Recent advances in non-invasive magnetic resonance imaging assessment of hepatocellular carcinoma

Figure 3 Gd-EOB-DTPA enhanced magnetic resonance images of a 67-year-old male patient with large hepatocellular carcinoma lesion in the right liver lobe. Panels A-B: T1-weighted sequences “in and out of phase” demonstrate a heterogeneous mass slightly hypointense without a signal drop in “out of phase” sequence. Panels C-D: T2-weighted image without and with fat saturation demonstrates a slightly hyperintense mass with a central, homogeneous hyperintense area, as per necrosis. Panels E-H: Dynamic contrast-enhanced images delineate the typical contrast behavior of hepatocellular carcinoma (HCC): Hyperenhancement during the arterial phase (F) followed by wash-out in portal and delayed phase (G-H). In the hepatobiliary phase image 20 min after Gd-EOB-DTPA injection the nodule appears highly hypointense compared with the surrounding enhanced liver (panel I). Panel J: On the diffusion weighted image, HCC lesion is hyperintense due to the restriction of water diffusion. Panel K-L: Perfusion images derived from semiquantitative analysis (relative arterial enhancement and maximum enhancement) the HCC is characterized by high vascularity intensity signals, shown as hot-spots signals.