Presentation
The patient is known to have cirrhotic liver, with a suspicious lesion detected on contrast enhanced CT scan.
Patient Data
The liver appears shrunken and has irregular outline, with innumerable regenerative nodules scattered throughout the liver. Hypertrophied caudate lobe.
There is a well defined lesion in segment II of the liver, it appears hypo/isointense on T1, hyperintense on T2, with diffusion restriction on DWI images. After IV contrast administration, there was a non-rim arterial enhancement on the late arterial phase, non-rim washout and capsular enhancement on portovenous and delayed phases. This lesion measures about 13 x 13 x 14 mm (AP.TRANS.CC). Features are consistent with LI-RADS 5 lesion (definitely HCC).
Lower oesophagal and peri-gastric varices are noted. Peri-splenic varicosities and collaterals draining into the left portal vein are also noted. Features indicate portal venous hypertension.
Gastro-hepatic and porta hepatis subcentimetric short axis lymph nodes are noted.
Incidental few tiny bilateral renal cysts.
An incidental anatomical variant of circum-aortic left renal vein.
Case Discussion
The typical appearance of hepatocellular carcinoma (HCC) and regenerative nodules on MRI:
The regenerative nodules typically show low T2 signal intensity, variable T1 signal intensity, and no enhancement on arterial phase.
HCC tends to show mildly higher T2 signal intensity than the background liver and variable T1 signal intensity, with intense enhancement on arterial phase from neovascularity.1