There are many stigmata of cirrhosis in this patient : micronodular liver contours & parenchyma, relative hypertrophy of the left liver lobe, dilated portal vein, splenomegaly, permeable umbilical vein, etc. Minimal ascite surrounds the periphery of the liver.
MRI shows a mass occupying the 8 & 4A liver segments, iso-intense on T2WI - slightly hyperintense on T1WI (in-phase). There is an important drop of signal on in and out of phases images, compatible with microscopic fat (intracytoplasmic). The mass only enhances peripherally on all T1C+ images, including delayed images at 30 minutes. The mass is reponsible for a focal upstream dilatation of intra-hepatic bile duct. Considering the cirrhosis stigmata, the most probable diagnosis is hepatocellular carcinoma until proven otherwise. Peripheral cholangiocarcinoma are not known to contain microscopic fat. Other fat containing lesions are highly improbable.
There is a siderotic nodules located in segment 7 (hypo-intense T1 & T2, non enhancing).
Left adrenal adenoma with cystic component, otherwise typical (50 % washout, signal drop on in & out of phase, etc.).
- MRI (T2 fat sat):
- MRI (T1 C+ fat sat):