0:02

Hello and welcome to Noon Conferences hosted by MRI Online. In response

0:06

to the changes happening around the world right now and the shutting down

0:09

of in person events, we have decided to provide free daily Noon Conferences

0:13

to all radiologists worldwide. Today, we are excited to welcome back Dr.

0:17

Mahan Mathur. He is an Associate Professor of Radiology and Biomedical Imaging

0:21

at Yale School of Medicine, Associate Program Director for Diagnostic Radiology

0:26

Residency, and Director of Medical Student Education in Radiology. He has

0:30

been awarded the Yale Radiology Teacher of the Year four times.

0:33

A reminder that there will be time at the end of this hour

0:36

for a Q&A session. Please use the Q&A feature to ask all questions

0:40

and we will get to as many as we can before our time

0:42

is up. That being said, thank you so much for joining us again

0:45

today, Dr. Mathur. I will let you take it from here.

0:48

Thank you very much. Thank you for the invitation. It's a huge honor

0:52

to be here and a real privilege to be able to speak to

0:55

everyone again. So I'm going to share my screen.

1:02

We have lots of people logged in and we are ready to go.

1:05

So as mentioned, my name is Mahan Mathur. I'm a radiologist at Yale.

1:09

You can read my credentials over here. And today we're going to talk

1:12

about imaging of benign liver masses. All right. So we're going to cover

1:17

a whole bunch of lesions in the liver, all of which are benign.

1:21

It doesn't mean you don't need to worry about them necessarily,

1:24

but certainly some of them you don't need to worry about.

1:26

And we'll go through them over the course of this next hour or so.

1:30

So we'll start off with some unknown cases. And I'm going to ask

1:33

the audience to help me out with some of these.

1:37

Here's your first unknown case. I'm not going to provide much history for

1:42

many of these cases. Feel free to type in your answers.

1:45

Let me see what you guys are thinking. It's a T2 weighted image, T1 post

1:48

contrast subtracted image. We've got some answers starting to come up over

1:57

here. I'm going to wait for some people to think about it,

2:00

let it marinate a little bit, see if we can come up with

2:03

some good answers. All right. A lot of people coming up with some

2:06

nice answers here. Okay. All right. And all sort of along the same

2:12

lines for the most part, so I like it.

2:15

So let's move on to our second case and we'll come back to

2:17

it in a little bit. How about this case over here?

2:24

So case number two, showing a T2 weighted image in a T1 post

2:28

contrast image, a solitary lesion in this liver. It looks simple enough,

2:37

but is there a twist over here? Is there a trick over here?

2:40

Simple cyst, simple cyst, some good debris. Everyone who's saying it's a

2:46

simple cyst, some good debris, I could not fault you

2:49

for saying that. Certainly. This is sort of

2:52

an annoying case in that sense, but there have been a few people

2:55

who've given me the specific right answer and we'll go and get back

2:59

to it during the course of this talk. And we'll talk a little

3:02

bit about why this entity is something you should talk about when you

3:06

see this specific type of lesion. All right. Case number three,

3:09

I'm showing you a T2 weighted image from 2013

3:14

as a line for this patient and then 2018 T2 weighted image post

3:18

contrast sequences are portal lesions in equilibrium phase in 2019. Help

3:24

me out and let's figure out what's going on with this patient.

3:27

What's the best diagnosis here? Some answers here. All right. So a couple

3:33

of answers, some on the right lines. We'll get back to this case

3:35

in a little bit. I got a couple more cases to share with

3:37

you. A lot of images to see over here. I'm just going to go

3:39

through them as you type in your answers. T2 weighted image.

3:43

This is T1 in phase. T1 out of phase. And then dynamic post

3:47

contrast sequences, arterial, portal venous, equilibrium phase. There's

3:52

a lesion in this liver. What are we going to call it?

3:55

Oh, everyone has the right answer here, I think. All right. Good.

4:02

So there was a terrific talk earlier this week with MRI online that

4:05

went through what this entity is. I highly suggest you listen to that.

4:08

Really a great talk. And so we'll touch base on some of those

4:11

points here today as well as a lot more answers could. So everyone

4:14

along the same lines over here. Now help me out with this one.

4:18

Case number five, one of our last cases I'm going to show you.

4:21

Unknown cases. T2 fat sat, T1 in out of phase, and then your

4:25

dynamic post contrast images. Lesion in the liver. What do we think the

4:28

right answer is over here? Imagine we're at the workstation seeing this

4:33

case. We need to provide one diagnosis for this patient. What's the best

4:36

diagnosis? All right. So people are starting to come up with some answers.

4:43

And some people coming up with answers that... I can't really...

4:47

I'm not giving you much history here. So I'll say the right line.

4:50

Some people coming up with other answers. Yeah, but it's a tough one.

4:55

This one is all over the place, which is great. Hopefully we can,

4:58

at the end of the talk, come to a better, a more unified

5:03

conclusion. Okay. I think, penultimate case. I'm showing you a CT scan.

5:09

This was done for a patient with lung cancer. They saw the lung... It

5:12

was a chest CT, they saw the lung faces, bunch of liver lesions.

5:15

Wanted to get an MR. I'm showing you just a few sequences from

5:17

the MRT1 in phase, out of phase, and post contrast, I believe in

5:21

the portal venous phase. So what are these lesions?

5:25

You have to decide whether they're metastases or not. That was the clinical

5:28

concern. If they're not metastases, then can we give a specific diagnosis

5:32

to what they are? All right. So someone, some people think it could

5:36

be metastasis. Got some corollaries disease, some METs. Some people think

5:41

it may be some fatty liver histoplasmosis. There was a talk on,

5:44

I think, CT histoplasmosis earlier this week in the lung, which is a

5:48

great talk as well. So again, some people I think are on the

5:52

right line. Some people, a few different answers. Let's talk a little bit

5:55

towards the end about what the right answer is for this.

5:58

And let's just read a few more answers before we move on.

6:00

Okay. And this is our last case, unknown case.

6:05

T2 weighted image, lesion in the liver. What is the diagnosis?

6:09

All right. Everybody has got this one. Very good. Now, I'll ask you

6:14

one more question because I did anticipate everyone may get the right answer

6:18

here. So you all are correct. What is the correct WHO classification of

6:23

this lesion? I'll tell you, this is something I didn't really know about

6:29

until relatively recently, but I had to learn about it. We had a

6:31

case and our providers wanted to know, and so I had to look

6:34

it up. And so we all know what it is. What's the WHO

6:38

classification? All right. Who knows? Very good. And some people are coming

6:43

up with some numbers. So I like that. So I think some people

6:47

are really on top of it. Very good. So some people are really

6:50

coming on top of it. So we'll reach back to this right towards

6:52

the end. So what are our objectives for this talk? We're talking about

6:56

benign liver lesions. These are a whole host of entities we're going to

6:59

talk about.