History of hepatocellular carcinoma status post TACE RFA. ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhotic liver morphology. The segment 5 ablation cavity measures 3.4 x 3.1 cm, unchanged. Intrinsic high T1 weighted signal intensity is compatible with proteinaceous/hemorrhagic debris.Just inferior to the ablation cavity there is a new conglomerate of enhancing nodules measuring up to 3.7 x 3.0 cm extending inferiorly. There are multiple additional arterially enhancing nodules in both lobes of the liver which are new and/or more conspicuous than on the prior study. These are associated with mild T2 weighted hyperintensity and restricted diffusion. No definite washout is seen of these lesions.The more central segment 5 lesion demonstrates peripheral nodular discontinuous enhancement which gradually increases centrally measuring 3.0 x 3.0 cm, compatible with a hemangioma.The hepatic vasculature is patent.Distended gallbladder without specific evidence of gallbladder inflammation.No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Normal splenic size with perisplenic varices.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Multiple new and more conspicuous arterial enhancing lesions in both lobes of the liver including a 3.7 x 3.0 cm conglomerate of small nodules adjacent to the ablation cavity are highly suspicious for multifocal hepatocellular carcinoma, however these do not meet imaging criteria for HCC as there is no definite washout of these arterial enhancing lesions.