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On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
1 topic, 5 min.
2 topics, 13 min.
35 topics, 2 hr. 11 min.
Morphologic Cirrhosis
5 m.Non-Malignant Nodules in the Cirrhotic Liver
2 m.Dysplastic Nodules
4 m.Portal Hypertension – 2 Patient Case Review
4 m.Pseudocirrhosis
3 m.LI-RADS – Summary
12 m.LI-RADS 1 or 2
3 m.LI-RADS 3
3 m.LI-RADS 3 (THID)
3 m.LI-RADS 4
3 m.LI-RADS 3 Upgraded to LI-RADS 4
4 m.LI-RADS 5
3 m.LI-RADS 5 Change in Lesion Overtime
4 m.LI-RADS 5 – Non-peripheral Washout (NPWO)
3 m.LI-RADS 4 – Psuedo Capsule
4 m.LI-RADS 3 – No Ancillary Imaging Findings
3 m.LI-RADS 5 – Size, Psuedo Capsule, & NPWO
3 m.LI-RADS 5 – 22mm with NPWO
3 m.LI-RADS 4 – Greater than 20mm, Lacking Ancillary Features
4 m.LI-RADS 5 – All-qualifiers, HCC
4 m.LI-RADS – Tumor in Vein (TIV)
6 m.LI-RADS – TIV Infiltrative Tumor
4 m.LI-RADS M – Metastatic Urothelial Cancer
5 m.Fibrolamellar Hepatocellular Carcinoma (FHCC)
6 m.Treatment Options
9 m.Successfully Treated LI-RADS 5
4 m.Successfully treated LI-RADS 5, with Recurrence
4 m.2 Lesions Treated with Transarterial Embolization
4 m.Partially Successful TASE
3 m.Recurrence in a Patient Treated with Radioembolization (Y-90)
4 m.2 Patients with Cholangiocarcinoma
8 m.Hypervascular Mets
4 m.Hypovascular Metastasis from Breast Cancer
4 m.Mucinous Liver Metastasis
4 m.Hypovascular Metastasis Post-op
4 m.0:01
This patient, uh, also presents
0:02
for screening for hepatocellular
0:05
carcinoma, has a history of cirrhosis.
0:08
And in fact, uh, it's the same, uh, images,
0:10
same patient that we saw previously has
0:12
another lesion, which I wanted to discuss.
0:15
So as we scroll through these images, I want
0:17
you to focus on this lesion right over here.
0:20
So this is the T1 FATSAT post
0:24
contrast image in the arterial phase.
0:27
We can see up here in, uh,
0:28
or down here in segment five.
0:31
We have a, uh, nodule with, uh, non-
0:36
rim arterial phase hyperenhancement.
0:40
If we measure this nodule, this is
0:42
going to be less than 10 millimeters.
0:45
Alright, so this is going to be a
0:48
pretty small nodule with definite
0:50
arterial phase hyperenhancement.
0:52
But again, to sort of qualify this
0:53
and figure out what BI-RADS category
0:55
it'll fit into, we need to look at
0:57
the remaining post-contrast images.
0:59
Thank you.
1:00
So this is one of the other, uh,
1:02
post-contrast images, T1 FATSAT post
1:05
contrast in the equilibrium phase.
1:08
We can see the same nodule that was arterially,
1:11
uh, enhancing demonstrates unequivocal washout.
1:15
And if you look at it, this qualifies as non-
1:18
peripheral washout in that it's not the outside
1:21
of it that's getting darker, but in fact,
1:22
the inside of the nodule that is unequivocal
1:25
darker when you compare it to
1:27
the adjacent liver parenchyma.
1:28
So compared to this liver parenchyma,
1:29
this nodule on the inside is darker.
1:32
So if we were to put together these
1:35
findings, we would find that we have
1:37
a mass in segment five that has non-
1:40
RIM arterial phase hyperenhancement.
1:43
We measure the size of it.
1:44
It is less than 10 millimeters.
1:46
We look for other features and it demonstrates
1:49
evidence of unequivocal non-peripheral washout.
1:53
This qualifies this nodule
1:55
as a BI-RADS 4 nodule.
1:57
Alright, so when you qualify something
1:59
as a BI-RADS 4, next step is it needs
2:02
to be discussed in a multidisciplinary
2:05
conference, a liver tumor board.
2:07
In that instance, they may recommend to go
2:09
for biopsy, they may recommend very short-term
2:12
interval follow-up, depending on the discussion
2:14
that occurs with a multidisciplinary team.
Interactive Transcript
0:01
This patient, uh, also presents
0:02
for screening for hepatocellular
0:05
carcinoma, has a history of cirrhosis.
0:08
And in fact, uh, it's the same, uh, images,
0:10
same patient that we saw previously has
0:12
another lesion, which I wanted to discuss.
0:15
So as we scroll through these images, I want
0:17
you to focus on this lesion right over here.
0:20
So this is the T1 FATSAT post
0:24
contrast image in the arterial phase.
0:27
We can see up here in, uh,
0:28
or down here in segment five.
0:31
We have a, uh, nodule with, uh, non-
0:36
rim arterial phase hyperenhancement.
0:40
If we measure this nodule, this is
0:42
going to be less than 10 millimeters.
0:45
Alright, so this is going to be a
0:48
pretty small nodule with definite
0:50
arterial phase hyperenhancement.
0:52
But again, to sort of qualify this
0:53
and figure out what BI-RADS category
0:55
it'll fit into, we need to look at
0:57
the remaining post-contrast images.
0:59
Thank you.
1:00
So this is one of the other, uh,
1:02
post-contrast images, T1 FATSAT post
1:05
contrast in the equilibrium phase.
1:08
We can see the same nodule that was arterially,
1:11
uh, enhancing demonstrates unequivocal washout.
1:15
And if you look at it, this qualifies as non-
1:18
peripheral washout in that it's not the outside
1:21
of it that's getting darker, but in fact,
1:22
the inside of the nodule that is unequivocal
1:25
darker when you compare it to
1:27
the adjacent liver parenchyma.
1:28
So compared to this liver parenchyma,
1:29
this nodule on the inside is darker.
1:32
So if we were to put together these
1:35
findings, we would find that we have
1:37
a mass in segment five that has non-
1:40
RIM arterial phase hyperenhancement.
1:43
We measure the size of it.
1:44
It is less than 10 millimeters.
1:46
We look for other features and it demonstrates
1:49
evidence of unequivocal non-peripheral washout.
1:53
This qualifies this nodule
1:55
as a BI-RADS 4 nodule.
1:57
Alright, so when you qualify something
1:59
as a BI-RADS 4, next step is it needs
2:02
to be discussed in a multidisciplinary
2:05
conference, a liver tumor board.
2:07
In that instance, they may recommend to go
2:09
for biopsy, they may recommend very short-term
2:12
interval follow-up, depending on the discussion
2:14
that occurs with a multidisciplinary team.
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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