fig3

Figure 3. Absence of washout of HCC developed on a steatotic liver in a 65-year-old male. Unenhanced (A) and enhanced CT images obtained during HAP (B), PVP (C), and LVP (D) images show a large HCC in the right liver lobe. The HCC is slightly hyperattenuating to the background liver (steatotic); it shows non-rim arterial phase hyperenhancement on HAP but no washout nor enhancing capsule in PVP (C) and LVP (D). Note the intense drop of the signal of the background liver on MR out-of-phase T1 image (F - asterisk) compared to the T1 in-phase image (E), consistent with severe hepatic steatosis. On gadolinium-enhanced fat-suppressed T1 images, the nodule shows non-rim arterial phase hyperenhancement (G - arrow) but no washout on PVP (H). Conversely to CT, an enhancing capsule is depicted on MRI on PVP (H). HCC: Hepatocellular carcinoma; CT: computed tomography; HAP: hepatic arterial phase; PVP: portal venous phase; LVP: late venous phase; MR: magnetic resonance; MRI: magnetic resonance imaging.