0:00

So the next patient is a 60-year-old

0:02

gentleman, history of cirrhosis, has in fact

0:05

had multiple prior hepatocellular carcinomas

0:09

and has been treated for this via multiple

0:11

ablations, has had TACEs, but continues

0:15

to have disease despite these treatments.

0:18

And so he's being considered for Y90

0:20

treatment, that is the radioembolization.

0:22

So I'm going to show his pre-Y90 scans and,

0:26

uh, subsequently we'll show what it looks like

0:28

after, uh, he's undergone radioembolization.

0:31

So, in these pre-treatment scans, I'll start off

0:34

by looking at the, uh, post-contrast images.

0:37

And as we scroll through them, you can see

0:39

that there are just numerous lesions in

0:41

this patient's liver, which demonstrate

0:44

features of hepatocellular carcinoma with

0:45

arterial hyperenhancement and washout.

0:48

I'm going to focus on this

0:50

large lesion over here.

0:52

This is a T1 fat-sat post-

0:54

contrast arterial phase.

0:56

This is portal venous phase, and you

0:58

can see a rather large lesion over here.

1:01

That's probably surrounding a prior

1:03

treatment cavity; we'll ignore that though.

1:05

And it has arterial hyperenhancement; it

1:07

has areas of very heterogeneous washout.

1:09

There's another lesion over here

1:11

with similar imaging features.

1:12

There's one here that we partially imaged.

1:14

So really, multifocal disease in this patient.

1:17

In addition, if you scroll through, you can

1:19

see in the left hepatic lobe, there's evidence

1:21

of bland thrombus, as can be seen over here.

1:25

Alright, dark-appearing thrombus within

1:27

the portal vein, and once you start having

1:29

thrombus within the portal vein, transarterial

1:31

chemoembolization becomes less effective,

1:35

and radioembolization with the radioactive

1:37

element of Y90 becomes a more viable option.

1:41

So this patient was treated, and

1:43

let's look with, let's see what

1:44

the post-treatment scans look like.

1:46

So here we have some images

1:48

from the post-treatment scan.

1:50

I want to compare it to the pre-treatment

1:51

scan just to show you how the ablation

1:54

cavities look after they've been treated.

1:56

So this is the pre-Y90 study,

2:00

and this is the post-Y90 study.

2:04

This is a T1-weighted image, FAT SAT, post-

2:08

contrast, subtracted image that we've used.

2:11

And there's a little bit of motion on this

2:12

exam, so not everything's going to appear as

2:14

clean as we would like, but if we look at it

2:17

in general, things are looking a lot better.

2:19

If we look at this hepatocellular carcinoma

2:22

in the medial left hepatic lobe, arterial

2:25

hyperenhancing before, now, post-treatment,

2:28

it looks like an avascular cavity, maybe a

2:30

thick rim of enhancement around here, maybe

2:32

a little bit of enhancement, but for the

2:33

most part, it looks pretty non-viable.

2:36

If we look at this tumor over here, similarly,

2:39

this looks quite non-viable as well.

2:41

Good treatment response.

2:43

If we look at this large hepatocellular

2:46

carcinoma, on the pre-Y90 study and compared to

2:49

what's left on the post-Y90 study, you can see

2:53

that there are large portions of this that really

2:57

don't demonstrate residual viability.

3:00

So, um, this is an example of a relatively

3:03

good treatment response to Y90 in a patient

3:06

who's undergone multiple rounds of prior

3:08

treatment and has had recurrent and residual

3:11

disease despite all those treatments.