0:00

So this next patient is a 50-year-old

0:02

gentleman with cirrhosis.

0:04

We're doing a study, uh, of the abdomen to

0:06

look for potential hepatocellular carcinomas.

0:10

And so, we have our first set of sequences,

0:13

the dynamic post-contrast images.

0:16

And there are actually two

0:17

lesions of interest in the liver.

0:19

One up over here, and one in

0:21

the left hepatic lobe over here.

0:24

And both really have very similar imaging

0:26

features, so I'm going to focus on the one

0:27

that's larger in the right hepatic lobe.

0:30

So this is our T1 Fatsat post-contrast image.

0:35

We have the arterial phase over here,

0:36

the portal venous phase over here.

0:38

We can see a lesion, uh, really at the

0:41

periphery of segment eight over here that

0:44

has non-RIM arterial phase hyperenhancement.

0:49

It's certainly larger than

0:51

20 millimeters in size.

0:53

On the portal venous phase

0:55

images, this demonstrates washout.

0:58

And a very, very thin rim around it,

1:00

so that's going to be the pseudocapsule.

1:03

So based on all these criteria,

1:05

this qualifies as a LI-RADS 5 lesion.

1:08

And if we look at our other lesion,

1:10

seen more inferiorly and in the left

1:11

hepatic lobe in segment 3, very,

1:13

very similar imaging features, right?

1:16

There's non-RIM arterial phase hyperenhancement.

1:21

It's certainly just about

1:23

larger than 20 millimeters.

1:24

There's washout on the

1:26

portal venous phase images.

1:28

We can see a pseudocapsule.

1:29

By all accounts, this is a LI-RADS 5.

1:31

And this was presented to the tumor board,

1:34

and it was deemed that a transarterial,

1:36

uh, chemoembolization approach would be

1:38

the best way to treat these tumors.

1:41

And so that was performed in this patient,

1:43

and a subsequent study was performed to evaluate

1:46

the treatment response of that treatment.

1:49

So these are the

1:49

post-treatment scans in our patient.

1:51

This is a T1

1:52

Fatsat post-contrast image.

1:55

This is the arterial phase.

1:56

This is the portal venous phase.

1:58

Again, we're looking at the subtraction

1:59

images in order to take away some of

2:02

that T1 hyperintense content that

2:04

may be present after these ablations.

2:06

And again, as with all ablations, we're

2:08

really looking for avascular cavities.

2:11

And so we can see a cavity now in that,

2:13

uh, in place of that segment 8 lesion.

2:15

Internally, it looks like there may be

2:17

some bright signal, but if you look at the pre-

2:19

contrast images, in this image, all this turns

2:22

out to be artifact from misregistration.

2:25

If you look at the portal venous phase

2:26

images, it really does look quite

2:27

nice and clean on the inside of it.

2:30

The outside of it has this

2:31

relatively thick rind of enhancement.

2:34

And particularly for the first few,

2:37

first study post-treatment, that's

2:38

not an abnormal finding to see.

2:41

You may even see some enhancement surrounding

2:43

the lesion itself that's separate from

2:45

that rind of tissue around the cavity.

2:48

And again, it's important to just look

2:50

at that, acknowledge it, and see what

2:52

happens to it on subsequent studies.

2:54

Does it stay the same in size, or does

2:56

it diminish, which is what we expect?

2:58

Either stay the same or diminish, or

2:59

does it get thicker, more nodular?

3:02

Alright, so that's what we're looking for.

3:04

And these, uh, post-treatment cavities.

3:06

If we look at our other lesion as well,

3:08

over here in segment three, this also

3:10

demonstrates very similar imaging features.

3:12

No internal vascularity and the rind of

3:17

enhancement, which is relatively normal.

3:20

Make sure that stays similar or

3:22

diminishes, but never gets thicker.

3:24

And so both these cavities have been

3:26

successfully treated by transarterial

3:27

chemoembolization. And we can then follow

3:30

up how they look on subsequent studies.

3:32

Thanks.

3:33

Thanks.