0:01

Here's a patient with cirrhosis

0:02

who's getting a screening study to

0:03

look for hepatocellular carcinoma.

0:05

Go ahead and start looking

0:06

at some of the images.

0:08

So here we have the post-contrast images,

0:11

arterial, portal venous, and equilibrium phase.

0:13

And I want to focus on this lesion

0:15

that we see here in the hepatic dome.

0:17

Here's the T1 FATSAT post-contrast

0:20

arterial image, portal venous, equilibrium

0:23

phase image, and this is the lesion.

0:26

You can see that it's, um, sort of centered

0:29

in segment 7, segment 8, probably at the

0:31

borderline of those two segments.

0:34

And it demonstrates unequivocal non-

0:37

rim arterial phase hyperenhancement.

0:41

Now unlike a lot of the lesions that we've

0:42

seen so far, this one's a little bit larger.

0:45

If we were to measure this, this

0:46

falls above a 20 millimeter radius.

0:51

Range and size, right?

0:52

So we measure it from here to here, certainly

0:54

larger than 20 millimeters or 2 centimeters.

0:57

It has arterial phase hyperenhancement,

0:59

and we now have to look at our remaining

1:01

post-contrast images to figure out what

1:03

Lyrads category that we put it into.

1:06

So we move on to the portal venous phase images.

1:08

The inside of it looks pretty

1:10

similar to the liver parenchyma.

1:11

I can't say there's washout based on this image.

1:14

And there's probably a little rim.

1:15

I would qualify this as a little rim that's

1:17

surrounding this, a little pseudocapsule.

1:19

If we look at the equilibrium phase

1:20

images, we can see that the inside

1:21

of it unequivocally washes out.

1:23

It is darker than the adjacent parenchyma.

1:26

The outside of it has a little

1:27

rim as well surrounding it.

1:29

And so when we look at those, uh, we

1:31

add these observations to our lesion,

1:34

we see that there is unequivocal

1:36

washout, which is non-peripheral, right?

1:39

The inside of it is washing out.

1:40

We see that there is a pseudocapsule.

1:43

And so all these things allow us to

1:46

qualify this lesion as a Lyrads 5 lesion.

1:50

This is a lesion that we are almost certain that

1:54

this is going to be an HCC with about 95%

1:57

certainty, if not a little bit more than that.

1:59

This can be presented at a tumor board.

2:02

We can start discussing treatment

2:03

strategies in order to move on to

2:06

the next step for this patient.