MRI
Axial Arterial phase
Axial 30 seconds
Axial 3:30 minutes
Axial 4 minutes
Axial Delayed 60 min
Axial T2
Axial T2 fat sat
DWI
Axial ADC
The liver shows cirrhotic changes manifested by irregular contours and parenchymal dysmorphism. An ill-defined lesion is noted at segment VI (3.4cm); showing heterogeneous postcontrast enhancement, with delayed washout. It shows evident restriction on DWI/ADC consistent with hepatocellular carcinoma (HCC-LR5).
A small enhancing nodule is seen at segment VI/VII interface with mild restriction and no definite wash out (LV4 nodule).
A sizable porta hepatis lymph node is noted measuring about (8 x 7 x 6.8 cm) in average diameters, indenting the medial aspect of the caudate lobe, stretching and displacing the common hepatic artery and portal vein anteriorly. This is associated with other smaller lymph nodes at the right paracaval, aortocaval and para-aortic nodes, ranging in diameter from 2.3 cm to 3.8 cm, consistent with nodal deposits.
Floating bland thrombus in the portal vein extending to the leinorenal collaterals. Left renal vein bland thrombi are also noted with fine extension into the IVC.
Dilated lienorenal collaterals.
The spleen is surgically removed; with small splenule (4.4 cm) is noted at the operative bed.
Both kidneys are normal in size, shape and position. Bilateral cortical renal cysts, the largest on the left side (2.7 cm). No backpressure changes identified.