Male 64 years old with a pancreatic neuroendocrine tumor since 2011 with hepatic metastatic resection July 2015. The exam is limited as the top 1-2 cm of the liver are not included in the field-of-view on axial images.ABDOMEN:LIVER, BILIARY TRACT: Posttreatment changes are again seen in segment 8. There is stable very faint, ill-defined enhancement superior to the cavity (series 903, image 357) without T2 hyperintensity. The nonenhancing hypointense segment 3 focus is unchanged and likely postsurgical in etiology.There are multiple foci of restricted diffusion with associated ill-defined arterial enhancement and washout increased in size and number compared to the previous exam and suspicious for metastatic disease. For reference, a segment 7 lesion measures 9 x 7 mm (series 3, image 372).Cholelithiasis without evidence of acute cholecystitis. No biliary ductal dilatation or ascites. The hepatic vasculature is patent.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy. The remaining pancreas enhances homogeneously. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Juxtaphrenic lymph nodes on the right are stable to mildly increased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Increase in size and number of multiple arterially enhancing hepatic lesions with washout concerning for new and progressive metastatic disease.2.Stable post treatment changes in segment 8 with likely treatment related faint enhancement (similar in appearance to prior imaging).