Cause

Description

Imaging Characteristics

Hepatocellular Carcinoma (HCC)

A primary liver cancer often arising in the context of cirrhosis or chronic liver disease.

Arterial phase hyperenhancement (APHE), nonperipheral washout, and enhancing capsule.

Regenerative Nodule

Benign nodules that form in cirrhotic livers as part of liver's regeneration attempt.

Iso- or hypointense on T1 and T2- weighted MRI, no arterial phase enhancement.

Dysplastic Nodule

Premalignant nodules in cirrhotic livers that have a higher risk of progressing to HCC.

Mild arterial phase hyperenhancement, typically without washout or enhancing capsule.

Focal Nodular Hyperplasia (FNH)

Benign liver lesion, often asymptomatic and discovered incidentally.

Strong arterial phase enhancement with central scar, no washout, isointense in portal venous phase.

Hepatic Adenoma

Benign liver tumor, more common in women, often associated with oral contraceptive use.

Arterial phase hyperenhancement, no washout or capsule, variable signal on T1/T2.

Intrahepatic Cholangiocarcinoma (ICC)

Primary liver cancer arising from bile ducts within the liver.

Arterial phase hyperenhancement, delayed enhancement, peripheral biliary dilatation, capsular retraction.

Hemangioma

Common benign vascular tumor of the liver.

Peripheral nodular enhancement in arterial phase with centripetal fill-in on delayed images.

Abscess

Collection of pus within the liver, often due to bacterial or parasitic infection.

Irregular arterial enhancement with enhancing capsule, often with symptoms of infection.

Metastatic Disease

Secondary malignancies that have spread to the liver from other primary cancers.

Arterial phase hyperenhancement possible, typically with central necrosis, variable washout.

Sclerosing Hemangioma

Rare benign tumor that represents an involuting hemangioma.

Progressive central enhancement, lacks typical hemangioma characteristics.

Focal Fat Sparing or Deposition

Areas of liver spared from steatosis or focal fat deposition, mimicking lesions.

Mimics lesions due to signal differences, no arterial phase enhancement, washout or enhancing capsule.

Fibrolamellar Carcinoma

Rare variant of HCC typically affecting younger patients without liver disease.

Arterial phase hyperenhancement, central scar, lacks washout and capsule.

Liver Cyst

Benign, fluid-filled sacs within the liver.

Non-enhancing, severly hyperintense lesions on T2-weighted images, thin, well- defined walls.

Hepatic Angiosarcoma

Rare, aggressive malignant vascular tumor of the liver.

Irregular enhancement, multiple lesions, can mimic other malignancies like HCC or metastases.

Epithelioid Hemangioendothelioma

Rare vascular tumor with intermediate malignancy potential.

Multifocal lesions with capsular retraction, peripheral enhancement, sometimes calcifications.

Biomarker

LI-RADS 3
Elevation (%)

LI-RADS 4
Elevation (%)

Difference (%)

P-value

95% Confidence Interval (CI)

AFP

47.61%

25%

-22.61

0.045

(15.3, 29.9)

AFP-L3

33%

48%

+15

0.032

(10.7, 19.2)

GGT

8%

20%

+12

0.1

(6.1, 17.3)

ALP

19%

31%

+12

0.08

(10.2, 15.9)

LDH

27%

33%

+6

0.05

(4.1, 7.8)

CEA

1.2%

5.7%

+4.5

0.25

(3.2, 6.3)

CA19-9

0.9%

2.8%

+1.9

0.3

(0.8, 2.5)

HGF

77%

90%

+13

0.001

(11.3, 14.8)

IL-6

27%

47%

+20

0.03

(15.6, 22.3)

CRP

8%

9.9%

+1.9

0.1

(0.5, 2.4)

TGF-β

57.7%

71.7%

+14

0.015

(12.2, 15.7)

VEGF

29.7%

35.9%

+6.2

0.02

(4.9, 7.3)