0:01

So the following is a 60-year-old female,

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with a history of adenocarcinoma of

0:05

the cecum, with a liver mass that they

0:08

would like evaluated with MR imaging.

0:10

Let's go ahead and look at the images.

0:12

We'll start off with our T2-weighted

0:14

sequence, and I'll scroll downwards

0:16

till we get to the lesion itself.

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So this is a T2-weighted and fat-saturated

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sequence. No contrast has been given, and

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we see a solitary mass, but a rather large

0:27

mass within the inferior right hepatic lobe.

0:30

We can see it over here.

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And I think what's most striking about this

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lesion is the T2 signal within it.

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It's quite bright.

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Very intense T2-weighted signal on

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the inside of it, for the most part, and

0:44

certain aspects of it are very similar to CSF.

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I've always said that when you have a lesion

0:49

with internal signal that's similar to CSF, for

0:53

the most part, you don't need to worry about it.

0:56

However, this is one exception.

0:57

And so I'll show you a little bit

0:59

more images on this patient,

1:01

and we'll figure out what this is.

1:03

So we'll go on to the in and out of phase image.

1:06

Here we have the T1 out-of-phase image. Here we

1:09

have the T1 in-phase image. And I just look at

1:12

this to reevaluate the lesion, make sure there's

1:15

no fat within this, and there indeed is no fat.

1:17

The T1 signal is essentially identical

1:20

on the in and out of phase images, and

1:22

it's essentially T1 hypointense on both.

1:26

Let's see what happens

1:27

though when we give contrast.

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So here are some post-contrast images: T1,

1:32

FAT SAT, post-contrast, arterial phase,

1:35

portal venous phase, equilibrium phase.

1:38

Over here again we see this lesion

1:40

in the inferior right hepatic lobe.

1:42

There's certainly no arterial phase hyperenhancement,

1:44

if anything there's a bit of

1:46

irregular sort of peripheral rim enhancement.

1:49

On the portal venous phase, some of that

1:51

enhancement becomes more apparent, maybe

1:53

there are some exceptions within it.

1:55

And on the equilibrium phase, furthermore, the

1:57

enhancement becomes more and more apparent.

2:00

And so you have this sort of

2:01

centripetal filling within this lesion.

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It's quite bright on the T2-weighted images.

2:06

So there may be a tendency to want to call

2:09

this a hemangioma based on a T2 signal and

2:12

centripetal enhancement, except hemangiomas

2:15

have a very specific enhancement pattern,

2:17

which is discontinuous, as opposed to

2:19

continuous enhancement you see here.

2:21

Discontinuous, peripheral, nodular enhancement

2:25

that fills in and follows the blood pool.

2:27

This is continuous enhancement.

2:29

It's not that nodular, and it

2:31

doesn't follow the blood pool.

2:32

It's quite irregular and heterogeneous.

2:33

So we'd be doing a disservice

2:35

if we call this a hemangioma.

2:38

It's not really a cholangiocarcinoma,

2:40

even though it does fill in because

2:42

the T2 signal is too bright.

2:44

This patient has a history of colon cancer, and

2:47

particularly with patients with colon cancer

2:49

and ovarian cancers, you can get hemangiomas,

2:51

mucinous liver metastases, and they are

2:55

characterized by quite hyperintense T2 signal,

3:00

which then enhances heterogeneously. And so,

3:04

certainly in somebody with colon cancer or

3:05

a lesion like this, you have to be worried about

3:07

a metastasis, a mucinous liver met. And this

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is what it turned out to be in this patient.