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. Supported and endorsed by the American College of Radiology (ACR), the system has been developed by a committee of radiologists, hepatologists, pathologists, surgeons, lexicon experts, and ACR staff, with input from the American Association for the Study of Liver Diseases and the Organ Procurement Transplantation Network/United Network for Organ Sharing. Development of LI-RADS has been based on literature review, expert opinion, rounds of testing and iteration, and feedback from users. This article summarizes and assesses the quality of evidence supporting each LI-RADS major feature for diagnosis of HCC, as well as of the LI-RADS imaging features suggesting malignancy other than HCC. Based on the evidence, recommendations are provided for or against their continued inclusion in LI-RADS.
RSNA, 2017 Online supplemental material is available for this article.
This study evaluates the performance of diffusion‐weighted magnetic resonance imaging (DWI) for the detection of hepatocellular carcinoma (HCC) in pre–liver transplantation patients, compared and ...combined with contrast‐enhanced T1‐weighted imaging (CET1WI), using liver explant as the standard of reference. We included 52 patients with cirrhosis (40 men, 12 women; mean age, 56 years) who underwent DWI and CET1WI within 90 days of liver transplantation. Magnetic resonance images were analyzed for HCC detection in three separate sessions by two independent observers: DWI images (DW‐set), CET1WI (CE‐set), and all images together (All‐set). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), per‐patient accuracy, and per‐lesion PPV were calculated for each image set. A total of 72 HCCs were present in 33 patients at explant (mean size, 1.5 cm range, 0.3‐6.2 cm). Per‐patient sensitivity and NPV of CE‐set were significantly higher than those of DW‐set when using pooled data between observers (P = 0.02 and 0.03, respectively), whereas specificity, PPV, and accuracy were equivalent. Per‐lesion sensitivity was significantly higher for CE‐set versus DW‐set (59.0% versus 43.8%; P = 0.008, pooled data from two observers). When stratified by lesion size, the difference was significant only for lesions with a size between 1 and 2 cm (42.0% for DW‐set versus 74.0% for CE‐set; P = 0.001). The addition of DWI to CET1WI improved sensitivity for the more experienced observer. Conclusion: DWI is outperformed by CET1WI for detection of HCC, but represents a reasonable alternative to CET1WI for detection of HCC with a size above 2 cm. The addition of DWI to CET1WI slightly increases the detection rate. (HEPATOLOGY 2012;56:140–148)
Five percent to 9% of pancreatic ductal adenocarcinomas (PDACs) develop in patients with a germline
or
(g
+) mutation. Phase IB data from a trial that used cisplatin, gemcitabine, and veliparib ...treatment demonstrated a high response rate (RR), disease control rate (DCR), and overall survival (OS) in this population. We designed an open-label, randomized, multicenter, two-arm phase II trial to investigate cisplatin and gemcitabine with or without veliparib in g
+ PDAC.
Eligible patients had untreated g
PDAC with measurable stage III to IV disease and Eastern Cooperative Oncology Group performance status of 0 to 1. Treatment for patients in arm A consisted of cisplatin 25 mg/m
and gemcitabine 600 mg/m
intravenously on days 3 and 10; treatment for patients in arm B was the same as that for patients in arm A, and arm A also received veliparib 80 mg orally twice per day on days 1 to 12 cycled every 3 weeks. The primary end point was RRs of arm A and arm B evaluated separately using a Simon two-stage design. Secondary end points were progression-free survival, DCR, OS, safety, and correlative analyses.
Fifty patients were evaluated by modified intention-to-treat analysis. The RR for arm A was 74.1% and 65.2% for arm B (
= .55); both arms exceeded the prespecified activity threshold. DCR was 100% for arm A and 78.3% for arm B (
= .02). Median progression-free survival was 10.1 months for arm A (95% CI, 6.7 to 11.5 months) and 9.7 months for arm B (95% CI, 4.2 to 13.6 months;
= .73). Median OS for arm A was 15.5 months (95% CI, 12.2 to 24.3 months) and 16.4 months for arm B (95% CI, 11.7 to 23.4 months;
= .6). Two-year OS rate for the entire cohort was 30.6% (95% CI, 17.8% to 44.4%), and 3-year OS rate was 17.8% (95% CI, 8.1% to 30.7%). Grade 3 to 4 hematologic toxicities for arm A versus arm B were 13 (48%) versus seven (30%) for neutropenia, 15 (55%) versus two (9%) for thrombocytopenia, and 14 (52%) versus eight (35%) for anemia.
Cisplatin and gemcitabine is an effective regimen in advanced g
+ PDAC. Concurrent veliparib did not improve RR. These data establish cisplatin and gemcitabine as a standard approach in g
/
+ PDAC.
MRI of the Pancreas Harrington, Kate A.; Shukla‐Dave, Amita; Paudyal, Ramesh ...
Journal of magnetic resonance imaging,
February 2021, Letnik:
53, Številka:
2
Journal Article
Recenzirano
MRI has played a critical role in the evaluation of patients with pancreatic pathologies, from screening of patients at high risk for pancreatic cancer to the evaluation of pancreatic cysts and ...indeterminate pancreatic lesions. The high mortality associated with pancreatic adenocarcinomas has spurred much interest in developing effective screening tools, with MRI using magnetic resonance cholangiopancreatography (MRCP) playing a central role in the hopes of identifying cancers at earlier stages amenable to curative resection. Ongoing efforts to improve the resolution and robustness of imaging of the pancreas using MRI may thus one day reduce the mortality of this deadly disease. However, the increasing use of cross‐sectional imaging has also generated a concomitant clinical conundrum: How to manage incidental pancreatic cystic lesions that are found in over a quarter of patients who undergo MRCP. Efforts to improve the specificity of MRCP for patients with pancreatic cysts and with indeterminate pancreatic masses may be achieved with continued technical advances in MRI, including diffusion‐weighted and T1‐weighted dynamic contrast‐enhanced MRI. However, developments in quantitative MRI of the pancreas remain challenging, due to the small size of the pancreas and its upper abdominal location, adjacent to bowel and below the diaphragm. Further research is needed to improve MRI of the pancreas as a clinical tool, to positively affect the lives of patients with pancreatic abnormalities. This review focuses on various MR techniques such as MRCP, quantitative imaging, and dynamic contrast‐enhanced imaging and their clinical applicability in the imaging of the pancreas, with an emphasis on pancreatic malignant and premalignant lesions.
Level of Evidence 5
Technical Efficacy Stage 3
J. MAGN. RESON. IMAGING 2021;53:347–359.
Purpose
Intraductal papillary mucinous neoplasms (IPMNs) are radiographically visible precursor lesions of pancreatic cancer. Despite standard criteria for assessing risk, only 18% of cysts are ...malignant at resection. Thus, a large number of patients undergo unnecessary invasive surgery for benign disease. The ability to identify IPMNs with low or high risk of transforming into invasive cancer would optimize patient selection and improve surgical decision‐making. The purpose of this study was to investigate quantitative CT imaging features as markers for objective assessment of IPMN risk.
Methods
This retrospective study analyzed pancreatic cyst and parenchyma regions extracted from CT scans in 103 patients to predict IPMN risk. Patients who underwent resection between 2005 and 2015 with pathologically proven branch duct (BD)‐IPMN and a preoperative CT scan were included in the study. Expert pathologists categorized IPMNs as low or high risk following resection as part of routine clinical care. We extracted new radiographically inspired features as well as standard texture features and designed prediction models for the categorization of high‐ and low‐risk IPMNs. Five clinical variables were also combined with imaging features to design prediction models.
Results
Using images from 103 patients and tenfold cross‐validation technique, the novel radiographically inspired imaging features achieved an area under the receiver operating characteristic curve (AUC) of 0.77, demonstrating their predictive power. The combination of these features with clinical variables obtained the best performance (AUC = 0.81).
Conclusion
The present study demonstrates that features extracted from pretreatment CT images can predict the risk of IPMN. Development of a preoperative model to discriminate between low‐risk and high‐risk IPMN will improve surgical decision‐making.
Colorectal cancer (CRC) is a major cause of worldwide morbidity and mortality. Surgical treatment is common, and there is a great need to improve the delivery of such care. The gold standard for ...evaluating surgery is within well-designed randomized controlled trials (RCTs); however, the impact of RCTs is diminished by a lack of coordinated outcome measurement and reporting. A solution to these issues is to develop an agreed standard "core" set of outcomes to be measured in all trials to facilitate cross-study comparisons, meta-analysis, and minimize outcome reporting bias. This study defines a core outcome set for CRC surgery.
The scope of this COS includes clinical effectiveness trials of surgical interventions for colorectal cancer. Excluded were nonsurgical oncological interventions. Potential outcomes of importance to patients and professionals were identified through systematic literature reviews and patient interviews. All outcomes were transcribed verbatim and categorized into domains by two independent researchers. This informed a questionnaire survey that asked stakeholders (patients and professionals) from United Kingdom CRC centers to rate the importance of each domain. Respondents were resurveyed following group feedback (Delphi methods). Outcomes rated as less important were discarded after each survey round according to predefined criteria, and remaining outcomes were considered at three consensus meetings; two involving international professionals and a separate one with patients. A modified nominal group technique was used to gain the final consensus. Data sources identified 1,216 outcomes of CRC surgery that informed a 91 domain questionnaire. First round questionnaires were returned from 63 out of 81 (78%) centers, including 90 professionals, and 97 out of 267 (35%) patients. Second round response rates were high for all stakeholders (>80%). Analysis of responses lead to 45 and 23 outcome domains being retained after the first and second surveys, respectively. Consensus meetings generated agreement on a 12 domain COS. This constituted five perioperative outcome domains (including anastomotic leak), four quality of life outcome domains (including fecal urgency and incontinence), and three oncological outcome domains (including long-term survival).
This study used robust consensus methodology to develop a core outcome set for use in colorectal cancer surgical trials. It is now necessary to validate the use of this set in research practice.
One of the most striking quantum effects in an interacting Bose gas at low temperature is superfluidity. First observed in liquid 4He, this phenomenon has been intensively studied in a variety of ...systems for its remarkable features such as the persistence of superflows and the proliferation of quantized vortices. The achievement of Bose-Einstein condensation in dilute atomic gases provided the opportunity to observe and study superfluidity in an extremely clean and well-controlled environment. In the solid state, Bose-Einstein condensation of exciton polaritons has been reported recently. Polaritons are strongly interacting light-matter quasiparticles that occur naturally in semiconductor microcavities in the strong-coupling regime and constitute an interesting example of composite bosons. Here, we report the observation of spontaneous formation of pinned quantized vortices in the Bose-condensed phase of a polariton fluid. Theoretical insight into the possible origin of such vortices is presented in terms of a generalized Gross-Pitaevskii equation. Whereas the observation of quantized vortices is, in itself, not sufficient for establishing the superfluid nature of the non-equilibrium polariton condensate, it suggests parallels between our system and conventional superfluids.
Rational decisions Binmore, K. G; Binmore, K. G
2009., 20081229, 2008, 2009, 2009-01-01, 20090101, c2009, Letnik:
4
eBook
It is widely held that Bayesian decision theory is the final word on how a rational person should make decisions. However, Leonard Savage--the inventor of Bayesian decision theory--argued that it ...would be ridiculous to use his theory outside the kind of small world in which it is always possible to "look before you leap." If taken seriously, this view makes Bayesian decision theory inappropriate for the large worlds of scientific discovery and macroeconomic enterprise. When is it correct to use Bayesian decision theory--and when does it need to be modified? Using a minimum of mathematics, Rational Decisions clearly explains the foundations of Bayesian decision theory and shows why Savage restricted the theory's application to small worlds. The book is a wide-ranging exploration of standard theories of choice and belief under risk and uncertainty. Ken Binmore discusses the various philosophical attitudes related to the nature of probability and offers resolutions to paradoxes believed to hinder further progress. In arguing that the Bayesian approach to knowledge is inadequate in a large world, Binmore proposes an extension to Bayesian decision theory--allowing the idea of a mixed strategy in game theory to be expanded to a larger set of what Binmore refers to as "muddled" strategies. Written by one of the world's leading game theorists, Rational Decisions is the touchstone for anyone needing a concise, accessible, and expert view on Bayesian decision making.
Objectives
This study aims to measure the reproducibility of radiomic features in pancreatic parenchyma and ductal adenocarcinomas (PDAC) in patients who underwent consecutive contrast-enhanced ...computed tomography (CECT) scans.
Methods
In this IRB-approved and HIPAA-compliant retrospective study, 37 pairs of scans from 37 unique patients who underwent CECTs within a 2-week interval were included in the analysis of the reproducibility of features derived from pancreatic parenchyma, and a subset of 18 pairs of scans were further analyzed for the reproducibility of features derived from PDAC. In each patient, pancreatic parenchyma and pancreatic tumor (when present) were manually segmented by two radiologists independently. A total of 266 radiomic features were extracted from the pancreatic parenchyma and tumor region and also the volume and diameter of the tumor. The concordance correlation coefficient (CCC) was calculated to assess feature reproducibility for each patient in three scenarios: (1) different radiologists, same CECT; (2) same radiologist, different CECTs; and (3) different radiologists, different CECTs.
Results
Among pancreatic parenchyma-derived features, using a threshold of CCC > 0.90, 58/266 (21.8%) and 48/266 (18.1%) features met the threshold for scenario 1, 14/266 (5.3%) and 15/266 (5.6%) for scenario 2, and 14/266 (5.3%) and 10/266 (3.8%) for scenario 3. Among pancreatic tumor-derived features, 11/268 (4.1%) and 17/268 (6.3%) features met the threshold for scenario 1, 1/268 (0.4%) and 5/268 (1.9%) features met the threshold for scenario 2, and no features for scenario 3 met the threshold, respectively.
Conclusions
Variations between CECT scans affected radiomic feature reproducibility to a greater extent than variation in segmentation. A smaller number of pancreatic tumor-derived radiomic features were reproducible compared with pancreatic parenchyma-derived radiomic features under the same conditions.
Key Points
• For pancreatic-derived radiomic features from contrast-enhanced CT (CECT), fewer than 25% are reproducible (with a threshold of CCC < 0.9) in a clinical heterogeneous dataset.
• Variations between CECT scans affected the number of reproducible radiomic features to a greater extent than variations in radiologist segmentation.
• A smaller number of pancreatic tumor-derived radiomic features were reproducible compared with pancreatic parenchyma-derived radiomic features under the same conditions.
Prevention of hyperuricaemia (HU) is critical to the prevention of gout. Understanding causal relationships and relative contributions of various risk factors to hyperuricemia is therefore important ...in the prevention of gout. Here, we use attributable fraction to compare the relative contribution of genetic, dietary, urate-lowering therapy (ULT) and other exposures to HU. We use Mendelian randomisation to test for the causality of diet in urate levels.
Four European-ancestry sample sets, three from the general population (n = 419,060) and one of people with gout (n = 6781) were derived from the Database of Genotypes and Phenotypes (ARIC, FHS, CARDIA, CHS) and UK Biobank. Dichotomised exposures to diet, genetic risk variants, BMI, alcohol, diuretic treatment, sex and age were used to calculate adjusted population and average attributable fractions (PAF/AAF) for HU (≥0.42 mmol/L ≥7 mg/dL). Exposure to ULT was also assessed in the gout cohort. Two sample Mendelian randomisation was done in the UK Biobank using dietary pattern-associated genetic variants as exposure and serum urate levels as outcome.
Adherence to dietary recommendations, BMI (< 25 kg/m
), and absence of the SLC2A9 rs12498742 urate-raising allele produced PAFs for HU of 20 to 24%, 59 to 69%, and 57 to 64%, respectively, in the three non-gout cohorts. In the gout cohort, diet, BMI, SLC2A9 rs12498742 and ULT PAFs for HU were 12%, 49%, 48%, and 63%, respectively. Mendelian randomisation demonstrated weak causal effects of four dietary habits on serum urate levels (e.g. preferentially drinking skim milk increased urate, β = 0.047 mmol/L, P = 3.78 × 10
). These effects were mediated by BMI, and they were not significant (P ≥ 0.06) in multivariable models assessing the BMI-independent effect of diet on urate.
Diet has a relatively minor role in determining serum urate levels and HU. In gout, the use of ULT was the largest attributable fraction tested for HU.
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