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Hemangioma-like Lesions in Chronic Liver Disease: Diagnostic Evaluation in Patients¹

¹ From the Division of Gastroenterology, Division of Medicine, Department of Anatomy and Histopathology, Ospedale Casa Sollievo della Sofferenza, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Cappuccini, I-71013 San Giovanni Rotondo, Foggia, Italy (E.C., D.A.S., M.S., A.A., M.B.); Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy (M.P.); and Department of Radiology and Diagnostic Imaging, Università di Ancona, Italy (F.B.). Received August 4, 2000; revision requested September 20; final revision received January 11, 2001; accepted January 22. Address correspondence to E.C. (e-mail: e.caturelli@tiscalinet.it).

PURPOSE: To quantify the risk of misdiagnosis of focal hepatic lesions manifesting at ultrasonography (US) as typical hemangiomas in a population at high risk for hepatocellular carcinoma (HCC) and to identify the most effective approach to their diagnostic evaluation.

MATERIALS AND METHODS: A total of 1,982 patients with newly diagnosed cirrhosis underwent US and serum -fetoprotein determinations for early detection of HCC. Focal lesions with typical features of hemangioma were evaluated with confirmatory findings of contrast material–enhanced dynamic or spiral computed tomography (CT) and/or single photon emission CT with technetium 99m-labeled red blood cells and, in the absence of confirmatory imaging findings, US-guided fine-needle biopsy. Patients whose initial US scan depicted no lesions or hemangiomas were enrolled in a US follow-up program. All hemangioma-like lesions detected during follow-up were evaluated, or biopsy was performed.

RESULTS: US depicted hemangioma-like lesions in 44 of 1,982 patients: 22 hemangiomas and 22 HCCs. Hemangioma-like lesions detected during follow-up in 1,648 patients were HCCs (n = 22) or dysplastic nodules (n = 4). Only 85 (22%) of 383 patients with HCC had -fetoprotein levels suggestive of the diagnosis. The probability of a diagnosis of HCC (or preneoplastic lesion) is 100% for hemangioma-like lesions depicted on subsequent US scans.

CONCLUSION: If initial US examination of a cirrhotic liver depicts a hemangioma, confirmatory findings of imaging studies are necessary since 50% of hemangiomas in this study were hyperechogenic HCCs. US-guided biopsy can be safely performed, and its findings can be used to confirm the diagnosis.

Index terms: Angioma, 761.3194 • Liver, CT, 761.12112, 761.12115 • Liver, SPECT, 761.12162 • Liver, US, 761.12981 • Liver neoplasms, 761.323

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