34 YOM potential living liver donor. 38 YO male living liver donor candidate. Adenomatosis. FNH vs Adenoma

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1 34 YOM potential living liver donor 38 YO male living liver donor candidate Adenomatosis FNH vs Adenoma FNH Hepatobiliary agents have a role in distinguishing the two! Adenoma But beware 3 minute post 20 minute post

2 Hepatic Metastases Most common malignant liver lesion After lymph nodes, most common site for mets Hepatic Metastases Imaging Hypovascular Hypervascular

3 Hypovascular Pattern Colon Lung Breast Gastric Prostate TCC Hepatic Metastases DDx: Abscess, Inflammatory Ring-enhancing Metastases Hypervascular Pattern Carcinoid Thyroid Melanoma Renal cell Ilt Islet cell

4 Diffusion Imaging 44 YOF with breast carcinoma 58 YOM with lung carcinoma 58 YOM with lung carcinoma

5 50 YOM with ileal carcinoid 50 YOM with ileal carcinoid 50 YOM with ileal carcinoid

6 50 YOM with ileal carcinoid 50 YOM with ileal carcinoid

7 61 YOM with pancreas and liver lesion 61 YOM with pancreas and liver lesion 61 YOM with pancreas and liver lesion

8 61 YOM with pancreas and liver lesion Which image is post contrast? 61 YOM with pancreas and liver lesion Which image is post contrast? 61 YOM with pancreas and liver lesion

9 61 YOM Repeat with scan pancreas 3 months and liver later lesion Repeat scan 3 months later 35 YOF with melanoma

10 Hepatocellular Carcinoma Most common primary liver malignancy Often arise in cirrhotic liver M > F Often increased alpha fetoprotein Myriad clinical presentations Cirrhosis Imaging: Hepatic Nodularity Morpholigic Changes Compensated Caudate & Lat Seg C Cirrhosis Imaging: Extrahepatic Portal HTN Splenomegaly Ascites Varices Gamna Gandy Bodies

11 Hepatocellular Carcinoma T1 appearance can vary T1 often isointense, may be hyperintense if hemorrhage or copper May contain microscopic i fat Hepatocellular Carcinoma T2 often mildly hyperintense similar to spleen, may be isointense Hepatocellular Carcinoma Small lesions have arterial uniform enhancement

12 Hepatocellular Carcinoma Small lesions have arterial uniform enhancement Often washout in more delayed phases Hepatocellular Carcinoma Large lesions have heterogeneous enhancement Uncommonly have capsule appearance with delayed enhancement Hepatocellular Carcinoma Nodule within a nodule appearance is uncommon, but specific

13 Vascular invasion commonly seen Hepatocellular Carcinoma Infiltrating HCC with tumor thrombus Hepatocellular Carcinoma Vascular invasion commonly seen MR Elastography Technique to detect early hepatic fibrosis Mechanical waves are induced in the liver using an external device ( wave machine ) Waves are measured with a sensitive phasecontrast MR technique Resulting images quantify tissue stiffness

14 Normal Liver Cirrhotic Liver Wave images: Elastographic images: RadioGraphics 2009; 29: YOM with hepatitis C $$

15 Cholangiocarcinoma Cholangiocarcinoma 2 nd most common primary hepatic tumor Etiologies PSC Caroli s Choledochal cyst Thoratrast Cholangiocarcinoma Imaging appearance variable due to growth pattern: Mass forming Intraductal Periductal infiltrating and location: Hepatic bifurcation Klatskin Distal CBD Intrahepatic (5 15%)

16 Cholangiocarcinoma Imaging appearance variable due to growth pattern: Mass forming Intraductal Periductal infiltrating and location: Hepatic bifurcation Klatskin Distal CBD Intrahepatic (5 15%) Cholangiocarcinoma Klatskin tumor Cholangiocarcinoma Intrahepatic Capsular retraction

17 Cholangiocarcinoma Intrahepatic Capsular retraction Biliary Duct Dilataton Cholangiocarcinoma Imaging: Varies due to amount of fibrosis and necrosis Atrophy Capsular retraction Biliary duct dilatation Hypovascular Progressive, delayed hyperenhancement due to fibosis 60 YOM with liver tumor

18 v Summary Radiology plays a key role in the evaluation of liver lesions Correct diagnosis often depends on lesion features and select clinical data When required, most lesions are amenable to percutaneous image guided biopsy Summary

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