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Salzburg Weill Cornell Seminar in Diagnostic Imaging Hepatic tumors

Salzburg Weill Cornell Seminar in Diagnostic Imaging Hepatic tumors 9 – 15 October 2011, Salzburg, Austria. Siarhei Kharuzhyk, M.D., Ph.D. N.N. Alexandrov National Cancer Center, Minsk Region, Belarus. Patient history. Male, 57 y. o. Liver hemangioma on US for 8 y.

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Salzburg Weill Cornell Seminar in Diagnostic Imaging Hepatic tumors

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  1. Salzburg Weill Cornell Seminar in Diagnostic Imaging Hepatic tumors 9 – 15 October 2011, Salzburg, Austria Siarhei Kharuzhyk, M.D., Ph.D. N.N. Alexandrov National Cancer Center, Minsk Region, Belarus

  2. Patient history Male, 57 y. o. Liver hemangioma on US for 8 y. Pain in the abdomen for 1 month

  3. Diagnostic procedures • Laboratory tests: • Erythrocyte sedimentation rate – 21 mm/hr (upper normal value 15 mm/hr) • The rest of blood tests were normal • Patient was sent to abdominal CT/MRI

  4. Native phase CT Tumor in liver segments 1-4 (density 43 HU) on the background of steatosis

  5. Late arterial phase Tumor density 60 HU max. Portal venous phase 97 HU max. Delayed phase 10 min 84 HU max. Do you see something else???

  6. MRI T2w Two hyperintense tumors, the larger one is heterogeneous

  7. MRI T1w CE Delayed enhancement in both tumors Native 25 sec. 3 min. 6 min. 12 min. 25 min.

  8. MRI T1w CE at the lower level Native 25 sec. 3 min. 6 min. 12 min. 25 min. Larger tumor enhance heterogeneously, no contrast wash-out at 25 min

  9. What is yours conclusion?

  10. Correct diagnosis Hemangioma in the right liver lobe (segments 7-8) Cholangiocarcinoma in the left liver lobe (segments 1-4)

  11. Hints to diagnosis • Hemangioma: • Mostly homogeneous high signal on T2w • Lacunar enhancement • Progressive filling from periphery to center • Complete contrast filling in delayed phases

  12. Hints to diagnosis • СhС: • Heterogeneously high signal on T2w • Heterogeneous rimlike or bandlike CE • Concentric but incomplete contrast filling (fibrotic component!) “Lacunar-like” enhancement!

  13. Hints to diagnosis • СhС: • Dilated bile ducts (!!!) • Enlarged lymph node (metastasis)

  14. Outcome Patient underwent left hemihepatectomy with portal hepatic lymph nodes metastases excision Unfortunately, liver and brain metastases developed 4 months after operation

  15. Thank you for attention!

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