Multiphasic contrast-enhanced CT of the liver shows a 3 cm hepatic mass in a patient with cirrhosis (Child-Pugh B). The lesion shows arterial phase hyperenhancement and venous/delayed phase washout with a peripheral enhancing capsule. According to LI-RADS criteria, this observation pattern is categorised as:

• A LR-4 (probably HCC) due to single major feature only
• B LR-3 (intermediate probability for HCC)
• C LR-M (probably or definitely malignant but not HCC-specific)
• D LR-5 (definitely HCC) based on major features: arterial enhancement + washout + enhancing capsule in a mass ≥ 2 cm ✓

Explanation

In LI-RADS, LR-5 (definite HCC) requires: arterial phase hyperenhancement (APHE) as the major imaging feature plus at least one of — washout appearance, enhancing capsule, or threshold growth — in observations ≥ 10 mm. A 3 cm cirrhotic liver mass showing APHE + washout + enhancing capsule satisfies LR-5 criteria without biopsy. LR-4 requires APHE with fewer additional features. LR-M applies to malignant-appearing masses not fitting HCC profile.

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

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Written and medically reviewed by the StethoPrep medical team.