A patient suspected of hepatocellular carcinoma; which diagnostic test is best?

• A. Ultrasound with AFP
• B. CT scan
• C. MRI
• D. Biopsy

Answer: (A)

Screening for hepatocellular carcinoma in at‑risk patients starts with a liver ultrasound because it’s quick, noninvasive, and can detect new or enlarging nodules. Adding measurement of alpha‑fetoprotein provides additional diagnostic information since many HCCs elevate AFP, improving detection when a lesion is present. While imaging with contrast (CT or MRI) offers more detailed characterization and can confirm the diagnosis, ultrasound with AFP remains the practical first-step approach to raise suspicion and guide further testing. If the ultrasound shows a lesion or AFP is elevated, you would typically pursue contrast-enhanced CT or MRI to characterize the lesion and determine management; biopsy is generally reserved for cases where imaging is inconclusive or non-typical for HCC.