Purpose To evaluate the diagnostic performance and interrater reliability of the Liver Imaging Reporting and Data System (LI-RADS) version 2014 in differentiating hepatocellular carcinoma (HCC) from non-HCC malignancy in a population of patients at risk for HCC. Materials and Methods This retrospective HIPAA-compliant institutional review board-approved study was exempt from informed consent. A total of 178 pathology-proven malignant liver masses were identified in 178 patients at risk for HCC but without established extrahepatic malignancy from August 2012 through August 2015. Two readers blinded to pathology findings and clinical follow-up data independently evaluated a liver protocol magnetic resonance or computed tomography study for each lesion and assigned LI-RADS categories, scoring all major and most ancillary features. Statistical analyses included the independent samples t test, x test, Fisher exact test, and Cohen k. Results This study included 136 HCCs and 42 non-HCC malignancies. Specificity and positive predictive value of an HCC imaging diagnosis (LR-5 or LR-5V) were 69.0% and 90.5%, respectively, for reader 1 (R1) and 88.3% and 95.5%, respectively, for reader 2 (R2). Tumor in vein was a common finding in patients with non-HCC malignancies (R1, 10 of 42 [23.8%]; R2, five of 42 [11.9%]). Exclusion of the LR-5V pathway improved specificity and positive predictive value for HCC to 83.3% and 92.9%, respectively, for R1 (six fewer false-positive findings) and 92.3% and 96.4%, respectively, for R2 (one fewer false-positive finding). Among masses with arterial phase hyperenhancement, the rim pattern was more common among non-HCC malignancies than among HCCs for both readers (R1: 24 of 36 [66.7%] vs 13 of 124, [10.5%], P < .001; R2: 27 of 35 [77.1%] vs 21 of 123 [17.1%], P < .001) (k = 0.76). Exclusion of rim arterial phase hyperenhancement as a means of satisfying LR-5 criteria also improved specificity and positive predictive value for HCC (R1, two fewer false-positive findings). Conclusion Modification of the algorithmic role of tumor in vein and rim arterial phase hyperenhancement improves the diagnostic performance of LI-RADS version 2014 in differentiating HCC from non-HCC malignancy. RSNA, 2017 Online supplemental material is available for this article.

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Management of patients with post-tonsillectomy hemorrhage (PTH) is not well defined but may include observation, topical bedside treatments, or return to the operating room. Data on the use and efficacy of silver nitrate as a topical bedside agent for the management of PTH remain unexplored. Our primary objective was to assess the efficacy of silver nitrate in reducing the need for operative control of PTH. MethodsSingle-institution retrospective chart review included patients aged 5-18 years who presented with tonsillar bleeding within 30 days of tonsillectomy. Patients undergoing observation or bedside silver nitrate cautery were compared based on clinical characteristics and experience of the physician performing the procedure. The outcome of interest was rebleeding requiring operative control. Sample characteristics according to treatment modality were described using Fisher's exact tests and ANOVA. ResultsOf the patients eligible for inclusion, 29 (20%) were observed and 70 (48.3%) were treated with topical silver nitrate. Age was the only statistically significant clinical difference among treatment groups. The silver nitrate group had more patients who underwent operative control of PTH compared to the observation group (p = 0.004). When comparing the need for operative control between the observation group and patients who had initial success with silver nitrate, there was no difference (p = 0.29). No differences were found in the rate of bleeding requiring operative control when comparing experience of the physician performing the procedure (p = 0.20). ConclusionMore patients who underwent silver nitrate cautery required PTH control in the operating room compared to the observation group. This may be due to patient selection as our results also suggest that there is no statistical difference in rates of operative control of PTH when comparing initial successful treatment with topical silver nitrate to observation. Age is likely a factor that was used by physicians in this study to decide the initial management of PTH. Provider experience does not appear to affect rebleeding rates. Future studies are necessary to evaluate the clinical impact of silver nitrate in the context of PTH and will benefit from more robust sample sizes and enhanced diversity in the sample group.