Interactive Transcript
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So in this case, we have a seven-year-old
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gentleman, um, history of cirrhosis, and we're
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looking for liver lesions in this patient.
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And so we'll move on to our
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images, see what we find.
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So as we scroll through our post-contrast
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images, we can see a rather large lesion
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in segments seven and eight, sort of
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centered in segment seven, but perhaps,
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uh, encroaching upon segment eight itself.
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So here we have the T1 FatSat post-
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contrast image in the arterial phase.
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This is the portal venous phase.
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A little bit of motion on the arterial phase,
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but here is the lesion over here, a rather
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large lesion, and uh, whereas not all of
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it is enhancing, I would say the majority
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of it is enhancing, demonstrating that
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non-RIM arterial phase hyper-enhancement.
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It's certainly larger than
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20 millimeters in size.
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If we look at the portal venous phase images,
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there are probable areas that are washing out.
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For example, over here.
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If you're not sure about that, there's
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certainly a capsule that's surrounding this.
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That, I think, is pretty reasonable to assume.
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So, I would say, uh, pseudocapsule
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and questionable washout,
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areas of questionable washout.
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But even if we ignore the washout,
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based on these criteria itself, this
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qualifies, this lesion is a Lyra at five,
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a lesion that's almost certainly going
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to reflect a powder cell or carcinoma.
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Given, uh, the large size of this, this,
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and the location, this is not deemed to be
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appropriate for percutaneous techniques,
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and a transarterial chemoembolization
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was suggested to treat this tumor.
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And so this was treated, and let's see
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what the post-treatment scans look like.
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So in the post-treatment scans, uh,
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we look at the post-contrast images,
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T1 weighted, FATSAT, post-contrast.
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Arterial phase, portal venous phase.
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As always, I like to look at the
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subtraction images provided they're
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a good technique and well performed.
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In this case, they are.
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And now, in lieu of the lesion that we saw
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previously, we see an ablation cavity, and we
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can see that much of it is vascular, right?
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So there's certainly areas within it that
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no longer have enhancing tumor, but there
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are, at the same time, quite a bit there.
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Of this lesion, particularly at the
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periphery that has very nodular viable tumor.
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You can see it over here.
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You can see it over here.
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You can see it over here.
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This demonstrates arterial hyper-enhancement.
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And it doesn't even have to wash out for us
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to think of this as residual disease, but
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in this instance, it actually does wash out.
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And if we were to measure something like this
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in terms of the amount, you know, the viable
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tumor, you'd measure the longest dimension
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of a residual tumor not crossing the
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non-viable portion of the cavity itself.
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And so I'd measure something like from here
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to here, and give that in my report as the
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largest or the longest dimension of viable
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tumor in this patient who has been treated
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with TACE and has only been partially
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successful at eliminating the tumor itself.
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