Decoding the image: finding diagnostic signals in multi-modality abdominal artifacts

Imaging artifacts and related physiologic, pathologic, and iatrogenic phenomena are common across every radiology modality and often provide useful diagnostic information. This pictorial essay introduces a structured, four-category framework for recognizing and interpreting abdominal artifacts and related phenomena (ARPs): (1) the "Virtual Biopsy," encompassing ARPs that aid in characterizing tissue composition and pathology; (2) the "Flowmeter," representing ARPs that provide insight into physiologic or pathologic flow states; (3) the "Signpost," describing ARPs that direct attention toward or mimic the underlying pathology; and (4) the "Tiebreaker," reviewing ARPs that prompt multi-modality correlation or other problem-solving to reach the correct diagnosis. Representative clinical cases illustrate each category across medical imaging modalities. This framework provides a systematic approach to incorporating ARPs into diagnostic reasoning.