History of hepatocellular carcinoma status post TACE/RFA. Evaluation is mildly limited by dielectric artifact due to ascites and patient body habitusABDOMEN:LIVER, BILIARY TRACT: Cirrhotic nodular liver morphology. Normally distended gallbladder with trace nonspecific gallbladder wall thickening. No intra or extrahepatic biliary ductal dilatation. Large volume of perihepatic ascites.Segment 5 ablation cavity is slightly increased in size following 7/20/2016 ablation with reference measurements as below. Increased intrinsically T1 hyperintense material within the cavity is compatible with blood products/treatment change. The previously seen arterially enhancing focus along the anterior medial and caudal aspect of the ablation cavity is no longer seen. There is no significant arterial enhancement associated with the ablation cavity to suggest marginal recurrence.In segment 7/8, there is a new lesion with reference measurements below. The lesion demonstrates a rim of increased T2 signal, isointense T1 signal, restricted diffusion, as well as arterial peripheral enhancement which fades but does not definitely washout and with relative hypoenhancement centrally.In segment 3, there is a new lesion with reference measurements below. The lesion demonstrates a rim of increased T2 signal, slightly decreased T1 signal, restricted diffusion, as well as arterial peripheral enhancement which fades but does not definitely washout and with relative hypoenhancement centrally.In segment 7, there is redemonstration of a lesion, slightly increased in size, with reference measurements below. The lesion demonstrates isointense T1 signal, decreased T2 signal, and relative hypoenhancement on more delayed images but lacks definite arterial enhancement or washout. SPLEEN: The spleen measures 13.7 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: Large volume ascites.BONES, SOFT TISSUES: Left greater than right pleural effusions.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/16/2016 07:59:30)SEGMENT 7/8 LESION: 1.4 x 1.1 cm (Image 22, Series 1203).SEGMENT 7 LESION: 1.3 x 1.3 cm (Image 22, Series 1203); 1.3 x 1.0 cm on prior (6/16/2016) (Image 31, Series 10).SEGMENT 5 ABLATION CAVITY: (Image 11, Series 10); (Image 22, Series 1200); 4.0 x 2.2 cm (Image 39, Series 1202); 3.0 x 1.9 cm on prior (6/16/2016) (Image 43, Series 10).SEGMENT 3 LESION: 2.4 x 2.4 cm (Image 34, Series 1201).
1.Examination is mildly limited by dielectric artifact which is exacerbated by abdominal ascites; paracentesis can be considered prior to the subsequent follow-up examination.2.Interval ablation of arterial enhancing lesion along segment 5 ablation cavity without evidence of residual disease or marginal recurrence at this site.3.Slight increase in size of segment 7 lesion which demonstrates imaging features most suggestive of a dysplastic nodule.4.New lesions in segments 3 and 7/8 which demonstrate somewhat atypical imaging features but which are suspicious for hepatocellular carcinoma.