A Multicenter Assessment of Interreader Reliability of LI-RADS Version 2018 for MRI and CT.

Background Various limitations have impacted research evaluating reader agreement for Liver Imaging Reporting and Data System (LI-RADS). Purpose To assess reader agreement of LI-RADS in an international multicenter multireader setting using scrollable images. Materials and Methods This retrospective study used deidentified clinical multiphase CT and MRI and reports with at least one untreated observation from six institutions and three countries; only qualifying examinations were submitted.

The adoption of LI-RADS: a survey of non-academic radiologists.

Purpose: To understand the practice and determinants of non-academic radiologists regarding LI-RADS and the four current LI-RADS algorithms: CT/MRI, contrast-enhanced ultrasound (CEUS), ultrasound (US), and CT/MRI Treatment Response.

Materials And Methods: Seven themes were covered in this international survey, as follows: (1) demographics of participants and sub-specialty, (2) HCC practice and interpretation, (3) reporting practice, (4) screening and surveillance, (5) HCC imaging diagnosis, (6) treatment response, and (7) CT and MRI technique.

Results: Of the 232 participants, 69.

How to Use LI-RADS to Report Liver CT and MRI Observations.

Primary liver cancer is the fourth leading cause of cancer-related deaths worldwide, with hepatocellular carcinoma (HCC) comprising the vast majority of primary liver malignancies. Imaging plays a central role in HCC diagnosis and management. As a result, the content and structure of radiology reports are of utmost importance in guiding clinical management.

Clinicians and surgeon survey regarding current and future versions of CT/MRI LI-RADS.

Purpose: To determine preferences of clinicians and surgeons regarding radiology reporting of liver observations in patients at risk for hepatocellular carcinoma (HCC).

Methods: Members of the American College of Radiology Liver Imaging and Data Reporting System (LI-RADS) Outreach & Education Group (30 members) as well as Society of Abdominal Radiology Disease-Focused Panel on HCC diagnosis (27 members) created and distributed an 18-question survey to clinicians and surgeons, with focus on preferences regarding radiology reporting of liver observations in patients. The survey questions were directed to physician demographics, current use of LI-RADS by their local radiologists, their opinions about current LI-RADS and potential improvements.

LI-RADS: a conceptual and historical review from its beginning to its recent integration into AASLD clinical practice guidance.

The Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system for standardizing the terminology, technique, interpretation, reporting, and data collection of liver observations in individuals at high risk for hepatocellular carcinoma (HCC). LI-RADS is supported and endorsed by the American College of Radiology (ACR). Upon its initial release in 2011, LI-RADS applied only to liver observations identified at CT or MRI.

White paper of the Society of Abdominal Radiology hepatocellular carcinoma diagnosis disease-focused panel on LI-RADS v2018 for CT and MRI.

The Liver Imaging and Reporting Data System (LI-RADS) is a comprehensive system for standardizing the terminology, technique, interpretation, reporting, and data collection of liver imaging with the overarching goal of improving communication, clinical care, education, and research relating to patients at risk for or diagnosed with hepatocellular carcinoma (HCC). In 2018, the American Association for the Study of Liver Diseases (AASLD) integrated LI-RADS into its clinical practice guidance for the imaging-based diagnosis of HCC. The harmonization between the AASLD and LI-RADS diagnostic imaging criteria required minor modifications to the recently released LI-RADS v2017 guidelines, necessitating a LI-RADS v2018 update.

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging-based Diagnosis of Hepatocellular Carcinoma: A Systematic Review.

The Liver Imaging Reporting and Data System (LI-RADS) standardizes the interpretation, reporting, and data collection for imaging examinations in patients at risk for hepatocellular carcinoma (HCC). It assigns category codes reflecting relative probability of HCC to imaging-detected liver observations based on major and ancillary imaging features. LI-RADS also includes imaging features suggesting malignancy other than HCC.

Biliary Leak in the Postsurgical Abdomen: A Primer to HIDA Scan Interpretation.

Postsurgical bile leaks can be associated with significant morbidity and even mortality, if not identified and treated at an early phase. Hepatobiliary iminodiacetic acid (HIDA) scan is an important test for detection of bile leaks in the postoperative abdomen. However, the lack of anatomical details on planar images can make interpretation difficult, especially in the setting of altered postsurgical anatomy.

Hepatocellular carcinoma imaging systems: why they exist, how they have evolved, and how they differ.

Over the past 16 years, several scientific organizations have proposed systems that incorporate imaging for surveillance, diagnosis, staging, treatment, and monitoring of treatment response of hepatocellular carcinoma (HCC). These systems are needed to standardize the acquisition, interpretation, and reporting of liver imaging examinations; help differentiate benign from malignant observations; improve consistency between radiologists; and provide guidance for management of HCC. This review article discusses the historical evolution of HCC imaging systems.

Overview of the Novel and Improved Pulmonary Ventilation-Perfusion Imaging Applications in the Era of SPECT/CT.

Objective: In this article, we describe the concepts of ventilation-perfusion planar, SPECT, and SPECT/CT and outline the advantages of integrated ventilation-perfusion SPECT/CT over planar imaging. We present an overview of the traditional and new applications of ventilation-perfusion scintigraphy.

Conclusion: SPECT/CT has improved the diagnostic accuracy of ventilation-perfusion imaging and opened the door for a new spectrum of applications.

Diagnostic Accuracy of Preoperative Gadoxetic Acid-enhanced 3-T MR Imaging for Malignant Liver Lesions by Using Ex Vivo MR Imaging-matched Pathologic Findings as the Reference Standard.

Purpose: To determine per-lesion sensitivity and positive predictive value (PPV) of gadoxetic acid-enhanced 3-T magnetic resonance (MR) imaging for the diagnosis of malignant lesions by using matched (spatially correlated) hepatectomy pathologic findings as the reference standard. Materials and

Methods: In this prospective, institutional review board-approved, HIPAA-compliant study, 20 patients (nine men, 11 women; mean age, 59 years) with malignant liver lesions who gave written informed consent underwent preoperative gadoxetic acid-enhanced 3-T MR imaging for surgical planning. Two image sets were independently analyzed by three readers to detect liver lesions (set 1 without and set 2 with hepatobiliary phase [HBP] images).

Correlation of transesophageal ultrasound of the pericardium with computed tomography.

Objective: In this study, we assess the sensitivity and specificity of ultrasound and computed tomography (CT) for pericardial effusion and constrictive pericarditis.

Materials And Methods: This was a retrospective, institutional review board-approved, and health insurance privacy accountability act compliant study performed at a single tertiary center over a 10-year period (2001-2011) for patients who had clinical symptoms of pericarditis and had undergone both cardiac CT imaging and transesophageal echocardiogram (TEE) in a span of 2 weeks.

Inclusion Criteria: Inclusion criteria included patients with clinical symptoms of pericarditis, pericardial thickness measuring more than 2 mm on CT, and patients who had both cardiac CT imaging and TEE performed within 2 weeks.

Understanding LI-RADS: a primer for practical use.

The Liver Imaging-Reporting and Data System (LI-RADS) is a comprehensive system for standardized interpretation and reporting of computed tomography and magnetic resonance examinations performed in patients at risk for hepatocellular carcinoma. LI-RADS includes a diagnostic algorithm, lexicon, and atlas as well as suggestions for reporting, management, and imaging techniques. This primer provides an introduction to LI-RADS for radiologists including an explanation of the diagnostic algorithm, descriptions of the categories, and definitions of the major imaging features used to categorize observations with case examples.

Risk of nephrogenic systemic fibrosis is low in patients with chronic liver disease exposed to gadolinium-based contrast agents.

Purpose: To determine the risk of nephrogenic systemic fibrosis (NSF) in a cohort of patients with chronic liver disease.

Materials And Methods: This retrospective, Institutional Review Board (IRB)-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study was performed at a single tertiary liver center. The study cohort comprised 1167 patients with chronic liver disease followed in a liver clinic and exposed to gadolinium-based contrast agents (GBCAs) between February 2004 and October 2007.

An update on criteria for assessing tumor response to treatment.

Standardized tumor response criteria have been developed over time since the advent of cytotoxic anticancer therapies. The criteria have evolved and continue to do so as the understanding of the therapeutic basis of various anticancer agents increases and as novel therapeutic agents are developed. Currently, the criteria can be divided into the following main categories: anatomical-based criteria; tumor- and therapy-specific criteria; metabolic-based criteria; and response assessment of lymphomas.

A comprehensive review of the retroperitoneal anatomy, neoplasms, and pattern of disease spread.

A clear understanding of the normal anatomy and pattern of disease spread is important in evaluating many retroperitoneal disorders. Primary retroperitoneal tumors are uncommon, accounting for 0.1%-0.

Imaging-based diagnostic systems for hepatocellular carcinoma.

Objective: Noninvasive imaging plays critical roles in the treatment of patients with cirrhosis or other risk factors for the development of hepatocellular carcinoma. In recognition of the critical roles played by imaging, numerous international scientific organizations and societies have, in the past 12 years, proposed diagnostic systems for the interpretation of liver imaging examinations performed of at-risk patients.

Conclusion: Although these imaging-based diagnostic systems represent important advances, they have limitations and they are not perfectly consistent with each other.

Toward a standardized system for hepatocellular carcinoma diagnosis using computed tomography and MRI.

Contrast-enhanced computed tomography and MRI are frequently used for the noninvasive diagnosis of hepatocellular carcinoma (HCC). Despite their important role in diagnosis and management of HCC, until recently, there has been no standardized system for their interpretation, reporting and data collection. In 2008, the American College of Radiology convened a committee to develop such a standardized system.

Noninvasive classification of hepatic fibrosis based on texture parameters from double contrast-enhanced magnetic resonance images.

Purpose: To demonstrate a proof of concept that quantitative texture feature analysis of double contrast-enhanced magnetic resonance imaging (MRI) can classify fibrosis noninvasively, using histology as a reference standard.

Materials And Methods: A Health Insurance Portability and Accountability Act (HIPAA)-compliant Institutional Review Board (IRB)-approved retrospective study of 68 patients with diffuse liver disease was performed at a tertiary liver center. All patients underwent double contrast-enhanced MRI, with histopathology-based staging of fibrosis obtained within 12 months of imaging.

Herlyn-Werner-Wunderlich syndrome with a partially obstructed hemivagina.

Uterine didelphys with obstructed hemivagina and ipsilateral renal agenesis is a rare congenital anomaly of the Müllerian duct system referred to as Herlyn-Werner-Wunderlich syndrome. Because of its rare occurrence, a high level of suspicion is often required for diagnosis. Clinically, these patients usually present after menarche with pelvic pain, dysmenorrhea, and a palpable pelvic mass.

Quantitative Assessment of Liver Fat with Magnetic Resonance Imaging and Spectroscopy.

Hepatic steatosis is characterized by abnormal and excessive accumulation of lipids within hepatocytes. It is an important feature of diffuse liver disease, and the histological hallmark of non-alcoholic fatty liver disease (NAFLD). Other conditions associated with steatosis include alcoholic liver disease, viral hepatitis, HIV and genetic lipodystrophies, cystic fibrosis liver disease, and hepatotoxicity from various therapeutic agents.

In vivo characterization of the liver fat ¹H MR spectrum.

A theoretical triglyceride model was developed for in vivo human liver fat (1) H MRS characterization, using the number of double bonds (-CH=CH-), number of methylene-interrupted double bonds (-CH=CH-CH(2)-CH=CH-) and average fatty acid chain length. Five 3 T, single-voxel, stimulated echo acquisition mode spectra (STEAM) were acquired consecutively at progressively longer TEs in a fat-water emulsion phantom and in 121 human subjects with known or suspected nonalcoholic fatty liver disease. T(2)-corrected peak areas were calculated.