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LI-RADS 3 – No Ancillary Imaging Findings

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This patient also presents, uh, to us for

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screening or surveillance for hepatocellular

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carcinoma as a history of cirrhosis.

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So let's go ahead and look at

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the images and see what we find.

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So we'll start off with our dynamic

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post-contrast images, and we can

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scroll through these sequences.

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I'm going to focus on this lesion

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over here, and this is in segment six.

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This, of course, is the T1 FATSAT post-contrast

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arterial phase image, portal venous phase image,

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equilibrium phase image, and, uh, this lesion

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here in segment six demonstrates unequivocal non-

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rim arterial phase hyperenhancement, so that's

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the first thing we need to decide: is there

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arterial phase hyperenhancement or is there not?

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If we do decide that there is, we look

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at the size of the lesion and we measure

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it out, and this lesion falls somewhere

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between 10 to 19 millimeters in size.

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And once that happens, we need to look

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at the other features to see if, uh, we

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qualify this as a, uh, LI-RADS 3, 4, or 5.

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The other features, we look at the portal

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venous phase and equilibrium phase images.

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We're looking for washout,

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portions of the lesion that are

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darker than the liver parenchyma.

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We're also trying to see if

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there's a capsule around it.

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If we look in the approximate

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location of where we expect to see

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this lesion, we just don't see it.

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It's quite iso-intense on both the portal venous

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phase images and the equilibrium phase images.

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So, in terms of washout, no washout here. In

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terms of pseudocapsule, no pseudocapsule here.

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And in terms of growth, no priors to compare

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to, so can't really talk about growth.

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I'll just say no growth for the

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sake of simplicity over here.

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And so putting all this together, this

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qualifies this lesion as a LI-RADS 3 lesion.

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Now, one thing is we've seen a bunch of

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cases already regarding this arterial

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phase hyperenhancement in this sort of

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size category of 10 to 19 millimeters.

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If there's no other features,

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it's going to be a LI-RADS 3.

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If it has two or more of these

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features, it'll be a LI-RADS 5.

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But if it only has one of these other

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categories, if that category is washout or

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growth, that qualifies it as a LI-RADS 5 lesion.

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However, if that one category

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is just a pseudocapsule, that

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keeps it as a LI-RADS 4 lesion.

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Alright, so if there's two plus,

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it's going to be a LI-RADS 5.

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If there's only one, depending on

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what that one is, it actually is a 5

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or a 4 lesion.

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And remember, in some of the cases I've shown

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you previously, you know, I'm just showing

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you the post-contrast images, you have to

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look at all the remaining sequences to see if

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there's any other ancillary imaging features

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that can bump this up from a LI-RADS 3 to a

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4 or downgrade it from a LI-RADS 3 to a 2.

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Remember, some of the ancillary features

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that bump it up include, or the common ones

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that can bump it up include hyperintensity

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T2 signal, presence of fat within it. So

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these are two things that I look at in all

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these lesions to see if I can bump up these,

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uh, nodules to a LI-RADS IV potentially.

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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