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HCC LI-RADS 5 — RACP Adult Medicine MCQ

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EasyGastroenterologyHCC LI-RADS 5RACP Adult Medicine

A 55-year-old man with known hepatitis B cirrhosis has a 3 cm liver mass detected on surveillance ultrasound. AFP is 350 μg/L. Contrast CT shows arterial phase hyperenhancement with washout in the portal venous phase. The mass has a capsule appearance on delayed phase. What is the most likely diagnosis?

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Correct answer: E — Hepatocellular carcinoma

Liver mass in cirrhosis with arterial hyperenhancement + portal venous washout + capsule appearance on dynamic contrast imaging fulfils LI-RADS 5 criteria (definite HCC) — no biopsy needed. AFP >200 μg/L further supports HCC. This non-invasive diagnosis is possible only in cirrhotic liver (pre-test probability is high). In non-cirrhotic liver, biopsy is usually required. Management depends on BCLC staging: curative options include resection, ASCT, or ablation.

Reference: AASLD – 2023 – HCC; LI-RADS; Cancer Council Australia 2024