PURPOSE: To evaluate the differences in sonographic appearance and hemodynamics between hypoechoic andhyperechoic hemangioma. MATERIAL AND METHOD: We retrospectively reviewed the sonographic appearance and MRIfindings of 23 hypoechoic hepatic hemangiomas in 16 consecutive patients. Nine were men and seven were women, witha mean age of 50 years(range, 40-72). We analyzed the sonographic appearance such as size, shape, border,echogenecity, posterior acoustic enhancement and the presence of fatty liver, and MRI findings such as signalintensity, enhancement pattern. For comparison, we also reviewed the sonographic appearance and MRI findings of 23hyperechoic hemangiomas in 16 randomly selected patients. RESULTS: There were no differences in size, shape,incidence of posterior acoustic enhancement, MR signal intensity or enhancement pattern between hypoechoic andhyperechoic hemangiomas(p>0.05, Chi-square). However, fatty infiltration of the liver and echogenic rim of themasses were more commonly seen in hypoechoic hemangiomas(9:1, 5:0, respectively, p<0.05). CONCLUSIONS: There wereno differences in MR enhomcement pattern or incidence of posterior acoustic enhancement between hypoechoichyperechoic hemangioma. The vascularity of a mass therefore seems to contribute little to its echogenecity.