In a patient at risk, measure the observation and look for the major features — arterial-phase hyperenhancement, washout, an enhancing capsule, threshold growth — then assign the LI-RADS category of the version in use.
Orient first
- LI-RADS applies ONLY to patients at risk of hepatocellular carcinoma (cirrhosis, chronic hepatitis B, current or prior HCC) — not to a normal liver.
- The major features are non-rim arterial-phase hyperenhancement, non-peripheral washout, an enhancing capsule, size and threshold growth; ancillary features adjust the category.
- LR-M means probably malignant but not HCC-specific (rim enhancement, targetoid appearance) — cholangiocarcinoma must be considered. State the LI-RADS version.
Acquire the study
- Late arterial, portal venous and delayed (3–5 min) phases; thin slices.
The manoeuvre
- Late arterial phase: non-rim hyperenhancement compared with the surrounding liver.
- Portal venous and delayed phases: non-peripheral washout and an enhancing capsule.
- Size: largest diameter in mm, measured on the phase where the margin is clearest (not the arterial phase).
- Tumour in vein: enhancing soft tissue in the portal or hepatic vein (LR-TIV).
- Compare with prior studies for threshold growth.
What confirms it
- An LR-5 observation (definite HCC) by the major features of the stated version.
What licenses you to exclude it
- LR-1 (definitely benign) requires a specific benign diagnosis such as a cyst or haemangioma.
The classic misread
- Measuring an observation on the arterial phase, where perfusion alteration exaggerates it.