Cirrhosis and hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Liver contour: Nodular liver morphology with caudate and left hepatic lobe hypertrophy compatible with cirrhosis. T2 hyperintense reticular liver parenchyma consistent with fibrosis. Features of portal hypertension: Splenomegaly. Patent vasculature.Lesions: There are numerous well defined T2 hyperintense nonenhancing hepatic cysts. Several intrinsically T1 hyperintense nonenhancing lesions likely represent proteinaceous contents. Numerous small siderotic nodules are also noted, as evident on the in-phase imaging.Segment IVb, inferior medial segment of the left lobe, lesion demonstrates new from prior nodule in nodule appearance with central T1 hypointensity and T2 hyperintensity and peripheral T1 hyperintensity and T2 hypointensity (series 11/34 and series 4/12). The entire lesion measures 3.0 x 2.2 cm, unchanged from the prior. The central component demonstrates late arterial enhancement and fading (i.e. becomes isointense to liver parenchyma) on the transitional/equilibrium phase and demonstrates hepatobiliary agent uptake on the hepatobiliary phase, measuring 1.5 x 1.5 cm (series 9/13). On the prior study the lesion did not demonstrate enhancement as evident on the subtraction imaging. This likely represents a large dysplastic nodule developing a central high-grade dysplastic nodule without meeting strict imaging criteria for HCC.Approximately 2.3 x 2.0 cm mildly T2 hyperintense (series 9/8) arterial enhancing lesion (series 12/23) in segment 7/8 demonstrating washout (series 13/23). The lesion demonstrates intralesional fat on in/out of phase imaging, an ancillary feature further supporting the diagnosis of HCC .Arterial enhancing region in the peripheral segment VII (series 12/24) without definite washout on the more delayed imaging likely represents a transient hepatic intensity difference given its somewhat wedge-shaped appearance and peripheral location. Normally distended gallbladder with small gallstones.SPLEEN: Splenomegaly measuring 18.4 cm in craniocaudal dimension.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.
1.2.3 cm segment 7/8 lesion meets imaging criteria for HCC.2.The segment IVb medial segment of the left lobe 3 cm nodule is stable in size but demonstrates interval nodule in nodule appearance development with a 1.5 cm central nodule demonstrating arterial enhancement without washout. This is suspicious for an early central HCC/higher grade dysplastic nodule developing within a lower grade dysplastic nodule. Short interval follow-up is recommended.3.Cirrhosis with stigmata of portal hypertension including splenomegaly.