APASL and AASLD Consensus Guidelines on Imaging Diagnosis of Hepatocellular Carcinoma: A Review

Figure 3

Chronic HBV patient with known multifocal HCC presumed to be confined to the right lobe, completed one session of TACE. US suggested possible nodule in the left hepatic lobe, but this was occult on multiphasic CT. MRI with standard dose of Gd-EOB-DTPA was performed.

(a) Axial fat-saturated respiratory triggered T2-weighted fast spin echo image (TE 80 msec) does not reveal abnormal signal focus in the left lobe, even on retrospective review

(b) Axial LAVA image in the portal venous phase shows a questionable focus of mixed intensity (arrow) in segment 3. This was mainly due to pulsation artefact from the abdominal aorta. No enhancement was seen in the corresponding section on hepatic arterial phase imaging (not shown)

(c) Axial LAVA hepatocyte-specific phase image at 20 min post injection confirms the presence of a 2.2 cm lesion (arrow) in the subcapsular region of segment 3. Given the size, HCC is highly suspected, even in the absence of classical imaging features. Note partially treated lesion in the right lobe (arrowhead)