On multiphasic CT liver, a 2.5 cm hepatic lesion shows arterial phase hyperenhancement with portal venous washout and capsular enhancement. In the appropriate clinical context (cirrhosis, elevated AFP), this pattern is diagnostic of:
- A Hepatic haemangioma
- B Hepatocellular carcinoma (HCC) — LI-RADS 5 ✓
- C Cholangiocarcinoma
- D Focal nodular hyperplasia
Correct answer: B. Hepatocellular carcinoma (HCC) — LI-RADS 5
Explanation
Per LI-RADS (2018 ACS), a hepatic observation ≥20 mm in a cirrhotic liver showing arterial phase hyperenhancement (APHE) plus washout appearance and capsule enhancement is classified LI-RADS 5 — diagnostic of HCC, not requiring biopsy. This triad (APHE + washout + capsule) is virtually pathognomonic. Haemangioma shows peripheral nodular enhancement with centripetal fill-in. Cholangiocarcinoma shows peripheral rim enhancement. FNH shows spoke-wheel arterial enhancement and central scar.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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