LI-RADS v2018: utilizing ancillary features on gadoxetate-enhanced MRI to modify final LI-RADS category.

PURPOSE: To quantify how often the LI-RADS v2018 category changed when utilizing major features only, when utilizing major and ancillary features, and when utilizing major and ancillary features excluding gadoxetate-specific ancillary features. METHODS: Retrospective analysis of 100 patients age 18 and older at high risk for hepatocellular carcinoma who had an MRI abdomen performed with intravenous contrast gadoxetate between 1/1/2017 and 3/23/2018. Each examination was reviewed by a body fellowship-trained radiologist. LI-RADS category was assigned to the liver observation after review of major features only. Ancillary features were then reviewed and LI-RADS category assigned both including and excluding ancillary features specific to gadoxetate. RESULTS: Utilizing all MRI ancillary features, including those specific to gadoxetate, changed the final LI-RADS category in 56.4% of liver observations, the majority an increase or decrease from LR-3. When not including the ancillary features specific to gadoxetate, the final LI-RADS category changed in 30.9% of observations, the majority increasing from LR-3 to LR-4. CONCLUSION: Utilizing LI-RADS v2018 ancillary features can significantly alter the final LI-RADS category, especially when using gadoxetate-specific ancillary features. Understanding the correct application of ancillary features for the final LI-RADS category helps implement a more consistent category assessment amongst users.

Injury-induced insulin resistance in adipose tissue.

Hyperglycemia and insulin resistance are common findings in critical illness. Patients in the surgical ICU are frequently treated for this 'critical illness diabetes' with intensive insulin therapy, resulting in a substantial reduction in morbidity and mortality. Adipose tissue is an important insulin target tissue, but it is not known whether adipose tissue is affected by critical illness diabetes. In the present study, a rodent model of critical illness diabetes was used to determine whether adipose tissue becomes acutely insulin resistant and how insulin signaling pathways are being affected. There was a reduction in insulin-induced phosphorylation of IR, IRS-1, Akt and GSK-3ß. Since insulin resistance occurs rapidly in adipose tissue, but before the insulin resistance in skeletal muscle, it may play a role in the initial development of critical illness diabetes.