Classification system for nodules seen on images of cirrhotic livers from the Organ Procurement and Transplantation Network (OPTN)

Class and description	Additional requirements
OPTN class 0
Incomplete or technically inadequate study	Repeat study required for adequate assessment; automatic priority MELD points cannot be assigned on basis of an imaging study categorized as OPTN class 0.
OPTN class 5
Meets radiographic criteria for HCC, and potentially eligible for MELD exception points.
Class 5A: ≥1 cm and <2 cm measured on late arterial or portal venous phase images	Increased contrast enhancement in late hepatic arterial phase and either washout during later phases of contrast enhancement and peripheral rim enhancement on delayed phase, or biopsy confirmation.
Class 5A-g: same size as OPTN class 5A HCC	Increased contrast enhancement in late hepatic arterial phase and growth by 50% or more documented on serial CT or MR images obtained ≤6 months apart.
Class 5B: maximum diameter ≥2 cm and ≤5 cm	Increased contrast enhancement in late hepatic arterial phase and either washout during later contrast phases or peripheral rim enhancement (capsule or pseudocapsule) or growth by 50% or more documented on serial CT or MR images obtained ≤6 months apart (OPTN class 5B-g) or biopsy confirmation.
Class 5T: prior regional treatment for HCC	Any class 5A, 5A-g, or 5B lesion that was automatically approved for MELD HCC exception points upon initial request or extension and has been subsequently ablated.
Class 5X: maximum diameter ≥5 cm	Increased contrast enhancement in late hepatic arterial phase and either washout during later contrast phases or peripheral rim enhancement (capsule or pseudocapsule). Not eligible for MELD HCC exception points.

NOTE: OPTN class number denotes whether an imaging examination is nondiagnostic (OPTN class 0) or the study includes an image that contains at least one treated or untreated HCC (OPTN class 5). OPTN class 5 is further subdivided by adding a capital letter to denote UNOS stage 1 disease (OPTN class 5A), UNOS stage 2 disease (OPTN class 5B), a treated HCC (OPTN class 5T), or HCC beyond acceptable size for transplantation (OPTN class 5X). The g in OPTN class 5A-g and OPTN class 5B-g is used to indicate that growth was used to arrive at the HCC diagnosis.

MELD: Model for End Stage Liver Disease score; HCC: hepatocellular carcinoma; CT: computed tomography; MR: magnetic resonance; UNOS: United Network for Organ Sharing.
* As assessed according to the American Liver Tumor Study Group modification of the standard TNM staging system (stage II, T2N0M0).

Reproduced with permission from: Wald C, Russo MW, Heimbach JK, et al. New OPTN/UNOS Policy for Liver Transplant Allocation: Standardization of Liver Imaging, Diagnosis, Classification, and Reporting of Hepatocellular Carcinoma. Radiology 2013; 266:376-382. Copyright © 2013 Radiological Society of North America.

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Classification system for nodules seen on images of cirrhotic livers from the Organ Procurement and Transplantation Network (OPTN)