Differentiation of vascular patterns in hepatic hemangioma using superb microvascular imaging (SMI) technology of ultrasound at Chulabhorn Hospital

Abstract

Superb Microvascular Imaging (SMI) is an innovative ultrasound Doppler technique that allows visualization of micro-slow flow vessel. This technique provides highly detailed vascularity in tumor. Purpose: This study aimed to explore SMI role in characterizing vascular patterns of hepatic hemangioma in ultrasound. Methods: Twenty patients with 29 hepatic lesions in the size range of 0.8 – 3.5 cm were included in this retrospective study. All lesions were confirmed with computed tomography and/or magnetic resonance imaging and were evaluated vascular patterns by SMI. Lesions were classified as benign tumors (hemangioma and inflammation) and malignant tumors (hepatocellular carcinoma and metastasis). Fisher’s exact test was used to compare the frequencies of the SMI patterns between benign and malignant tumors. Results: According to the vascular patterns on SMI, 19 hemangiomas exhibited five patterns, including nodular rim, non-specific, nodular rim with dot-like, staining and no signal were 31.58%, 26.32%, 21.05%, 5.26%, 1.79%, respectively. Two cases of inflammation exhibited nodular rim and no signal patterns were 50% and 50%, respectively. Seven metastases exhibited non-specific and no signal patterns were 85.71% and 14.29%, respectively. Hepatocellular carcinoma (HCC) exhibited a staining pattern. The SMI vascular patterns of HCC and metastatic lesions were statistically significant difference from those of hemangioma (p<0.05). Conclusion: SMI is able to provide useful information for significantly differential diagnosis of HCC and metastatic lesions from hemangiomas.