A 50-year-old man with cirrhosis and rising serum AFP (1200 ng/mL) has a 3 cm hepatocellular carcinoma on imaging showing arterial enhancement and portal-venous washout on dynamic CT. The WHO/AASLD Liver Imaging Reporting and Data System (LI-RADS) category for this lesion would be:

• A LR-3 — intermediate probability of HCC, biopsy required
• B LR-M — probably or definitely malignant, not HCC-specific
• C LR-4 — probably HCC, additional workup needed
• D LR-5 — definitively hepatocellular carcinoma based on major imaging features in a cirrhotic liver ✓

Explanation

LI-RADS LR-5 is assigned to observations ≥1 cm in cirrhotic patients that demonstrate major HCC-specific imaging features: arterial hyperenhancement plus portal-venous or delayed washout ± capsule appearance ± size threshold growth. A 3 cm lesion with arterial enhancement and portal-venous washout satisfies LR-5 criteria, allowing clinical diagnosis of HCC without biopsy per AASLD guidelines.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.