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The following is a 65-year-old female who

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is getting an MRI for restaging purposes.

0:07

So we'll start off by looking at

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the T2-weighted sequences and some

0:11

of the T1 post-contrast sequences.

0:13

And both on the T2-weighted sequence

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and the T1 FATSAT post-contrast sequence,

0:19

performed in the arterial phase, we can see

0:22

that the liver has a very nodular contour.

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So if I trace the liver border here and I

0:27

go across it, very lumpy, bumpy, very nodular.

0:30

And this is also seen, perhaps to a lesser

0:33

degree on the arterial phase image here,

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but certainly there are findings of cirrhosis.

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And so this patient has cirrhosis and

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we've seen examples of what that looks

0:42

like in the past few video vignettes.

0:44

However, it is quite telling to see what this

0:47

patient looked like a year prior to this exam.

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And if we were to do that, we can see that

0:54

About a year ago, the patient did not quite

0:57

have that nodular contour that we see.

0:59

So that's something that's developed

1:01

in about 12 months' time.

1:04

Relatively smooth border.

1:06

What we see within the inside of the

1:08

liver are numerous liver lesions.

1:10

We can see something over here, something over

1:12

here, something over here, something over here.

1:14

Many of them are quite small.

1:16

On the T2-weighted sequences,

1:18

they're relatively bright.

1:19

On the T1 FATSAT post-contrast

1:22

sequence, we see that they enhance.

1:25

And so the added history in this patient is

1:27

this patient has a history of breast cancer.

1:30

Breast cancer with all these liver lesions

1:32

turning out to be liver metastases.

1:35

And over the course of treating these

1:36

liver metastases, the patient has

1:38

developed a cirrhotic liver morphology.

1:41

And this is known as pseudocirrhosis.

1:46

So this is an entity that has been

1:47

classically been described in the setting

1:50

of treated breast cancer mets to the liver.

1:55

Now it's important to remember that we

1:57

can see it with other primaries, so not

2:00

just with breast, but classically it's

2:01

been described with treated breast cancer.

2:03

It's also been described in patients

2:06

who've had a marked desmoplastic

2:08

response to their metastatic disease

2:10

who have not undergone treatment.

2:11

So, classically we treat breast cancer, but

2:13

also described in a few different settings,

2:16

and these patients can also develop signs of

2:18

portal hypertension, as has been discussed

2:20

previously, including ascites, portal systemic

2:22

collaterals, varices, splenomegaly, etc.