A 45-year-old woman with known cirrhosis undergoes contrast-enhanced CT. A 2.5 cm hepatic lesion shows marked arterial-phase hyperenhancement followed by washout appearance (hypodensity compared to liver) in the portal venous phase with a peripheral capsule. Which diagnosis is confirmed by this pattern alone according to current imaging criteria?

• A Hepatic hemangioma
• B Focal nodular hyperplasia
• C Hepatocellular carcinoma ✓
• D Cholangiocarcinoma

Explanation

Hepatocellular carcinoma (HCC) in a cirrhotic liver is diagnosed by imaging alone when a lesion greater than 1 cm demonstrates the hallmark LI-RADS 5 vascular pattern: arterial hyperenhancement (due to arterial neovascularization) followed by portal or delayed venous washout, often with a peripheral capsule. This non-invasive imaging diagnosis is accepted by EASL and AASLD guidelines without biopsy. Hemangiomas show peripheral nodular enhancement with centripetal fill-in. FNH has a central scar and isoenhancement in portal phase. Cholangiocarcinoma shows peripheral rim enhancement with progressive centripetal enhancement in delayed phases.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.