Fig. 3.

A 60-year-old woman with hepatitis B-related cirrhosis and 51-mm steatohepatitic hepatocellular carcinoma with CT (A−C) and MRI (D−G).

The lesion showed non-rim arterial phase hyperenhancement (B and F), non-peripheral ‘washout’, and enhancing ‘capsule’ on portal venous phases (C and G). All readers agreed on the presence of fat in mass as an ancillary feature, visible on pre-contrast CT image (A, arrow), and as marked signal drop on the MRI sequence (E, arrow). The observation was categorised as LR-5 by all readers on MRI and as LR-5 by 2 of 3 readers on CT. Macroscopic examination of the resected tumour (H) showed a well-demarcated encapsulated yellow tumour. Microscopic examination (I) showed a steatohepatitic pattern with numerous steatotic tumour cells and few ballooning tumour cells associated with fibrosis and lymphocytic inflammation consistent with the diagnosis of steatohepatitic hepatocellular carcinoma. CT, computed tomography; MRI, magnetic resonance imaging.