Assessment of CEUS for evaluation of hepatic infantile hemangiomas

Background: Infantile hemangiomas (IH) are the most common benign vascular tumor in infants. Despite their spontaneous regression, IH can cause aesthetic, functional, and vital organ complications. Hepatic involvement requires particular attention in infants with multiple cutaneous hemangiomas. While magnetic resonance imaging (MRI) is the established diagnostic standard, contrast-enhanced ultrasound (CEUS) emerges as a promising alternative. Objective: To compare the diagnostic accuracy of CEUS and MRI in hepatic IH detection and characterization, and to evaluate potential diagnostic imaging markers. Materials and Methods: A retrospective multicenter analysis was conducted to identify infants diagnosed with hepatic IH who underwent CEUS, MRI, or both between 2016 and 2024. Lesion size and count were compared in patients who underwent both imaging modalities. Data from 24 patients was included in the analysis. Results: Of 24 patients, 15 underwent only CEUS, 3 underwent only MRI, and 6 received both imaging modalities. CEUS findings were comparable to MRI regarding lesion size and number, with CEUS demonstrating capability to detect lesions as small as 4 mm. Treatment decisions were predominantly based on CEUS findings. Conclusion: CEUS showed diagnostic accuracy comparable to MRI in hepatic hemangioma evaluation, without compromising disease severity assessment. CEUS advantages include real-time imaging and avoidance of sedation or anesthesia in young patients. These findings support CEUS as a viable, less invasive, and resource-efficient alternative to MRI for hepatic IH evaluation, enabling optimization of diagnostic and treatment protocols.