Analysis of Prenatal Sonographic Features in Rare Fetal Giant Hepatic Hemangioma and Prediction of Prenatal Complications and Prognosis

ABSTRACT Objective This study aimed to evaluate the sonographic features of giant fetal hepatic hemangioma (GFHH) as predictors of complications and outcomes. Methods We conducted a retrospective analysis of prenatally diagnosed GFHH cases between 2014 and 2024, reviewing ultrasonographic features, complications, and neonatal outcomes. Results Among 36 fetuses, 38.9% exhibited homogeneous masses and 61.1% showed heterogeneous masses. Peripheral annular or semi‐annular blood flow was observed in 88.9% of cases. Heterogeneous echogenicity was more frequent in the complicated group (93.3%, 14/15) than in the uncomplicated group (38.1%, 8/21) ( p < 0.01). Significant differences were identified between the complicated and uncomplicated groups regarding the presence of vascularity, arteriovenous fistula (AVF), hepatic artery peak systolic velocity (HAPSV) (> 106 cm/s), and hepatic vein dilation (≥ 3 veins) (all p < 0.05). The survival rate was 100% among the 21 fetuses in the uncomplicated group, compared with 73.3% among the 15 fetuses in the complicated group. Conclusion The typical presentation of GFHH is a well‐defined hypoechoic mass with peripheral circular or semicircular vascularity. Homogeneous masses are predictive of favorable outcomes, whereas within heterogeneous masses, features such as hypervascularity, AVF, HAPSV > 106 cm/s, and dilation of three hepatic veins are closely correlated with an increased risk of complications.