Hemangioma-like lesions in chronic liver disease: Diagnostic evaluation inpatients

PURPOSE: To quantify the risk of misdiagnosis of focal hepatic lesions mani festing at ultrasonography (US) as typical hemangiomas in a population at h igh risk for hepatocellular carcinoma (HCC) and to identify the most effect ive approach to their diagnostic evaluation. MATERIALS AND METHODS: A total of 1,982 patients with newly diagnosed cirrh osis underwent US and serum ol-fetoprotein determinations for early detecti on 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 fin dings, US-guided fine-needle biopsy. Patients whose initial US scan depicte d no lesions or hemangiomas were enrolled in a US follow-up program. All he mangioma-like lesions detected during follow-up were evaluated, or biopsy w as performed. RESULTS: US depicted hemangioma-like lesions in 44 of 1,982 patients: 22 he mangiomas 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 cl-fetoprotein levels suggestive of the d iagnosis. The probability of a diagnosis of HCC (or preneoplastic lesion) i s 100% for hemangioma-like lesions depicted on subsequent US scans. CONCLUSION: If initial US examination of a cirrhotic liver depicts a hemang ioma, confirmatory findings of imaging studies are necessary since 50% of h emangiomas in this study were hyperechogenic HCCs. US-guided biopsy can be safely performed, and its findings can be used to confirm the diagnosis.