CT of hepatocellular carcinoma

Hepatocellular carcinoma. CT images before and after dynamic contrast of a 74-year-old male with cirrhosis and a history of alcohol exposure.
(A) Unenhanced image of liver shows exophytic mass (arrow) and a hypoattenuating mass (arrowhead) in segment VII.
(B) Contrast-enhanced image of the liver during late arterial phase shows hyperenhancement of both lesions (arrowhead, arrow) and multiple other additional masses (short arrows). These are all suspicious for multifocal hepatocellular carcinoma.
(C) Imaging during the portal venous phase shows washout of contrast of one of the segment VII lesions (arrowhead) relative to the liver. Thus, this lesion (arrowhead) would be considered displaying all features diagnostic of hepatocellular carcinoma. The other segment VII lesion (arrow) does not yet show washout and would be considered only suspicious for hepatocellular carcinoma.