On CECT abdomen, the LI-RADS (Liver Imaging Reporting and Data System) designation LR-5 requires which combination of features in a cirrhotic patient?

• A Arterial phase hyperenhancement alone in any lesion >10 mm
• B Portal-venous phase hypoenhancement with T2 hyperintensity on MRI only
• C Any nodule with biopsy-confirmed dysplasia
• D Arterial phase hyperenhancement plus portal-venous or delayed washout appearance and/or enhancing capsule in a lesion ≥10 mm ✓

Explanation

LR-5 (definite HCC) requires in a cirrhotic patient: a nodule ≥10 mm showing arterial phase hyperenhancement (APHE) plus either washout appearance (hypodensity on portal venous/delayed phase) or an enhancing capsule, or both. APHE alone is insufficient (LR-3 or LR-4 depending on size). The combination of APHE + washout/capsule reaches the LR-5 threshold due to very high specificity for HCC. Biopsy is reserved for indeterminate lesions.

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

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Written and medically reviewed by the StethoPrep medical team.