Sonographic appearances of soft tissue angioleiomyomas: Differences from other circumscribed soft tissue hypervascular tumors

Objectives-The purpose of this study was to evaluate the sonographic features of angioleiomyomas with priority given to the vascular pattern to help in the differential diagnosis from other hypervascular soft tissue tumors. Methods-The inclusion criteria for this retrospective and nonblinded study were fulfilled in 33 patients with circumscribed hypervascular soft tissue tumors based on pathologic identification. Thirteen cases were angioleiomyomas; 9 cases were nonsubungual glomus tumors; and 11 cases were hemangiomas. Two musculoskeletal radiologists interpreted the results by consensus. Sonographic findings, including the shape, size, echogenicity, vascular pattern, and vascular density of the angioleiomyomas, were compared with those of the other hypervascular tumors. Vascular patterns were categorized into 3 vascular types: 1, several linear vessels clustered in the tumor with convergence to one point; 2, diffusely scattered irregular vessels in the tumor, and 3, one or more vessels that were centrally located. The vascularity of the mass was also categorized as rich (covering >50% of the area of the lesion), moderate (between 20% and 50%), and little (<20%). Results-All of the angioleiomyomas were hypoechoic (100% [13 of 13]), a statistically significant result (P = .001). The type 1 vascular pattern was observed in 69% of the angioleiomyomas (9 of 13; P = .029), and the statistically significant shape was round (38% [5 of 13]; P = .035). Conclusions-Most angioleiomyomas reveal a homogeneously hypoechoic echo texture with a circumscribed margin and show straight and linear vessels in the tumor with convergence to one point on color Doppler sonography. These characteristics may be helpful when differentiating angioleiomyomas from other circumscribed hypervascular soft tissue tumors.