Conventional ultrasonography and elastography for the diagnosis of congenital and infantile hemangiomas

Infantile and congenital hemangiomas are difficult to distinguish in infants. The aim of this study was to compare the conventional ultrasonographic (US) and elastographic features of infantile and congenital hemangiomas. The US findings in 118 patients with congenital hemangioma (58 non-involuting, 36 rapidly involuting, 24 partially involuting) and 111 with 120 infantile hemangioma were retrospectively evaluated. On US imaging, 31.7% of infantile hemangiomas were hyperechoic, 31.7% hypoechoic and 36.6% mixed-echoic with hyperechoic and hypoechoic areas; 57.6% of congenital hemangiomas were mixed-echoic with a hypoechoic area and many vessels visible, 39.0% hypoechoic and 3.4% were mixed-echoic with hyperechoic and hypoechoic area. Calcifications were present in 6.8% and visible vessels involving muscle in 24.6% of congenital hemangiomas. All infantile hemangiomas and 82.2% of congenital hemangiomas were well-defined. All congenital hemangiomas were subcutaneous whereas 17.5% of the infantile hemangiomas were superficial. The maximum diameter and vascular density were greater in congenital hemangiomas. Elastography demonstrated that the congenital hemangiomas were softer than the infantile hemangiomas. The maximum diameter (including of visible vessels), thickness, vascular density, venous blood flow velocity and elasticity scores were greater for rapidly and partially involuting congenital hemangiomas than for non-involuting ones. The density of visible vessels in congenital hemangiomas decreased in the order of non-involuting, partially involuting and rapidly involuting. In conclusion, congenital hemangiomas have distinctive US imaging characteristics, including a greater maximum diameter, vascular density, number of visible vessels, visible vessels involving muscle, calcifications and elasticity score.