The Unexpected High Incidence of Hepatic Hemangiomas, With a Delayed-Phase Washout, During Contrast-Enhanced Ultrasound Utilizing a New Ultrasound Equipment System: A Case Series

The delayed imaging phase of hepatic hemangiomas, during a contrast-enhanced ultrasound (CEUS), was investigated utlizing a recent-generation ultrasound equipment system. From April 2021 to October 2021, ten patients (seven women and three men), with a median age of 52.2 years, were retrospectively reviewed, based on having a known or probable hepatic hemangioma, at least 15–60 mm in diameter. The CEUS examination was conducted using an Aplio i800 (Canon Medical Systems, Otawara, Japan) ultrasound equipment system and a blood pool contrast agent (SonoVue; Bracco, Milan, Italy). The imaging evaluation of the hemangiomas with CEUS was extended beyond 240 seconds from contrast injection. In this study, 80% of hepatic hemangiomas showed washout from 240 to 540 seconds, after contrast bolus injection. Previous studies indicated that hepatic hemangiomas demonstrated a washout in the delayed phase and were considered atypical and rare. However, by using a recent ultrasound equipment system, these lesions may appear more frequently. Since this atypical aspect of hemangioma could lead to confusion, based on a differential diagnosis, with liver malignancy, further studies are needed.