Female 63 years old with HCV cirrhosis and HCC s/p TACE/RFA 7/2016, follow up imaging for recurrence. ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour with a cirrhotic morphology including caudate and left hepatic lobe hypertrophy and fissural prominence, unchanged.The ablation cavity in hepatic segment 5 measures 3.6 x 1.7 cm (series 904, image 211), previously 3.7 x 1.7 cm and has intrinsic T1 hyperintensity consistent with blood products. There is a nodular focus of enhancement along the superolateral aspect of the ablation cavity with no definite washout. This lesion should be followed on subsequent exams. The focus of arterial enhancement in segment 6 has increased in size now measuring 2.0 x 0.9 cm (series 903, image 206), previously 1.3 x 0.9 cm with diffusion restriction but no washout on delayed images. This does not meet criteria for HCC but is suspicious for neoplasm, perhaps atypical HCC or a small cholangiocarcinoma.There is a new subcentimeter enhancing lesion in segment IVb with no diffusion restriction or washout (series 3, image 218). This lesion is indeterminate and can be followed on subsequent exams.No intra or extrahepatic biliary ductal dilatation. Status post cholecystectomy with prominent common duct measuring up to 11 mm, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent periportal lymph nodes are nonspecific in the setting of cirrhosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Cirrhotic liver morphology.2.Segment 5 ablation cavity is unchanged in size however there is a new focus of nodular enhancement along the superolateral aspect of the should be followed on subsequent exams.3.Arterially enhancing segment 6 lesion with restricted diffusion has increase in size. While this does not meet criteria for hepatocellular carcinoma, it is suspicious for a neoplastic process such as atypical hepatocellular carcinoma or a small cholangiocarcinoma.4.There is a new enhancing lesion in segment IVb which is indeterminate and can be followed on subsequent exams.