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.
Percutaneous image-guided biopsy is an invaluable technique in the management of a myriad of different conditions; however, percutaneous access to some targets remains challenging. Trans-osseous ...biopsy provides safe, high-yield access to many challenging lesions in the chest, abdomen, and pelvis which might otherwise require more invasive procedures, such as mediastinoscopy or surgery to establish a histological diagnosis. Additionally, trans-osseous biopsy is well tolerated and may reduce the risk of injury to intervening vital structures as compared to other percutaneous techniques. In this article we review the indications, technical challenges, alternative techniques, and potential complications of trans-sternal, trans-costal, trans-scapular, trans-vertebral, trans-iliac, and trans-sacral biopsies.
Objective
To examine whether incorrect AI results impact radiologist performance, and if so, whether human factors can be optimized to reduce error.
Methods
Multi-reader design, 6 radiologists ...interpreted 90 identical chest radiographs (follow-up CT needed: yes/no) on four occasions (09/20–01/22). No AI result was provided for session 1. Sham AI results were provided for sessions 2–4, and AI for 12 cases were manipulated to be incorrect (8 false positives (FP), 4 false negatives (FN)) (0.87 ROC-AUC). In the Delete AI (No Box) condition, radiologists were told AI results would not be saved for the evaluation. In Keep AI (No Box) and Keep AI (Box), radiologists were told results would be saved. In Keep AI (Box), the ostensible AI program visually outlined the region of suspicion. AI results were constant between conditions.
Results
Relative to the No AI condition (FN = 2.7%, FP = 51.4%), FN and FPs were higher in the Keep AI (No Box) (FN = 33.0%, FP = 86.0%), Delete AI (No Box) (FN = 26.7%, FP = 80.5%), and Keep AI (Box) (FN = to 20.7%, FP = 80.5%) conditions (all
p
s < 0.05). FNs were higher in the Keep AI (No Box) condition (33.0%) than in the Keep AI (Box) condition (20.7%) (
p
= 0.04). FPs were higher in the Keep AI (No Box) (86.0%) condition than in the Delete AI (No Box) condition (80.5%) (
p
= 0.03).
Conclusion
Incorrect AI causes radiologists to make incorrect follow-up decisions when they were correct without AI. This effect is mitigated when radiologists believe AI will be deleted from the patient’s file or a box is provided around the region of interest.
Clinical relevance statement
When AI is wrong, radiologists make more errors than they would have without AI. Based on human factors psychology, our manuscript provides evidence for two AI implementation strategies that reduce the deleterious effects of incorrect AI.
Key Points
•
When AI provided incorrect results, false negative and false positive rates among the radiologists increased.
•
False positives decreased when AI results were deleted, versus kept, in the patient’s record.
•
False negatives and false positives decreased when AI visually outlined the region of suspicion.
The aim of our study is to evaluate the diagnostic performance of CT-guided biopsy of lung nodules ≤10 mm based on their lobar and segmental location.
This was a retrospective study performed on 193 ...CT-guided percutaneous transthoracic needle biopsies of lung nodules ≤10 mm in greatest dimension, between January 1, 2013 and April 30, 2019. Biopsies were classified as either diagnostic or non-diagnostic based on final cytology and surgical pathology reports. Diagnostic results were those that met parameters for malignancy or a specific benign diagnosis, whereas atypical cells, non-specific benignity, or insufficient specimen were considered non-diagnostic.
A total of 1577 CT-guided percutaneous transthoracic needle biopsies were reviewed. Of these, 193 nodules (12.24%) measured ≤10 mm and were selected for further analysis. Of the 193 biopsies, 138 yielded diagnostic results while 56 yielded nondiagnostic results (71% vs 29%, respectively). When analyzed by nodule location, the superior segments of the lower lobes boasted the highest diagnostic yield compared to nodules located in the basal segments of the lower lobes which had the lowest diagnostic yield (84.2% vs 64.7%, respectively). Nodules in the upper lobes and in the middle lobes had a diagnostic yield of 70% and 66.7%, respectively.
The diagnostic performance of CT-guided biopsy of lung nodules ≤10 mm in diameter may be affected by lobar and segmental location. While the overall performance was good (diagnostic yield of 71%), the yield varied nearly 20% depending on location.
•Interventional radiologists are faced with an increasing number of sub-centimeter lung nodules to biopsy.•We studied the diagnostic performance of CT-guided biopsy of lung nodules ≤ 10 mm based on their lobar/segmental location.•Our hypothesis is that biopsies of small lung nodules located in the lower lobes will have the lowest diagnostic yield.•Our results showed that biopsy of lung nodules ≤ 10 mm in the basal segments of the lower lobes had the lowest diagnostic yield.
Abdominal and pelvic wall hernias are classically defined as a weakness or opening of the muscular wall through which abdominal or pelvic tissues protrude. The aim of this manuscript is to review the ...imaging findings of abdominal and pelvic wall hernias and their mimics and to discuss pearls and pitfalls for accurately diagnosing and classifying these entities.
•Abdominal wall hernias are common findings on CT of the abdomen and pelvis.•Identification of a hernia and its potential complications is critical to patient care.•Review of available prior cross-sectional imaging can aid in avoiding hernia-related complications during procedures.
Ventriculogallbladder (VGB) shunts are currently placed as a salvage procedure in treatment of hydrocephalus when all other options are exhausted. Although VGB shunts work well when successfully ...implanted, they are still rarely used because of the technical challenges with the traditional surgical technique.
To implant VGB shunts using a minimally invasive technique that is safer and less technically challenging.
We discussed our utilization of a percutaneous transhepatic approach to placement of the distal catheter into the gallbladder as a new technique that offers a solution to the established but surgically demanding current approach. We presented a complex patient with multiple failed shunts who underwent placement of a VGB shunt.
The shunt was successfully placed and did not incur any complications or require any revisions in 5 yr.
Given the safety and ease of this minimally invasive approach, we believe percutaneous transhepatic approach in VGB shunts should be considered as a reasonable option in patients with complex hydrocephalus.
Ganglioneuromas are rare tumors that occur spontaneously or arise from a poorly differentiated neuroblastic tumor. Although they are typically described in the pediatric population, they can occur in ...adults. Ganglioneuromas are often discovered incidentally and their typical imaging appearance, although non-specific, is that of a well-defined solid mass. We are presenting a case of a fat-containing adrenal lesion in a 53-year-old male. The extensive lipomatous changes within the lesion led to the presumption that it represented an adrenal myelolipoma. Pathology revealed a ganglioneuroma with extensive lipomatous changes. This is an uncommon presentation of an adrenal ganglioneuroma mimicking an adrenal myelolipoma. The diagnosis of an adrenal ganglioneuroma raises the possibility of syndromic associations for which patients may undergo genetic testing. We provide a review of typical imaging features of an adrenal ganglioneuroma and provide insight into the situations in which a ganglioneuroma can be suggested as a diagnostic consideration.
Abstract Delayed splenic rupture following conservative management of splenic injury is an extremely rare complication. We report a case of an adult patient who presented with delayed splenic rupture ...necessitating splenectomy, 2 months following blunt abdominal trauma. Imaging at the initial presentation demonstrated only minimal splenic contusion and the patient was discharge following 24 hours of observation.
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