Signal from hepatic hemangiomas on power Doppler US: real or artefactual?

To describe imaging findings of hepatic hemangiomas on power Doppler (PD) ultrasound (US) with revised Doppler parameters for preventing PD artefacts from stationary hyperechoic tissue, we prospectively evaluated 48 hemangiomas by PD US with predetermined PD settings to prevent artefactual signals from stationary hyperechoic tissue (pulse repetition frequency of 1000 Hz, medium wall filter, and PD gain of 60-85%). Intratumoral PD signals were not seen in 32 lesions (67%). Minimal (n = 15) or moderate (n = 1) intratumoral PD signals were seen in 16 lesions (33%) and were distributed in the peripheral portion only in 12 lesions (75%) and in the peripheral and central portion in 4 lesions (25%). Due to the lack of sensitivity of PD to detect slow flow in hemangiomas, PD US should no longer be used for the evaluation of echogenic liver masses caused by hemangiomas from other hypovascular malignant lesions of the liver.