Ultrasound and contrast-enhanced ultrasound imaging in hepatic epithelioid hemangioendothelioma: a retrospective study of 13 patients.

Aim: The purpose of this study was to analyze the features of conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) in hepatic epithelioid hemangioendothelioma (HEHE).

Material and methods: We retrospectively analyzed the US images (grayscale, color Doppler and CEUS) of the patients with histopathologically confirmed HEHE in our hospital from March 2015 to August 2021 who had underwent a US investigation.

Results: A total of 13 patients were reported during the study period (seven men, aged from 23 to 62 years, with an average age of 40 years). The unifocal, multifocal, and diffuse lesions were 2, 9, and 2, respectively. Five patients (5/13) had liver involvement of both lobes, and eight (8/13) patients had only right lobe involvement. The maximum diameter of the lesions ranged from 1.9 to 7.0 cm. The grayscale US of HEHE mainly showed multiple hypoechoic lesions (n=9) near the capsule of the right lobe of the liver, with well-defined margins (n=7), accompanied by a hypoechoic halo (n=3) or capsule retraction (n=4) and calcification (n=8). Color Doppler US can detect blood flow in the lesion (n=8). CEUS was performed in five patients (5/13). The enhancement pattern of CEUS varied in the arterial phase, mainly including rim-like hyper-enhancement (n=2) and inhomogeneous hypo-enhancement (n=2), but was approximately the same in the portal venous phase and the late venous phase, both showing varying degrees of regression.

Conclusions: The grayscale US and CEUS seem to provide some reference value for diagnosing HEHE.