Hep C Discussion Forum

Hi John,

Thanks for the report. I'll try to be careful in giving my personal opinion. My report would be 3 times as long.

Interestingly, your lesion is in segment 2 of the L. liver lobe, same as mine.

The report mentions that the lesion was present on the previous scan of 28th June but 'less conspicuous'. This is a relief!

The lesion is 'mildly lobulated', and shows 'peripheral globular enhancement'.

No mention is made of a central scar, or washout. Boy, 27 mls of MagneVist is a lot of contrast- I weigh 78 kg, and get 23 mls!

Opinion: I would be fairly confident this is benign, and is either an haemangioma, adenoma or FNH (Focal Nodular Hyperplasia). I base this on the fact that you had a big dose of contrast, and a 1.7 cm HCC would show more enhancement as they derive a rich blood supply from the hepatic artery. I would want a followup in 3 months and ask for a comment about washout.  Just my opinion mate.  Cheers.

Yeah it is saying file too long when I try that!

Not sure if it is going through - I can't seem to attach it.  I have it as a word file and a tif file - I can't save it as a jpeg. 

-- Edited by JLynch30 on Wednesday 27th of November 2013 10:00:21 PM

Just the report John. There will be hundreds of images, even though there is usually just a selection on the CD. Cheers.

Hi John,

MRI and CT scans are very different.  I'm surprised you didn't know it was an MR as on 23May you posted 'They are going to do an MRI. I just had one 2 months ago.....' . For an MRI you are in a sealed room in a tunnel, with space-age music as the machine runs through each sequence, and the examination takes about 40 minutes.

Radiologists have their own preferred imaging modalities. I prefer MRI provided the required sequences are done after the IV contrast.  I would be interested to read your report.  I hope they compared it with the previous MRI. If it was reported as an haemangioma, your doctor must be nuts to be discussing Rx options for HCC with you. Good luck.

Okay I think you just answered my question.  Thanks.

Hi again John,

That would be 1.7 cm as lesions measuring 1.7 mm can't be distinguished. From your previous posts, I see you had an MRI in about March 2013, as you had a slightly elevated AFP. Ask your doctor whether this has been compared with your recent CT. The good news is that it is a single lesion.

The doubt might be arising from the fact that they may have just done a standard CT.  In these, only arterial and venous phase scans are obtained ( after the injection of I.V. contrast).  As I said before, only a delayed scan can reliably tell the difference between an HCC and haemangioma. An HCC washes out ( i.e. the IV contrast is gone) quickly, whereas an haemangioma stays bright (i.e. containing IV contrast). I had the same problem when I had my first CT in 2002. I was unhappy with my Ultrasound results as my liver is high under the diaphragm, and I felt I could only see ~80% of the liver clearly.  I went to another Radiology practice and had a routine scan, and deliberately didn't look at the films. I then had a call from the Radiologist ( the same day) to go back for another CT, this time with delayed films, and a larger dose of IV contrast.  Like you, I was freaking out.      I had the repeat scan then saw the problem. I had a 1.1 cm round lesion in segment 2 of my L liver lobe.  On the previous scans, it could have been an HCC.  However, after the second scan, it didn't wash out, so we could be 99% certain it was an haemangioma.  Several MRI's and CT's ( and 11 years) later, it now measures 1.2 cm and is obviously a typical haemangioma.  It it still extremely difficult to see on Ultrasound and often can't be seen at all.  If I were you, I'd ask for a comparison with the MRI, then a repeat CT with delayed films. You shouldn't be messed around like this. Again, sorry to be technical, but there's no easy way to describe this. Cheers.

Guys,

Please, please, no more Dr.M's. I'm just another grateful Forum member. Thanks.

Hi John,

Yes, it does. They'll probably do a followup, just to be certain. Cheers.

I can't thank you enough for your responses - you are btter than my doctors at explaining things to me in a clear, concise manner.  You are a Godsend!

Hi John,

On a modern multislice CT machine, HCC should be easy to differentiate from haemangioma in 98% of cases. Both lesions appear hypodense on a non-contrast scan.  After a bolus of I.V. contrast, arterial phase images show intense filling-in with HCC, and peripheral filling in with an haemangioma. On portal phase slices, HCC's show early washout with the lesion becoming rapidly isodense or hypodense.  Haemangiomas show very slow washout, and usually show retained enhancement on the delayed films. In cirrhotics, regenerative nodules are more difficult to diagnose. These may appear similar to an HCC, and often followup is required.  I know this is very technical, but 'wondering if it will grow' doesn't sound very enlightened.  Actually, MRI is easier for sorting out small liver lesions, with the new sequences and liver contrast. Cheers.

Hi John,

Liver haemangiomas are common, and are often found on routine Ultrasounds, CT or MRI examinations of the liver.  They are usually between 1 and 3 cm in diameter, and are vascular, congenital tumours. They very, very rarely cause problems, and they have a distinct vascular pattern after I.V. contrast on both CT and MRI. The main thing is to distinguish them from a small HCC.  I have one in Segment 2 of my L liver lobe and it has not changed in 10 years. Don't worry about them. Cheers.