Role of ultrasound in diagnosis and differential diagnosis of deep infantile hemangioma and venous malformation

Objective: For vascular anomalies, when clinical findings are not sufficient, auxiliary examination is essential. In this study, we characterize and differentiate the ultrasound (US) findings of deep infantile hemangioma (DIH) and venous malformation (VM). Methods: A total of 135 patients (140 lesions) with clinically proven DIH and VM were analyzed. The following US characteristics were assessed: size, shape, border, echogenicity, echotexture, vascularity, and lesion softness. One-way analysis of variance, nonparametric test, chi(2) test, Fisher exact test, and paired sample t-test were used to analyze the US results. Results: On gray-scale US images, DIH and VM were more common in subcutaneous soft tissue, but VM could invade the muscle. Most DIHs were expressed as hyperechoic structures (47.0%), had a well-defined border (74.2%), and were homogeneous (53%), whereas the majority of VMs showed mixed echoic with anechoic structures (87.8%), had an ill-defined border (58.1%), and were heterogeneous (100%). On color Doppler US, most DIHs (90.9%) showed high vascular density, whereas only a few blood flow signals were found in most VMs (98.6%). On elastic US, VM was softer than DIH (2.9 +/- 0.8 vs 2.6 +/- 0.5; P=.048). After DIH involution, the distance from the body surface increased (P= .015); the lesion's vertical diameter, peak arterial systolic velocity, and Vmax were significantly decreased (P=.006, P=.047, and P= .026, respectively). Also, early VM (<18 months) has the typical US performance of VM. Compared with elastic US, gray-scale and Doppler US provided stronger evidence for differential diagnosis. Conclusions: DIH and VM have different US manifestations that can provide evidence for diagnosis and differential diagnosis of DIH and early VM.