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2 Lesions Treated with Transarterial Embolization

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0:00

So this next patient is a 50-year-old

0:02

gentleman with cirrhosis.

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We're doing a study, uh, of the abdomen to

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look for potential hepatocellular carcinomas.

0:10

And so, we have our first set of sequences,

0:13

the dynamic post-contrast images.

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And there are actually two

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lesions of interest in the liver.

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One up over here, and one in

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the left hepatic lobe over here.

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And both really have very similar imaging

0:26

features, so I'm going to focus on the one

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that's larger in the right hepatic lobe.

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So this is our T1 Fatsat post-contrast image.

0:35

We have the arterial phase over here,

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the portal venous phase over here.

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We can see a lesion, uh, really at the

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periphery of segment eight over here that

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has non-RIM arterial phase hyperenhancement.

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It's certainly larger than

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20 millimeters in size.

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On the portal venous phase

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images, this demonstrates washout.

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And a very, very thin rim around it,

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so that's going to be the pseudocapsule.

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So based on all these criteria,

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this qualifies as a LI-RADS 5 lesion.

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And if we look at our other lesion,

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seen more inferiorly and in the left

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hepatic lobe in segment 3, very,

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very similar imaging features, right?

1:16

There's non-RIM arterial phase hyperenhancement.

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It's certainly just about

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larger than 20 millimeters.

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There's washout on the

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portal venous phase images.

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We can see a pseudocapsule.

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By all accounts, this is a LI-RADS 5.

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And this was presented to the tumor board,

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and it was deemed that a transarterial,

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uh, chemoembolization approach would be

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the best way to treat these tumors.

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And so that was performed in this patient,

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and a subsequent study was performed to evaluate

1:46

the treatment response of that treatment.

1:49

So these are the

1:49

post-treatment scans in our patient.

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This is a T1

1:52

Fatsat post-contrast image.

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This is the arterial phase.

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This is the portal venous phase.

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Again, we're looking at the subtraction

1:59

images in order to take away some of

2:02

that T1 hyperintense content that

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may be present after these ablations.

2:06

And again, as with all ablations, we're

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really looking for avascular cavities.

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And so we can see a cavity now in that,

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uh, in place of that segment 8 lesion.

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Internally, it looks like there may be

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some bright signal, but if you look at the pre-

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contrast images, in this image, all this turns

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out to be artifact from misregistration.

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If you look at the portal venous phase

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images, it really does look quite

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nice and clean on the inside of it.

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The outside of it has this

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relatively thick rind of enhancement.

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And particularly for the first few,

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first study post-treatment, that's

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not an abnormal finding to see.

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You may even see some enhancement surrounding

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the lesion itself that's separate from

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that rind of tissue around the cavity.

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And again, it's important to just look

2:50

at that, acknowledge it, and see what

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happens to it on subsequent studies.

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Does it stay the same in size, or does

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it diminish, which is what we expect?

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Either stay the same or diminish, or

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does it get thicker, more nodular?

3:02

Alright, so that's what we're looking for.

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And these, uh, post-treatment cavities.

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If we look at our other lesion as well,

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over here in segment three, this also

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demonstrates very similar imaging features.

3:12

No internal vascularity and the rind of

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enhancement, which is relatively normal.

3:20

Make sure that stays similar or

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diminishes, but never gets thicker.

3:24

And so both these cavities have been

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successfully treated by transarterial

3:27

chemoembolization. And we can then follow

3:30

up how they look on subsequent studies.

3:32

Thanks.

3:33

Thanks.

Report

Faculty

Mahan Mathur, MD

Associate Professor, Division of Body Imaging; Vice Chair of Education, Dept of Radiology and Biomedical Imaging

Yale School of Medicine

Tags

Neoplastic

MRI

Liver

Gastrointestinal (GI)

Body

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