Background The Liver Imaging Reporting and Data System (LI-RADS) assigns a risk category for hepatocellular carcinoma (HCC) to imaging observations. Establishing the contributions of major features can inform the diagnostic algorithm. Purpose To perform a systematic review and individual patient data meta-analysis to establish the probability of HCC for each LI-RADS major feature using CT/MRI and contrast-enhanced US (CEUS) LI-RADS in patients at high risk for HCC. Materials and Methods Multiple databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus) were searched for studies from January 2014 to September 2019 that evaluated the accuracy of CT, MRI, and CEUS for HCC detection using LI-RADS (CT/MRI LI-RADS, versions 2014, 2017, and 2018; CEUS LI-RADS, versions 2016 and 2017). Data were centralized. Clustering was addressed at the study and patient levels using mixed models. Adjusted odds ratios (ORs) with 95% CIs were determined for each major feature using multivariable stepwise logistic regression. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (PROSPERO protocol: CRD42020164486). Results A total of 32 studies were included, with 1170 CT observations, 3341 MRI observations, and 853 CEUS observations. At multivariable analysis of CT/MRI LI-RADS, all major features were associated with HCC, except threshold growth (
Purpose The purpose of this study was to assess and compare diagnostic ability of LI-RADS (LR) v. 2017 and ESGAR guidelines in hepatocellular carcinoma (HCC) diagnosis using MRI with hepatobiliary contrast agents. Methods Seventy pathologically confirmed lesions in 32 patients (24 males and 8 females) who had MRI with hepatobiliary contrast done before surgery or biopsy were reviewed retrospectively. Six lesions were <10mm, 31 lesions 10-19mm, and 33 lesions ≥20mm. Two readers assessed all lesions according to LI-RADS v.2017 criteria and ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents. Statistical analysis was performed to compare diagnostic ability of both guidelines including receiver operative curves (ROC) and area under curve (AUC). Results For LR ≥ 4 sensitivity, specificity, accuracy, and AUC were 96%, 75%, 88.6%, and 85.5, respectively. For LR5 they were 74%, 95%, 80%, and 84.5, respectively. For ESGAR criteria with major and additional features, they were 88%, 75%, 84.3%, and 81.5, respectively. For ESGAR criteria only with major features they were 78%, 80%, 78.6%, and 79, respectively. AUC analysis revealed that overall diagnostic ability of LI-RADS was higher than ESGAR but the results did not show statistical significance. Conclusions Both LI-RADS and ESGAR guidelines presented high diagnostic ability in HCC diagnosis of MRI studies with hepatobiliary contrast agents. More complex LI-RADS criteria performed better than ESGAR guidelines and it may justify extra effort that needs to be put in the report. However, the results were not statistically different and the simplicity of the ESGAR guidelines should also be taken into consideration.
The Liver Imaging-Reporting and Data System (LI-RADS or LR) is a classification system for reading and reporting imaging studies in patients with high risk for hepatocellular carcinoma (HCC). One of its main goals is to improve communication between specialties, especially radiologists, hepatologists, surgeons, and pathologists. LI-RADS defines imaging features of the lesions and stratifies the risk of HCC into categories. It is the most comprehensive and highly specific system; however, its seeming complexity prevents many radiologists from using it in everyday practice. This article is a detailed review of the latest version of LI-RADS (v. 2017), which should be helpful for radiologists who are not very familiar with the system and its latest update.
Cystic adventitial disease is a rare disorder that occurs in peripheral arteries. Calf claudication caused by compression of the popliteal artery is a typical presentation of this disease. This is a report of two cases of occluded popliteal artery decompression by percutaneous ultrasound-guided cyst aspiration. In both cases, decompression of the artery was achieved with a significant decrease in the size of adventitial cysts and restoration of flow. Both patients reported complete resolution of symptoms and no calf pain 5 years after the procedure. MR findings and resolution of symptoms in these two patients show the efficacy of percutaneous adventitial cyst aspiration in a 5-year follow-up.
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