Figure 12.

Small, non-washing-out hepatocellular carcinoma. A: Pre- and post-contrast fat-suppressed 3D-GRE T1-weighted images during the late hepatic arterial (B) and delayed phases (C). D: Fat-suppressed SSFSE T2-weighted image. There is a small nodule at hepatic segment #5, which demonstrates minimally decreased T1 signal on pre-contrast images (arrow, A) and increased arterial enhancement (arrow, B). The nodule demonstrates iso to slightly increased signal on the delayed phase images, without clear washout (C), but mildly increased T2 signal intensity (arrow, D) in keeping with an HCC. Note that T2 signal alteration increased the accuracy of diagnosing HCC in this patient, despite the lack of delayed washout (also see Figure 17). HCC: Hepatocellular carcinoma; GRE: Gradient recalled echo; SSFSE: Single-shot fast spin-echo.