0:01

So this patient is a seven-year-old

0:02

patient with cirrhosis, and we were asked

0:04

to evaluate for hepatocellular carcinoma.

0:07

And I wanted to show this case for a

0:08

specific finding that will sort of build

0:11

upon something we discussed in another case.

0:13

So starting off with the T2-weighted

0:15

images, you know, we look at the liver and

0:17

there's a lot of stuff going on over here.

0:20

Looks like there is lots of T2 hyperintense

0:24

abnormality, sort of in the central portion,

0:27

clustered in the central portion of the liver.

0:29

Some of it is extending out to the periphery,

0:30

but the majority of it is in the center.

0:33

And if we look at the portal vein, we

0:35

notice that this sort of appearance

0:37

on both sides of the portal vein.

0:39

And I think if you were to look at this

0:40

in the beginning, you know, someone may

0:42

consider this being dilated bile ducts.

0:45

But as mentioned in one of the other cases,

0:49

there's also this entity of peribiliary cysts,

0:52

which are these dilatations of glands within

0:55

the periductal tissue of intrahepatic bile ducts

0:59

that don't communicate with the biliary tree

1:00

and for whatever reasons, particularly

1:03

patients who are cirrhotic, they can get

1:05

obstructed and these glands can dilate.

1:07

They dilate and they look like clusters

1:10

and clusters of cysts that are on both

1:12

sides of the portal vein and they have no

1:15

communication to the biliary tree itself.

1:18

And one of the reasons I wanted to show

1:19

this case is that, you know, certainly this,

1:22

this has that sort of appearance, but just

1:24

to kind of showcase the fact that these are

1:26

not communicating with the biliary tree,

1:29

this particular patient was done, you know,

1:31

with and without intravenous contrast.

1:33

And for contrast, we use an agent

1:35

which has partial hepatobiliary

1:37

excretion, which is Eovist.

1:39

And so what we see on the post-contrast images

1:41

done at around 20 minutes after giving the

1:43

contrast agent is that there is actual excretion

1:47

of the contrast agent in the bile ducts, right,

1:50

hepatic ducts, and some of the left hepatic

1:53

ducts over here, but there is no excretion

1:56

of contrast within these clusters of cysts.

1:59

And so that again proves the point

2:02

that these are cystic structures

2:05

that represent dilatation of

2:07

ducts associated with the biliary tree.

2:10

But they don't communicate with it.

2:11

If they did communicate with it, they would

2:13

also contain some of this contrast agent.

2:15

But the fact that they remain hypointense

2:18

and don't contain any of this contrast agent,

2:20

again, highlights that important concept

2:23

that these are peribiliary cysts that just

2:25

sort of are adjacent to, but separate

2:28

really from the bile ducts themselves.

2:31

And once again, this finding in and of

2:33

itself is of no clinical importance.

2:34

As the patient's liver disease gets worse, we

2:37

can sometimes see the finding get worse,

2:39

but as such, nothing really to worry

2:41

about when you see them, even though

2:42

they have quite a dramatic appearance

2:44

sometimes on these T2-weighted images.