0:00

So this is a 60-year-old gentleman who

0:03

has liver lesions, and they've done an

0:05

MRI for us to evaluate them and give

0:09

an answer to what they look like.

0:11

I'll start off with the post-contrast

0:13

images in the arterial phase.

0:15

And we can see many liver lesions

0:18

spread throughout this liver.

0:19

One here, starting at the liver dome.

0:22

Another one over here.

0:23

Another one over here.

0:25

I'll just scroll through them just to

0:26

kind of give you an appreciation of all

0:29

these sort of liver lesions here, here,

0:31

and here that we can see in this patient.

0:34

And I'll just focus on one of them to

0:36

sort of describe it a little bit more.

0:38

If we just focus on this lesion here on

0:40

the right hepatic lobe, this is a T1 FATSAT

0:44

post-contrast image in the arterial phase.

0:47

This demonstrates, you know, non-RIM

0:51

arterial phase hyperenhancement.

0:53

And we've seen that term used before to

0:55

describe, you know, lesions in the literature,

0:58

lexicon, and the only reason I use that here

1:01

is just to show that, yes, you know, this

1:03

may be enhancing, but, you know, this

1:06

is not a case where we would use the literature,

1:08

lexicon. This patient has no history of

1:10

cirrhosis, no history of chronic liver disease,

1:12

but does have a lesion that demonstrates

1:15

sort of arterial phase hyperenhancement.

1:17

Let's see what happens to this

1:18

on the, uh, portal venous phase.

1:21

On the portal venous phase, so this is

1:22

T1 FATSAT post-contrast portal venous

1:25

phase. The same lesion demonstrates washout.

1:28

So you know, there is a temptation to describe

1:31

this lesion as a hepatocellular carcinoma

1:34

because we see arterial hyperenhancement

1:35

and washout, except as seen in some of the

1:38

previous examples, this patient does not have

1:40

cirrhosis and we see multiple lesions, and

1:43

so this in fact is an example, once again,

1:46

of what a hypervascular liver metastasis

1:51

looks like, right? Can look identical to HCC

1:53

except the difference is patients don't have

1:55

cirrhosis or a history of chronic liver disease.

1:58

And what we had talked about in some

1:59

of the earlier segments was how we

2:01

can use local-regional therapy to

2:03

treat hepatocellular carcinomas.

2:05

We can use percutaneous techniques.

2:07

We can use transarterial techniques, and

2:10

to a certain degree, the same can be applied for

2:12

liver metastases in a patient like this who has

2:15

diffuse liver metastases that are hypervascular.

2:18

We can certainly use transarterial

2:20

techniques to try to treat them.

2:22

And so that's what was decided for this

2:24

patient, and this patient underwent

2:25

radioembolization with Y90, and I'll show

2:27

you what the results of that look like.

2:30

So here we have the pre-Y90 treatment

2:33

studies, and this is the post-Y90

2:35

treatment exam, and again, we're just

2:37

looking for avascular ablation cavities.

2:40

Here we had one of the hypervascular

2:41

metastases, the index lesion that I've

2:44

shown you, now looks completely avascular.

2:47

If we look at other lesions within the

2:49

liver, for example, this lesion over

2:51

here, this looks completely avascular.

2:53

If we look more inferiorly, a lesion

2:56

over here now looks completely avascular.

2:58

A lesion over here now

2:59

looks completely avascular.

3:01

So we can use these local-regional therapies

3:04

for diseases other than hepatocellular

3:06

carcinomas, and we can get a fairly good

3:09

effect if done in the appropriate patients.