Liver Imaging Reporting and Data System criteria for the diagnosis of hepatocellular carcinoma in clinical practice: A pictorial minireview

Figure 19  Axial volumetric interpolated breath-hold examination, arterial phase. A-C: Axial volumetric interpolated breath-hold examination (A), arterial phase (B) showed an observation measuring almost 20 mm with arterial phase hyperenhancement (arrows) without washout on portal image (C) categorized as LR-4; D and E: On diffusion-weighted imaging (D), the observation showed high signal intensity (arrows) but the ancillary features lacked sufficient specificity for hepatocellular carcinoma to allow for an LR-5 upgrade. After multidisciplinary discussion, ablation was performed (E); F-H: On follow-up, an ablation defect was seen without residual areas of arterial enhancement or washout. This was classified as LR-treatment response non-viable. Note a previous ablation defect in the right lobe (arrows).