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Comment & Response
April 2015

Growth Assessment of Hepatic Venous Malformations—ReplyGrowth Assessment of Hepatic Venous Malformations

Author Affiliations
  • 1Department of Surgery, Medical College of Wisconsin, Milwaukee
  • 2Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Milwaukee
  • 3Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Milwaukee
JAMA Surg. 2015;150(4):371. doi:10.1001/jamasurg.2014.3933

In Reply The letter by Fernandez-Pineda and Sandoval emphasizes the nomenclature of hepatic lesions, focusing on infantile hemangiomas and a perceived discrepancy between the diagnosis of hemangiomas based on radiographic criteria and those diagnoses proposed by the International Society for the Study of Vascular Anomalies. However, our article focuses on a common clinical problem among adults: how to manage patients for whom “hepatic hemangiomas” are identified.1 In clinical practice, there are well-accepted criteria for the diagnosis of hepatic hemangiomas that are universally used and that have been well validated by pathologic diagnosis.2 In fact, studies dating back to the late 1970s and early 1980s have shown that axial imaging with computed tomography and magnetic resonance imaging has been reliable in distinguishing hepatic hemangiomas from other benign and malignant lesions.35 In the interval since that time, imaging technology has improved dramatically, particularly with the introduction of advanced magnetic resonance imaging techniques, and, more recently, reported sensitivities and specificities greater than 90% have been described for computed tomography and magnetic resonance imaging.2,6 Therefore, the radiographic diagnosis of hepatic hemangiomas based on established radiographic criteria should be considered reliable.

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