Reason: assess liver for HCC History: cirrhosis and chronic hepatitis B. Evaluation mildly limited by motion. ABDOMEN:LIVER, BILIARY TRACT: There is relative hypertrophy of the left hepatic lobe, widening of the hepatic fissures, and mild nodular hepatic contour compatible with cirrhosis.There is a lesion within hepatic segments 6/7 with reference measurements below. The lesion demonstrates increased T2 signal, decreased T1 signal, restricted diffusion, and arterial enhancement with washout and is compatible with hepatocellular carcinoma. The lesion mildly attenuates the adjacent segmental branches of the right portal vein.There is an additional smaller lesion within segments 7/8 at the dome with reference measurements below. This lesion demonstrates increased T2 signal, decreased T1 signal, restricted diffusion, probable arterial enhancement, and probable washout centrally although the small size somewhat limits evaluation.There is an additional subcentimeter lesion along the periphery in segment 4A with reference measurements below. The lesion demonstrates increased T2 signal, decreased T1 signal, and arterial enhancement without washout may reflect a benign flash filling hemangioma.The gallbladder is nondistended. Mild diffuse gallbladder wall thickening is nonspecific but likely related to ascites and/or chronic liver disease. No significant biliary ductal dilatation.SPLEEN: The spleen is mildly enlarged measuring up to 13.3 cm in the cranial caudal dimension. Normal variant splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right renal cyst.RETROPERITONEUM, LYMPH NODES: Mildly prominent gastrohepatic and para-aortic lymph nodes which are nonspecific but may be related to chronic hepatic disease.BOWEL, MESENTERY: Mild diffuse wall thickening of the visualized small bowel nonspecific but likely related to ascites/chronic liver disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Marked abdominopelvic ascites.INDEX LESION MEASUREMENTS (Current exam date/time: 9/15/2016 14:22:00)HEPATIC SEGMENT 6/7 LESION: 1.9 x 1.6 cm (Image 17, Series 3).HEPATIC SEGMENT 7/8 DOME LESION: 0.9 x 0.6 cm (Image 8, Series 3).SEGMENT 4A LESION: 0.6 x 0.7 cm (Image 11, Series 3).
1.Cirrhosis and sequelae of portal hypertension including marked abdominal ascites.2.Hepatic lesion within segment 6/7 highly suspicious for hepatocellular carcinoma.3.Subcentimeter hepatic lesion within segment 7/8 suspicious for hepatocellular carcinoma, although subcentimeter size somewhat limits characterization.4.Subcentimeter hepatic lesion within segment 4A with features suggestive of a benign flash filling hemangioma.Discussed with Dr. Andrew Aronsohn at 4:34 PM on 9/22/2016.