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Early-detection demo · Liver cancer

1.8 cm LI-RADS 5 nodule on cirrhosis surveillance MRI

1.8 cm hepatic nodule with arterial-phase hyperenhancement and washout — LI-RADS 5 (definite HCC).

Patient: Aisha · 59 · HCV-cured cirrhoticModality: MRIRisk: high · 71/100
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01

Risk profile

What OCTON knew before the scan
Risk
71
high
Tier
high
Genotype-1 HCV cleared with DAA therapy 4 years ago. Child-Pugh A cirrhosis. AFP trending: 6 → 8 → 14 → 22 ng/mL over 18 months.
Contributing factors
  • Established cirrhosis (Child-Pugh A)+28
  • HCV history (cured but cirrhotic)+18
  • Rising AFP trend (6 → 22 over 18 months)+14
  • Age 59+6
  • Type 2 diabetes+5
Narrative

Aisha is in the high-tier band. Cirrhosis from any cause (post-DAA HCV included) carries 1–3% annual HCC risk. AFP trend over 1 year is more predictive than absolute value — her trajectory triggered surveillance MRI per AASLD 2023.

02

Scan + AI report

What MRI found · Multi-phase liver MRI with extracellular contrast (gadoteridol)
MRI · DEMO
LI-RADS 5
OCTON · scanning · live
conf 0.88
OCTON Impression · 88% confidence

1.8 cm nodule in segment 8 with non-rim arterial-phase hyperenhancement, portal-venous washout, and capsular enhancement — LI-RADS 5 (definite HCC).

Findings
  • 1.8 cm enhancing lesion in segment 8 · Liver segment 8, dome18 mm
  • Non-rim arterial-phase hyperenhancement · Lesion
  • Portal-venous and delayed-phase washout · Lesion
  • Enhancing capsule · Lesion periphery
  • No vascular invasion, no extrahepatic spread · Hepatic vasculature, abdomen
Differential diagnosis
  • Hepatocellular carcinoma (HCC)92%
  • Dysplastic nodule (high-grade)5%
  • Intrahepatic cholangiocarcinoma2%
  • Focal nodular hyperplasia1%
Recommended actions
  • ▸Multidisciplinary liver-tumor-board within 7 days (BCLC 0/A — early-stage)
  • ▸Refer for curative-intent therapy: surgical resection, ablation, or transplant evaluation
  • ▸AFP, AFP-L3, DCP repeat at staging
  • ▸Cross-sectional chest CT to complete staging
Caveats
  • LI-RADS 5 = definite HCC by imaging — biopsy is NOT required and is generally avoided due to seeding risk.
  • BCLC stage A (single ≤2 cm, preserved function) has 5-year survival >70% with curative therapy.
03

360° Preventative plan

Drugs · surveillance · diet · exercise · lifestyle — generated for this case
Clinical anchors
Drugs · labs · imaging · surveillance
Medical
Tumor-board referral + staging CT
FrequencyWithin 7 days (current finding)
Startsage 59
BCLC 2022 algorithm
Monitoring
Liver MRI with extracellular contrast
FrequencyEvery 6 months · cirrhosis surveillance
Startsage 50
AASLD 2023 HCC Surveillance Guidelines
Monitoring
Serum AFP
FrequencyEvery 6 months
Startsage 50
AASLD 2023 (paired imaging recommended)
04

What changed

The early-detection win

Aisha was on twice-yearly HCC surveillance. AFP rose from 6 to 22 ng/mL over 18 months — under the conventional 200 ng/mL threshold but the AI flagged the *trajectory*. The next MRI showed an 18 mm LI-RADS 5 nodule. Microwave ablation cleared the lesion; 4 years post-treatment Aisha remains disease-free.

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