Interactive Transcript
2:00
It makes it very difficult for the person receiving
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the report to know what exactly you mean.
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If you give it a number 1 2 3 4 5 and we have
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some data behind it, it allows everybody,
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whether it's me and one center to another radiologist
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in another country or another center or to a clinician,
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they can all at least understand what we're saying. Even if we
2:19
might use different words in real life. In terms of content,
2:24
we want to make sure that we put all the relevant things that the
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surgeons and clinicians that receive
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our reports actually need.
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So if we have a standard way of doing doing things, we won't
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forget that because it prompts us during our dictation to
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ensure we do that. And then in terms of data collection,
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it's important that we standardize in terms of
2:41
literature so that we can do larger data aggregates
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and figure out what's going on.
2:47
So LI-RADS was started in 20...
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or the first version came out in 2011 and there have been a
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few versions since. The most recent one is version 2018,
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and we're working on a new version, which we do every three
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years or so based on the literature.
3:00
This particular LI-RADS version has an ultrasound component,
3:06
contrast-enhanced ultrasound,
3:08
how to diagnose HCC, I'm not going to talk about that today.
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I'll focus on the CT and MRI portion and then there's
3:15
a treatment response section for people who have undergone
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local regional therapy, and I will touch on that today.
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The important thing to remember for LI-RADS is
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it's specifically to patients with cirrhosis
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or who have chronic hepatitis B,
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because we know that they have an increased risk of getting
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hepatocellular carcinoma, even if they don't have cirrhosis.
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LI-RADS does not apply to people who
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don't have risk factors for HCC.
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It does not apply to children at this point.
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And it doesn't apply to people who have
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vascular causes such as Budd–Chiari and HHT,
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and cardiac congestion cirrhosis.
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Because the imaging characteristics in these particular
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subgroup of patients are two similar between HCC
4:00
and their various vascular abnormalities that they get.
4:04
This is a small subset of people who
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have liver disease at risk for HCC,
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but we have chosen to exclude them because
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it causes too much overlap.
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And one of the things that's really important with LI-RADS
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is we have to be very specific with final diagnosis.
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Particularly if you're calling something in HCC,
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which would be LI-RADS 5, because it's one of the only imaging...
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it's one of the only studies where the radiology
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imaging report is enough to bypass biopsy,
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and allow patients to undergo definitive therapy or
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local regional therapy without actual pathology.
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So it's really important that we be specific
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in what we're talking about.
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I'll just touch on the ultrasound portion.
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So most patients when they first come in to the screening
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setting, many are evaluated with ultrasound.
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There are centers that do evaluate and screen people with CT,
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but for most places in North America and Canada,
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where I'm from, ultrasound is the first test and it's done every
5:04
six months in people with cirrhosis or at risk for HCC,
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which includes patients with chronic hepatitis B.
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So, the three options you have with your ultrasound is either
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it's negative. So you see nothing.
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You have a lesion that's less than 10 mm,
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and that's called sub threshold.
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And then, you have your type ultrasound version 3,
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which is positive,
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in which case these patients would be then recommended
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to go on to CT or MRI for more definitive characterization.
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The other one short thing about the ultrasound is that there's
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visualization score because we know that in certain patients
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who have cirrhosis, like the bottom image here,
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there's a lot of attenuation of the sound and
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we can't actually see the body, you know,
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posterior half of the liver in this case.
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So this would be a limited study,
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the one on the bottom, compared to the one on the top.
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And in this case,
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we may actually be better off imaging this patient.
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Whether it's screening or characterization with CT or MRI.
6:00
So this patient would not be somebody who should be
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screened with ultrasound. Everybody else are fine.
6:07
Now, this is the algorithm for CT and MRI.
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So patient comes in at risk for HCC.
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You do the CT or the MRI and you apply this.
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And this is part one.
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And, of course,
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remember they have to have HCC
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and then this is the second part.
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So first, I'll go back to this part.
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So if you can't image, interpret
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the images because they've missed a bunch of sequences,
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the timings way off or the patient breathed, or coughed,
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or whatever might have happened,
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then you would characterize it, is not...
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not characterizable.
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And then it goes 1 and 2, which is benign.
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And then there's this black one here,
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called tumor in vein,
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and that's really a bad prognostic factor for patients.
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And this is really important for us to look for initially,
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because it trumps everything else that we see below.
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