fig3

Figure 3. Superior demonstration of APHE with CEUS. MRI of a 2.3-cm liver lesion in a 71-year-old man with NASH cirrhosis shows minimal to absent APHE (arrow in A) but with clear washout and enhancing capsule at portal venous phase (arrow in B), meeting criteria for LR-4 with CT/MRI LI-RADS. At CEUS, the lesion shows clear APHE (arrows in C) and washout that is mild and late (arrows in D), meeting criteria for LR-5 with CEUS LI-RADS, diagnostic of HCC. The lack of clear APHE on the MRI was probably due to slightly early acquisition; the dynamic continuous acquisition of CEUS is not susceptible to this shortcoming.