Contrast-enhanced imaging in hepatic epithelioid hemangioendothelioma: retrospective study of 10 patients.

Klinger, Christoph; Stuckmann, Gerhard; Dietrich, Christoph F; Berzigotti, Annalisa; Horger, Marius S; Debove, Ines; Gilot, Bryant J; Pauluschke-Fröhlich, Jan; Hoffmann, Tatjana; Sipos, Bence; Fröhlich, Eckhart (2019). Contrast-enhanced imaging in hepatic epithelioid hemangioendothelioma: retrospective study of 10 patients. Zeitschrift für Gastroenterologie, 57(6), pp. 753-766. Thieme 10.1055/a-0886-0081

Text Klinger, 2019, contrast_enhanced imaging in hepatic epithelioid hemangioendothelioma.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (1MB)

PURPOSE

The purpose of this study was to analyze imaging findings in hepatic epithelioid hemangioendothelioma (HEHE) with a particular focus on contrast-enhanced ultrasound (CEUS).

MATERIALS AND METHODS

This retrospective multicenter study included 10 patients with histologically proven HEHE from 5 European centers. All existing ultrasound images/videos were independently analyzed by 2 experienced examiners (DEGUM level III, internal medicine) using a standardized evaluation form. Patterns of contrast enhancement were correlated with computed tomography (CT), magnetic resonance imaging (MRI), and pathological findings.

RESULTS

B-mode ultrasound, CEUS, CT, and MRI were performed in 90 %, 70 %, 100 %, and 90 % of patients, respectively. Multifocal HEHE could be observed in 80 % with affection of both liver lobes in 70 %. Analysis of CEUS revealed 3 characteristic patterns that correlated well with contrast patterns on CT and MRI: (a) peripheral nodular enhancement with centripetal fill-in and wash-out in the portal venous and late venous phase (PVLP), (b) rim-like arterial enhancement with wash-out in the PVLP, and (c) inversed target sign with/without wash-out in the PVLP. Wash-out in the PVLP as a sign suspicious of malignancy was observed in 6/7 patients (85.7 %).

CONCLUSIONS

Knowledge of the different characteristic CEUS patterns is of importance to avoid misdiagnosis due to resemblance of patterns A and B to the much more common focal liver lesions hemangioma and intrahepatic cholangiocarcinoma. Of importance, sonographers should be aware that wash-out in the PVLP might be absent in some patients.

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