Safety and Effectiveness of Image-Guided Therapies for Giant Hepatic Hemangiomas: A Systematic Review and Meta-Analysis of 2,617 Patients

Purpose: To evaluate the safety and effectiveness of image-guided therapies—including transarterial chemoembolization (TACE), radiofrequency (RF) ablation, microwave ablation, and percutaneous sclerotherapy—for the treatment of giant hepatic hemangiomas (GHHs). Materials and Methods: A comprehensive search was performed across PubMed, Scopus, and Web of Science, including studies with ≥5 patients that reported image-guided treatment of GHHs. Primary outcomes included technical success, adverse events (AEs; classified according to the Society of Interventional Radiology [SIR] system), clinical success (symptom relief without additional intervention), and radiologic success (≥50% size reduction and/or lack of enhancement on follow-up imaging). A subgroup analysis was performed for GHHs of ≥10 cm. Outcomes were analyzed using a random-effect meta-analysis. Results: Twenty-eight studies (2,617 patients; 32.5% men; mean age, 46.1 years [SD ± 3.2]) with 2,996 GHHs, ranging from 4 to 30 cm, were included. Of these, 22 were noncomparative, and 6 compared either 2 image-guided therapies or surgery, reporting outcomes for TACE (n = 13), RF ablation (n = 7), microwave ablation (n = 6), and percutaneous sclerotherapy (n = 4). The pooled technical success rate was 99.9%. Grade 2–4 AEs occurred in 1.64%, with TACE having the lowest rate (0.2%) and RF ablation the highest (2.1%). Clinical success at final follow-up was 99.9%, while radiological success was 85.7%. Grade 2–4 AEs were significantly higher in the subanalysis of GHHs of ≥10 cm (10.6%; P < .001), despite similar technical success and radiological and clinical outcomes. Conclusions: Image-guided therapies are safe and effective for GHHs, achieving high technical, clinical, and radiological success with minimal Grade 2–4 AEs. However, for GHHs ≥10 cm, AE rates were higher.