0:01

The following is, uh, a patient with

0:03

cirrhosis who presents for screening,

0:06

uh, for hepatocellular carcinoma.

0:08

So for this case, it's best to go straight

0:11

to the, uh, post-contrast imaging sequences

0:13

that I have up here, and we're going to scroll

0:15

downwards, and I want to focus on a lesion

0:18

seen in the right hepatic lobe, inferiorly.

0:21

So here we have T1, post-contrast,

0:25

FAT SAT, arterial phase, uh, image.

0:28

This is the portal venous phase image.

0:29

This is the delayed or equilibrium phase images.

0:33

And at least if we sort of look at

0:35

these images side by side as we're doing

0:38

over here, I want you to focus on this

0:40

lesion right by the gallbladder fossa.

0:43

This would be around segment 5.

0:45

This lesion over here.

0:47

And it really manifests best

0:49

as a focal area of washout.

0:52

If we were to look at it on the portal

0:55

venous phase, yeah, we see a little

0:56

bit over here, but not as nicely.

0:59

If we look at it in the arterial

1:00

phase, there's really no arterial phase

1:03

hyperenhancement associated with it.

1:05

So if we look at the, uh, LI-RADS lexicon

1:08

and go through our table, you know, we have a

1:09

lesion with no arterial phase hyperenhancement.

1:13

We measure the size, we can measure it

1:14

from here to here, and I'll tell you that

1:16

this lesion is less than 20 millimeters.

1:20

So it's a small lesion, no arterial

1:23

phase hyperenhancement, and the

1:26

only other secondary feature that

1:28

this has is the presence of washout.

1:31

When we say washout, the internal

1:33

signal is less than the signal

1:35

of the adjacent liver parenchyma.

1:36

And as we work through our LI-RADS table,

1:40

this will then qualify as a LI-RADS 3 lesion.

1:45

And if you recall with LI-RADS 3 lesions, this

1:48

is a patient who would then return for another

1:51

imaging study in about three to six months from

1:53

now to follow up the imaging appearance of this.

1:56

So there are two other liver

1:57

lesions in this patient,

1:59

which have somewhat similar imaging

2:01

features, however, are staged differently

2:03

according to the LI-RADS lexicon.27 00:01:05,675 --> 00:01:08,085 So if we look at the, uh, LI-RADS lexicon

1:08

and go through our table, you know, we have a

1:09

lesion with no arterial phase hyperenhancement.

1:13

We measure the size, we can measure it

1:14

from here to here, and I'll tell you that

1:16

this lesion is less than 20 millimeters.

1:20

So it's a small lesion, no arterial

1:23

phase hyperenhancement, and the

1:26

only other secondary feature that

1:28

this has is the presence of washout.

1:31

When we say washout, the internal

1:33

signal is less than the signal

1:35

of the adjacent liver parenchyma.

1:36

And as we work through our LI-RADS table,

1:40

this will then qualify as a LI-RADS 3 lesion.

1:45

And if you recall with LI-RADS 3 lesions, this

1:48

is a patient who would then return for another

1:51

imaging study in about three to six months from

1:53

now to follow up the imaging appearance of this.

1:56

So there are two other liver

1:57

lesions in this patient,

1:59

which have somewhat similar imaging

2:01

features, however, are staged differently

2:03

according to the LI-RADS lexicon.

2:04

Again, we have our arterial phase images,

2:07

portal venous phase images, equilibrium

2:09

phase images, and we've scrolled a few

2:11

slices lower than where we were previously.

2:13

We can see that there are

2:14

lesions, again, in segment 5.

2:16

You can see them over here, these two

2:18

lesions, and they're not associated with

2:20

any arterial phase hyperenhancement.

2:23

If you measure them, unlike the

2:24

other lesion, these ones are actually

2:26

greater or equal to 20 millimeters.

2:28

Like the other lesion, there

2:29

is washout within this.

2:31

And so, based on the fact that its size

2:34

is more than 20 millimeters, this will

2:36

actually bump it up to a LI-RADS 4 category.

2:39

This is the sort of lesion which would then

2:41

go to a multidisciplinary conference to be

2:45

discussed, uh, potentially biopsied if, if

2:48

possible, or, um, get short-term follow-up.