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Partially Successful TASE

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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

0:13

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.

1:03

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

1:19

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,

1:27

and a transarterial chemoembolization

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was suggested to treat this tumor.

1:32

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.

1:42

Arterial phase, portal venous phase.

1:45

As always, I like to look at the

1:46

subtraction images provided they're

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a good technique and well performed.

1:50

In this case, they are.

1:51

And now, in lieu of the lesion that we saw

1:54

previously, we see an ablation cavity, and we

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can see that much of it is vascular, right?

2:02

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.

2:11

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.

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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