66-year-old male with HCV and alcoholic cirrhosis, NASH. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Stigmata of portal hypertension including splenomegaly and esophageal/splenic varices.In hepatic segment 3, there is a 1 x 1 cm lesion that is hyperintense in arterial phase and demonstrates washout on the delayed phase (axial series 9 images 51, 243) (axial series 100 image 52, axial series 101 image 52). This central enhancing lesion is faintly T2 hyperintense and demonstrates restricted diffusion (axial series 4 image 94), and these characteristics are consistent with an HCC. The peripheral aspect of this focus demonstrates T1 hyperintense signal (axial series 8 image 52), no enhancement, and remains isointense to the hepatic parenchyma on portal venous and delayed phases. The imaging characteristics of this peripheral component is most compatible with a high-grade dysplastic nodule. The combined appearance of these 2 foci are characteristic of a "nodule within a nodule".Small focus of persistent hyperenhancement in hepatic segment 8 is of unclear etiology (axial series 100 image 35, axial series 101 image 44).SPLEEN: Mild splenomegaly measuring 14 cm in length.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: Small fat-containing ventral hernia.OTHER: No significant abnormality noted.
1."Nodule within a nodule" appearance of hepatic segment 3 HCC. The 1 cm central focus with arterial enhancement and washout is consistent with HCC. The peripheral crescentic T1 hyperintense component has imaging characteristics most consistent with a high-grade dysplastic nodule.2. Small focus of persistent hyperenhancement in hepatic segment 8 could be perfusional. Attention to this region is recommended on subsequent imaging.3. Cirrhotic liver morphology with sequela of portal hypertension. 