WHAT ARE THE ANCILLARY FEATURES ( OPTIONAL , USED TO UP- OR DOWNGRADE SUSPICION) Flashcards
WHAT DOES ANCILLARY FEATURES MEAN?
The ancillary features are features / additional findings that can modify the probability of HCC but donot independently determine the LI-RADS category .
It can increase or decrease suspicion when used with major features.
what are the ancillary features that increase suspicion for HCC?
MR H F B CNS- Mighty Ryan Has Fatty Brain CNS
M:- Mild - moderate T2 hyper intensity ( HCC often appears slightly brighter on T2 wI )
R:- Restricted diffusion on DWI ( diffusion -weighted imaging)( suggesting cellular density)
H:- Hepatobiliary phase hypo intensity- lesion appears dark on hepatic biliary phase in gadoxetate enhanced MRI)
F:- Fat in mass ( intralesional fat , commonly in HCC).
B:- Blood products in mass( intratumoral hemorrhage)
C:- corona enhancement( perilesional enhancement d/t arterial phase hyper perfusion)
N. Nodule -in -nodule appearance ( a smaller enhancing nodule within a larger nodule, suggests progression)
S:- sub threshold growth( increase in size but less than 50%)
CONCEPTUAL RADIOLOGY:-
RCNFIM- RYAN CAN NEVER FALL INTO MOSAIC
1.RYAN:- Radiating Septa
Definition:-Internal linear structures radiating from the lesion.
significance:- Commonly seen in HCC
2. CAN:- Coronary vein sign:-
definition:- the presence of an accessory or collateral vessels supplying the lesion.
significance:- suggests HCC
3. Nodule-in-nodule:
Definition:-a smaller nodule within the larger one, where the inner nodule has different imaging characteristics.
significance:- suggests HCC
4.FAT in Mass:-
Definition :- presence of intralesional fat.
significance:- Often indicates a progressed HCC within a dysplastic nodule.
5. iron sparing in mass
Definition:- Areas within a lesion that donot show iron deposit while the rest of the liver does.
SIGNIFICANCE:- S/O HCC
6.MOSAIC ARCHITECTURE:-
Definition:- heterogenous appearance with areas of different enhancement.
significance:- common in HCC
what are the ancillary features that decrease suspicion for HCC?
MHIH- Mark HAD INTERNAL HEMORRHAGE
Mark:- Marked T2 hyper intensity( suggests a benign lesion like a cyst or hemangioma)
HAD:- homogenous marked t1 hyperintensity ( seen in fat containing benign lesion like adenoma)
INTERNAL :- Iron in mass( iron deposition is uncommon in HCC but can be seen in sideritic nodules)
HEMORRHAGE:- Hepatobiliary phase isointensity or hyperintensity suggests being hepatocellular lesion like FNH)
CONCEPTUAL RADIOLOGY:-
ESP
E:- enhancement similar to blood pool
DEFINITION:- Lesion enhancement similar to blood vessels
SIGINIFICANCE:- S/O HEMANGIOMA
S:- SIZE STABILITY OVER > 2 YEARS
DEFINITION:- no significant change in size over a period of more tahn two years
SIGNIFICANCE:- indicates benign nature.
P:- PARALLELS IMAGING APPEARNCE OF KNOWN BENIGN LESION
Definition:- Imaging characteristics match those of a benign lesion( e.g. hemangioma, cyst)
significance:- Supports a benign diagnosis.
