What imaging hallmark distinguishes hepatic hemangioma?

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Hepatic hemangioma shows a characteristic pattern of peripheral nodular enhancement in the arterial phase with gradual, centripetal (progressive) fill-in on delayed phases. This reflects the lesion’s cavernous vascular spaces that fill from the outside in as contrast slowly perfuses the lesion. On CT or MRI, you’ll see discontinuous, peripheral enhancement early, which then progressively becomes more homogeneous as time passes. This fill-in pattern is what sets hemangiomas apart from malignant lesions.

In contrast, a central scar with radiating vessels points to focal nodular hyperplasia, not hemangioma. Rapid washout after contrast is typical of hepatocellular carcinoma or metastases, not a benign hemangioma. Homogeneous arterial-phase enhancement with no delayed fill-in would lack the typical peripheral-to-central progression and is not the hallmark of a hepatic hemangioma.