A 65-year-old man with alcoholic cirrhosis undergoes surveillance ultrasound showing a new 2.5 cm arterially-enhancing hepatic nodule. Contrast-enhanced CT confirms arterial hyperenhancement and portal venous phase washout with an enhancing capsule. Based on LI-RADS criteria, what category should be assigned?
- A LI-RADS 3 (Intermediate probability of malignancy)
- B LI-RADS 4 (Probably HCC)
- C LI-RADS M (Probably or definitely malignant, not HCC specific)
- D LI-RADS 5 (Definitely HCC) ✓
Explanation
LI-RADS 5 (LR-5) is assigned to observations with imaging features diagnostic of HCC with very high specificity. A nodule larger than 20 mm showing arterial phase hyperenhancement (the major feature) together with at least one of the ancillary major features — non-peripheral washout appearance, enhancing capsule, or threshold growth — qualifies as LR-5. The described 2.5 cm nodule with arterial hyperenhancement, washout, and an enhancing capsule fulfils two additional major features, confirming LR-5 classification, which allows treatment without biopsy in clinical practice.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.