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

Figure 2 A practical diagnosis-first framework for hepatic hemangioma. The flowchart illustrates a six-step multidisciplinary diagnostic and management strategy. The framework highlights the importance of clinical context (Step 1), specific indications for escalation to advanced multimodality imaging (Steps 2-3), the necessity of reclassifying lesion types (Step 4), stringent criteria for biopsy (Step 5), and customized interventional or surgical management based on lesion biology (Step 6). HH: Hepatic hemangioma; MRI: Magnetic resonance imaging; CEUS: Contrast-enhanced ultrasound; VM: Venous malformation.