Study population
This combined retrospective and prospective study from April 2014 to March 2020 on 186 adult patients (54 males and 132 females) with 244 hepatic hemangioma lesions. The median age of patients was 45 years and the range was 18–68 years.
Patient inclusion criteria
Adult patients (age is more than 18 years) having hepatic hemangioma.
Patient exclusion criteria
Patients younger than 18 years, females receiving oral contraceptive pills, and patients who had received treatment for the hemangiomas were excluded.
Follow-up was performed to observe the accurate site, size, number, rate of growth of the lesions, and their tendency to cause symptoms or complications. Diagnosis of hemangiomas was done by typical ultrasonographic findings and patients with atypical manifestations underwent enhanced computed tomography or magnetic resonance imaging.
Patients were divided into two age groups: 18–45 years and > 45 years. Data regarding sex, age, tumor diameter, and follow-up period were recorded. The maximum diameter was used to assess the tumor size. The change of tumor growth was expressed in mm/year. Ultrasound examinations for all patients were done every 6 months for at least 2 times after the initial diagnosis.
Follow-up period of 12 to 24 months was performed in the outpatient clinics, with repeated US and blood examinations (complete blood count, prothrombin time and liver function tests) every 6 months. Giant hemangiomas were defined in the current study as hemangiomas with a diameter > 10 cm [7].
Written consent form was filled by every patient after detailed explanation of the study and the plane of management.
The study was approved by the Ethics Review Committee of our institute.
Study design
Combined retrospective and prospective study was conducted on 186 adult patients (more than 18 years) having 244 hepatic hemangiomas who attended to the outpatient clinics, 54 males and 132 females. Follow-up was performed to observe the accurate site, size, number, rate of growth of the lesions, and their tendency to cause symptoms or complications.
Imaging proctocol
Ultrasound examination was performed by ultrasound scanner (EPIQ 7 Machine-Philips ultrasound). Ultrasonography of the whole liver parenchyma was done with several imaging access, and many application techniques were used during examination (subcostal diagonal, subcostal longitudinal, sagittal and transverse, right intercostal lateral plans). The selection of planes depends on the accessibility of the lesion by the ultrasound beam intra-abdominally away from ribs and gas containing viscera.
CT examination was performed by CT scanner (Aquilion PRIM-Canon Medical). Triphasic CT scanning of the liver where performed at 120 kvp and 200–250 mAs. Patients were fasting for 5 h before procedure then were given non-ionic I/V contrast of 1.5 ml/kg with dose ranging from 80 to 100 ml. Patient preparation also included administration of 1000 ml of water 30–60 min prior to the examination as oral contrast. First, we scan all the liver before I/V contrast injection (non-contrast images) then after injection of intravenous contrast material, liver was scanned in the arterial phase for 15–35 s, the portal was scanned for 60–70 s, venous phase for 70–90 s, and delayed scanning after 5–10 min).
MRI examination was performed by MRI scanner (Ingenia Philips Medical Systems). Technique of MRI requires numerous sequences and imaging at multiple times after the administration of contrast at different axial and coronal plans. T2-weighted sequence: T2 HASTE and T2 fat-saturated, non-contrast T1-weighted sequences: T1 in-phase and out-of-phase, T1 fat-saturated, diffusion-weighted imaging (DWI): fat-saturated single-shot diffusion-weighted EPI, post-contrast dynamic sequences T1 2D or 3D gradient-echo sequences: arterial phase: 20–30 s, portal venous phase: 60–70 s, equilibrium phase: 5–10 min, with and without fat sat.
We used the longitudinal, sagittal, and transverse plans for measuring the size of lesions by ultrasonography. By CT and MRI, we estimated the volume of the lesion from the axial and coronal images by measuring the antero-posterior, transverse, and longitudinal diameters.
Statistical analysis
Statistical analysis was performed using SPSS, Version 23 (SPSS Inc., Chicago, IL). Chi-square test was used to compare between the groups with respect to categorical data. Comparisons between two groups for normally distributed numeric variables were done using Student’s t test while for non-normally distributed numeric variables, comparisons were done by Mann–Whitney U test. Numerical variables were presented as mean ± SD. Descriptive statistics were reported as frequencies and percent.