Top-5 Similar Historical Cases
Insight-enriched ranking active
Detailed Findings from Cases with Corrected Diagnoses
CASE-2023-047: Diagnosis Corrected — Washout Initially Overlooked, Confirmed HCC
Case Summary
A 58-year-old male with HCV cirrhosis presented with a 2.1 cm lesion in hepatic segment VII. The lesion showed arterial phase hyperenhancement (APHE) but the washout on portal venous phase was subtle and initially overlooked. The case was classified as LI-RADS 3 (indeterminate). Follow-up pathology confirmed HCC, leading to reclassification as LI-RADS 5.
Outcome: 3-month delay in treatment initiation.
Features Initially Overlooked
- Subtle washout on portal venous phase (hypointensity relative to background liver)
- Partial enhancing capsule on delayed phase (visible on only one slice)
- Mild restricted diffusion on DWI (not reviewed in initial reading)
Relevance to Current Case
- Similar lesion size and location (Segment VII, 2.3 cm vs 2.1 cm)
- Same clinical background: HCV cirrhosis, elevated AFP
- Comparable arterial phase hyperenhancement pattern
- Portal venous phase shows possible subtle washout — warrants careful review
Key Lesson: In cirrhotic livers, subtle washout on the portal venous phase can be easily overlooked, especially for lesions near hepatic veins where flow artifacts may mimic or obscure washout. Consider side-by-side windowing of arterial and portal venous phases, and review coronal reformats.
CASE-2023-112: Diagnosis Corrected — Atypical Hemangioma Initially Classified as Probable HCC
Case Summary
A 55-year-old female with NASH cirrhosis had a 1.8 cm lesion showing a flash-fill arterial enhancement pattern, initially interpreted as APHE suspicious for HCC. Classified as LI-RADS 4. Subsequent biopsy revealed cavernous hemangioma.
Outcome: Unnecessary percutaneous biopsy performed.
Key Distinguishing Feature
- Hemangioma: progressive centripetal fill-in on delayed phase (not washout)
- HCC: washout on portal venous/delayed phase
- Flash-fill hemangiomas show peripheral nodular enhancement (not diffuse APHE)
Key Lesson: Atypical hemangiomas with flash-fill enhancement can mimic HCC on the arterial phase. The critical differentiator is the delayed phase: hemangiomas show progressive fill-in while HCC shows washout. Always evaluate delayed phase images before classifying arterial-enhancing lesions.
Feature Comparison: Query vs. Cases with Corrected Diagnoses
| Feature | CASE-2024-089 (Query) | CASE-2023-047 (Corrected) | CASE-2023-112 (Corrected) |
|---|---|---|---|
| Age / Sex | 62M | 58M | 55F |
| Etiology | HCV Cirrhosis | HCV Cirrhosis | NASH Cirrhosis |
| Lesion Size | 2.3 cm | 2.1 cm | 1.8 cm |
| Segment | VII | VII | VI |
| AFP | 87 ng/mL (elevated) | 52 ng/mL (elevated) | 6 ng/mL (normal) |
| APHE | Present | Present | Flash-fill pattern |
| Portal Venous | Ambiguous | Subtle washout (overlooked) | Progressive fill-in |
| Delayed Phase | Pending review | Capsule (overlooked initially) | Continued fill-in |
| Initial Dx | LR-3 | LR-3 → LR-5 (HCC) | LR-4 → Hemangioma |
Clinical Impact Metrics — Current Month
12
Cases Enriched
With insights from similar cases
8
Found Useful
67% usefulness rate
3
Assessments Refined
Based on case insights
4.2 min
Avg Time Saved
Per enriched case
Insight Categories
| Insight Type | Category | Cases | Level | Historical Frequency |
|---|---|---|---|---|
| Benign/malignant distinction | Interpretation | 8 | IMPORTANT | ~12% in atypical lesions |
| Subtle washout patterns | Perception | 14 | IMPORTANT | ~18% for subtle washout |
| LI-RADS category refinement | Interpretation | 11 | NOTE | ~15% inter-reader variation |
| Capsule appearance recognition | Perception | 6 | NOTE | ~20% for partial capsules |
| Small satellite lesions | Perception | 5 | NOTE | ~25% for lesions <1 cm |
| Vascular invasion indicators | Perception | 3 | IMPORTANT | ~10% early-stage |
Recognized Patterns
| Pattern | Risk | Correction Rate | Cases | Recommendation |
|---|---|---|---|---|
| Small lesion + ambiguous enhancement | High | ~30% | 18 | Assess all LI-RADS features; consider follow-up |
| Cirrhotic liver + lesion near major vessel | Medium | ~15% | 9 | Verify focus on lesion, not vessel artifact |
| Post-TACE/ablation + new enhancing area | High | ~25% | 7 | Compare with pre-treatment imaging |
| Atypical hemangioma (flash-fill) | Medium | ~20% | 5 | Confirm delayed phase fill-in pattern |
| Multiple lesions, different morphology | Medium | ~20% | 4 | Evaluate each lesion independently |
System Learning — Continuous Improvement
47
Cases with Corrected Diagnoses Catalogued
218
Supplementary Learning Scenarios
5
Active Insight Patterns
Corrected-Diagnosis Cases Catalogued Over Time
Clinician Usefulness Rating (%)
Insight Patterns Discovered
Monthly: Cases Enriched vs. Assessments Refined
Recent Clinician Feedback
| Date | Case | Insight | Useful | Clinician Note |
|---|---|---|---|---|
| 2024-11-08 | CASE-2024-083 | Subtle washout insight | Yes | Prompted me to re-examine PVP. Found subtle washout I initially overlooked. |
| 2024-11-06 | CASE-2024-081 | Benign/malignant distinction | Yes | Changed my assessment from LR-3 to LR-4 after reviewing the similar corrected case. |
| 2024-11-05 | CASE-2024-079 | Capsule appearance | No | Capsule was clearly visible in my read. Insight was not relevant for this case. |
| 2024-11-03 | CASE-2024-076 | Satellite lesion pattern | Yes | Found a 7 mm satellite lesion on re-review. Changed treatment plan. |
| 2024-11-01 | CASE-2024-074 | Subtle washout insight | Yes | Helpful context. The historical case details were highly relevant. |