case_images: PMC8326146_01
case_images: A 64-year-old male with hepatocellular carcinoma presenting with diarrhea. (a-d) multiphase abdominal CT scan showed a nodule (arrow) of -11 HU in non-contrast (a), late arterial (b), venous (c), and delayed phase (d and c). (e and d, h and f) Follow-up examination 3 months later showed that the nodule had enlarged in non-contrast (e), late arterial (f), venous (g), and delayed phase (h) with enhancement in late arterial phase (f and e) and washout in the delayed phase (h and f).
case_images: JCIS-11-36-g001.jpg
case_images: PMC8326146_01_JCIS-11-36-g001.jpg
case_images: F1
case_images: Three months later, a follow-up CT scan showed the mass had enlarged from 0.7 cm to 1.4 cm, leading to a suspicion for malignancy [Figure 1].
case_images: A 64-year-old male with hepatocellular carcinoma presenting with diarrhea. (a and b) MRI chemical shift imaging done 6 months after the initial CT scan showed a hyperintense mass (white arrow) during in-phase (a) with signal loss during opposed phase (b). (c) T1 fat-saturation also shows signal loss in the mass. (d and f) Dynamic MR in late arterial (d), venous (e), and hepatobiliary phase (f) showed late arterial phase enhancement that was not followed by washout during venous phase. While there is uptake in the non-fatty component, the tumor's fatty component did not show uptake with hepatobiliary contrast administration.
case_images: JCIS-11-36-g002.jpg
case_images: PMC8326146_01_JCIS-11-36-g002.jpg
case_images: F2
case_images: Using hepatobiliary-specific contrast, no uptake was seen on the fatty component with uptake on the non-fatty component [Figure 2].
case_images: PMC8326146_02
case_images: A 46-year-old male presented with hepatocellular carcinoma presenting with passing black tarry stool for 3 months. (a-c) Multiphase angiography CT scan in non-contrast (a), late arterial (b), and portal venous phase (c). A liver mass (white arrow) appeared to enhance during late arterial phase (b) followed with isodense appearance during delayed phase (c). The fat-density area did not enhance after contrast administration.
case_images: JCIS-11-36-g003.jpg
case_images: PMC8326146_02_JCIS-11-36-g003.jpg
case_images: F3
case_images: Meanwhile, the other part of the mass showed contrast enhancement during late arterial phase without washout during delayed phase [Figure 3].
case_images: A 46-year-old male presented with hepatocellular carcinoma presenting with passing black tarry stool for 3 months. (a and b) T1 chemical shift abdominal MRI showed a hyperintense mass (white arrow) during inphase (a) along with signal loss during opposed-phase (b). (c) Hyperintense component was seen on T2-weighted sequence. (d) The mass appeared to be suppressed during T2 fat saturation technique. (e) On DWI sequence, part of the mass appeared with pathologic diffusion restriction.
case_images: JCIS-11-36-g004.jpg
case_images: PMC8326146_02_JCIS-11-36-g004.jpg
case_images: F4
case_images: On T2 sequence, there was a hyperintense component which was suppressed when we used fat-saturation technique [Figure 4].
case_images: PMC8326146_03
case_images: A 67-year-old male with hepatocellular carcinoma presenting with weakness, nausea, and vomiting. (a-c) Multiphase abdominal CT showed a hyperdense mass (white arrow) component during late arterial phase (a) that appeared isodense during venous phase (b) and washout during delayed phase (c). A hypodense component (black arrow) that did not enhance with contrast was also seen.
case_images: JCIS-11-36-g005.jpg
case_images: PMC8326146_03_JCIS-11-36-g005.jpg
case_images: F5
case_images: Meanwhile, the more hyperdense component showed enhancement during late arterial phase followed by washout during delayed phase [Figure 5].
case_images: A 67-year-old male with hepatocellular carcinoma presenting with weakness, nausea, and vomiting. (a and b) T1 chemical shift abdominal MRI showed a heterogenous mass that appeared iso- to hyperintense during (a) in-phase along with signal loss during (b) opposed-phase (white arrow), indicating the presence of fat. (c) Hyperintense component of the mass was seen on T2-weighted sequence. (d) Part of the mass was suppressed on fat-saturation T2 sequence. (e) On DWI sequence, part of the mass had pathologic diffusion restriction. (f-h) Contrast administration showed enhancement during late arterial phase followed by washout and partly isointense appearance during delayed phase (g) without uptake during hepatobiliary phase (h). No contrast enhancement was found in the fat component.
case_images: JCIS-11-36-g006.jpg
case_images: PMC8326146_03_JCIS-11-36-g006.jpg
case_images: F6
case_images: Diffusion restriction was seen [Figure 6].