MRI Findings: Assessing Liver Lesions After HCC Surgery

MRI Report

Several years ago, a family member underwent surgery for liver cancer and recovered well, with follow-ups every three months.
Recently, a CT scan indicated a gray shadow on the liver, prompting the doctor to order blood tests and a nuclear magnetic resonance (NMR) examination.
The blood tests showed all liver parameters within normal ranges, but the NMR report indicated the following:
MR of the Liver, Structural Report:
- Cor FIESTA +FS, Large FOV
- Axi Dynamic LAVA 3D, 0, 30s, 1, 3, and 5 mins, 5-mm slice.
Indication(s): HCC + CCC S/P OP.

FU Comparison: CT on 2023-06-08, 2022-04-19
Findings:
1.
Tumor profiles:
- Prior management: partial hepatectomy of segments S5/S6, S4/S5/S8.
- Local recurrence (viable):
- A growing nodule with early enhancement and early washout at the S2/S3 junction, approximately 2 cm in size, favoring HCC.
- About three poorly enhanced nodules at S2, S6, and S7, ranging from 0.5 to 1.3 cm in size, relatively stable or slightly larger than prior studies, suspected to be regenerative nodules or hypovascular HCCs, suggesting close follow-up.
2.
Interval change: The S2/S3 lesion is larger than in prior studies.
3.
Portal vein: Patent.
4.
Regional lymphadenopathy: None.
5.
Cirrhosis of liver: None.
6.
Ascites: None.
7.
Splenomegaly: None.
8.
Portosystemic collaterals: None.
9.
Biliary tree: Unremarkable.
10.
Pancreas: Unremarkable.
11.
Kidneys: Unremarkable.
12.
Adrenals: Unremarkable.
Impression: A growing HCC at the S2/S3 junction, 2 cm, and several stable washout nodules at S2, S6, and S7.
Based on the examination, what is the likelihood that the lesion at the S2/S3 junction is liver cancer, or could it be a benign tumor? Is there a possibility of hepatic nodule formation? Should further monitoring be conducted?

Xiao Jing, 30~39 year old female. Ask Date: 2023/09/19

Dr. Chen Shidian reply Gastroenterology and Hepatology

The report indicates a recurrence of liver cancer; please discuss this with the attending physician for their assessment.

Reply Date: 2023/09/19

More Info

The MRI findings you provided indicate a concerning situation regarding the potential recurrence of hepatocellular carcinoma (HCC) after your family member's previous liver cancer surgery. The report highlights a growing nodule at the S2/S3 junction, measuring approximately 2 cm, which is characterized by early enhancement and early washout. These imaging features are suggestive of HCC, as they are consistent with the typical behavior of malignant liver lesions.

To address your questions regarding the likelihood of the S2/S3 junction lesion being HCC versus a benign tumor, it is important to consider the imaging characteristics and the clinical context. The report explicitly states that the findings "favor HCC," which implies that the imaging features are more consistent with a malignant process rather than a benign one. Additionally, the presence of other nodules that are described as having poor enhancement and being relatively stable raises the possibility of regenerative nodules or hypovascular HCCs, which can occur in the context of liver cirrhosis or after liver surgery.

Regarding the possibility of these lesions being benign, it is essential to note that while benign liver tumors (such as hemangiomas or focal nodular hyperplasia) can exist, the specific characteristics of the lesion at the S2/S3 junction, particularly its growth and enhancement patterns, lean more towards malignancy. Therefore, the probability of this lesion being HCC is significant, especially given the patient's history of liver cancer.

As for whether further follow-up is necessary, the report suggests close follow-up due to the growing nature of the lesion. In cases of suspected HCC recurrence, it is standard practice to conduct regular imaging studies, such as MRI or CT scans, to monitor the lesion's behavior over time. The frequency of these follow-ups can vary based on clinical guidelines and the treating physician's recommendations, but typically, patients with a history of HCC may be monitored every 3 to 6 months.

In conclusion, the findings from the MRI report strongly suggest the possibility of HCC recurrence at the S2/S3 junction. It is crucial to discuss these results with the treating physician, who can provide a comprehensive assessment and determine the best course of action, including the need for potential biopsy or further imaging studies. Early detection and intervention are vital in managing liver cancer, so maintaining a vigilant follow-up schedule is essential.

Similar Q&A

Understanding MRI Findings of Liver Nodules in Cancer Survivors

Hello, doctor. My mother is 60 years old. She was diagnosed with stage 1A gastric cancer in August 2018 and underwent surgical treatment. Since then, she has been undergoing annual check-ups. In July 2020, an abdominal CT scan revealed a small nodule in the liver. An MRI performe...

Dr. Wang Yifen reply Radiology
Hello, your mother has a history of gastric cancer and requires regular follow-up. The imaging report consists of a written description, and the diagnosis and treatment of the disease should be based on a comprehensive analysis of the actual imaging and relevant clinical data to ...

Understanding Hepatic Cysts: What Your MRI Report Means and Next Steps

Hello Doctor, I would like to ask you about this MRI report. I have fatty liver disease and was found to have a nodule in my liver. I previously underwent a whole-body PET scan which showed no significant issues, and now I have been scheduled for an MRI. MRI Report: MRCP shows:...

Dr. Hong Yuanbin reply Internal Medicine
Hello, according to this report, it is just a liver cyst and there are no signs of cancer. Regular follow-up is sufficient. Thank you for your inquiry.

Understanding Liver Issues: Insights from Ultrasound Reports and Symptoms

Hello Dr. Tsai! I would like your help reviewing my abdominal ultrasound reports from two different hospitals, thank you. First Report: - Spleen Index: 7.18 × 3.75 cm - CBD: 0.63 cm - Portal vein: 1.05 cm - Normal liver size, bright and heterogeneous parenchyma with mild inc...

Dr. Cai Anshun reply Gastroenterology and Hepatology
Hello: 1. According to the report you provided, the liver appears to be only fibrotic, with no signs of cirrhosis. Additionally, your platelet count is 241,000; individuals with cirrhosis typically have platelet counts below the normal range (169,000). 2. Chronic anemia can i...

Understanding Unidentified Liver Lesions in Fatty Liver Patients

Hello Dr. Lee, I would like to ask about my father who is 61 years old. He was recently diagnosed with fatty liver (with normal liver enzymes), but there is a 1 cm unidentified mass on the surface of his liver. What could this possibly be? He hasn't had an ultrasound yet, so...

Dr. Li Yongming reply Gastroenterology and Hepatology
In clinical practice, the diagnosis of "fatty liver" refers to the condition where the weight of fat (primarily triglycerides) accumulated in the liver exceeds 5% of the total liver weight, or when more than 10% of liver cells in a liver tissue biopsy exhibit fatty vacu...