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Chronic Hep B - Liver Cyst detected

Please help understand the MRI result below. Last Ultrasound (6/2020) and CT (4/2019) were normal and didn't have any liver cyst. I've known of the kidney cyst for several years.
My AFP tumor Marker test has always been less than 6.1 (normal upper limit) with the last one on 9/17/2020 5.7 . Another doctor recommended the triple biomarker - DCP/AFP & AFP L3 and the result came back on 1/13/2021 with Total AFP of 7.1 (normal range 1.6 - 4.5 ng/ml). DCP < 1.0 and AFP L3 not detected. Should this be a concern?

My AST/ALT 20/22 on 12/31/2020 - always in the normal range since 2012.

12/31/2020
GLUCOSE 83
CREATININE 1
eGFR NON-AFR. AMERICAN 90
eGFR AFRICAN AMERICAN 105
SODIUM 142
POTASSIUM 4.6
CHLORIDE 105
CARBON DIOXIDE 28
CALCIUM 9.7
PROTEIN, TOTAL 7.3
ALBUMIN 4.5
GLOBULIN 2.8
ALBUMIN/GLOBULIN RATIO 1.6
BILIRUBIN, TOTAL 0.9
BILIRUBIN, DIRECT
BILIRUBIN, INDIRECT
ALKALINE PHOSPHATASE 49
AST 20
ALT 22
12/31/2020
INR - 1
PT - 10.9
Vit D- 58

EXAM:
MRI ABDOMEN W/WO CONTRAST

CLINICAL HISTORY:
Chronic viral hepatitis B without delta-agent

COMPARISON:
MRI Enterography dated 4/15/2016

TECHNIQUE:
Multiplanar, multisequence images obtained of the abdomen with and without IV
contrast. Pelvis not ordered or scanned.

FINDINGS:
Motion degraded study.

Thorax: Visualized thorax clear of significant pathology.
Liver: 8 mm T2 hyperintense, T1 hypointense, nonenhancing cyst and segment 7. No
enhancing mass. No biliary dilation..
Gallbladder: No stones or inflammation. Nondistended. This a linear T2 hypointense
structure extending along the anterior wall of the gallbladder from the neck to the
fundus, greatest in thickness at the fundus where it measures approximately 6-7 mm.
This is hyperintense on the Eovist sequences such as series 9, most conspicuous on
image 50.
Spleen: Unremarkable.
Pancreas: Unremarkable.
Adrenal Glands: Unremarkable.
Kidneys: No acute pathology. 1.9 cm simple cyst upper pole left kidney, enlarged from
prior..
Stomach: Unremarkable.
Bowel: No obstruction, inflammation, or mass.
Vasculature: No significant pathology.
Lymph Nodes: No pathologically enlarged or abnormal nodes.
Abdominal Wall: Normal.
Bones: No significant pathology.

Additional Significant Findings: None

IMPRESSION:
1. NO ACUTE ABDOMINAL PATHOLOGY. NO ENHANCING LIVER MASS.
2. BENIGN CYSTS IN THE RIGHT HEPATIC LOBE AND UPPER POLE OF THE LEFT
KIDNEY.
3. INDETERMINATE T2 HYPOINTENSE LINEAR STRUCTURE ALONG THE
ANTERIOR WALL OF THE GALLBLADDER FROM THE NECK TO THE FUNDUS,
GREATEST IN THICKNESS AT THE FUNDUS WHERE IT MEASURES 7 MM. THIS
COULD REPRESENT ARTIFACT FROM BILIARY EXCRETION OF EOVIST, OR
POSSIBLY SOME SORT OF VASCULAR STRUCTURE. LIKELY BENIGN OR
ARTIFACTUAL, BUT A FOLLOW-UP WITH A GALLBLADDER ULTRASOUND IS
RECOMMENDED WITH SPECIFIC ATTENTION TO THE ANTERIOR WALL OF THE
FUNDUS.
5 Responses
683231 tn?1467323017
There are no medical professionals here all I can do is google your results. For sound medical information and advice you best bet would be to discuss this with your doctor who ordered this test.

Best of luck
683231 tn?1467323017
Your blood work looks better than mine my platelet count is around 105 and my AFP has been slightly elevated for a decade
683231 tn?1467323017
Also you have asked your question in the hep C forum. This forum is mostly for people living with or undergoing treatment for hepatitis c. This is a virtual support group for hep c patients. We cannot offer medical advice.

So again I would strongly suggest you ask your doctor your question
Avatar universal
Thank you flyinlynn, i did talk to the doctor and there's no concern at this time. Im doing an Ultrasound of the gallbladder to rule out any issue with the gallbladder which they believe it's just artifact from the MRI EOVIST liquid excretion. If you don't mind me asking , how high is your AFP?  I don't believe i have liver cirrhosis yet per all the test we performed over the past few year  - Last Biopsy  - 2015 Grade 2 Stage 1 an subsequent Fibroscan   were 4.7 and 4.4 (2017). im due for the next scan and hope to have done soon.  I was just concern about the benign liver cyst since it wasn't on the last Ct or Ultrasound . I was told MRI is very sensitive and could pick up sometime that US wouldn't .  Again thank you
17 Comments
Before I was finally cured of hep c my AFP was around 15.4 in the oldest test result I could find. My most recent AFP was 8.7 from this month.

Yes that is correct you do not have cirrhosis. My liver biopsy from January 2008 result was F4 cirrhosis. My Fibroscan before my last treatment for hep C was 29. My most recent Fibroscan from a couple of years ago is still scoring as 30 even though my hep c was cured in 2015.

Why are you having these tests done? Do you have hepatitis c? I’m asking because you are posting in the hepatitis C forum.

I had two liver masses on my January ultrasound which were not on my July ultrasound or any previous. I had a CT scan today. Hoping it’s not HCC and just benign masses of some kind.
I hope these are benign masses and nothing to be concerned about. Best of luck and no worries.
I've chronic hep b diagnosed back in 2012. Not sure for how long I've had it but it seems im the only one in the family who tested positive. I've been on treatment since 2018.
Please keep us posted on the CT result and again best of luck :) prayers...
Hi flyinlynn - Hope you're doing ok. did everything check out fine on your last CT?  
Ct said LIRAD3 indeterminate having another CT with contrast in late April trying to set that up
I hope everything comes back normal. will put that in prayers.  

The follow-up ultrasound came back clear on the gallbladder - no stone no sludge. I'm scheduled for a fibroscan  on Monday. Last one was back in 2017 - 4.4Kpa. I plan to do the AFP again in April before my next appointment. My Hepatologist (R. Gish)  believes my low platelet result is not related to my Hep B status and it could be that I have a low set point. In fact, My hematologist did do extensive analysis back in 2017 and confirmed that I had a low set point for WBC due to my ethnicity. My Hepatologist is suggesting we may have to switch my med to a different class just to see if  my platelet rebounds.    
Factors that can decrease platelet production include:
Leukemia and other cancers.
Some types of anemia.
Viral infections, such as hepatitis C or HIV.
Chemotherapy drugs and radiation therapy.
Heavy alcohol consumption.

https://www.mayoclinic.org/diseases-conditions/thrombocytopenia/symptoms-causes/syc-20378293


Your last Fibroscan score puts you at F0 to F1 so congrats on having a healthy liver.

My Fibroscan scores have been between 29 an 33 which is F4 aka cirrhosis. I was diagnosed as F4 cirrhosis with a liver biopsy back in January 2008  
I am assuming that you know that platelets are not the same as WBC which is of course your white blood cell count.
Just scheduled the follow up liver CT scan with contrast for 4/28

Will see what we get
By the grace of God only benign cyst, Let's put our confidence in his power. Overall, are you feeling OK?
My fibro scan appointment was cancelled this past Monday and rescheduled for next Monday. This is the 2nd time it has been cancelled by UM-University of Miami and not all hospital offer fibroscan..  
Yup feel fine same as many years of having cirrhosis. But feeling fine does not mean is couldn’t be early HCC

By the time you feel bad due to liver cancer it is generally way to late for medical intervention
Hey how are you flyinlynn....Here is my latest fibroscan result. Not sure if eating prior the test affects the result. I was supposed to fast 3 hours prior to the test but i ate 2 1/5 hours  before and arrive at the appointment early. They decided to perform the test.
The Liver FibroScan was completed with a M probe using a lateral intercostal rib space and ten consecutive valid measurements were obtained. The Liver FibroScan median kPa measurement was 5.1. The median dB/m CAP measurement was 196.
Haven’t eaten two recently could make your results seem worse than they really are. Congratulations on having a unscarred and healthy Liver
Oops typo

“Having eaten too recently...”
Hey  Flyinlynn - Hope all is well.. Just wanted to say hi...
Hi thanks for checking in :-)

Having my abdominal CT with contrast this Thursday so I guess I may find out something then about the liver masses seen on my ultrasound and previous CT
Good luck on your CT tomorrow....Have a good night.
So it was a better scan than the last apparently I have a number of small objects (foci) that are enhanced with the dye. (Enhanced foci). My liver specialist believes they are likely cirrhotic regenerative nodules and probably not cancerous. So back to watchful waiting will be getting another test in three months. Knock on wood
Avatar universal
Thank you Flyinlynn - That's what I thought that eating before the test could make the results seem worse than they really are.  I hope you will hear some good news on your next scan. I just had the normal AFP marker done this week and the level is 5.7 which is my level before I tried DCP/AFP & AFP L3 biomarker.  My assumption is that DCP/AFP & AFP L3 biomarker is more sensitive which resulted in Total AFP of 7.1 (normal range 1.6 - 4.5 ng/ml) higher than normal. Have a great weekend.
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