0:01

So here we have another patient with

0:02

cirrhosis, and we were asked to evaluate,

0:05

uh, their imaging, their MR imaging of the

0:07

abdomen to look for hepatocellular carcinoma.

0:10

So I'll start off by looking at the,

0:11

uh, arterial phase images in this

0:14

patient, and I'm going to focus on a

0:15

lesion seen in the right hepatic lobe.

0:18

So this one is T1 post-contrast FATSAT arterial

0:23

phase image, and this is the lesion in question.

0:26

We can see it here in segment six.

0:29

And this demonstrates unequivocal non-RIM

0:33

arterial phase hyperenhancement, right?

0:37

Once again, non-RIM, it's not the

0:39

periphery, it's not ring enhancement.

0:40

The inside of this lesion is enhancing in

0:43

the arterial phase when we give contrast.

0:45

If we were to measure this, this again, like our

0:48

prior case, is a larger lesion, so this is going

0:50

to be at or equal to 20 millimeters in size.

0:54

And then for us to sort of finally,

0:56

qualify it as a LIRADS lesion,

0:57

we need to see if there's any other features

0:59

present in this lesion, such as washout,

1:01

pseudocapsule, and potential growth.

1:04

In terms of growth, we

1:05

don't have prior studies.

1:06

We'll knock that one out.

1:08

And so we're really looking

1:09

for pseudocapsule or washout.

1:12

So let's have a look.

1:13

This is the T1 FATSAT post-contrast

1:16

image in a delayed phase in this patient.

1:19

And we can again look at this lesion in

1:20

segment six and look at the inside of it.

1:24

Is it darker

1:25

than the adjacent liver parenchyma?

1:27

As we look at it, to my eye unequivocally,

1:30

portions inside of this are darker than

1:32

the liver parenchyma outside of it.

1:35

So we're going to call this washout.

1:38

So we have non-RIM arterial phase

1:42

hyperenhancement in a lesion that's

1:45

more than 20 millimeters in size,

1:47

and this is associated with washout.

1:50

We're going to see if

1:50

there's a capsule around it.

1:52

And I don't see a rim around this, I don't see a

1:53

definite rim that I can draw around this lesion.

1:56

So I'm going to say that there's

1:57

no capsule associated with this.

1:59

As I said, we have no priors, so I'm going to

2:01

say there's no growth, because we can't really

2:04

assess for growth if we don't have any priors.

2:06

And so putting these categories together,

2:08

these features together, this will

2:10

qualify this lesion as a LIRADS 5 lesion.

2:16

So, it doesn't have to have

2:18

all of the other categories.

2:20

It doesn't even have to have two of them.

2:21

It just needs to have one.

2:22

It needs to have either washout,

2:24

pseudocapsule, or growth.

2:26

If it's more than 20 millimeters and has

2:28

arterial phase hyperenhancement, the addition

2:29

of any one of these categories will be

2:31

sufficient to call this a LIRADS 5 liver lesion.