Learning objectives
Recognition of the role of Dynamic MRI in the diagnosis of residual or recurrentHCC afterradiofrequency ablationby the additionof subtraction sequence.
Background
· Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide.
It has a poor prognosis unless treated.
· Many ablative treatment options are currently of wide use as surgical,
chemical,
thermal or functional .
· Among all the thermal ablative technique; RFA is the one most widely used for both primary and secondary malignances of the liver.
· Contrast enhanced dynamic CT and MRI are widely used in the post-treatment follow-up of these patents,
· RFA produces coagulation necrosis; sometimes demonstrate imaging features...
Findings and procedure details
· Cases should be subjected to full clinical assessment,
laboratory investigations with the revision of their previous radiological investigations.
· Suggested protocol that could be used: Axial T1,
T2,
T2 SPAIR sequences and dynamic imaging using 3D fat-suppressed T1-weighted gradient echo sequence.
The dynamic study is performed after contrast injection consisting of one pre-contrast series followed by at least four successive post-contrast series.
· Subtraction imaging is performed by subtracting the pre-contrast series from the late arterial phase or any phase of choice.
· Images...
Conclusion
DynamicMRI is valuable in detecting recurrent lesions however,
this value is augmented by the addition of subtraction technique especially in lesions having high T1 signal.
References
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Post-treatment MRI findings of hepatocellular carcinoma. Diagn Interv Radiol 2009: 15:111-120.
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Thermoablative Treatment for Malihnant Liver Lesions: 10-Year Experience of MRI Appearance of treatment Response.
AJR 2010,
194:523-529.
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Kamel IR and Morgan HR.
MRI appearance of treated liver lesions.
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4.
Newatia A,
Khatri G,
Friedman B,
et al.
Subtraction Imaging Applications...