0:01

This patient, uh, also presents

0:02

for screening for hepatocellular

0:05

carcinoma, has a history of cirrhosis.

0:08

And in fact, uh, it's the same, uh, images,

0:10

same patient that we saw previously has

0:12

another lesion, which I wanted to discuss.

0:15

So as we scroll through these images, I want

0:17

you to focus on this lesion right over here.

0:20

So this is the T1 FATSAT post

0:24

contrast image in the arterial phase.

0:27

We can see up here in, uh,

0:28

or down here in segment five.

0:31

We have a, uh, nodule with, uh, non-

0:36

rim arterial phase hyperenhancement.

0:40

If we measure this nodule, this is

0:42

going to be less than 10 millimeters.

0:45

Alright, so this is going to be a

0:48

pretty small nodule with definite

0:50

arterial phase hyperenhancement.

0:52

But again, to sort of qualify this

0:53

and figure out what BI-RADS category

0:55

it'll fit into, we need to look at

0:57

the remaining post-contrast images.

0:59

Thank you.

1:00

So this is one of the other, uh,

1:02

post-contrast images, T1 FATSAT post

1:05

contrast in the equilibrium phase.

1:08

We can see the same nodule that was arterially,

1:11

uh, enhancing demonstrates unequivocal washout.

1:15

And if you look at it, this qualifies as non-

1:18

peripheral washout in that it's not the outside

1:21

of it that's getting darker, but in fact,

1:22

the inside of the nodule that is unequivocal

1:25

darker when you compare it to

1:27

the adjacent liver parenchyma.

1:28

So compared to this liver parenchyma,

1:29

this nodule on the inside is darker.

1:32

So if we were to put together these

1:35

findings, we would find that we have

1:37

a mass in segment five that has non-

1:40

RIM arterial phase hyperenhancement.

1:43

We measure the size of it.

1:44

It is less than 10 millimeters.

1:46

We look for other features and it demonstrates

1:49

evidence of unequivocal non-peripheral washout.

1:53

This qualifies this nodule

1:55

as a BI-RADS 4 nodule.

1:57

Alright, so when you qualify something

1:59

as a BI-RADS 4, next step is it needs

2:02

to be discussed in a multidisciplinary

2:05

conference, a liver tumor board.

2:07

In that instance, they may recommend to go

2:09

for biopsy, they may recommend very short-term

2:12

interval follow-up, depending on the discussion

2:14

that occurs with a multidisciplinary team.