Abdominal pain, jaundice with significantly elevated alpha feto-protein : 5223 ng/ml in a cirrhotic patient with history of previous chemoembolization and RF-ablation of two malignant hepatic lesions.
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- Cirrhotic liver with heterogenous parenchyma and rather hypertrophied left and caudate lobes as well as prominent inter-lobar fissure. A relatively large ill-defined right liver lobe segment VIII mass lesion measuring 7 X 5 X 6 cm in its orthogonal dimensions is seen, the lesion shows heterogenous predominantly hypointense T1 signal with foci of hyperintensity as well as mildly hyperintense T2 signal intensity and restricted diffusion with hyperintense DWI signal. The lesion shows rapid heterogeneous enhancement in the arterial phase with preferential washout in the portal venous and delayed phases. Two non-enhancing radio-frequency ablated and chemo-embolized focal lesions are seen at the left liver lobe segment IVa and right liver lobe segment V measuring 3 X 2.5 & 4 X 3.5 cm respectively with no definite enhancement in all phases.
- No evidence of intra-hepatic or extra-hepatic biliary tree dilatation.
- The portal vein and its main branches are patent and homogenously enhancing. Dilated porto-systemic collaterals are seen at the splenic hilum.
- The spleen is markedly enlarged with small hypointense, non-enhancing foci, representing foci of haemosidrin (Gamna-Gandy bodies).
- Normal pancreas and both kidneys apart from right renal mid-zonal 4.2 X 3.8 cm simple cystic lesion (Bosniak type I).
- The gall bladder shows a small signal void stone.
- Enlarged portahepatis lymph nodes, with the largest is 2.5 X 2 cm.
- No significant upper abdominal ascites.
- Liver cirrhosis with a right liver lobe segment VIII ill-defined malignant mass lesion; consistent with hepatocellular carcinoma (HCC).
- Right liver lobe segment V and left liver lobe segment IVa chemo-embolized and RF-ablated focal lesions with no definite residual or recurrent malignant activity.
- Portal hypertension and marked splenomegaly.
- Porta hepatis lymphadenopathy.
- Small gall bladder stone.
Hepatocellular carcinoma is typically T2 and DWI hyperintense as well as T1 hypointense. A hepatoceelular nodule 1 cm or larger with rapid arterial enhancement and rapid wash-out in the portal-venous and delayed phases with capsular / coronal enhancement in either CT or MRI is diagnostic of HCC according to the latest Update of the American Association of the Study of Liver Disease (AASLD)
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