Schmillevitch Joel, Szutan Luiz Arnaldo, Ferreira Fábio Gonçalves, Santos Maria de Fátima, Mincis Ricardo, Gorski Ana
Department of Surgery, Faculty of Medical Sciences, Santa Casa of São Paulo, São Paulo, SP, Brasil.
Arq Gastroenterol. 2011 Apr-Jun;48(2):119-23. doi: 10.1590/s0004-28032011000200007.
The incidence of hepatic hemangiomas ranges from 0.4% to 20% in the general population. Conventional ultrasound is usually the first diagnostic method to identify these hemangiomas, typically as an incidental finding. Ultrasonography with second generation contrast materials is being used in various areas of hepatology, yielding similar results to those obtained with computerized tomography and magnetic resonance imaging in the diagnosis of hepatic hemangiomas.
To evaluate the agreement between ultrasound with perflutrene contrast and magnetic resonance imaging in the diagnosis of hepatic hemangiomas.
A total of 37 patients were prospectively examined between January 2006 and August 2008. A total of 57 hepatic nodules were documented in this group as incidental findings on routine ultrasound exams. The 37 patients were administered perflutrene contrast without adverse reactions, and were all submitted to magnetic resonance exams.
Conventional ultrasound identified 15 patients with nodules typical of hemangiomas and 22 patients with other nodules. In 35 patients, the contrast characteristics were consistent with hepatic hemangiomas.
Agreement between the data obtained from ultrasound with contrast and magnetic resonance was 94.5%. In discordant cases, the magnetic resonance diagnosis prevailed. In the case which presented indeterminate findings on contrast ultrasonography, magnetic resonance was repeated after 3 months, confirming the diagnosis of a hepatic hemangioma. A biopsy was performed on the suspected malignant nodule which also confirmed the presence of a hepatic hemangioma. Ultrasonography with contrast has the advantages of being more accessible to the public at large and lower cost than magnetic resonance. The results of our study highlight the need for a new protocol in hepatic nodules incidentally identified on conventional ultrasonography. In the case of typical hemangiomas, conventional ultrasound is sufficient for diagnosis. However, for poorly defined nodules, ultrasonography with contrast is indicated. After confirming the presence of a hepatic hemangioma on contrast ultrasonography, no further exams are needed to finalize the diagnosis.
肝血管瘤在普通人群中的发病率为0.4%至20%。传统超声通常是识别这些血管瘤的首选诊断方法，通常为偶然发现。使用第二代造影剂的超声检查正在肝病学的各个领域得到应用，在肝血管瘤的诊断中产生的结果与计算机断层扫描和磁共振成像所获得的结果相似。
评估全氟丙烷超声造影与磁共振成像在肝血管瘤诊断中的一致性。
2006年1月至2008年8月对37例患者进行前瞻性检查。该组在常规超声检查中偶然发现共记录到57个肝结节。对37例患者给予全氟丙烷造影剂且无不良反应，所有患者均接受磁共振检查。
传统超声检查发现15例患者的结节具有血管瘤典型特征，22例患者有其他结节。35例患者的造影特征与肝血管瘤一致。
超声造影与磁共振成像数据的一致性为94.5%。在不一致的病例中，以磁共振诊断为准。在超声造影检查结果不确定的病例中，3个月后重复磁共振检查，确诊为肝血管瘤。对疑似恶性结节进行活检，也证实为肝血管瘤。超声造影的优点是比磁共振成像更普及且成本更低。我们的研究结果强调了对常规超声偶然发现的肝结节需要一种新的诊断方案。对于典型的血管瘤，传统超声足以诊断。然而，对于边界不清的结节，则需要超声造影检查。在超声造影证实存在肝血管瘤后，无需进一步检查即可完成诊断。
