A 22 year old man presents with a solitary 2 cm space occupying lesion of mixed echogenicity in the right lobe of the liver on ultrasound examination. The rest of the liver is normal. Which of the following tests should be done next –
Lesion in right hepatic lobe with mixed echogenicity on USG suggests the diagnosis of hemangioma.
MRI is the most accurate method of diagnosing liver hemangioma and is indicated when liver hemangioma is suspected on USG and the diameter of the lesion is smaller than 2.5 cm. However, MRI is not provided in the options.
A second most accurate method of diagnosing liver hemangioma is SPECT RBC scintigraphy (hepatic scintigraphy). It is indicated to confirm the diagnosis when hemangioma is suspected on USG and the diameter of the lesion is greater than 2.5 cm.

Suspected hemangioma on USG:-
Lesion smaller than 2.5 cm in diameter   → MRI
Lesion greater than 2.5 cm in diameter    → hepatic scintigraphy
Ultrasound guided biopsy of the lesion
Hepatic scintigraphy
Hepatic angiography
Contrast enhanced CT scan of the liver