Contrast-enhanced ultrasound of histologically proven hepatic epithelioid hemangioendothelioma

Yi Dong, Wen-Ping Wang, Vito Cantisani, Mirko D'Onofrio, Andre Ignee, Lorenzo Mulazzani, Adrian Saftoiu, Zeno Sparchez, Ioan Sporea, Christoph F Dietrich

38 Citations (Scopus)


AIM: To analyze contrast-enhanced ultrasound (CEUS) features of histologically proven hepatic epithelioid hemangioendothelioma (HEHE) in comparison to other multilocular benign focal liver lesions (FLL).

METHODS: Twenty-five patients with histologically proven HEHE and 45 patients with histologically proven multilocular benign FLL were retrospectively reviewed. Four radiologists assessed the CEUS enhancement pattern in consensus.

RESULTS: HEHE manifested as a single (n = 3) or multinodular (n = 22) FLL. On CEUS, HEHE showed rim-like (18/25, 72%) or heterogeneous hyperenhancement (7/25, 28%) in the arterial phase and hypoenhancement (25/25, 100%) in the portal venous and late phases (PVLP), a sign of malignancy. Eighteen patients showed central unenhanced areas (18/25, 72%); in seven patients (7/25, 28%), more lesions were detected in the PVLP. In contrast, all patients with hemangioma and focal nodular hyperplasia showed hyperenhancement as the most distinctive feature (P < 0.01).

CONCLUSION: CEUS allows for characterization of unequivocal FLL. By analyzing the hypoenhancement in the PVLP, CEUS can determine the malignant nature of HEHE.

Original languageEnglish
JournalWorld Journal of Gastroenterology
Issue number19
Pages (from-to)4741-9
Number of pages9
Publication statusPublished - 21 May 2016


  • Journal Article


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