Fig. 5

Discordance in LT eligibility as per MC from HCC diagnosis by OPTN criteria and LI-RADS. In a 62-year-old man, EOB-MRI (a–c) and CECT (d and e) demonstrated a 28-mm observation with non-rim APHE (arrows, d) and washout (arrows, b and e), but without enhancing capsule in segment 4a/8. The lesion was categorized/classified as LR-5 and 5B by LI-RADS and OPTN criteria, respectively. Additionally, there were four 1–1.9 cm-sized LR-5 observations (one is shown in segment 5; hollow arrow, f–j), with non-rim APHE (f and i) and washout (g and j) but no enhancing capsule. Lesions demonstrated HBP hypointensity (arrows, c; hollow arrow, h). None of these five observations were eligible to be classified as 5A according to OPTN criteria due to lack of delayed peripheral enhancement, and therefore, based on the presence of a single 5B observation, the patient would be deemed as meeting the MC. In contrast, he would be considered beyond the MC according to LI-RADS categories (presence of five LR-5 observations). Since histopathologic examination of the liver explant revealed five HCC, the patient was indeed beyond MC and unsuitable for liver transplantation. Abbreviations: APHE: arterial phase enhancement, CECT: contrast-enhanced computed tomography, EOB-MRI: Gadoxetate-enhanced-MRI, HCC: hepatocellular carcinoma, HBP: hepatobiliary phase, LI-RADS: Liver Imaging Reporting and Data System, MC: Milan criteria, OPTN: Organ Procurement and Transplantation Network