Aa
MRI for hcc
A ct scan recently showed a 1.4 cm lesion so I was sent for a follow up MRI. Although the lesion did not show any characteristics of HCC, the doctor wants me to repeat the MRI in 3 months. I understand the MRI radiology report but I am a bit confused with this line under impression:
1.4 cm posterior hepatic segment focus of arterial phase enhancement without corresponding abnormality on additional sequences may be perfusional in nature.
It's the last part - perfusional in nature - that I don't understand. I know what perfusion means, but what does it mean when referencing the lesion that was noted?
Thank you!
1.4 cm posterior hepatic segment focus of arterial phase enhancement without corresponding abnormality on additional sequences may be perfusional in nature.
It's the last part - perfusional in nature - that I don't understand. I know what perfusion means, but what does it mean when referencing the lesion that was noted?
Thank you!
I have nothing to add to the information Can-do and Hector provided, but I do want you to know that you are in my thoughts, and I am hoping for the very best for you in the future.
Thank you both for your responses. I will continue to hope for good news at the next MRI in October. Take care!
"1.4 cm posterior hepatic segment focus of arterial phase enhancement without corresponding abnormality on additional sequences may be perfusional in nature. "
Perfusion means - the passage of a fluid through a specific organ. Since HCC is a hypervascular growth (it has many blood vessels) there is often an increase in blood flow to that area of the liver.
This means that there was arterial phase enhancement (which is characteristic of HCC) but they was no other characteristics of HCC in the other phases of the scan. (Such as "washout" which is typically seen with HCC). So the report is saying that the lesion "may be" caused by increase flow of blood in the area of the liver, NOT HCC.
It is prudent to watch if there is any further growth or if the area/lesion starts to develop characteristics of HCC. It is always best to catch HCC as early as possible like most cancers.
AASLD Guidelines HCC
"Patients with liver nodules having a nonspecific vascular profile and negative biopsy should continue to undergo enhanced follow-up. There are no data to establish the best follow-up policy at this point, but repeated biopsy or follow-up CT/MRI to detect further growth should be considered. There are emerging data indicating that the smaller the lesion, the less likely there is to be microscopic vascular invasion. In addition, smaller lesions are more likely to be associated with treatment that will be curative.
Finally decision analysis also confirms that ideally, for the best outcome, the lesion should be smaller than 2 cm at diagnosis.It is therefore important to make the diagnosis of HCC as early as possible. However, it is equally important not to apply invasive treatment to lesions that do not have any malignant potential and may still regress. This is a fine distinction that is not always possible to make."
Recommendations:
7. Nodules larger than 1 cm found on ultrasound screening of a cirrhotic liver should be investigated further with either 4-phase multidetector CT scan or dynamic contrast enhanced MRI. If the appearances
are typical of HCC (i.e., hypervascular in the arterial phase with washout in the portal venous or delayed phase), the lesion should be treated as HCC.
If the findings are not characteristic or the vascular profile is not typical, a second contrast enhanced study with the other imaging modality should be
performed, or the lesion should be biopsied (level II).
I hope you don't have HCC. Time will tell the tale.
Best of luck!
Hector
Perfusion means - the passage of a fluid through a specific organ. Since HCC is a hypervascular growth (it has many blood vessels) there is often an increase in blood flow to that area of the liver.
This means that there was arterial phase enhancement (which is characteristic of HCC) but they was no other characteristics of HCC in the other phases of the scan. (Such as "washout" which is typically seen with HCC). So the report is saying that the lesion "may be" caused by increase flow of blood in the area of the liver, NOT HCC.
It is prudent to watch if there is any further growth or if the area/lesion starts to develop characteristics of HCC. It is always best to catch HCC as early as possible like most cancers.
AASLD Guidelines HCC
"Patients with liver nodules having a nonspecific vascular profile and negative biopsy should continue to undergo enhanced follow-up. There are no data to establish the best follow-up policy at this point, but repeated biopsy or follow-up CT/MRI to detect further growth should be considered. There are emerging data indicating that the smaller the lesion, the less likely there is to be microscopic vascular invasion. In addition, smaller lesions are more likely to be associated with treatment that will be curative.
Finally decision analysis also confirms that ideally, for the best outcome, the lesion should be smaller than 2 cm at diagnosis.It is therefore important to make the diagnosis of HCC as early as possible. However, it is equally important not to apply invasive treatment to lesions that do not have any malignant potential and may still regress. This is a fine distinction that is not always possible to make."
Recommendations:
7. Nodules larger than 1 cm found on ultrasound screening of a cirrhotic liver should be investigated further with either 4-phase multidetector CT scan or dynamic contrast enhanced MRI. If the appearances
are typical of HCC (i.e., hypervascular in the arterial phase with washout in the portal venous or delayed phase), the lesion should be treated as HCC.
If the findings are not characteristic or the vascular profile is not typical, a second contrast enhanced study with the other imaging modality should be
performed, or the lesion should be biopsied (level II).
I hope you don't have HCC. Time will tell the tale.
Best of luck!
Hector
Maybe Hector or Mikesimon will respond.
"perfusional in nature"
My guess would be......... Hemangioma: Benign "blood vessel" tumor, no cancer risk and rarely rupture.
"perfusional in nature"
My guess would be......... Hemangioma: Benign "blood vessel" tumor, no cancer risk and rarely rupture.
Hi, having a liver cyst is not uncommon and more then likely benign but when were told about it scares the crap out of us........ Here's a post from a Doctor on it from MedHelp, hang in the wishing you the best..
http://www.medhelp.org/posts/Digestive-Disorders---Gastroenterology/Liver-lesion-hemangioma-vs-malignancy/show/234077
http://www.medhelp.org/posts/Digestive-Disorders---Gastroenterology/Liver-lesion-hemangioma-vs-malignancy/show/234077
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