Current Guidelines for the Diagnosis and Management of Hepatocellular Carcinoma: A Comparative Review.

OBJECTIVE: The purpose of this article is to review aspects of guidelines pertinent to radiologists involved in the diagnosis or treatment of hepatocellular carcinoma. CONCLUSION: Early diagnosis and treatment of hepatocellular carcinoma are important because only 10% of patients meet the criteria for curative therapy at the time of diagnosis. Several organizations have developed guidelines for screening, diagnosis, and treatment of hepatocellular carcinoma. Radiologists play a pivotal role in every aspect of these guidelines.

CT of the Abdomen with Reduced Tube Voltage in Adults: A Practical Approach.

Recent innovations in computed tomographic (CT) hardware and software have allowed implementation of low tube voltage imaging into everyday CT scanning protocols in adults. CT at a low tube voltage setting has many benefits, including (a) radiation dose reduction, which is crucial in young patients and those with chronic medical conditions undergoing serial CT examinations for disease management; and (b) higher contrast enhancement. For the latter, increased attenuation of iodinated contrast material improves the evaluation of hypervascular lesions, vascular structures, intestinal mucosa in patients with bowel disease, and CT urographic images. Additionally, the higher contrast enhancement may provide diagnostic images in patients with renal dysfunction receiving a reduced contrast material load and in patients with suboptimal peripheral intravenous access who require a lower contrast material injection rate. One limitation is that noisier images affect image quality at a low tube voltage setting. The development of denoising algorithms such as iterative reconstruction has made it possible to perform CT at a low tube voltage setting without compromising diagnostic confidence. Other potential pitfalls of low tube voltage CT include (a) photon starvation artifact in larger patients, (b) accentuation of streak artifacts, and (c) alteration of the CT attenuation value, which may affect evaluation of lesions on the basis of conventional enhancement thresholds. CT of the abdomen with a low tube voltage setting is an excellent radiation reduction technique when properly applied to imaging of select patients in the appropriate clinical setting.

Soy foods and supplementation: a review of commonly perceived health benefits and risks.

In recent years, the impact of soy foods and supplements upon human health has become increasingly controversial among the general public. No one has conducted a broad evaluation of the scientific evidence supporting or refuting popular perceptions of the health effects of soy consumption. In this article, the authors have conducted a comprehensive assessment of the literature surrounding the health effects of soy consumption that are of greatest interest. This review has focused on 5 health benefits- relief of menopausal symptoms and prevention of heart disease, breast cancer, prostate cancer, and osteoporosis, and 5 health risks-increased risk of breast cancer, male hormonal and fertility problems, hypothyroidism, antinutrient content, and harmful processing by-products. Systematic reviews of human trials, prospective human trials, observational human studies, animal models, in vitro studies, and laboratory analyses of soy components were included for review. This literature review revealed that soy foods and isoflavones may provide relief from menopausal symptoms and protect against breast cancer and heart disease. Soy does not appear to offer protection against osteoporosis. The evidence on male fertility and reproductive hormones was conflicting; some studies demonstrated a deleterious impact caused by soy consumption and others showed no effect. Soy supplementation also appears to affect thyroid function in an inconsistent manner, as studies have shown both increases and decreases in the same parameters of thyroid activity. Soaking, fermentation, and heating may reduce problematic antinutrients contained in soy. The authors found that consuming moderate amounts of traditionally prepared and minimally processed soy foods may offer modest health benefits while minimizing potential for adverse health effects. However, additional studies are necessary to elucidate the variable thyroid response to soy supplementation, and more rigorous studies are required to assess dose-response relationships, the relationship between intestinal-flora composition and the response to soy, potential fertility issues among males, and the unknown long-term health effects of consuming highly processed modern soy foods.

Split-bolus single scan CTA for evaluation of mesenteric ischemia.

PURPOSE: To evaluate split-bolus single scan CTA protocol for evaluation of acute mesenteric ischemia. MATERIALS AND METHODS: In this HIPAA-compliant IRB-approved study, consecutive patients evaluated for mesenteric ischemia between 11/2015 and 10/2016 were included. Patients scanned prior to 4/2016 were scanned with multiphasic CTA protocol and after with split-bolus single scan CTA. Objective and subjective evaluation was performed by three board-certified readers. Findings were correlated to composite clinical reference outcome. RESULTS: Eighty patients were included: 40 with split-bolus and 40 with multiphasic CTA protocol with similar age (60.3 ± 16.2 years vs. 64.7 ± 17.0 years, p = 0.19) and BMI (28.0 ± 6.7 vs. 27.0 ± 8.7, p = 0.56). SMA attenuation was higher in multiphasic protocol compared to split-bolus protocol (336.5 ± 97.5 HU vs. 258.0 ± 67.3 HU, p < 0.001) with similar SMV attenuation (multiphasic 213.7 ± 58.4 HU vs. split-bolus 194.2 ± 52.2 HU, p = 0.14). Optimal phase of bowel, liver, and spleen enhancement was seen in similar high proportion (94-99%) in both protocols. There were 8/40 (20%) positive cases of mesenteric ischemia in each group. There was no difference in the diagnostic confidence of the readers for evaluation of the mesenteric vessels and bowel ischemia. There were no missed cases of mesenteric ischemia in either group. Mean effective dose was 42% lower in the split-bolus group, p < 0.001. There was a higher number of axial images to review in multiphasic protocol compared to split-bolus protocol (437.9 ± 48.7 vs. 263.5 ± 31.2, p < 0.001). CONCLUSIONS: The split-bolus protocol for evaluation of mesenteric ischemia is clinically feasible with confident and accurate diagnostic ability, while reducing number of images and decreasing radiation exposure to the patient.

Common genetic determinants of uveitis shared with other autoimmune disorders.

Uveitis is a complex multifactorial autoimmune disease of the eye characterized by inflammation of the uvea and retina, degeneration of the retina, and blindness in genetically predisposed patients. Using the rat model of experimental autoimmune uveitis (EAU), we previously identified three quantitative trait loci (QTL) associated with EAU on rat chromosomes 4, 12, and 10 (Eau1, Eau2, and Eau3). The primary goal of the current study is to delineate additional non-MHC chromosomal regions that control susceptibility to EAU, and to identify any QTLs that overlap with the QTLs of other autoimmune diseases. Using a set of informative microsatellite markers and F(2) generations of resistant and susceptible MHC class II-matched rat strains (F344 and LEW), we have identified several new significant or suggestive QTLs on rat chromosomes 2, 3, 7, 10, and 19 that control susceptibility to EAU. A protective allele was identified in the susceptible LEW strain in the Eau5 locus at D7Wox18, and epistatic interactions between QTLs were found to influence the severity of disease. The newly identified regions (Eau4 through Eau9) colocalize with the genetic determinants of other autoimmune disease models, and to disease-regulating syntenic regions identified in autoimmune patients on human chromosomes 4q21-31, 5q31-33, 16q22-24, 17p11-q12, 20q11-13, and 22q12-13. Our results suggest that uveitis shares some of the pathogenic mechanisms associated with other autoimmune diseases, and lends support to the "common gene, common pathway" hypothesis for autoimmune disorders.