0:00

The following vignette will showcase a patient

0:04

who has cirrhosis, with several nodules

0:07

in the liver, um, and it'll, we'll use it

0:10

as an opportunity to talk a little bit more

0:12

about some of the non-malignant nodules that

0:13

we can see in patients who have cirrhosis.

0:16

So here's our patient,

0:17

a 7-year-old male who's being screened

0:18

for hepatocellular carcinoma.

0:20

Over here we have a T2-weighted sequence.

0:23

Here we have a T1-weighted

0:24

sequence with fat saturation.

0:26

And we're going to focus on this nodule here.

0:30

The lateral left hepatic lobe.

0:32

Now, as has been mentioned previously,

0:34

with cirrhosis, there's chronic

0:36

inflammation, the liver parenchyma gets

0:38

destroyed, and then the liver tries to

0:39

regenerate some of that lost parenchyma.

0:42

And it does this, yielding

0:43

these regenerative nodules.

0:45

And they're composed generally

0:46

of normal liver cells.

0:48

But in addition to these regenerative

0:49

nodules, you can also develop

0:52

something called dysplastic nodules.

0:55

Now, dysplastic nodules will harbor

0:58

histologically abnormal cells.

1:00

They can have a variety of imaging

1:02

appearances, but in general, on the

1:03

T2-weighted imaging, they're going to

1:05

be lower in signal or hypointense.

1:08

On the T1-weighted imaging, they're going to

1:10

be hyperintense, as can be seen over here.

1:13

And when we give contrast, again, as can be seen

1:15

on this T1-weighted image with fat saturation,

1:18

post-contrast arterial phase, this is in the

1:21

portal venous phase, this lesion over here,

1:24

Generally, it demonstrates enhancement that is

1:27

similar to the liver or less than the liver.

1:32

There won't be any arterial hyperenhancement

1:37

associated with these dysplastic nodules.

1:39

Now it is thought that these dysplastic nodules

1:42

undergo various degrees of differentiation.

1:45

As a result, their imaging appearance can

1:48

change, so they can go from low-grade dysplastic

1:51

nodules to high-grade dysplastic nodules.

1:53

And in the following vignette, we're

1:55

going to showcase how some of these

1:57

changes look like on MR imaging.