0:00

So in this case, we have a seven-year-old

0:02

gentleman, um, history of cirrhosis, and we're

0:05

looking for liver lesions in this patient.

0:08

And so we'll move on to our

0:09

images, see what we find.

0:11

So as we scroll through our post-contrast

0:13

images, we can see a rather large lesion

0:15

in segments seven and eight, sort of

0:17

centered in segment seven, but perhaps,

0:19

uh, encroaching upon segment eight itself.

0:22

So here we have the T1 FatSat post-

0:26

contrast image in the arterial phase.

0:28

This is the portal venous phase.

0:30

A little bit of motion on the arterial phase,

0:32

but here is the lesion over here, a rather

0:34

large lesion, and uh, whereas not all of

0:38

it is enhancing, I would say the majority

0:39

of it is enhancing, demonstrating that

0:42

non-RIM arterial phase hyper-enhancement.

0:46

It's certainly larger than

0:47

20 millimeters in size.

0:49

If we look at the portal venous phase images,

0:52

there are probable areas that are washing out.

0:55

For example, over here.

0:57

If you're not sure about that, there's

0:58

certainly a capsule that's surrounding this.

1:01

That, I think, is pretty reasonable to assume.

1:03

So, I would say, uh, pseudocapsule

1:06

and questionable washout,

1:08

areas of questionable washout.

1:09

But even if we ignore the washout,

1:11

based on these criteria itself, this

1:14

qualifies, this lesion is a Lyra at five,

1:17

a lesion that's almost certainly going

1:19

to reflect a powder cell or carcinoma.

1:21

Given, uh, the large size of this, this,

1:23

and the location, this is not deemed to be

1:25

appropriate for percutaneous techniques,

1:27

and a transarterial chemoembolization

1:30

was suggested to treat this tumor.

1:32

And so this was treated, and let's see

1:34

what the post-treatment scans look like.

1:36

So in the post-treatment scans, uh,

1:37

we look at the post-contrast images,

1:39

T1 weighted, FATSAT, post-contrast.

1:42

Arterial phase, portal venous phase.

1:45

As always, I like to look at the

1:46

subtraction images provided they're

1:48

a good technique and well performed.

1:50

In this case, they are.

1:51

And now, in lieu of the lesion that we saw

1:54

previously, we see an ablation cavity, and we

1:57

can see that much of it is vascular, right?

2:02

So there's certainly areas within it that

2:05

no longer have enhancing tumor, but there

2:09

are, at the same time, quite a bit there.

2:11

Of this lesion, particularly at the

2:13

periphery that has very nodular viable tumor.

2:17

You can see it over here.

2:19

You can see it over here.

2:20

You can see it over here.

2:21

This demonstrates arterial hyper-enhancement.

2:23

And it doesn't even have to wash out for us

2:25

to think of this as residual disease, but

2:28

in this instance, it actually does wash out.

2:30

And if we were to measure something like this

2:32

in terms of the amount, you know, the viable

2:34

tumor, you'd measure the longest dimension

2:38

of a residual tumor not crossing the

2:40

non-viable portion of the cavity itself.

2:43

And so I'd measure something like from here

2:45

to here, and give that in my report as the

2:48

largest or the longest dimension of viable

2:51

tumor in this patient who has been treated

2:53

with TACE and has only been partially

2:56

successful at eliminating the tumor itself.