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Hyperechoic and Hypoechoic Hepatic Hemangiomas Smaller Than 3 cm Seldom Coexist

Wu, Size MD; Tu, Rong PhD, MD; Liu, Guangqing MD; Guan, Ying MD; Zhao, Yanyan MD

doi: 10.1097/RUQ.0000000000000058
Original Research

Purpose: The purpose of this study was to determine whether hyperechoic and hypoechoic hepatic hemangiomas coexist.

Methods: Archives of 456 patients with multiple smaller (≤3 cm) hepatic hemangiomas were reviewed, including sex, age, imaging study (ultrasound [US], computed tomography [CT], and magnetic resonance imaging [MRI]), follow-up, and laboratory test. Patients with chronic liver disease or other malignancy and diameter of lesion larger than 3 cm were excluded. The mean age of the patients was 41.8 ± 13.9 years (range, 18–78 years). The liver was observed with US; undetermined cases were evaluated by using CT and/or MRI. The follow-up time was from 35 to 39 months (mean, 36.3 months). Echo patterns, patterns of enhancement on CT and MRI, and associated findings of the hepatic hemangiomas were studied.

Results: The number of hemangiomas was from 2 to 6, including 154 patients with 2 lesions, 196 patients with 3 lesions, 78 patients with 4 lesions, 18 patients with 5 lesions, and 10 patients with 6 lesions. Among them, hyperechoic accounts for 71.93% (328/456), hypoechoic 27.85% (127/456), and hyperechoic and hypoechoic coexistence 0.22% (1/456). There were significant differences of distribution between the hyperechoic and hypoechoic coexistence and other echo patterns (all P < 0.001). Diameter of the hemangioma was from 8.6 and 30.0 mm (15.5 ± 4.9 mm).

Conclusions: Hyperechoic and hypoechoic hemangiomas rarely coexist in the liver. In the event that hypoechoic and hyperechoic lesions are simultaneously found in the liver, CT, MRI, or contrast-enhanced US should be performed for a definitive diagnosis.

Department of Medical Imaging, Affiliated Hospital of Hainan Medical College, Haikou, China.

Received for publication August 24, 2013; accepted October 27, 2013.

The authors declare no conflict of interest.

Reprints: Rong Tu, PhD, MD, Department of Medical Imaging, Affiliated Hospital of Hainan Medical College, No. 31, Longhua Rd, Haikou 570102, China (e-mail:

© 2014 by Lippincott Williams & Wilkins