Ma YX, Zhou CM, Yilihaer Y, Jiang TM, Ruze R, Shao YM, Wen H, Aji T. Diagnosis and surgical decision-making in hepatic hemangioma: From venous malformation overlap to artificial intelligence-assisted multimodality imaging. World J Gastrointest Surg 2026; 18(10): 123208 [DOI: 10.4240/wjgs.123208]
Corresponding Author of This Article
Tuerganaili Aji, Professor, Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, No. 393 Xinyi Road, Xincheng District, Urumqi 830054, Xinjiang Uygur Autonomous Region, China. tuergan78@sina.com
Research Domain of This Article
Gastroenterology & Hepatology
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review-article
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Ma YX, Zhou CM, Yilihaer Y, Jiang TM, Ruze R, Shao YM, Wen H, Aji T. Diagnosis and surgical decision-making in hepatic hemangioma: From venous malformation overlap to artificial intelligence-assisted multimodality imaging. World J Gastrointest Surg 2026; 18(10): 123208 [DOI: 10.4240/wjgs.123208]
World J Gastrointest Surg. Oct 27, 2026; 18(10): 123208 Published online Oct 27, 2026. doi: 10.4240/wjgs.123208
Diagnosis and surgical decision-making in hepatic hemangioma: From venous malformation overlap to artificial intelligence-assisted multimodality imaging
Yu-Xiang Ma, Yierfan Yilihaer, Tie-Min Jiang, Rexiati Ruze, Ying-Mei Shao, Tuerganaili Aji, Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
Cheng-Ming Zhou, Department of Liver and Laparoscopic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
Hao Wen, State Key Laboratory of Pathogenesis, Prevention, Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
Co-first authors: Yu-Xiang Ma and Cheng-Ming Zhou.
Co-corresponding authors: Hao Wen and Tuerganaili Aji.
Author contributions: Ma YX and Zhou CM contribute equally to this study as co-first authors; Wen H and Aji T conceived and designed the project and they contribute equally to this study as co-corresponding authors; Ma YX, Zhou CM, Yilihaer Y, Jiang TM, and Ruze R performed the literature search and collected the data; Ma YX, Zhou CM, Yilihaer Y, Shao YM, and Wen H analyzed and interpreted the data; Ma YX, Zhou CM, and Yilihaer Y drafted the manuscript; Jiang TM, Ruze R, Shao YM, Wen H, and Aji T critically revised the manuscript for important intellectual content; and all authors read and approved the final manuscript.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Supported by State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia Fund, No. SKL-HIDCA-2026-11.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Corresponding author: Tuerganaili Aji, Professor, Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, No. 393 Xinyi Road, Xincheng District, Urumqi 830054, Xinjiang Uygur Autonomous Region, China. tuergan78@sina.com
Received: May 12, 2026 Revised: July 7, 2026 Accepted: August 5, 2026 Published online: October 27, 2026 Processing time: 152 Days and 7 Hours
Abstract
Hepatic hemangioma (HH) represents the most frequent non-cystic benign liver lesion. However, when its diagnosis is ambiguous, it can severely impact clinical decisions, from avoiding unnecessary biopsies to planning complex surgeries. In this narrative review, we explore how adult HH conceptually overlaps with low-flow venous malformations and assess the evolving roles of imaging, artificial intelligence (AI), and therapeutic strategies. To gather evidence, we searched the PubMed and Web of Science databases through March 2026 for English studies covering hepatic lesions, various imaging techniques [ultrasound, contrast-enhanced ultrasound (CEUS), computed tomography, magnetic resonance imaging (MRI)], radiomics, and local treatments. Most typical hemangiomas are easily identified noninvasively. The real diagnostic challenge lies in giant, sclerosed, or flash-filling lesions that resemble cancer, a problem magnified in patients suffering from cirrhosis or extrahepatic malignancies. Currently, MRI is the preferred modality to resolve these uncertainties, supplemented by the dynamic real-time insights of CEUS. Although AI and radiomics present new ways to analyze tricky lesions, current research is held back by retrospective data, inconsistent labeling, and a lack of strong external validation. Ultimately, clinical outcomes could be improved by prioritizing an accurate initial diagnosis. By combining advanced imaging and safely validated AI with the principles of vascular anomalies, clinicians can better manage surveillance, avoid biopsies, and confidently choose between conservative local therapies and major liver resections.
Core Tip: This review reframes the evaluation of hepatic hemangioma (HH) as a diagnosis-driven clinical problem rather than redefining the lesion itself. A key innovation lies in connecting modern concepts of vascular anomalies, particularly the possible biological overlap between selected adult HHs and low-flow venous malformations, with multimodality imaging and treatment selection. This article highlights the importance of magnetic resonance imaging and contrast-enhanced ultrasound in addressing atypical lesions, advises against premature biopsy, and presents artificial intelligence as a decision support tool for indeterminate lesions that may resemble malignancy.
