A 45-year-old man with chronic hepatitis B and cirrhosis undergoes surveillance ultrasound, which shows a 1.5 cm hypoechoic nodule in segment VII. Contrast-enhanced MRI with gadoxetic acid (Primovist/EOB) is performed. The lesion shows arterial phase hyperenhancement, washout in the portal venous phase, and is hypointense in the hepatobiliary phase (20 minutes). According to LI-RADS, this lesion should be categorized as:
- A LR-3 (Intermediate probability for HCC)
- B LR-5 (Definitely HCC) ✓
- C LR-4 (Probably HCC)
- D LR-M (Probably or definitely malignant, not HCC specific)
Correct answer: B. LR-5 (Definitely HCC)
Explanation
LI-RADS LR-5 requires arterial phase hyperenhancement plus washout plus capsule enhancement (or threshold growth) for lesions ≥1 cm in a cirrhotic liver. With EOB-MRI, hepatobiliary phase hypointensity is an ancillary feature supporting HCC. The combination of APHE, washout, and hepatobiliary phase hypointensity in a cirrhotic patient with hepatitis C is diagnostic of HCC (LR-5). LR-4 would lack one major feature; LR-3 lacks two major features.
Reference: ACR LI-RADS v2018 (American College of Radiology), 2018 ed.
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Written and medically reviewed by the StethoPrep medical team.