MRI liver shows a 3 cm lesion in segment VI with: T1 hypointense, T2 moderately hyperintense, diffusion restriction, arterial phase hyperenhancement (APHE), and washout on portal venous phase with enhancing capsule. The LI-RADS (v2018) category for this observation is:
- A LR-3 (intermediate probability of HCC)
- B LR-4 (probably HCC)
- C LR-5 (definitely HCC — positive predictive value >95%) ✓
- D LR-M (probably or definitely malignant, not HCC specific)
Explanation
LI-RADS v2018 criteria: an observation ≥20 mm in a cirrhotic liver showing APHE (arterial phase hyperenhancement) plus BOTH washout AND enhancing capsule qualifies as LR-5, indicating definite HCC with PPV >95%. The key major features are: APHE, washout appearance (hypoenhancement relative to liver on portal venous or delayed phase), and enhancing capsule. Diffusion restriction is an ancillary feature that supports malignancy but is not a major feature. LR-M is applied when features suggest non-HCC malignancy (targetoid appearance, marked diffusion restriction, infiltrative morphology).
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.