THID

[halfwatt]

Hi,

I have HCC and just got my latest MRI. Recent ablation efforts seem to be successful on the known tumor.

I will be seeing one of my oncologists the 27th to discuss these results, but I was hoping for some information regarding the significance of the possible THID that is mentioned before that.

My labs look pretty good: AFT 9.5 / AST 35 / Ammonia 26, however my ALT is up a bit 54 and so is my bilirubin 1.6 (MELD=8).

I had my gall bladder removed, as well as RF ablation and ethanol ablation on 8/2/2013. Prior to that 2 DEB-TACE's.

Thank you very much in advance !

Here is the report:
MRI LIVER W WO CONTRAST

CPT:74183Accession#:5681688PRV

MRI ABDOMEN COMBINED

INDICATION: Hepatoma status post ethanol ablation and RF ablation.

Followup evaluation.

COMPARISON: 30 August 2013.

TECHNIQUE: Multiplanar T1, T2 and diffusion weighted images of the

abdomen were obtained without and with IV contrast. 10 mL of Gadavist

was administered intravenously.

FINDINGS: The liver has a nodular surface consistent with cirrhosis.

The medial left lobe of the liver shows atrophy and contains a stable

nonenhancing mass representing the ablation site. There is an area of

heterogeneous hyperenhancement in the dome of the liver adjacent to the

ablation site which is only seen in the arterial phase of contrast

imaging. Otherwise, no new hepatic lesions are identified. The portal

venous system is patent. There is no dilatation of the biliary tree.

The gallbladder is absent. The pancreas, spleen, kidneys, adrenals and

abdominal aorta are within normal limits. There is no free fluid or

lymphadenopathy.

IMPRESSION:

Stable ablation site in the atrophic medial left lobe of the liver.

Area of heterogeneous enhancement adjacent to the ablation site may

represent a transient hepatic intensity difference (THID). Eovist

should be used if followup evaluation by MRI is indicated.

SQR

[John Irlam, DO, FASCP]

Hi Halfwatt,
Thank you for such an interesting question and all of the details that you've included.  I'm very happy that your treatments have gone so well!  It appears as though there is no tumor see on your MRI.  I had to do some searching about THID, and from what I've read the cause of THID is still unknown.  Physicians think that it's due to an imbalance between blood flow in the arteries and veins in your liver with compromised blood flow to the veins.  It might be worth trying to post in one of the radiology forums to see if they have any additional info, this isn't my area of expertise.  I think the labs look great, the increase in your ALT and Bilirubin have to be taken into context, especially with the treatment that your liver has undergone.  Will you let us all know how the appointment goes?
Good luck!
John      

[John Irlam, DO, FASCP]

Sounds great Brian, I'd love to know if they have any additional info.  Stay in touch!

[halfwatt]

Dr. Irlam,

Thank you so much for your reply !

I  will take your suggestion and post my question in radiology forums.

Thank you for your good wishes - I will let you know what I find out on the 27th.

Brian