Liver Imaging Reporting and Data System criteria for the diagnosis of hepatocellular carcinoma in clinical practice: A pictorial minireview.

Hepatocellular carcinoma (HCC) is the sixth most common cancer. The main risk factors associated with HCC development include hepatitis B virus, hepatitis C virus, alcohol consumption, aflatoxin B1, and nonalcoholic fatty liver disease. However, hepatocarcinogenesis is a complex multistep process. Various factors lead to hepatocyte malignant transformation and HCC development. Diagnosis and surveillance of HCC can be made with the use of liver ultrasound (US) every 6 mo. However, the sensitivity of this imaging method to detect HCC in a cirrhotic liver is limited, due to the abnormal liver parenchyma. Computed tomography (CT) and magnetic resonance imaging (MRI) are considered to be most useful tools for at-risk patients or patients with inadequate US. Liver biopsy is still used for diagnosis and prognosis of HCC in specific nodules that cannot be definitely characterized as HCC by imaging. Recently the American College of Radiology designed the Liver Imaging Reporting and Data System (LI-RADS), which is a comprehensive system for standardized interpretation of CT and MRI liver examinations that was first proposed in 2011. In 2018, it was integrated into the American Association for the Study of Liver Diseases guidance statement for HCC. LI-RADS is designed to ensure high sensitivity, precise categorization, and high positive predictive value for the diagnosis of HCC and is applied to "high-risk populations" according to specific criteria. Most importantly LI-RADS criteria achieved international collaboration and consensus among liver experts around the world on the best practices for caring for patients with or at risk for HCC.

Graft failure prior to discharge after coronary artery bypass surgery: a prospective single-centre study using dual 64-slice computed tomography.

AIMS: The purpose of this study was to assess the incidence and predictors of graft failure prior to discharge. Multi-slice computed tomography has the ability to evaluate graft patency in a non-invasive way. METHODS AND RESULTS: Of 145 consecutive patients who were screened, 73 were included in the study (78% male, mean age 65 years). A total of 206 grafts were analysed (2.8±0.9 grafts/patient). Of the 206 grafts, 126 were venous, 72 were left internal mammary, five were right internal mammary and three were radial grafts. We evaluated 100% of proximal anastomoses sites and 92% (190/206) of the distal anastomoses. We identified five patients (6.8%) who had at least one occluded graft. A total of seven out of 206 (3.4%) grafts were occluded. Independent predictors of successful graft outcome were left anterior descending artery as a recipient artery, good distal run-off as assessed by a surgeon and vessel size larger than 2 mm. CONCLUSIONS: The results demonstrate that the in-hospital acute graft failure rate is 3.4% (6.8% of patients). Multi-slice computed tomography is a robust technique to assess novel therapies to reduce the rate of graft attrition further, and might be clinically useful in patients with persistent or early recurrence of symptoms after CABG.

Core needle biopsy of spinal lesions under CT guidance: review of 79 cases.

The authors report the results of a retrospective study about computed tomography (CT)-guided percutaneous vertebral biopsies in 79 cases (44 males and 35 females, aged from 6 to 84 years old). Five biopsies were performed at the cervical level, 31 at the thoracic, 30 at the lumbar, and 13 at the sacrum. A diagnosis was obtained in 75 out of the 79 patients. Diagnostic yield was 95%, and diagnostic accuracy was 97.3%. Core needle biopsy under CT guidance for spinal lesions is a fast, relatively simple, minimally invasive, and low-cost method, with high levels of diagnostic accuracy and few complications. It plays a major role in the correct diagnosis and therapeutic planning. CT guidance allows safe and accurate biopsy of osseous lesions throughout the spine, obviating invasive open biopsy in most cases.

Dural lesions mimicking meningiomas: A pictorial essay.

The purpose of this essay was to illustrate the radiological and pathological findings in a wide spectrum of dural lesions mimicking meningiomas. Familiarity with and knowledge of these findings will narrow the differential diagnosis and provide guidance for patient management. In this pictorial review, we describe the following entities: Solitary fibrous tumors, hemangiopericytoma, gliosarcoma, leiomyosarcoma, dural metastases, Hodgkin's disease, plasmocytoma, Rosai-Dorfman disease, neurosarcoidosis, melanocytic neoplasms and plasma cell granuloma.

Intracortical osteosarcoma of the tibia in a 14-year-old girl.

Intracortical osteosarcoma is the rarest form of osteosarcoma. The lesion is histologically characterized as a sclerosing variant of osteosarcoma. In this study, a new case of pathologically proven tibia intracortical osteosarcoma in a 14-year-old girl is presented. Imaging findings on computed tomography and magnetic resonance imaging are discussed. The role of computed tomography-guided biopsy is emphasized.

Massive variceal bleeding secondary to splenic vein thrombosis successfully treated with splenic artery embolization: a case report.

INTRODUCTION: Splenic vein thrombosis results in localized portal hypertension called sinistral portal hypertension, which may also lead to massive upper gastrointestinal bleeding. Symptomatic sinistral portal hypertension is usually best treated by splenectomy, but interventional radiological techniques are safe and effective alternatives in the management of a massive hemorrhage, particularly in cases that have a high surgical risk. CASE PRESENTATION: We describe a 23-year-old Greek man with acute massive gastric variceal bleeding caused by splenic vein thrombosis due to a missing von Leiden factor, which was successfully managed with splenic arterial embolization. CONCLUSIONS: Interventional radiological techniques are attractive alternatives for patients with a high surgical risk or in cases when the immediate surgical excision of the spleen is technically difficult. Additionally, surgery is not always successful because of the presence of numerous portal collaterals and adhesion. Splenic artery embolization is now emerging as a safe and effective alternative to surgery in the management of massive hemorrhage from gastric varices due to splenic vein thrombosis, which often occurs in patients with hypercoagulability.

Nasal chondromesenchymal hamartoma in a child.

Nasal chondromesenchymal hamartoma (NCMH) is a benign tumor that was described in 1998. The occurrence of this lesion in the nasal cavity of infants and children is especially rare, with only 21 cases reported in the international literature. We report a 12-month-old boy with respiratory distress due to nasal obstruction. Computed tomographic scan and magnetic resonance imaging examination demonstrated a soft-tissue mass obstructing the left nasal cavity. Digital subtraction angiography and preoperative superselective embolization with microparticles were also performed. The tumor was completely resected surgically. Histopathology and immunohistochemical analyses of the tumor disclosed a NCMH. The imaging characteristics of the tumor are described and the radiology literature is reviewed.

Anterior chest wall tuberculous abscess: a case report.

The granulomatous inflammation of tuberculosis usually involves the lungs and the hilar lymph nodes. Musculoskeletal tuberculosis (TB) occurs in 1-3% of patients with TB, while TB of the chest wall constitutes 1% to 5% of all cases of musculoskeletal TB. Furthermore, nowadays it is rarer to find extrapulmonary TB in immunocompetent rather that non-immunocompetent patients. The present case reports a fifty-six-year-old immunocompetent man with an anterior chest wall tuberculous abscess. The rarity of the present case relates both to the localization of the tuberculous abscess, and to the fact that the patient was immunocompetent. The diagnosis of musculoskeletal tuberculous infection remains a challenge for clinicians and requires a high index of suspicion. The combination of indolent onset of symptoms, positive tuberculin skin test, and compatible radiographic findings, strongly suggests the diagnosis. TB, however, must be confirmed by positive culture or histologic proof. Prompt diagnosis and treatment are important to prevent serious bone and joint destruction.