Contrast-Enhanced Ultrasound Algorithms (CEUS-LIRADS/ESCULAP) for the Noninvasive Diagnosis of Hepatocellular Carcinoma - A Prospective Multicenter DEGUM Study.

BACKGROUND: This prospective multicenter study funded by the DEGUM assesses the diagnostic accuracy of standardized contrast-enhanced ultrasound (CEUS) for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients. METHODS: Patients at high risk for HCC with a histologically proven focal liver lesion on B-mode ultrasound were recruited prospectively in a multicenter approach. Clinical and imaging data were entered via online entry forms. The diagnostic accuracies for the noninvasive diagnosis of HCC were compared for the conventional interpretation of standardized CEUS at the time of the examination (= CEUS on-site) and the two CEUS algorithms ESCULAP (Erlanger Synopsis for Contrast-enhanced Ultrasound for Liver lesion Assessment in Patients at risk) and CEUS LI-RADS (Contrast-Enhanced UltraSound Liver Imaging Reporting and Data System). RESULTS: 321 patients were recruited in 43 centers; 299 (93.1 %) had liver cirrhosis. The diagnosis according to histology was HCC in 256 cases, and intrahepatic cholangiocarcinoma (iCCA) in 23 cases. In the subgroup of cirrhotic patients (n = 299), the highest sensitivity for the diagnosis of HCC was achieved with the CEUS algorithm ESCULAP (94.2 %) and CEUS on-site (90.9 %). The lowest sensitivity was reached with the CEUS LI-RADS algorithm (64 %; p < 0.001). However, the specificity of CEUS LI-RADS (78.9 %) was superior to that of ESCULAP (50.9 %) and CEUS on-site (64.9 %; p < 0.001). At the same time, the negative predictive value (NPV) of CEUS LI-RADS was significantly inferior to that of ESCULAP (34.1 % vs. 67.4 %; p < 0.001) and CEUS on-site (62.7 %; p < 0.001). The positive predictive values of all modalities were high (around 90 %), with the best results seen for CEUS LI-RADS and CEUS on-site. CONCLUSION: This is the first multicenter, prospective comparison of standardized CEUS and the recently developed CEUS-based algorithms in histologically proven liver lesions in cirrhotic patients. Our results reaffirm the excellent diagnostic accuracy of CEUS for the noninvasive diagnosis of HCC in high-risk patients. However, on-site diagnosis by an experienced examiner achieves an almost equal diagnostic accuracy compared to CEUS-based diagnostic algorithms.

The impact of fertilizers on the uptake of manganese in Cherry Belle radish plants: implications for human health.

Miracle-Gro Singles, Miracle-Gro Shake and Feed, and Vigoro fertilizers are associated with net loss/enhancement of Mn, up to an order of magnitude when referenced to controls in soil, radish vegetables, and radish leaves; Mn enhancements are a factor of 4 to 65 below the daily required intake for humans (2-5.5 mg/day). Manganese levels were measured by atomic absorption spectrometry (AAS). Control soil, radish vegetables, and radish leaves contained 65 µg/g to 146 µg/g (median = 108), 65 µg/g to 357 µg/g (median = 281), and 185 µg/g to 401 µg/g (median = 323) of Mn, correspondingly. Manganese uptake was ten times greater in radish leaves compared to radish vegetables and enhanced by a factor of 3 in soils. Edible radish leaves/vegetables contain 65 times less than human Mn daily requirements. This equates eating 140 lb/day of radish vegetables/leaves. The fertilizers have a minor impact on Mn accumulation in radish leaves/vegetables. The USDA Nutrient Database for radish (0.69 µg/g of Mn) contradicts this notion as one would need to consume ~ 7 to 18 lb/day of radish to satisfy their daily intake. This study complements investigations showing that fertilizers induce minimal uptake of heavy metals in food; simultaneously, the net loss of Mn amounts observed in some samples of radish leaves and vegetables is analogous to the dilution effect of minerals/nutrients in edibles. Although a deficiency/excess of Mn in one's diet may lead to adverse health effects, background inhalation exposure in general public, occupational, and emergency response settings has a greater influence on one's propensity toward developing adverse health effects related to Mn inhalation exposure.