How to diagnose hepatic hemangioma

Hepatic hemangioma should attract our attention. If we do not pay attention to the diagnosis of hepatic hemangioma, it may cause misdiagnosis, or even fail to effectively treat the disease, thus missing the best time for treatment. Strict examination is required to determine whether there is hepatic hemangioma, and it can usually be diagnosed in relevant hospitals. While doing the checkup, we should pay attention to our living habits and pay close attention to changes in our body. So, how should hepatic hemangioma be diagnosed?

1. Inspection

Hepatic hemangioma lacks specific clinical manifestations, and imaging examinations (such as B-ultrasound, CT, and MRI) are currently the main methods for diagnosing hemangioma.

1. Ultrasound examination

The B-ultrasound manifestations of hepatic hemangioma are high echoes, and those showing low echoes often have a reticular structure, uniform density, regular shape, and clear boundaries. The cross-section of a larger hemangioma may be lobed, and the internal echo is still mainly enhanced. It may be tubular or have irregular nodular or strip-like low-echo areas. Sometimes calcified high-echo and posterior acoustic shadows may also appear, which are caused by thrombosis, organization or calcification in the vascular cavity.

2. Contrast Ultrasound

For cases of hepatic hemangioma with atypical imaging manifestations, selective liver contrast ultrasound examination may be considered. Typical hemangioma ultrasound angiography shows nodular or ring-like enhancement in the periphery during the arterial phase, which gradually expands toward the center over time. This expansion process is slow, and the lesions are still in an enhanced state during the portal venous and delayed phases, with echoes equal to or higher than those of the surrounding liver tissue.

3. Spiral enhanced CT

CT plain scan examination shows round or quasi-round low-density lesions with clear boundaries in the liver parenchyma, and a few may be irregular in shape.

4. MRI

MRI examination shows low signal on T1-weighted examination and high signal on T2-weighted examination with uniform intensity, clear edges and obvious contrast with the surrounding liver, which is described as the "light bulb sign", which is the specific manifestation of hemangioma on MRI.

5. Others

Liver biopsy has a low accuracy rate and may cause bleeding, and hepatic artery angiography is an invasive examination and is often unnecessary. Whole-body positron emission tomography/computed tomography (PET/CT) is valuable in excluding metabolically active malignancies.

II. Treatment

1. Surgery

Currently, the main treatments for hepatic hemangioma include hemangioma resection, hemangioma suture ligation, hepatic artery ligation, microwave solidification, radiofrequency therapy, hepatic artery embolization, etc. Liver transplantation can also be used to treat diffuse hepatic hemangiomas or giant hemangiomas that cannot be removed, such as those with liver decompensation or combined with Kasabach-Merritt syndrome.

2. Non-surgical treatment

(1) Hepatic artery embolization (TAE) TAE is a treatment for hepatic hemangioma based on the fact that hepatic hemangioma is mainly supplied by the hepatic artery. After embolization of the artery, a thrombus may form in the tumor. The thrombus may become organized and fibrotic, causing the tumor to form a fibroma-like structure, thereby achieving the purpose of shrinking and hardening the hemangioma.

(2) Microwave solidification and radiofrequency treatment of hepatic hemangioma. Microwaves can be converted into heat energy to coagulate the surrounding tissues, causing the tumor to shrink and harden locally, thus achieving the purpose of solidifying the tumor.