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Multifocal liver hepatocellular carcinoma

Case Study
Prof. Valette, Pierre-Jean, M.D. Lyon South Hospital, Hospices Civils de Lyon • France

Patient history

A 57-year-old male with decompensated cirrhosis is referred to MRI to visualize the hepatocellular carcinoma (HCC) and the lesion extension and to help assess the feasibility of an Yttrium radioembolization. CT shows a heterogeneous liver without obvious nodule. The left portal branch is the site of a suspended thrombus.

MR examination

The examination was done on Ingenia 3.0T on R4.1.3 with dS Torso coil solution, patient feet first, arms up.

The Ingenia’s dS Torso coil solution has a large coverage. With this coil, whole abdomen acquisition is a single step for most patients. So, it is much faster to perform, for instance, bowel MRI for inflammatory diseases or tumors.


ExamCard used:

Images

 CT T2W DWI
CT
T2W
DWI
 T1W mDIXON pre contrast T1W arterial phase T1W portal phase
T1W mDIXON pre contrast
T1W arterial phase
T1W portal phase

T2-weighted MRI demonstrates large effusion ascites, heterogeneous liver with the presence of multiple slightly hyperintense nodules.

On DWI a multi-nodular lesion is seen in the liver with marked diffusion restriction. The portal vein nodule is also hyperintense suggesting a tumor thrombus.

On T1-weighted mDIXON the lesion shows arterial enhancement and portal phase wash-out.
dS SENSE in LR direction, T2W SP with MultiVane. DWI with b0-b1200, free breathing.

Diagnosis

MRI supports the diagnosis of decompensated liver cirrhosis with multinodular HCC.  Early opacification of the left portal vein at arterial phase suggesting the presence of arterioportal fistulas, by which radioembolization would not appear to be safe.

Clinical impact of Ingenia 3.0T

MRI clearly shows the HCC nodules and their extension. Ascites, although large in this case, does not interfere with the image quality. T1 sequences with dynamic acquisitions at arterial and portal phases combined with the high resolution images identify contrast uptake and also conditions of the liver perfusion that in this case are against an embolization.

Ingenia’s wide 70 cm bore enables to improve imaging strategy by implementing the high dS SENSE speedup in RL direction with arms-up patient positioning. This allows using a narrowed acquisition volume without the patient’s arms causing artifacts. This provides shorter breath hold times, higher resolution and sharper images because of reduced blurring in TSE and less distortion in DWI. This positioning is accepted by almost every patient, but requires an examination time not exceeding 20 to 25 minutes. The use of high RL dS SENSE factors in combination with armsup provides a real advantage. So often with MR, when you change something, you lose something somewhere else. In this case, it is just advantages.


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Mar 6, 2014

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Case Study
Ingenia 3.0T
Release 4
Body, dS SENSE, dS Torso coil solution, dStream, Hepatocellular carcinoma, Liver, Oncology
 

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