← All patterns
Liver lesion in cirrhosis
AbdomenCT / MRI
A nodule detected in a cirrhotic liver. Hepatocellular carcinoma is presumed until proven otherwise; LI-RADS classifies risk by enhancement dynamics.
Differential
Hepatocellular carcinoma
common- •Arterial-phase non-rim hyperenhancement with washout
- •Enhancing "capsule" and threshold interval growth
- •Elevated AFP; tumour in vein
Regenerative nodule
common- •Iso-attenuating, no arterial hyperenhancement or washout
- •Iron-containing (siderotic) nodules dark on T2*
Dysplastic nodule
less-common- •T1-hyperintense, T2-iso/hypo, no washout
- •Premalignant; may show variable arterial enhancement
Confluent hepatic fibrosis
less-common- •Wedge-shaped, radiating from porta with capsular retraction
- •Delayed (progressive) enhancement, no mass effect
Haemangioma
less-common- •Peripheral nodular discontinuous enhancement with fill-in
- •Follows blood pool; markedly T2-bright
Intrahepatic cholangiocarcinoma
rare- •Rim arterial enhancement with progressive central uptake
- •Capsular retraction and peripheral duct dilatation
Key discriminators
- •Arterial hyperenhancement + washout + capsule (HCC hallmark)
- •Threshold growth over time
- •T2 signal and blood-pool matching (haemangioma)
- •Capsular retraction (fibrosis, cholangiocarcinoma)
- •AFP level and vascular invasion
Work-up / next steps
- 1.Multiphase CT or MRI and apply LI-RADS
- 2.Hepatobiliary-agent MRI for indeterminate nodules
- 3.Serum AFP; surveillance ultrasound interval
- 4.Multidisciplinary discussion / biopsy for LR-M or indeterminate lesions
References
- ACR LI-RADS v2018 CT/MRI.
- Radiopaedia: Hepatocellular carcinoma.
Educational clinical decision support only. This differential does not make a diagnosis, is not a medical device, and must never substitute for interpretation by a qualified radiologist correlated with the full clinical picture and prior imaging.