Hepatocellular Carcinoma With Atypical Imaging Features: Review of the Morphologic Hepatocellular Carcinoma Subtypes With Radiology-Pathology Correlation.

Hepatocellular carcinoma (HCC) is the fastest growing cause of cancer death in the United States with the incidence rate more than doubling in 20 years. HCC is unique since a noninvasive diagnosis can be achieved with imaging alone when specific clinical criteria and imaging characteristics are met, obviating the need for tissue sampling. However, HCC is a highly heterogeneous neoplasm. Atypical HCC subtypes vary significantly in their morphology, which can be attributed to specific histologic and molecular features, and can cause deviations from the classic imaging characteristics. The different morphologic subtypes of HCC frequently present a diagnostic challenge for radiologists and pathologists since their imaging and pathologic features can overlap with those of non-HCC malignancies. Identifying an atypical subtype can have important clinical implications. Liver transplant, albeit a scarce and limited resource, is the optimal treatment for conventional HCC, potentially curing both the tumor and the underlying pre-malignant condition. Some HCC subtypes as well as mimickers are associated with unacceptably high recurrence and poor outcome after transplant, and there remains limited data on the role and prognosis of liver transplantation for treatment of rare HCC subtypes. Other subtypes tend to recur later than classic HCC, potentially requiring a different follow-up scheme. This review will discuss the appearance of different HCC subtypes in relation to their histopathologic features. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.

Pancreaticoduodenal Groove: Spectrum of Disease and Imaging Features.

The pancreaticoduodenal groove (PDG) is a small space between the pancreatic head and duodenum where vital interactions between multiple organs and physiologic processes take place. Muscles, nerves, and hormones perform a coordinated dance, allowing bile and pancreatic enzymes to aid in digestion and absorption of critical nutrition. Given the multitude of organs and cells working together, a variety of benign and malignant entities can arise in or adjacent to this space. Management of lesions in this region is also complex and can involve observation, endoscopic resection, or challenging surgeries such as the Whipple procedure. The radiologist plays an important role in evaluation of abnormalities involving the PDG. While CT is usually the first-line examination for evaluation of this complex region, MRI offers complementary information. Although features of abnormalities involving the PDG can often overlap, understanding the characteristic imaging and pathologic features generally allows categorization of disease entities based on the suspected organ of origin and the presence of ancillary features. The goal of the authors is to provide radiologists with a conceptual approach to entities implicating the PDG to increase the accuracy of diagnosis and assist in appropriate management or presurgical planning. They briefly discuss the anatomy of the PDG, followed by a more in-depth presentation of the features of disease categories. A table summarizing the entities that occur in this region by underlying cause and anatomic location is provided. ©RSNA, 2022.

Ultrasound Evaluation for Extremity Deep Vein Thrombus in COVID-19-Positive Patients: Exam Positivity Rate and Association With D-Dimer Level.

OBJECTIVES: Determine the rate of positive extremity ultrasound exams for DVT in patients with COVID-19 and assess for differences in laboratory values in patients with and without DVT, which could be used as a surrogate to decide the need for further evaluation with ultrasound. METHODS: Retrospective case control study with 1:2 matching of cases (COVID-19+ patients) to controls (COVID-19- patients) based on age, gender, and race. Laboratory values assessed were serum D-dimer, fibrinogen, prothrombin time, international normalized ratio, and C-reactive protein. Demographic variables, comorbidities, and clinical variables including final disposition were also evaluated. P-values for categorical variables were calculated with the chi-square test or Fisher's exact test. P-values for continuous variables were compared with the use of a two-tailed unpaired t-test. RESULTS: The rate of extremity ultrasound exams positive for DVT were similar in patients with (14.7%) and without (19.3%) COVID-19 (P = .423). No significant difference was observed in laboratory values including the D-dimer level in COVID-19 patients without (mean 9523.9 ng/mL (range 339 to >60,000)) or with DVT (mean 13,663.7 ng/mL (range 1193->60,000)) (P = .475). No differences were found in demographic variabilities or co-morbidities among COVID-19 patients with and without extremity DVT. CONCLUSIONS: We found no statistically significant difference in rate of positive DVT studies between COVID-19+ and COVID-19- patients. D-dimer levels are elevated, in some cases markedly, in COVID-19 patients with and without DVTs and therefore these data do not support their use as a surrogate when assessing the need for ultrasound evaluation.

Skull Base-related Lesions at Routine Head CT from the Emergency Department: Pearls, Pitfalls, and Lessons Learned.

Routine non-contrast material-enhanced head CT is one of the most frequently ordered studies in the emergency department. Skull base-related pathologic entities, often depicted on the first or last images of a routine head CT study, can be easily overlooked in the emergency setting if not incorporated in the interpreting radiologist's search pattern, as the findings can be incompletely imaged. Delayed diagnosis, misdiagnosis, or lack of recognition of skull base pathologic entities can negatively impact patient care. This article reviews and illustrates the essential skull base anatomy and common blind spots that are important to radiologists who interpret nonenhanced head CT images in the acute setting. The imaging characteristics of important "do not miss" lesions are emphasized and categorized by their cause and location within the skull base, and the potential differential diagnoses are discussed. An interpretation checklist to improve diagnostic accuracy is provided. ©RSNA, 2019.

Cost-effectiveness analysis of newborn pulse oximetry screening to detect critical congenital heart disease in Colombia.

BACKGROUND: In many countries, economic assessments of the routine use of pulse oximetry in the detection of Critical Congenital Heart Disease (CCHD) at birth has not yet been carried out. CCHDs necessarily require medical intervention within the first months of life. This assessment is a priority in low and medium resource countries. The purpose of this study was to assess the cost-effectiveness (CE) relation of pulse oximetry in the detection of cases of CCHD in Colombia. METHODS: A full economic assessment of the cost-effectiveness type was conducted from the perspective of society. A decision tree was constructed to establish a comparison between newborn physical examination plus pulse oximetry, versus physical examination alone, in the diagnosis of CCHDs. The sensitivity and specificity of pulse oximetry were estimated from a systematic review of the literature; to assess resource use, micro-costing analyses and surveys were conducted. The time horizon of the economic evaluation was the first week after birth and until the first year of life. The incremental cost-effectiveness ratio (ICER) was determined and, to control for uncertainty, deterministic and probabilistic sensitivity analysis were made, including the adoption of different scenarios of budgetary impact. All costs are expressed in US dollars from 2017, using the average exchange rate for 2017 [$2,951.15 COP for 1 dollar]. RESULTS: The costs of pulse oximetry screening plus physical examination were $102; $7 higher than physical examination alone. The effectiveness of pulse oximetry plus the physical examination was 0.93; that is, 0.07 more than the physical examination on its own. The ICER was $100 for pulse oximetry screening; that is, if one wishes to increase 1% the probability of a correct CCHD diagnosis, this amount would have to be invested. A willingness to pay of $26.292 USD (direct medical cost) per probability of a correct CCHD diagnosis was assumed. CONCLUSIONS: At current rates and from the perspective of society, newborn pulse oximetry screening at 24 h in addition to physical examination, and considering a time horizon of 1 week, is a cost-effective strategy in the early diagnosis of CCHDs in Colombia.Trial registration "retrospectively registered".

A Case of Concurrent Mpox and Chlamydial Proctitis in a Patient With HIV.

The monkeypox (mpox) outbreak that began in May 2022 spread globally with a wide range of presentations. Mpox proctitis has been recognized as one of the severe forms of the virus during this outbreak. We present the case of a 33-year-old male with well-controlled HIV engaging in receptive anal intercourse presented with profuse rectal bleeding, tenesmus, and anal pain in July 2022. His symptoms persisted despite treatment for his rectal chlamydia with doxycycline. Rectal imaging with computed tomography demonstrated impressive inflammation. Contrast-enhanced images highlighted rectal wall thickening and submucosal edema. Diffuse lymphadenopathy of the anorectal region was also clearly seen. He received symptomatic treatment with tecovirimat resulting in the resolution of his symptoms and complaints. Subsequent rectal imaging displayed improvement and decreased inflammation. A better understanding of various presentations, imaging characteristics, and management is necessary to curb further dissemination.

Oximetry and neonatal examination for the detection of critical congenital heart disease: a systematic review and meta-analysis.

Background: Undiagnosed congenital heart disease in the prenatal stage can occur in approximately 5 to 15 out of 1000 live births; more than a quarter of these will have critical congenital heart disease (CCHD). Late postnatal diagnosis is associated with a worse prognosis during childhood, and there is evidence that a standardized measurement of oxygen saturation in the newborn by cutaneous oximetry is an optimal method for the detection of CCHD. We conducted a systematic review of the literature and meta-analysis comparing the operational characteristics of oximetry and physical examination for the detection of CCHD. Methods: A systematic review of the literature was conducted on the following databases including published studies between 2002 and 2017, with no language restrictions: Pubmed, Science Direct, Ovid, Scopus and EBSCO, with the following keywords: oximetry screening, critical congenital heart disease, newborn OR oximetry screening heart defects, congenital, specificity, sensitivity, physical examination. Results: A total of 419 articles were found, from which 69 were selected based on their titles and abstracts. After quality assessment, five articles were chosen for extraction of data according to inclusion criteria; data were analyzed on a sample of 404,735 newborns in the five included studies. The following values were found, corresponding to the operational characteristics of oximetry in combination with the physical examination: sensitivity: 0.92 (CI 95%, 0.87-0.95), specificity: 0.98 (CI 95%, 0.89-1.00), for physical examination alone sensitivity: 0.53 (CI 95%, 0.28-0.78) and specificity: 0.99 (CI 95%, 0.97-1.00). Conclusions: Evidence found in different articles suggests that pulse oximetry in addition to neonatal physical examination presents optimal operative characteristics that make it an adequate screening test for detection of CCHD in newborns, above all this is essential in low and middle-income settings where technology medical support is not entirely available.

Multi-class chemical exposure in rural Peru using silicone wristbands.

Exposure monitoring with personal silicone wristband samplers was demonstrated in Peru in four agriculture and urban communities where logistic and practical constraints hinder use of more traditional approaches. Wristbands and associated methods enabled quantitation of 63 pesticides and screening for 1397 chemicals including environmental contaminants and personal care products. Sixty-eight wristbands were worn for approximately one month by volunteers from four communities of Alto Mayo, Peru. We identified 106 chemicals from eight chemical classes among all wristbands. Agricultural communities were characterized by pesticides and PAHs, while the urban communities had more personal care products present. Multiple linear regressions explained up to 40% of variance in wristbands from chlorpyrifos, cypermethrin, and DDT and its metabolites (DDx) (r2=0.39, 0.30, 0.40, respectively). All three pesticides were significantly different between communities, and cypermethrin and DDx were associated with participant age. The calculated relative age of DDT suggested some communities had more recent exposure than others. This work aids health research in the Alto Mayo and beyond by identifying typical mixtures and potential sources of exposure to organic chemicals in the personal environment. Silicone wristband sampling with chemical screening is a candidate for widespread use in exposure monitoring in remote areas.