Diagnosis and surgical decision-making in hepatic hemangioma: From venous malformation overlap to artificial intelligence-assisted multimodality imaging

Table 2 Multimodality imaging clues for typical and atypical hepatic hemangioma

Lesion	Typical ultrasound/CEUS pattern	Typical CT/MRI pattern	Main diagnostic pitfall
Typical HH	Well-defined hyperechoic lesion; CEUS shows peripheral nodular enhancement with progressive fill-in	T1 hypointense, markedly T2 hyperintense; peripheral nodular arterial enhancement with delayed centripetal fill-in	Usually, few pitfalls when the imaging pattern and clinical context are both classic
Flash-filling HH	May enhance rapidly and almost homogeneous on CEUS	Uniform arterial hyperenhancement, sometimes with less obvious delayed fill-in	Can mimic FNH, HCC, or hypervascular metastasis if delayed phases and T2 signal are underweighted
Sclerosed/hyalinized hemangioma	Often nonspecific or heterogeneous	Reduced T2 hyperintensity, incomplete enhancement, fibrosis, retraction	Frequently mistaken for cholangiocarcinoma or metastasis

HH: Hepatic hemangioma; CT: Computed tomography; MRI: Magnetic resonance imaging; CEUS: Contrast-enhanced ultrasound; FNH: Focal nodular hyperplasia; HCC: Hepatocellular carcinoma.