The diagnosis of hepatic neoplasms represents a challenging issue in abdominal radiology as it requires the careful analysis of multiple clinical and imaging parameters. First of all, the radiologist should have at hand precise clinical information, such as the patient’s age, sex, clinical history, lab test results, and clinical presentation . Then, findings of previous imaging tests should be accurately reviewed. This is followed by choosing the most accurate imaging modality allowing characterization of the (suspected) hepatic neoplasm. The imaging protocol, including acquisition parameters and contrast medium choice, needs to be tailored to the patient's case. The final, and obviously important, step is the image review. Image interpretation is strongly influenced by the radiologist’s experience. It requires a systematic approach in which all imaging findings are accurately reviewed and interpreted, leading to the correct diagnosis. The latter is achieved when it has been clearly demonstrated that the lesion shows the typical findings and clinical history described in the literature. However, there will also be many cases requiring that the radiologist is aware of the limits of diagnostic imaging, as in the case of a hepatic tumor with an atypical appearance or a mismatch between the imaging findings and the clinical data. When confronted with these situations it is imperative that the radiologist not overcall a specific diagnosis but instead accurately describe the imaging findings and recommend further management (alternative imaging, biopsy, follow-up, surgery). Moreover, each step of this complex diagnostic process is a source of potential pitfalls. There are many possible sources of error that can lead to a misdiagnosis or to a missed diag nosis of a hepatic lesion. Errors may be related to a lack of clinical information, an incorrect imaging modality or technical imaging protocol, and finally to the wrong interpretation of the images . Even when the imaging procedure is properly chosen and the imaging studies have been performed accurately, medical mistakes can still be made, in the form of a perceptive error or an interpretative error. A perceptive error results in a failure to identify a hepatic neoplasm, such as may occur if it is subtle or is hidden by marked hepatic steatosis or a transient hepatic attenuation difference (THAD). Radiologists who are not well trained are more likely to commit perceptive errors but there are other relevant causes of perceptive error as well, represented by human factors (e.g., insufficient time available for reporting due to a crowded work-list) and by all the possible causes of medical malpractice.
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