of Radiology, University of Palermo, Via Del Vespro 127, 90127 Palermo, Italy
- Tel.: +39 091 6552330; fax: +39 091 6552337.
Giuseppe Lo Re
- Department of Radiology, University of Palermo, Via Del Vespro 127, 90127 Palermo, Italy
- Tel.: +39 091 6552330; fax: +39 091 6552337.
Ludovico La Grutta
- Department of Radiology, University of Palermo, Via Del Vespro 127, 90127 Palermo, Italy
- Tel.: +39 091 6552330; fax: +39 091 6552337.
Roberto Grassi
- Institute of Radiology, Second University of Naples, Piazza Miraglia, 80138 Naples, Italy
Massimo Midiri
- Department of Radiology, University of Palermo, Via Del Vespro 127, 90127 Palermo, Italy
- Tel.: +39 091 6552330; fax: +39 091 6552337.

Received 12 December 2006; received in revised form 26 February 2007; accepted 28 February 2007.

Abstract

Objective

To report the prevalence and to describe the atypical centrifugal (inside-out) appearance of contrast-enhancement of liver hemangiomas on contrast-enhanced sonography.

Materials and methods

Baseline and SonoVue^®-enhanced ultrasonography of 92 patients with 158 liver hemangiomas – considered atypical at grey-scale examination and confirmed by computed tomography, magnetic resonance imaging and ultrasound follow-up – were reviewed in consensus by two experienced radiologists, who evaluated baseline echogenicity and the dynamic enhancement pattern of each lesion looking for the presence of central enhancing foci in the arterial phase followed by a centrifugal (inside-out) enhancement in the portal-venous and late phases.

Results

After administration of SonoVue^®, 12/158 hemangiomas (7.6%) (size range: 1–7cm; mean: 3.2cm) in seven patients (5 women, 2 men; age range: 34–71 years, mean: 50.8 years) showed a central enhancing focus in the arterial phase followed by a centrifugal enhancement in the portal-venous and late phases. In all cases centrifugal enhancement was incomplete at contrast-enhanced sonography, whereas computed tomography and/or magnetic resonance imaging were able to depict a complete and homogeneous fill-in.

Conclusion

Radiologist should be aware that centrifugal (inside-out) appearance on contrast-enhanced sonography is a rare but possible feature of liver hemangioma.

Keywords: Liver, Hemangiomas, Liver neoplasms, US, Ultrasound, Contrast media, Pulse inversion harmonic imaging