1. Salzburg Weill Cornell Seminar in Diagnostic Imaging Hepatic tumors 9 – 15 October 2011, Salzburg, Austria Siarhei Kharuzhyk, M.D., Ph.D. N.N. Alexandrov National Cancer Center, Minsk Region, Belarus

2. Male, 57 y. o. Liver hemangioma on US for 8 y. Pain in the abdomen for 1 month Patient history

3. Laboratory tests:  Erythrocyte sedimentation rate – 21 mm/hr (upper normal value 15 mm/hr)  The rest of blood tests were normal Patient was sent to abdominal CT/MRI Diagnostic procedures

4. Native phase CT Tumor in liver segments 1-4 (density 43 HU) on the background of steatosis

5. Late arterial phase Tumor density 60 HU max. Portal venous phase 97 HU max. Delayed phase 10 min 84 HU max. Do you see something else???

6. MRI T2w Two hyperintense tumors, the larger one is heterogeneous

7. MRI T1w CE Delayed enhancement in both tumors Native25 sec.3 min. 6 min.12 min.25 min.

8. MRI T1w CE at the lower level Native25 sec.3 min. 6 min.12 min.25 min. Larger tumor enhance heterogeneously, no contrast wash-out at 25 min

9. What is yours conclusion?

10. Hemangioma in the right liver lobe (segments 7-8) Cholangiocarcinoma in the left liver lobe (segments 1-4) Correct diagnosis

11. Hemangioma:  Mostly homogeneous high signal on T2w  Lacunar enhancement  Progressive filling from periphery to center  Complete contrast filling in delayed phases Hints to diagnosis

12. СhС:  Heterogeneously high signal on T2w  Heterogeneous rimlike or bandlike CE  Concentric but incomplete contrast filling (fibrotic component!) Hints to diagnosis “Lacunar-like” enhancement!

13. СhС:  Dilated bile ducts (!!!)  Enlarged lymph node (metastasis) Hints to diagnosis

14. Patient underwent left hemihepatectomy with portal hepatic lymph nodes metastases excision Unfortunately, liver and brain metastases developed 4 months after operation Outcome

15. Thank you for attention!