Semiautomated Detection of Early Infarct Signs on Noncontrast CT Improves Interrater Agreement.

BACKGROUND: Acute ischemic infarct identification on noncontrast computed tomography (NCCT) is highly variable between raters. A semiautomated method for segmentation of acute ischemic lesions on NCCT may improve interrater reliability. METHODS: Patients with successful endovascular reperfusion from the DEFUSE 3 trial (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke) were included. We created relative NCCT (rNCCT) color-gradient overlays by comparing the density of a voxel on NCCT to the homologous region in the contralateral hemisphere. Regions with a relative hypodensity of at least 5% were visualized. We coregistered baseline and follow-up images. Two neuroradiologists and 6 nonradiologists segmented the acute ischemic lesion on the baseline scans with 2 methods: (1) manually outlining hypodense regions on the NCCT (unassisted segmentation) and (2) manually excluding areas deemed outside of the ischemic lesion on the rNCCT color map (rNCCT-assisted segmentation). Voxelwise interrater agreement was quantified using the Dice similarity coefficient and volumetric agreement between raters with the detection index (DI), defined as the true positive volume minus the false positive volume. RESULTS: From a total of 92, we included 61 patients. Median age was 59 (64-77), and 57% were female. Stroke onset was known in 39%. Onset to NCCT was median, 8.5 hours (7-11) and median 10 hours (8.4-11.5) in patients with known and unknown onset, respectively. Compared with unassisted NCCT segmentation, rNCCT-assisted segmentation increased the Dice similarity coefficient by >50% for neuroradiologists (Dice similarity coefficient, 0.38 versus 0.83; P<0.001) and nonradiologists (Dice similarity coefficient, 0.14 versus 0.84; P<0.001), and improved the DI among nonradiologists (mean improvement, 5.8 mL [95% CI, 3.1-8.5] mL, P<0.001) but not among neuroradiologists. CONCLUSIONS: The high variability of manual segmentations of the acute ischemic lesion on NCCT is greatly reduced using semiautomated rNCCT. The rNCCT map may therefore aid acute infarct detection and provide more reliable infarct estimates for clinicians with less experience.

Intracardiac thrombosis and pulmonary thromboembolism during liver transplantation: A systematic review and meta-analysis.

Intracardiac thrombosis and/or pulmonary thromboembolism (ICT/PE) is a rare but devastating complication during liver transplantation. Its pathophysiology remains poorly understood, and successful treatment remains a challenge. This systematic review summarizes the available published clinical data regarding ICT/PE during liver transplantation. Databases were searched for all publications reporting on ICT/PE during liver transplantation. Data collected included its incidence, patient characteristics, the timing of diagnosis, treatment strategies, and patient outcomes. This review included 59 full-text citations. The point prevalence of ICT/PE was 1.42%. Thrombi were most often diagnosed during the neohepatic phase, particularly at allograft reperfusion. Intravenous heparin was effective in preventing early-stage thrombus from progressing further and restoring hemodynamics in 76.32% of patients it was utilized for; however, the addition of tissue plasminogen activator or sole use of tissue plasminogen activator offered diminishing returns. Despite all resuscitation efforts, the in-hospital mortality rate of an intraoperative ICT/PE was 40.42%, with nearly half of these patients dying intraoperatively. The results of our systematic review are an initial step for providing clinicians with data that can help identify higher-risk patients. The clinical implications of our results warrant the development of identification and management strategies for the timely and effective treatment of these tragic occurrences during liver transplantation.

Transcranial direct current stimulation for focal status epilepticus or lateralized periodic discharges in four patients in a critical care setting.

OBJECTIVE: Transcranial direct current stimulation (tDCS) has been advocated for various neurological conditions, including epilepsy. A 1-4-mA cathodal current applied to the scalp over a seizure focus can reduce spikes and seizures. This series of four patients with focal status epilepticus is among the first case series to demonstrate benefit of tDCS in the critical care setting. METHODS: Patients in the intensive care unit were referred for tDCS treatment when focal status epilepticus or clinically relevant lateralized periodic discharges did not resolve with conventional antiseizure medications and anesthetics. Battery-powered direct cathodal current at 2 mA was delivered by an ActivaDose (Caputron) tDCS device via a saline-soaked sponge on the scalp over the seizure focus. Anode was on the contralateral forehead or shoulder. Treatment was for 30 min, repeated twice in a day, then again 1-4 times more over the next few days. RESULTS: Three females and one male, aged 34-68 years, were treated. Etiologies of status epilepticus were posterior reversible encephalopathy syndrome in association with immunosuppressants for a liver transplant, perinatal hypoxic-ischemic injury, a prior cardioembolic parietal stroke, and central nervous system lupus. tDCS led to significant reduction of interictal spikes (.78 to .38/s, p < .0001) in three cases and electrographic seizures (3.83/h to 0/h, p < .001) in two cases. Medication reductions were enabled in all cases subsequent to tDCS. The only side effect of tDCS was transient erythema under the sponge in one case. Two patients died of causes unrelated to tDCS, one was discharged to a nursing home, and one became fully responsive as seizures were controlled with tDCS. SIGNIFICANCE: Spikes and electrographic seizure frequency significantly improved within 1 day of tDCS. Results are potentially confounded by multiple ongoing changes in medications and treatments. These results might encourage further investigation of tDCS in the critical care setting, but verification by controlled studies will be required.

O-RADS MRI After Initial Ultrasound for Adnexal Lesions: AJR Expert Panel Narrative Review.

The Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) and MRI risk stratification systems were developed by an international group of experts in adnexal imaging to aid radiologists in assessing adnexal lesions. The goal of imaging is to appropriately triage patients with adnexal lesions. US is the first-line imaging modality for assessment, whereas MRI can be used as a problem-solving tool. Both US and MRI can accurately characterize benign lesions such as simple cysts, endometriomas, hemorrhagic cysts, and dermoid cysts, avoiding unnecessary or inappropriate surgery. In patients with a lesion that does not meet criteria for one of these benign diagnoses, MRI can further characterize the lesion with an improved specificity for cancer and the ability to provide a probable histologic subtype in the presence of certain MRI features. This allows personalized treatment, including avoiding overly extensive surgery or allowing fertility-sparing procedures for suspected benign, borderline, or low-grade tumors. When MRI findings indicate a risk of an invasive cancer, patients can be expeditiously referred to a gynecologic oncologic surgeon. This narrative review provides expert opinion on the utility of multiparametric MRI when using the O-RADS US and MRI management systems.

Imaging Care for Transgender and Gender Diverse Patients: Best Practices and Recommendations.

Transgender and gender diverse (TGD) people experience health disparities, and many avoid necessary medical care because of fears of discrimination or mistreatment. Disparate care is further compounded by limited understanding of gender-affirming hormone therapy (GAHT) and gender-affirming surgery among the medical community. Specific to radiology, TGD patients report more negative imaging experiences than negative general health encounters, highlighting the need for guidance and best practices for inclusive imaging care. A patient's imaging journey provides numerous opportunities for improvement. Inclusive practice in a radiology department starts with ordering and scheduling the examination, facilitated by staff education on appropriate use of a patient's chosen name, gender identity, and pronouns. Contemporary electronic health record systems have the capacity for recording detailed sexual orientation and gender identity data, but staff must be trained to solicit and use this information. A welcoming environment can help TGD patients to feel safe during the imaging experience and may include institutional nondiscrimination policies, gender-neutral signage, and all-gender single-user dressing rooms and bathrooms. Image acquisition should be performed using trauma-informed and patient-centered care. Finally, radiologists should be aware of reporting considerations for TGD patients, such as avoiding the use of gender in reports when it is not medically relevant and using precise, respectful language for findings related to GAHT and gender-affirming surgical procedures. As a field, radiology has a range of opportunities for improving care delivery for TGD patients, and the authors summarize recommended best practices. See the invited commentary by Stowell in this issue. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Update on MRI in Evaluation and Treatment of Endometrial Cancer.

Endometrial cancer is the second most common gynecologic cancer worldwide and the most common gynecologic cancer in the United States, with an increasing incidence in high-income countries. Although the International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer is a surgical staging system, contemporary published evidence-based data and expert opinions recommend MRI for treatment planning as it provides critical diagnostic information on tumor size and depth, extent of myometrial and cervical invasion, extrauterine extent, and lymph node status, all of which are essential in choosing the most appropriate therapy. Multiparametric MRI using a combination of T2-weighted sequences, diffusion-weighted imaging, and multiphase contrast-enhanced imaging is the mainstay for imaging assessment of endometrial cancer. Identification of important prognostic factors at MRI improves both treatment selection and posttreatment follow-up. MRI also plays a crucial role for fertility-preserving strategies and in patients who are not surgical candidates by helping guide therapy and identify procedural complications. This review is a product of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease-Focused Panel and reflects a multidisciplinary international collaborative effort to summarize updated information highlighting the role of MRI for endometrial cancer depiction and delineation, treatment planning, and follow-up. The article includes information regarding dedicated MRI protocols, tips for MRI reporting, imaging pitfalls, and strategies for image quality optimization. The roles of MRI-guided radiation therapy, hybrid PET/MRI, and advanced MRI techniques that are applicable to endometrial cancer imaging are also discussed. Online supplemental material is available for this article. ©RSNA, 2022.

A deep learning framework for automated detection and quantitative assessment of liver trauma.

BACKGROUND: Both early detection and severity assessment of liver trauma are critical for optimal triage and management of trauma patients. Current trauma protocols utilize computed tomography (CT) assessment of injuries in a subjective and qualitative (v.s. quantitative) fashion, shortcomings which could both be addressed by automated computer-aided systems that are capable of generating real-time reproducible and quantitative information. This study outlines an end-to-end pipeline to calculate the percentage of the liver parenchyma disrupted by trauma, an important component of the American Association for the Surgery of Trauma (AAST) liver injury scale, the primary tool to assess liver trauma severity at CT. METHODS: This framework comprises deep convolutional neural networks that first generate initial masks of both liver parenchyma (including normal and affected liver) and regions affected by trauma using three dimensional contrast-enhanced CT scans. Next, during the post-processing step, human domain knowledge about the location and intensity distribution of liver trauma is integrated into the model to avoid false positive regions. After generating the liver parenchyma and trauma masks, the corresponding volumes are calculated. Liver parenchymal disruption is then computed as the volume of the liver parenchyma that is disrupted by trauma. RESULTS: The proposed model was trained and validated on an internal dataset from the University of Michigan Health System (UMHS) including 77 CT scans (34 with and 43 without liver parenchymal trauma). The Dice/recall/precision coefficients of the proposed segmentation models are 96.13/96.00/96.35% and 51.21/53.20/56.76%, respectively, in segmenting liver parenchyma and liver trauma regions. In volume-based severity analysis, the proposed model yields a linear regression relation of 0.95 in estimating the percentage of liver parenchyma disrupted by trauma. The model shows an accurate performance in avoiding false positives for patients without any liver parenchymal trauma. These results indicate that the model is generalizable on patients with pre-existing liver conditions, including fatty livers and congestive hepatopathy. CONCLUSION: The proposed algorithms are able to accurately segment the liver and the regions affected by trauma. This pipeline demonstrates an accurate performance in estimating the percentage of liver parenchyma that is affected by trauma. Such a system can aid critical care medical personnel by providing a reproducible quantitative assessment of liver trauma as an alternative to the sometimes subjective AAST grading system that is used currently.

Transfusion-Related Acute Lung Injury During Liver Transplantation: A Scoping Review.

Liver transplantation is associated with significant blood loss, often requiring massive blood product transfusion. Transfusion-related acute lung injury (TRALI) is a devastating cause of transfusion-related deaths. While reports have investigated the general incidence of TRALI, the incidence of TRALI specifically following transfusion during liver transplant remains unclear. This scoping review summarizes existing literature regarding TRALI during the liver transplantation perioperative period. Databases were searched for all articles and abstracts reporting on TRALI after liver transplantation. Data collected included number of patients studied, patient characteristics, incidences of TRALI, TRALI characteristics, and patient outcomes. The primary outcome investigated was the incidence of TRALI in the setting of liver transplantation. Thirteen full-text citations were included in this review. The incidence of TRALI post-liver transplant was 0.68% (65 of 9,554). Based on reported transfusion data, patients diagnosed with TRALI received an average of 10.92 ± 10.81 units of packed red blood cells (pRBC), 20.05 ± 15.72 units of fresh frozen plasma, and 5.75 ± 10.00 units of platelets. Common interventions following TRALI diagnosis included mechanical ventilation with positive end-expiratory pressure, inhaled high-flow oxygen, inhaled pulmonary vasodilator, and pharmacologic treatment using pressors or inotropes, corticosteroids, or diuretics. Based on reported mortality data, 26.67% of patients (12 of 45) diagnosed with TRALI died during the postoperative period. This scoping review underscores the importance of better understanding the incidence and presentation of TRALI after liver transplant surgery. The clinical implications of these results warrant the development of identification and management strategies for liver transplant patients at increased risk for developing TRALI.

An interpretable neural network for outcome prediction in traumatic brain injury.

BACKGROUND: Traumatic Brain Injury (TBI) is a common condition with potentially severe long-term complications, the prediction of which remains challenging. Machine learning (ML) methods have been used previously to help physicians predict long-term outcomes of TBI so that appropriate treatment plans can be adopted. However, many ML techniques are "black box": it is difficult for humans to understand the decisions made by the model, with post-hoc explanations only identifying isolated relevant factors rather than combinations of factors. Moreover, such models often rely on many variables, some of which might not be available at the time of hospitalization. METHODS: In this study, we apply an interpretable neural network model based on tropical geometry to predict unfavorable outcomes at six months from hospitalization in TBI patients, based on information available at the time of admission. RESULTS: The proposed method is compared to established machine learning methods-XGBoost, Random Forest, and SVM-achieving comparable performance in terms of area under the receiver operating characteristic curve (AUC)-0.799 for the proposed method vs. 0.810 for the best black box model. Moreover, the proposed method allows for the extraction of simple, human-understandable rules that explain the model's predictions and can be used as general guidelines by clinicians to inform treatment decisions. CONCLUSIONS: The classification results for the proposed model are comparable with those of traditional ML methods. However, our model is interpretable, and it allows the extraction of intelligible rules. These rules can be used to determine relevant factors in assessing TBI outcomes and can be used in situations when not all necessary factors are known to inform the full model's decision.

Implantation of subcutaneous defibrillator is feasible and safe with monitored anesthesia care.

BACKGROUND: The perioperative anesthesia care during subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation is still evolving. OBJECTIVE: To assess the feasibility and safety of S-ICD implantation with monitored anesthesia care (MAC) versus general anesthesia (GA) in a tertiary care center. METHODS: This is a single-center retrospective study of patients undergoing S-ICD implantation between October 2012 and May 2019. Patients were categorized into MAC and GA group based on the mode of anesthesia. Procedural success without escalation to GA was the primary endpoint of the study, whereas intraprocedural hemodynamics, need of pharmacological support for hypotension and bradycardia, length of the procedure, stay in the post-anesthesia care unit, and postoperative pain were assessed as secondary endpoints. RESULTS: The study comprises 287 patients with MAC in 111 and GA in 176 patients. Compared to MAC, patients in GA group were younger and had a higher body mass index. All patients had successful S-ICD implantation. Only one patient (0.9%) in the MAC group was converted to GA. Despite a similar baseline heart rate (HR) and mean arterial blood pressure (MAP) in both groups, patients with GA had significantly lower HR and MAP during the procedure and more frequently required pharmacological hemodynamic support. Length of the procedure, stay in the postanesthesia care unit, and postoperative pain was similar in both groups. CONCLUSION: This retrospective experience suggests that implantation of S-ICD is feasible and safe with MAC. Use of GA is associated with more frequent administration of hemodynamic drugs during S-ICD implantation.

NIST Spectroscopic Measurement Standards.

Ultraviolet (UV) absorbance measurements provide a rapid and reliable method to determine protein concentrations. the National Institute of standards and technology (NIST) has developed Standard Reference Material (SRM) 2082 as a pathlength standard for UV absorbance measurements for use with the new generation of microvolume spectrophotometers and short-pathlength cuvettes. short pathlengths are used with high-concentration targets to ensure that absorbance values are within the optimal range. the short-pathlength instruments and cuvettes also reduce the required volumes to conserve valuable samples. the authors compared the results obtained with high-quality dual-beam spectrophotometers and short-pathlength cuvettes to the results obtained from a microvolume spectrophotometer and a microvolume plate reader. SRM 2082 can be used to accurately calculate pathlength values, thereby increasing the accuracy in subsequent measurements using the short-pathlength cuvettes and microvolume absorbance instruments. RM 8671 (reference material, the NISTmAb) can then be used to ensure the accuracy and reproducibility of protein concentration measurements by providing an industrially relevant reference material, a well-characterized monoclonal antibody.

Creating Three-dimensional Printed Models of Acetabular Fractures for Use as Educational Tools.

Acetabular fractures are frequently encountered in some clinical practices, and the precise classification of these fractures greatly influences treatments and outcomes. The authors identified the need for an educational aid when teaching acetabular fracture classifications, given the complex spatial anatomy and the nonintuitive classification system that is commonly used. Three-dimensional ( 3D three-dimensional ) printing is an evolving technique that has applications as an educational aid, providing the student with a tangible object to interact with and learn from. In this article, the authors review their experience creating 3D three-dimensional printed models of the hip for educational purposes. Their goal was to create 3D three-dimensional printed models for use as educational aids when teaching acetabular fracture classifications. Complex cases involving a combination of fracture types, subtle nondisplaced fractures, and/or fractures with associated osteopenia or artifacts were excluded. The selected computed tomographic (CT) scans were loaded into a medical 3D three-dimensional volume-rendering program, and a 3D three-dimensional volumetric model was created. Standard Tessellation Language ( STL Standard Tessellation Language ) files were then exported to STL Standard Tessellation Language model-editing software and edited to retain only the involved hemipelvis. In some cases, the proximal femur and ipsilateral hemisacrum may be included to emphasize hip alignment or disruption of the force transfer. Displaced fracture fragments can be printed as separate segments or a single unit after the addition of struts. Printing was performed by using an additive manufacturing principle, with approximately 36-48 hours needed for printing, postprocessing, and drying. The cost to print a 1:1 scale model was approximately $100-$200, depending on the amount of plastic material used. These models can then be painted according to the two-column theory regarding acetabular fractures. ©RSNA, 2017.

Reducing Variability in Orthogonal Reformatted Image Quality Associated With Axial Long-z-Axis CT Angiography.

OBJECTIVE: The objective of our study was to reduce variation in image quality of orthogonal reformatted images generated from long-z-axis CT angiography (CTA) studies of the upper and lower extremities. SUBJECTS AND METHODS: Upper and lower extremity CTA studies were targeted at a single health care system. A correctly performed CTA examination was defined as one that met the following three criteria: Sagittal and coronal reformats were obtained, a high-resolution matrix greater than 512 × 512 was used, and reformatted images were available in a distance-measurable format. Baseline data were collected from February 1, 2014, through September 30, 2014. Corrective actions were implemented during three consecutive plan-do-check-act (PDCA) cycles from October 1, 2014, through July 31, 2015, that addressed human, technical, and systematic variations. A 3-month maintenance period followed in which no intervention was performed. Longitudinal data were analyzed monthly using a statistical process control chart (p-chart). RESULTS: The total number of long-z-axis extremity CTA studies analyzed was as follows: 351 CTA studies were analyzed at baseline, 94 at the first PDCA cycle, 92 at the second PDCA cycle, 114 at the third PDCA cycle, and 138 during the maintenance period. The monthly rate of correctly performed studies ranged from 7% to 51% (mean, 38% ± 13% [SD]) during the baseline period, 32-59% (mean, 46% ± 14%) during the first PDCA cycle, 40-81% (mean, 61% ± 21%) during the second PDCA cycle, and 80-82% (mean, 81% ± 0.9%) during the third PDCA cycle. The monthly rate improved to 90-91% (mean, 91% ± 0.5%) during the maintenance period. The upper and lower control limits of the p-chart were upshifted after the second and third PDCA cycles. Correcting systematic and technical variations led to the greatest improvements in reformat accuracy. CONCLUSION: Obtaining consistently and correctly reformatted images from long-z-axis CTA studies is achievable using iterative PDCA cycles.

Monitored Anesthesia Care for Subcutaneous Cardioverter-Defibrillator Implantation: A Single-Center Experience.

BACKGROUND: To date, general anesthesia has been suggested as the preferred approach for implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD). The purpose of this study was to assess the use of monitored anesthesia care (MAC) for S-ICD implantation. The goals were to assess adequate sedation and analgesia (efficacy endpoints) and major perioperative airway or hemodynamic compromise (safety endpoints). The authors hypothesized that MAC may provide adequate sedation and analgesia and no major perioperative airway or hemodynamic compromise during S-ICD implantation and multiple defibrillation threshold (DFT) testing. METHODS: Prospectively collected data of patients who underwent S-ICD implantation with MAC from 2015 to 2016 were analyzed retrospectively. The efficacy endpoints were the provision of an optimal depth of sedation and analgesia to facilitate S-ICD implantation without intra-procedure patient discomfort or awareness, and the absence of "severe" pain at the lead tunneling and the generator insertion sites post-procedure. The safety endpoints included: (1) periprocedural hypotension, as defined by a mean arterial pressure (MAP)<60 mmHg refractory to conventional pharmacotherapy, (2) heart rate (HR)<45 bpm requiring pharmacologic support, and (3) sedation-induced airway compromise requiring endotracheal intubation. MEASUREMENTS: MAP and HR were recorded during S-ICD implantation and DFT testing. The maximum and minimum infusion rates of propofol, supplemental sedatives, and analgesics, and doses of vasopressor and/or inotropic agents administered intra-procedurally were recorded. Post-procedure pain scores also were noted. RESULTS: Ten patients underwent S-ICD implantation with MAC (mean age, 56 years; 50% men; mean left ventricular ejection fraction was 39%). Implantation of the S-ICD system using MAC was successful in all patients without any major adverse events. The mean baseline MAP was 92.8 mmHg, and the mean end-procedure MAP was 88 mmHg (p = 0.26). When compared to baseline and end-procedure, the mean lowest intra-procedure MAP was significantly lower (67.4 mmHg; p = 0.0001). The mean baseline HR was 65.7 bpm, and the mean end-procedure HR was 70.1 bpm (p = 0.28). When compared to baseline and end-procedure, the mean lowest intra-procedure HR was significantly lower (55.8 bpm; p<0.001). MAC was not associated with airway compromise in any patient, and post-procedure pain was rated as no greater than "mild". CONCLUSIONS: Among a heterogeneous patient population undergoing S-ICD implantation and DFT testing, the use of MAC is efficacious, feasible, and safe.

Advances in awareness monitoring technologies.

PURPOSE OF REVIEW: Initial studies suggested that the use of processed electroencephalogram technology could significantly decrease the incidence of unintended intraoperative awareness events during general anesthesia. Subsequent work has cast doubts on these findings. This review will examine the current state of awareness monitoring. RECENT FINDINGS: Recently published randomized controlled trials examining the use of the bispectral index during general anesthesia have not been able to show superiority over other forms of monitoring depth of anesthesia, such as end-tidal anesthetic-agent concentration. Additionally, there is current interest in utilizing the unprocessed electroencephalogram to ascertain depth of anesthesia and recent studies have demonstrated its use in preventing postoperative delirium. SUMMARY: Although awareness monitors such as the bispectral index monitor may have benefit in patients in whom volatile anesthetic agents must be minimized - such as in hemodynamically unstable patients, or patients undergoing total intravenous anesthesia - these monitors do not appear to be useful for all patients.

A genome-wide scan identifies mutations in the gene encoding phosphodiesterase 11A4 (PDE11A) in individuals with adrenocortical hyperplasia.

Phosphodiesterases (PDEs) regulate cyclic nucleotide levels. Increased cyclic AMP (cAMP) signaling has been associated with PRKAR1A or GNAS mutations and leads to adrenocortical tumors and Cushing syndrome. We investigated the genetic source of Cushing syndrome in individuals with adrenocortical hyperplasia that was not caused by known defects. We performed genome-wide SNP genotyping, including the adrenocortical tumor DNA. The region with the highest probability to harbor a susceptibility gene by loss of heterozygosity (LOH) and other analyses was 2q31-2q35. We identified mutations disrupting the expression of the PDE11A isoform-4 gene (PDE11A) in three kindreds. Tumor tissues showed 2q31-2q35 LOH, decreased protein expression and high cyclic nucleotide levels and cAMP-responsive element binding protein (CREB) phosphorylation. PDE11A codes for a dual-specificity PDE that is expressed in adrenal cortex and is partially inhibited by tadalafil and other PDE inhibitors; its germline inactivation is associated with adrenocortical hyperplasia, suggesting another means by which dysregulation of cAMP signaling causes endocrine tumors.

Repeatability of diagnostic features and scoring systems for hepatocellular carcinoma by using MR imaging.

PURPOSE: To determine for expert and novice radiologists repeatability of major diagnostic features and scoring systems (ie, Liver Imaging Reporting and Data System [LI-RADS], Organ Procurement and Transplantation Network [OPTN], and American Association for the Study of Liver Diseases [AASLD]) for hepatocellular carcinoma (HCC) by using magnetic resonance (MR) imaging. MATERIALS AND METHODS: Institutional review board approval was obtained and patient consent was waived for this HIPAA-compliant, retrospective study. The LI-RADS discussed in this article refers to version 2013.1. Ten blinded readers reviewed 100 liver MR imaging studies that demonstrated observations preliminarily assigned LI-RADS scores of LR1-LR5. Diameter and major HCC features (arterial hyperenhancement, washout appearance, pseudocapsule) were recorded for each observation. LI-RADS, OPTN, and AASLD scores were assigned. Interreader agreement was assessed by using intraclass correlation coefficients and κ statistics. Scoring rates were compared by using McNemar test. RESULTS: Overall interreader agreement was substantial for arterial hyperenhancement (0.67 [95% confidence interval {CI}: 0.65, 0.69]), moderate for washout appearance (0.48 [95%CI: 0.46, 0.50]), moderate for pseudocapsule (0.52 [95% CI: 050, 0.54]), fair for LI-RADS (0.35 [95% CI: 0.34, 0.37]), fair for AASLD (0.39 [95% CI: 0.37, 0.42]), and moderate for OPTN (0.53 [95% CI: 0.51, 0.56]). Agreement for measured diameter was almost perfect (range, 0.95-0.97). There was substantial agreement for most scores consistent with HCC. Experts agreed significantly more than did novices and were significantly more likely than were novices to assign a diagnosis of HCC (P < .001). CONCLUSION: Two of three major features for HCC (washout appearance and pseudocapsule) have only moderate interreader agreement. Experts and novices who assigned scores consistent with HCC had substantial but not perfect agreement. Expert agreement is substantial for OPTN, but moderate for LI-RADS and AASLD. Novices were less consistent and less likely to diagnose HCC than were experts.

GPR124, an orphan G protein-coupled receptor, is required for CNS-specific vascularization and establishment of the blood-brain barrier.

Every organ in the body requires blood vessels for efficient delivery of oxygen and nutrients, but independent vascular beds are highly specialized to meet the individual needs of specific organs. The vasculature of the brain is tightly sealed, with blood-brain barrier (BBB) properties developing coincident with neural vascularization. G protein-coupled receptor 124 (GPR124) (tumor endothelial marker 5, TEM5), an orphan member of the adhesion family of G protein-coupled receptors, was previously identified on the basis of its overexpression in tumor vasculature. Here, we show that global deletion or endothelial-specific deletion of GPR124 in mice results in embryonic lethality associated with abnormal angiogenesis of the forebrain and spinal cord. Expression of GPR124 was found to be required for invasion and migration of blood vessels into neuroepithelium, establishment of BBB properties, and expansion of the cerebral cortex. Thus, GPR124 is an important regulator of neurovasculature development and a potential drug target for cerebrovascular diseases.