kwartalnik polskiego towarzystwa ultrasonograficznego

shunt haemangiomas are typically surrounded by
focal hypoechoic areas representing less fat content in
comparison with the surrounding liver parenchyma.
the metabolic changes are explained by a mainly arterial
blood supply of the hypoechoic areas whereas blood
supply of the surrounding liver parenchyma is mainly by
portal venous vessels containing more lipids and insulin.
arterioportal shunts have been observed in hepatic haemangiomas
not only using cEUs but also on multiphase
helical ct and magnetic resonance imaging (MRi) in
22 ULTRASONOGRAFIA nr 34, 2008
Dietrich C.F., Jędrzejczyk M.
Table 7. Contrast enhancing pattern of 58 histologically proven lesions.
Characteristics
Contrast enhancement, arterial
Peripheral nodular arterial enhancement 43/58 (74%)
Peripheral rim like enhancement 0/58 (0%)
not determinable (e.g., due to size of the lesion, solitary fibrotic nodule) 6/58 (10%)
strong homogenous arterial enhancement*
Centripetal filling
9/58 (16%)
complete (homogenous) fill-in 30 seconds and £ 60 seconds 6 (10%)
> 60 seconds and £ 180 seconds 27 (47%)
incomplete (inhomogenous, incomplete iris diaphragm sign, including one with
non-enhancing solitary necrotic nodule)
Sensitivity
13 /58 (22%)
Peripheral nodular arterial enhancement 43/58 (74%)
complete portal venous fill-in 45/58 (78%)
combination of both
*in two patients with liver cirrhosis shunt-haemangiomas were found.
57/58 (98%)
a significant percentage of haemangiomas (19%–26%)
[(10)] which is in the same range.
Focal nodular hyperplasia (FNH)
fnH is typically an isoechoic tumour of variable
size, with a central scar and calcifications (about 70%).
focal nodular hyperplasia and the important differential
diagnosis of hepatocellular adenoma (Hca) are
two benign, mostly incidentally discovered hepatic neoplasia.
Differentiation is essential because of different
therapeutic approaches. the examination of the hepatic
Figure 3. FNH. a) Power Doppler shows central vessel and smaller radiating vessels – “spoke wheel” pattern. b) Early
arterial phase – regular pattern of arteries within the lesion are visible. c) Following seconds of arterial phase – centrifugal
enhancement of the lesion. d) The end of arterial phase – whole lesion is hyperenhanced. e) Portal phase – lesion is slightly
hyperenhanced. f) Late phase – lesion is still slightly hyperenhanced.