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What preoperative studies are needed to plan a surgical ablation for hemangiomas?

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The standard preoperative imaging studies required for planning a surgical ablation for hemangiomas are ultrasonography, computed tomography, magnetic resonance imaging and nuclear medicine studies, according to a report published on Medscape.

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Adult Kasabach-Merritt syndrome due to hepatic giant hemangioma has a high mortality rate and challenging treatment options. Despite the imposing odds, surgical intervention, while not always certain, is the only known curative method, according to a report published by the American Society of Abdominal Surgeons.

Magnetic Resonance Imaging, utilizing arterial and delayed contrast, is the most discriminating and definitive diagnostic tool for hepatic hemangioma, notes Medscape. This is due to its high sensitivity and specificity in hepatic hemangioma diagnosis.

Ultrasonography (ultrasound) is generally used as the first avenue to obtaining a preoperative diagnosis of hepatic hemangioma, explains Medscape. While hemangiomas are generally echogenic, their sonographic appearance is variable and nonspecific. Adding color Doppler to the scan returns the best data and expands the scan's acuity. Analyses of size increases in the hemangioma are accomplished using sequential scans. Microbubble-enhanced ultrasound has been considered as a preoperative study; however, complete intensification does not always show in some larger lesions that present with scarring or central thrombosis.

Dynamic, computed, contrast-enhanced tomography scanning is favored over a routine CT, reports Medscape. During the contrast CT scan, the liver is first imaged without contrast. About 30 seconds after the contrast is injected, sequential portal venous images are obtained. Delayed images are obtained after several minutes.

Planar scintigraphic studies are regularly used to assist in the diagnosis of hepatic hemangiomas, notes Medscape. SPECT is the touchstone in ascertaining a diagnosis of hepatic hemangioma, despite the fact that the test has been shown to miss some lesions.

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