31-year-old female with liver lesions in the setting of NASH. Patient previously had FNH proven by biopsy, which has involuted. Other lesions are growing which was adenoma biopsy. She stopped all oral contraceptive pills. Please evaluate and characterize lesions, particularly the segment 4B lesion. Also prior history of osteosarcoma, AML, and diabetes. ABDOMEN:LIVER, BILIARY TRACT: Diffuse loss of signal intensity of the liver on out of phase imaging most suggestive of hepatic steatosis. Status post cholecystectomy.Multiple faintly T2 weighted hyperintense foci are again noted both lobes of the liver, and these lesions are stable to slightly decreased in size. Reference measurements listed below. Following contrast administration, these lesions demonstrate homogeneous enhancement on arterial phase and remain moderately hyperintense on portal venous and equilibrium phase imaging. The demonstration of avidly enhancing liver lesions against a background of hepatic steatosis may be seen in the setting of liver adenomas, particularly the inflammatory subtype. On the delayed/hepatobiliary phase, these lesions are centrally hypointense with a hyperintense peripheral rim (axial series 4 images 46, 76); FNH lesions typically demonstrate increased signal intensity in the hepatobiliary phase. The reference segment 4B lesion contains subtle focal increased T2 signal intensity, which could represent a central scar as in the case of FNH lesions.SPLEEN: No significant abnormality noted.PANCREAS: Stable small cystic lesion of the pancreatic head most compatible with a side branch IPMN (axial series 3 image 31 coronal series 6 image 26).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.INDEX LESION MEASUREMENTS (Current exam date/time: 8/29/2016 13:00:00)PERIPHERAL RIGHT HEPATIC LOBE LESION: 2.2 x 1.8 cm (Image 39, Series 10); 2.0 x 2.8 cm on prior (4/6/2016) (Image 35, Series 8).SEGMENT 4A LESION: 3.2 x 3.5 cm (Image 75, Series 10); 3.9 x 3.8 cm on prior (4/6/2016) (Image 68, Series 8).SEGMENT 2 LESION: 1.4 x 1.3 cm (Image 44, Series 10).
1. Bilobar enhancing lesions are stable to slightly decreased in size. Reference measurements listed above. Constellation of imaging characteristics are nonspecific and could represent atypical FNH lesions or atypical adenomas.2. Stable small cystic lesion of the pancreatic head most compatible with a side branch IPMN. 