What is your differential at this point?
Hepatocellular carcinoma (HCC), metastasis, focal nodular hyperplasia (FNH), possible hepatic adenoma.
If this were focal nodular hyperplasia (FNH), how would you expect it to enhance?
FNH shows early arterial enhancement, like HCC, but doesn't "wash out". It slowly fades to background hepatic signal intensity. Be very wary about calling an FNH in a liver with HCC risk factors.
Why is this *not* a fibrolamellar HCC?
Although there is a central "scar", fibrolamellar HCC is not a likely diagnosis since it presents at an earlier age (25Y +/- 13), may not have undelying liver disease, tends to be centrally located, and tends to be small (<5 cm). The central scar in fibrolamellar HCC also tends to be T2 *hypo*intense, unlike this case. (ref 1)
There is a 13 cm exophytic mass off of the right lobe of the liver. It is well-marginated, with the suggestion of a T1 and T2 hypointense rim. There is an irregular centrally T2 hyperintense / T1 hypointense region to the mass.