Akash J. Patel

ALT The transverse ultrasound image (A) shows a hypoechoic, solid-appearing lesion in the liver (arrows). The fat-suppressed, T1-weighted postcontrast image from an MRI obtained weeks after the ultrasound (B) shows a left lobar mass (arrow). The more caudal image (C) demonstrates portal venous tumor thrombus associated with the mass and typical of hepatocellular carcinoma with tumor in the vein (TIV) (arrow).

ALT The axial fat-suppressed, T1-weighted arterial phase postcontrast image (A) shows an approximately 2cm hypointense lesion in segment 4B that demonstrates heterogeneous hyperenhancement (arrow). The ultrasound image following microwave ablation (B) shows increased echogenicity within the treated lesion (arrow) indicating treatment effects. The subsequent fat-suppressed, T1-weighted postcontrast arterial phase image (C) shows an approximately 4cm hyperenhancing LI-RADS 5 lesion (arrow) confirming the diagnosis of HCC. An axial maximal intensity projection (MIP) image (D) from a subsequent chest CT shows numerous pulmonary nodules (arrows) typical of metastases.

ALT The axial fat-suppressed, T1-weighted postcontrast image (A) shows a 2cm heterogeneously hyperenhancing lesion in segment 5 (arrow). Over 3 years following transarterial chemoembolization (TACE), on the fat-suppressed, T1-weighted postcontrast image (B) the treated lesion (arrow) exhibits heterogeneous signal corresponding to posttreatment changes, although there is focal hyperenhancement adjacent to the treated lesion (thick arrow). The axial fat-suppressed, T1-weighted postcontrast image (C) obtained 14 years following repeat TACE and microwave ablation shows absent enhancement in the treated area in segment 5 (arrow) with a new hyperenhancing lesion in segment 3 (thick arrow).

ALT The axial fat-suppressed, T1-weighted delayed postcontrast image (A) shows a small hepatic segment 8 lesion exhibiting washout (arrow) and corresponding to a small HCC. The axial fat-suppressed, T1-weighted arterial phase postcontrast image obtained 11 years later (B) shows a 3cm hyperenhancing lesion (arrow) in segment 5 adjacent to the gallbladder (thick arrow) indicating recurrent HCC. On a more cephalad arterial phase image (C), a second hyperenhancing HCC (arrow) in segment 7 is evident. Four years later, the fat-suppressed, T1-weighted arterial phase postcontrast image (D) shows yet another large, hyperenhancing segment 4 lesion (arrow) consistent with HCC.