0:01

So this patient also has a history of cirrhosis,

0:04

and is undergoing an MR exam to look for

0:08

potential hepatocellular carcinomas.

0:11

So we'll dive right into the post-contrast

0:14

imaging sequences, and as you kind of scroll

0:17

through this, there are many, many arterial

0:20

enhancing lesions throughout this liver.

0:22

And so it's worth spending some time looking

0:25

at particularly the larger ones. To, um,

0:28

see if they contain any findings that can

0:30

be seen with hepatocellular carcinoma.

0:33

The one that I'm going to focus on is

0:34

one that's bordering segments 4A and 4B.

0:38

So this is the lesion in question.

0:40

This is our T1 FAT SAT image, post-

0:44

contrast. This is in the arterial phase,

0:47

this is the portal venous phase, and

0:49

this is the equilibrium phase over here.

0:52

If we look at this lesion, we notice that it has

0:56

non-rim arterial phase hyperenhancement, right?

1:01

The whole lesion is enhancing on the inside of

1:03

it. It's not just rim enhancement with this one.

1:06

Now if we were to measure this, this comes up

1:08

to between the 10 to 19 millimeter threshold, so

1:13

that's so far what we have. And in order for us

1:16

then to further look at it, we have to see what

1:17

it does on the remaining contrast sequences.

1:20

On the portal venous phase, you can see it a

1:22

little bit over here, but I think its appearance

1:25

is most telling on the equilibrium phase image,

1:28

where when you look at the inside of it, it

1:30

is darker than the adjacent liver parenchyma.

1:33

So in this case, there is what

1:35

we call non-peripheral washout.

1:38

The inside of this lesion washes out; it

1:39

becomes darker than the liver parenchyma.

1:42

And if we were to look at

1:43

the rim of this lesion,

1:45

we can see that there's a very thin enhancing

1:48

rim, something that we call a pseudocapsule.

1:49

So let's cycle back to those features.

1:51

Non-rim arterial phase

1:53

hyperenhancement, 10 to 19 millimeters.

1:55

We have non-peripheral washout.

1:57

We have a pseudocapsule.

1:59

If we go through the Lyrads

2:01

chart, we'll see that all these features

2:03

allow us to classify this as a Lyrads 5 lesion.

2:07

Remember, Lyrads 5 lesions are lesions

2:10

that we are almost certain are going

2:11

to be hepatocellular carcinomas.

2:13

Okay.

2:14

These can then now be brought to a tumor

2:16

board setting, and there's no need to

2:19

do a biopsy to confirm that this is an

2:21

HCC based on its imaging appearance.

2:24

We're going to call this a hepatocellular

2:26

carcinoma, and now we can initiate a discussion

2:29

of potentially how to treat this lesion.