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A hepatocellular carcinoma with marked bile production, i.e., a so-calledâgreen hepatoma,ãis one of the causes of hyperintensity at the hepatobiliary phase of gadoxetic acid-enhanced MRI. We present t...he details of a 3-cm green hepatoma in segment 4 of the liver in a 60-year-old Japanese male with alcoholic liver cirrhosis. Dynamic CT and MRI showed arterial-phase rim hyperenhancement with marked central necrosis, indicating a malignant liver tumor such as intrahepatic cholangiocarcinoma. We were thus unable to reach the definitive diagnosis of a hepatocellular carcinoma before surgery. The pathology examination revealed a moderately differentiated hepatocellular carcinoma with prominent bile production accompanied by central necrosis. A re-evaluation of the hepatobiliaryphase MRI scans showed high signal intensity at the peripheral portion of the tumor, indicating the uptake of contrast by functional tumor cells of the hepatocellular carcinoma. Attending physicians should keep in mind that hyperintensity observed at the hepatobiliary phase can aid a precise preoperative radiological diagnosis for green hepatoma, even if the arterial-phase findings are not typical for hepatocellular carcinoma.show more
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113-1_p018