Evaluate the feasibility, safety and accuracy of a CT-guided robotic assistance for percutaneous needle placement in the liver. Sixty-six fiducials were surgically inserted into the liver of ten ...swine and used as targets for needle insertions. All CT-scan acquisitions and robotically-assisted needle insertions were coordinated with breath motion using respiratory monitoring. Skin entry and target points were defined on planning CT-scan. Then, robotically-assisted insertions of 17G needles were performed either by experienced interventional radiologists or by a novice. Post-needle insertion CT-scans were acquired to assess accuracy (3D deviation, ie. distance from needle tip to predefined target) and safety. All needle insertions (43/43; median trajectory length = 83 mm (interquartile range IQR 72-105 mm) could be performed in one (n = 36) or two (n = 7) attempts (100% feasibility). Blinded evaluation showed an accuracy of 3.5 ± 1.3 mm. Accuracy did not differ between novice and experienced operators (3.7 ± 1.3 versus 3.4 ± 1.2 mm, P = 0.44). Neither trajectory angulation nor trajectory length significantly impacted accuracy. No complications were encountered. Needle insertion using the robotic device was shown feasible, safe and accurate in a swine liver model. Accuracy was influenced neither by the trajectory length nor by trajectory angulations nor by operator's experience. A prospective human clinical trial is recruiting.
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•The 2014 version of LI-RADS does not outperform AASLD criteria for the non-invasive diagnosis of HCC <3 cm.•The rate of HCC decreases from LR-5 to LR-3.•LI-RADS offers a nodule-based ...evaluation of the risk of HCC.•The added-value of ancillary features is limited for the non-invasive diagnosis of small HCC.
Non-invasive imaging is crucial for the early diagnosis and successful treatment of hepatocellular carcinoma (HCC). Terminology and criteria for interpreting and reporting imaging results must be standardized to optimize diagnosis. The aim of this study was to prospectively compare the diagnostic accuracy of the American Association for the Study of Liver Diseases (AASLD) and the 2014 version of Liver Imaging Reporting and Data System (LI-RADS®) criteria for the non-invasive diagnosis of small HCC, and to evaluate the diagnostic value of ancillary features used in the LI-RADS criteria.
Between April 2009 and April 2012, patients with cirrhosis and one to three 10–30 mm nodules were enrolled and underwent computed tomography (CT) and magnetic resonance (MR) imaging. The diagnostic accuracy of both the AASLD and the LI-RADS criteria were determined based on their sensitivity, specificity, positive (PPV) and negative predictive values (NPV).
A total of 595 nodules were included (559 341 HCC, 61% with MR imaging and 529 332 HCC, 63% with CT). Overall, no (0%) LR-1 and LR-2, 44 (33%) and 47 (41%) LR-3, 50 (53%) and 54 (55%) LR-4, 244 (94%) and 222 (91%) LR-5 and 4 (67%) and 9 (82%) LR-5V were HCC on MR imaging and CT, respectively. The sensitivity, specificity, PPV/NPV of the AASLD score was 72.5%, 87.6%, 90.2%, and 66.9% for MR imaging, and 71.4%, 77.7%, 84.3%, 61.7% for CT, respectively. For the combination of LR-5V and LR-5 nodules these measures were 72.5%, 89.9%, 91.9% and 67.5% on MRI and 66.9%, 88.3%, 90.9% and 63.3% on CT, respectively. For the combination of LR-5V, LR-5 and LR-4 nodules they were 87.1%, 69.1%, 81.6% and 77.3% on MRI and 85.8%, 66%, 81% on 73.5% on CT, respectively.
The 2014 version of the LI-RADS is no more accurate than the AASLD score for the non-invasive diagnosis of small HCC in high-risk patients, but it provides important and complementary information on the probability of having HCC in high-risk patients, allowing for possible changes in the management of these patients.
The 2014 version of Liver Imaging Reporting and Data System criteria does not outperform the American Association for the Study of Liver Diseases criteria for the non-invasive diagnosis of hepatocellular carcinoma (HCC) smaller than 3 cm. Liver Imaging Reporting and Data System offers a nodule-based evaluation of the risk of HCC, allowing possible changes in management in these patients. The added value of ancillary features appears limited for the non-invasive diagnosis of small HCC.
Objectives
To obtain the diagnostic performance of diffusion-weighted (DW) and gadoxetic-enhanced magnetic resonance (MR) imaging in the detection of liver metastases.
Methods
A comprehensive search ...(EMBASE, PubMed, Cochrane) was performed to identify relevant articles up to June 2015. Inclusion criteria were: liver metastases, DW-MR imaging and/or gadoxetic acid-enhanced MR imaging, and per-lesion statistics. The reference standard was histopathology, intraoperative observation and/or follow-up. Sources of bias were assessed using the QUADAS-2 tool. A linear mixed-effect regression model was used to obtain sensitivity estimates.
Results
Thirty-nine articles were included (1,989 patients, 3,854 metastases). Sensitivity estimates for DW-MR imaging, gadoxetic acid-enhanced MR imaging and the combined sequence for detecting liver metastases on a per-lesion basis was 87.1 %, 90.6 % and 95.5 %, respectively. Sensitivity estimates by gadoxetic acid-enhanced MR imaging and the combined sequence were significantly better than DW-MR imaging (
p
= 0.0001 and
p
< 0.0001, respectively), and the combined MR sequence was significantly more sensitive than gadoxetic acid-enhanced MR imaging (
p
< 0.0001). Similar results were observed in articles that compared the three techniques simultaneously, with only colorectal liver metastases and in liver metastases smaller than 1 cm.
Conclusions
In patients with liver metastases, combined DW-MR and gadoxetic acid-enhanced MR imaging has the highest sensitivity for detecting liver metastases on a per-lesion basis.
Key Points
• DW-MRI is less sensitive than gadoxetic acid-enhanced MRI for detecting liver metastases
• DW-MRI and gadoxetic acid-enhanced MRI is the best combination
• Same results are observed in colorectal liver metastases
• Same results are observed in liver metastases smaller than 1 cm
• Same results are observed when histopathology alone is the reference standard
Objectives
To evaluate gender differences in the authorship of articles published in two major European radiology journals,
European Radiology
(EurRad) and
CardioVascular and Interventional Radiology
...(CVIR).
Methods
A retrospective bibliometric analysis was performed of 2632 papers published in EurRad and CVIR sampled over a period of 14 years (2002–2016). The authors’ gender was determined. The analysis was focused on first and last authors. In addition, the characteristics of the articles (type, origin, radiological subspecialty, and country) were noted.
Results
Overall, 23% of first authors and 10% of the last authors were women. The proportion of women significantly increased over time in EurRad from 22% in 2002 to 35% in 2016 for first authors (
p
> 0.001), and from 13% in 2002 to 18% in 2016 for last authors (
p
= 0.05). There was no significant increase in the proportion of female authors in CVIR over time. Female authors were more frequently identified in breast imaging (48%), pediatrics, and gynecological imaging (29%). There were more female authors in articles from Spain (34%), the Netherlands (28%), France, Italy, and South Korea (26%). Forty-one percent and 21% of women were first authors with a woman or man as last author, respectively (
p
< 0.001).
Conclusion
There was a significant increase in female authorship in original diagnostic but not interventional imaging research articles between 2002 and 2016, with a strong influence of the radiological subspecialty. Women were significantly more frequently first authors when the last author was a woman.
Key Points
• There was a significant increase in female authorship in original diagnostic but not interventional imaging research articles between 2002 and 2016.
• There is a strong influence of the radiological subspecialty on the percentage of female authors.
• Women are significantly more frequently first authors when the last author is a woman.
Objectives
To evaluate the diagnostic performance of CT for transmural necrosis (TN) in non-occlusive mesenteric ischemia (NOMI) according to the bowel segment involved.
Methods
From January 2009 to ...December 2019, all patients admitted to the intensive care unit (ICU) and requiring laparotomy for NOMI were retrospectively studied. CT had to have been performed within 24 h prior to laparotomy and were reviewed by two abdominal radiologists, with a consensus reading in case of disagreement. A set of CT features of mesenteric ischemia were assessed, separating the stomach, jejunum, ileum, and right (RC) and left colon (LC). Univariate and multivariate analyses were performed to identify features associated with TN. Its influence on overall survival (OS) was assessed.
Results
Among 145 patients, 95 (66%) had ≥ 1 bowel segment with TN, including 7 (5%), 31 (21%), 43 (29%), 45 (31%), and 52 (35%) in the stomach, jejunum, ileum, RC, and LC, respectively. Overall inter-reader agreement of CT features was significantly lower in the colon than in the small bowel (0.59 0.52–0.65 vs 0.74 0.70–0.77 respectively). The absence of bowel wall enhancement was the only CT feature associated with TN by multivariate analysis, whatever the bowel segment involved. Proximal TN was associated with poorer OS (
p
< 0.001).
Conclusions
The absence of bowel wall enhancement remains the most consistent CT feature of transmural necrosis, whatever the bowel segment involved in NOMI. Inter-reader agreement of CT features is lower in the colon than in the small bowel. Proximal TN seems to be associated with poorer OS.
Key Points
•
The absence of bowel wall enhancement is the most consistent CT feature associated with transmural necrosis in NOMI, whatever is the bowel segment involved.
•
Inter-reader agreement is lower in the colon than in the small bowel in NOMI.
•
In NOMI, the more proximal the bowel necrosis, the worse the prognosis.
Objectives
To prospectively assess the role of the US attenuation imaging coefficient (AC) for the diagnosis and quantification of hepatic steatosis.
Methods
One hundred and one patients underwent ...liver biopsy and US-AC measurement on the same day. Liver steatosis was graded according to biopsy as absent (S0 < 5%), mild (S1 5–33%), moderate (S2 33–66%), or severe (S3 > 66%); liver fibrosis was graded from F0 to F4. The correlation between AC and steatosis on pathology (%) was calculated using the Pearson correlation coefficient. The Student
t
or Mann–Whitney
U
test was used to compare continuous variables and ROC curve analysis was used to assess diagnostic performance of AC in diagnosing steatosis.
Results
Overall, 43 (42%), 35 (35%), 12 (12%), and 11 (11%) patients were classified as S0, S1, S2, and S3, respectively. The AC was positively correlated with steatosis as a continuous variable (%) on pathology (
r
= 0.58,
p
< 0.01). Patients with steatosis of any grade had a higher AC than those without steatosis (mean 0.77 ± 0.13 vs. 0.63 ± 0.09 dB/cm/MHz, respectively;
p
< 0.01, AUROC = 0.805). Patients with S2–S3 had a higher AC than patients with S0–1 (0.85 ± 0.11 vs. 0.67 ± 0.11 dB/cm/MHz, respectively;
p
< 0.01, AUROC = 0.892). AC > 0.69 dB/cm/MHz had a sensitivity and specificity of 76% and 86%, respectively, for diagnosing any grade of steatosis (S1–S3), and AC > 0.72 dB/cm/MHz had a sensitivity and specificity of 96% and 74%, respectively, for diagnosing S2–S3. The presence of advanced fibrosis (F3–F4) did not affect the calculated AC.
Conclusions
The attenuation imaging coefficient is a promising quantitative technique for the non-invasive diagnosis and quantification of hepatic steatosis.
Key Points
• Measurement of the attenuation coefficient is achieved with a very high rate of technical success.
• We found a significant positive correlation between the attenuation coefficient and the grade of steatosis on pathology.
• The attenuation imaging coefficient is a promising quantitative technique for the noninvasive diagnosis and quantification of hepatic steatosis.
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