Long-term follow-up of hepatic adenoma and adenomatosis: analysis of size change on imaging with histopathological correlation.

AIM: To analyse the change in size on follow-up of hepatic adenomas (HAs) and adenomatosis, and to investigate the relationship of imaging features with size change. MATERIALS AND METHODS: The study included 44 patients (142 lesions) who underwent magnetic resonance imaging (MRI) or computed tomography (CT) for diagnosis and follow-up of HA. The imaging features and percentage change in maximum tumour dimension were observed over a follow-up duration of up to 139 months. RESULTS: With an average follow-up of 43 months, 37% lesions decreased in size, 58% were stable, 4% increased; one lesion regressed completely. Adenomas were stratified into size groups (<3, 3-5, and ≥5 cm). Size change among the three groups was similar (p>0.05). Percent size change was different for lesions followed for ≤12 months (-7.2%) compared with lesions followed for 13-60 months (-20.5%), and those followed for ≥60 months (-23.5%; p<0.05); there was no difference between lesions followed for 13-60 months and ≥60 months (p=0.523). Baseline size and percent size change was similar between the hepatocyte nuclear factor 1α-inactivated HA (HA-H) and inflammatory HA (HA-I) subtype (p>0.05). CONCLUSION: Most adenomas were either stable or regressed on follow-up. Size change was independent of baseline size. After an initial size decrease within 5 years, no further size reduction was noted on extended follow-up. The percent size change in the HA-H and HA-I subtype was similar.

Revenue Increase following 2017 Multiple Procedures Payment Reduction Modification: Differential Impact on Neuroradiology-Report from an Academic Medical Center.

BACKGROUND AND PURPOSE: The Centers for Medicare and Medicaid Services imposed a 25% professional component multiple procedure payment reduction for the professional component of advanced diagnostic imaging modalities in January 2012. In 2017, the Centers for Medicare and Medicaid Services rolled back the multiple procedure payment reduction to 5% for subsequent imaging. To evaluate the effect of this change, we analyzed 5 months of Centers for Medicare and Medicaid Services procedures at Johns Hopkins Medical Institution. MATERIALS AND METHODS: We analyzed the procedure codes and reimbursement rate for studies performed between January 1 and May 31, 2017. Patients with Medicare insurance who had multiple diagnostic procedures in a day were selected. Per the Centers for Medicare and Medicaid Services guidelines, procedures with the highest price were considered fully reimbursed and subsequent studies were marked for differences between 25% (2013-2016) and 5% reduction (2017). RESULTS: We included 8787 patients with 22,236 procedures (mean, 2.53 studies/day). CT, MR imaging, and ultrasound scans composed 75.9%, 21.5%, and 2.6% of all studies, with 61.2%, 54.9%, and 85.4% of the procedures of each technique subject to multiple procedure payment reduction, respectively. The projected reimbursement for these studies was $1,666,437, which translated to a $179,782 (12.1%) increase in revenue comparing 25%-versus-5% multiple procedure payment reduction rates for 5 months: $128,542 for CT, $47,802 for MR imaging, and $3439 for ultrasound. The annual overall prorated increase in revenue would be $431,476. The impact was maximal for neuroradiology. CONCLUSIONS: With the recent favorable adjustment in multiple procedure payment reduction regulations, CT-heavy subspecialties like neuroradiology benefit the most with revenue increases. Different practice settings might experience revenue increases to a different extent, depending on the procedure and payer mix.

A polymorphism in the resistin gene promoter and the risk of multiple sclerosis.

AIM: Multiple sclerosis (MS) is an inflammatory neurodegenerative disorder that inflammatory cytokines have been implicated in its immunopathogenesis. Resistin, a member of cysteine-rich secretory proteins family, identified with inflammatory properties in humans. To elucidate whether different genotypes of resistin are involved in MS pathogenesis, we compared serum levels of TNF-α, IL-1ß, hs-CRP, and resistin levels in different genotypes of MS patients with relapsing remitting type and healthy subjects. METHODS: IN a case-control study, 86 MS patients and 86 age- and sex-matched healthy subjects were enrolled. The age, gender distribution, and BMI of MS patientsand control group were similar. The serum levels of TNF-α, IL-1ß, and Resistin were measured by ELISA. hs-CRP was measured by imunoturbidimetric method. After DNA extraction, the analysis of -420C/G SNP (rs1862513) was performed via PCR-RFLP method. RESULTS: The resistin, TNF-α, IL1ß, and hs-CRP levels were significantly higher in MS patients compared with control group. The distribution of "rs1862513" genotypes were not significant between MS and control groups. Although resistin and TNFα levels were higher in GG genotype carriers of both groups, but the difference was significant only in MS patient. CONCLUSION: Resistin gene polymorphisms may modify the being susceptible to MS disease, which may cause through various levels of cytokines between genotypes.