MRI report....:
INDICATION: PATIENT WITH HISTORY OF COLON CANCER AND LIVER METS FOR EVALUATION.
Multisequence axial, coronal and sagittal images were obtained of the abdomen before and after the injection of 20 cc of intravenous gadolinium. This study is compared with the patient's prior PET/CT from this institution, dated 12/16/09, as well as multipule outside CT's dating back to 3/2/10, as well as a recent PET/CT from 4/14/11.
The liver is normal in size. There are multiple lesions within the liver, some of which appear to represent hemangiomas, and some of which are indeterminant enhancing lesions, likely metastatic in origin. These are as follows:
In the superior left dome of the liver, there is an 8 mm lesion, best seen on series 12, image 18, which shows peripheral nodular enhancement, most likely representing a hemangioma. There is an additional 1.3 x 1.2 cm lesion in the posterior segment of the right lobe of the liver, best seen on series 12, image 35, which shows a similar enhancement pattern, likely representing a hemangloma as well. The variable size of these lesions on the prior outside CT's are likely related to the fact that these are most likely hemangiomas with variable areas of enhancement.
However, there are additional lesions including a very small vague 6 mm enhancing lesion in the left anterior liver, seen on series 12, image 28, which is immediately enhancing. Secondary to the small size, this is inderminant and may represent a metastatic lesion, as this area was increased in activity on the prior PET/CT from 12/2009. Additionally, there is a 1.1 x 0.9 cm vague enhancing area in the posterior right dome of the liver, best seen on series 10, image 26, which is also immediately enhancing and was thought to represent an area of abnormal PET/CT of 4/2011, activities were not detected on these two described superior lesions. More inferiorly, in the posterior segment of the right lobe of the liver, there is a focal heterogeneously peripherally enhancing mass with a slight contour deformity. This is difficult to measure secondary to its shape. It measures approximately 1.8 x 1.5 cm, best seen on series 9, image 67. the measurement of the size is difficult to compare as there are no prior MRI studies for comparison. This is not significantly changed since the recent CT's from February and April of 2011, however. This is also thought to represent the area of residual activity on the recent PET/CT from 4/2011. This mass is also noted to have some calcification within it, which cannot be well visualized on the MRI. The gallbladder is not visualized.
The spleen and the pancreas are unremarkable. Mild nodular thickening of the left adrenal gland is identified. The right adrenal gland is unremarkable.
The kidneys demonstrate bilateral renal cysts.
There is no ascites or significantly enlarged retroperitoneal adenopathy.
IMPRESSION:
THERE ARE MULTIPLE LIVER LESIONS, SOME OF WHICH HAVE SIGNAL CHARACTERISTICS MOST CONSISTENT WITH HEMANGIOMATA. I BELIEVE THERE HAVE BEEN VARIABLE SIZE MEASUREMENTS FOR THESE LESIONS ON THE PRIOR CT, WHICH COULD BE ON THE BASIS OF THE DIFFERENT PHASE OF INJECTION.
HOWEVER, THERE ARE ADDITIONAL LESIONS IN THE POSTERIOR RIGHT DOME OF THE LIVER, ANTERIOR LEFT LIVER, AND THE POSTERIOR SEGMENT OF THE RIGHT LOBE OF THE LIVER, WHICH HAVE A NONENHANCING PATTERN, CONSISTENT WITH HEMANGIOMATA AND ARE SUSPICIOUS FOR POSSIBLE METASTATIC DISEASE. THE LARGEST LESION IN THE INFERIOR RIGHT LOBE OF THE LIVER LIKELY CORRESPONDS TO THE ABNORMAL TRACER UPTAKE ON THE RECENT PET/CT FROM 4/2011. PLEASE NOTE THAT ACCURATE ASSESSMENT AND COMPARISON IS DIFFICULT AS THERE ARE NO PRIOR MRI STUDIES FOR COMPARISON, AND CONSIDERATION MAY BE GIVEN TO FOLLOW UP MRI FOR FURTHER EVALUATION.
