The liver is of normal volume. There is no evidence of liver cirrhosis or hepatic steatosis.
Lesion 1: Segment 7,
23 mm x 31 mm x 27 mm, T2 hyperintense, slightly hyperintense on T1 in phase, signal drop on T1 opposed phase indicative of intralesional fat. Avid arterial enhancement with washout. No hepatocyte specific contrast agent uptake.
Lesion 2: Segment 6, 5 mm, not seen on T2-weighted imaging, DWI, or lipid sensitive imaging. No enhancement. Lack of hepatocyte specific contrast agent uptake.
Lesion 3: Segment 7, 8 mm, not seen on T2-weighted imaging, DWI, equivocal lipid content. No enhancement. Lack of hepatocyte specific contrast agent uptake.
Within segment 3, there is a 12 mm somewhat wedge shaped area of hypoenhancement identified, not seen on any other sequences. Not visible on CT
Within segment 7, there is a ovoid area of concentrated contrast agent and delayed and hepatocyte specific phase, likely representing a focally dilated bile duct.
The hepatic arterial anatomy is conventional. The portal vein and hepatic veins are patent. The biliary tree is of normal calibre. The gallbladder contains sludge. There is no evidence of gallstones.
The pancreas is normal in appearance. The main pancreatic duct is not dilated.
The kidneys, spleen and adrenal glands are normal in appearance.
There is no free fluid or lymphadenopathy.
Conclusion:
There are no imaging features to suggest cirrhosis. Despite this, the liver mass in segment 7 is suspicious for a well-differentiated HCC, particularly given the heterogeneous contrast enhancement, lesion capsule, high T2 signal and rapid washout. The lipid content and other imaging features overlap with hepatic adenoma. The subcentimetre lesions in segments 3, 4a, 6 and 7 are indeterminate but may well represent further adenomas. Does this patient have risk factors for hepatoma? Is this patient on the oral contraceptive pill?