Cases/Examples
History and query: 63-year-old patient with history of chronic hepatitis C. During his periodic clinical evaluation, an increase of alfa-feto protein was discovered. Ultrasound showed a focal liver lesion. A CT scan was performed to characterize the lesion (Fig.1). A single focal lesion, 2 cm in diameter, was revealed in segment IV with a dynamic pattern indicative of a HCC nodule. Post CT the patient underwent Primovist®-MRI in order to plan surgical resection.
CT of the liver:
CT findings: a single focal lesion, 2 cm in diameter, was revealed in segment IV. The lesion showed a contrast-enhanced dynamic pattern indicative of a HCC nodule.
MRI of the liver:
Contrast agent: I.v. of 10 ml of Primovist® at a flow rate of 1 ml/s, followed by 20 ml of NaCl
MR findings (Fig.2): MRI confirmed HCC nodule in segment IV already seen by CT. During the hepatobilary phase, the nodule showed a Primovist® uptake in segment V (2f). Furthermore, MR images revealed an additional lesion <1cm which appeared isointense (grey) during unenhanced T2-weighted imaging (2g) and sligthly hyperintense (bright) during out-of-phase T1-weighted imaging (2i) in segment V. Primovist® enhanced arterial phase did not reveal a pathologic vascularization (2l) as well as during the hepatobiliary phase the lesion did not show any uptake of contrast agent.
Surgery findings: At surgery the nodule located in segment IV resulted to be a moderately-differentiated HCC, whereas the nodule located in segment V resulted to be an early HCC.
Therapy management: Due to the identification of the second lesion the surgical therapy was changed.
With courtesy of Antonella Filippone, MD, Chieti, Italy
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Benign lesion
Cavernous hemangioma is the most common benign tumor of the liver
