Case 199:   Hepatocellular Carcinoma (HCC)

Diagnostic Category:

Clinical Presentation:

77 year old man with incidental hepatic mass on CT angiography performed for evaluation of abdominal aortic aneurysm.

MR: Fatty, with central scar

Imaging Findings:

MR shows cirrhosis and large HCC in the right lobe with mild hyperintesity in T2, and higher T2 signal intensity centrally from a scar.  Areas of signal loss on the T1w opposed-phase sequence indicate the presence of microscopic fat.

Enhancement of the HCC is heterogeneous.  On the arterial phase post contrast T1w fat-saturated sequence there are mildly hyperenhancing nodules along the lateral aspect of the HCC (arrowhead) that wash out on the equilibrium phase (arrowhead). Delayed enhancement of the scar results in it being isointense to the remainder of the mass and therefore less evident on the equilibrium phase.