65-year-old male patient with history of HCC status post Intra-Op RFA. Assess for liver lesions. Please note that this is a technically limited exam secondary to multiple technologist-related errors including partially unplugged coil leading to extensive signal loss (most pronounced anteriorly and affecting left liver lobe) and failure to acquire appropriate arterial or portal venous and delayed postcontrast imaging sequences. Patient to be contacted for reimaging and acquisition of additional sequences. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Findings concerning for new and enlarging hepatic lesions with corresponding restricted diffusion. Again visualized postablation cavities hepatic segment 7/6 on image 110 series 1401 and in segment 5 on image 92 series 1401. Unable to assess for arterially enhancing lesion along the caudal/medial aspect of the hepatic segment 7/6 ablation cavity as a reliable postcontrast arterial sequence was not acquired by the technologist. But the corresponding site of signal abnormality appears increased in size and shows restricted diffusion, lesion measures approximately 2.6 x 2.5 cm on image 101 series 1401 and on image 464 series 1308, previously measured 1.5 x 1.4 cm. Previously visualized focal arterial enhancement along anterior/lateral aspect of segment 5 cavity also unable to be evaluated for reasons above and again site of signal abnormality shows increased size now measuring approximately 2.5 x 1.5 cm on image 43 2 series 1/3/2008, previously measured 1.8 x 1.1 cm. There are additional more pronounced than on earlier exam focal ill-defined sites of apparent restricted diffusion, for example, in inferior pole of liver on image 288 series 1/3/2008, new sites of disease cannot be excluded.Postablation cavity in hepatic segment 2/3 stable to mildly increased in size.Subcentimeter previously seen hepatic segment 8 of arterially enhancing lesion not reliably seen.On submitted imaging sequence labelled arterial phase there are multiple peripherally based enhancing foci seen that are favored to be perfusional in etiology.Accounting for differences in technique stable to mildly increased in size subcentimeter simple appearing T2 hyperintense focus at level of dome on image 34 series 901, may reflect a cyst. Small perihepatic fluid.SPLEEN: Splenomegaly measuring 19.1 cm in longitudinal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Splenorenal shunting present.RETROPERITONEUM, LYMPH NODES: Small porta hepatis and cardiophrenic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously alluded to punctate vertebral body enhancing focus not visualized, again likely technical.OTHER: No significant abnormality noted.
Very limited exam due to technical errors made, see above. Patient to return and be re-imaged, please await report or addendum for that exam.Within limitations of study findings concerning for new and enlarging hepatic lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.