In cirrhosis, what imaging feature is most characteristic of hepatocellular carcinoma on contrast-enhanced imaging?

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Hepatocellular carcinoma in cirrhosis most characteristically shows arterial-phase hyperenhancement with washout in the portal venous or delayed phases on contrast-enhanced imaging. This pattern comes from the tumor’s predominantly arterial blood supply, which causes it to light up strongly in the arterial phase, followed by rapid washout as the contrast clears relative to the surrounding liver that remains more perfused via the portal system. This dynamic enhancement helps distinguish HCC from benign nodules, which typically do not exhibit this combination of arterial uptake and subsequent washout. Other imaging features like isoenhancement across phases or lack of enhancement are not the classic signature of HCC on dynamic contrast studies.