Describe the classic dynamic contrast-enhanced imaging pattern of hepatocellular carcinoma.

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Multiple Choice

Describe the classic dynamic contrast-enhanced imaging pattern of hepatocellular carcinoma.

Hepatocellular carcinoma classically has arterial neovascularity, so it shows strong enhancement during the arterial phase. In the subsequent portal venous and delayed phases, the surrounding liver tissue continues to enhance while the tumor does not, producing washout and appearing relatively hypoenhancing. This combination—arterial-phase hyperenhancement with washout in the portal or delayed phase on dynamic CT or MRI—is the hallmark pattern of HCC. Other lesions don’t match this pattern: benign nodules or regenerative changes often lack true arterial washout, while hemangiomas show peripheral nodular enhancement with gradual fill-in rather than washout, and cholangiocarcinoma tends to enhance later rather than wash out.

Hepatocellular carcinoma classically has arterial neovascularity, so it shows strong enhancement during the arterial phase. In the subsequent portal venous and delayed phases, the surrounding liver tissue continues to enhance while the tumor does not, producing washout and appearing relatively hypoenhancing. This combination—arterial-phase hyperenhancement with washout in the portal or delayed phase on dynamic CT or MRI—is the hallmark pattern of HCC.

Other lesions don’t match this pattern: benign nodules or regenerative changes often lack true arterial washout, while hemangiomas show peripheral nodular enhancement with gradual fill-in rather than washout, and cholangiocarcinoma tends to enhance later rather than wash out.

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