Is There a Difference Between LI-RADS 3 to LI-RADS 5 Progression Assessment Using CT Versus MR? A Retrospective, Single-Center, Longitudinal Study of Patients Who Underwent 5082 Radiologic Examinations for Surveillance of Hepatocellular Carcinoma Over a 43-Month Period.

OBJECTIVE: The Liver Imaging Reporting and Data System (LI-RADS) has been widely applied to CT and MR liver observations in patients at high-risk for hepatocellular carcinoma (HCC). We investigated the impact of CT vs MR in upgrading LI-RADS 3 to LI-RADS 5 observations using a large cohort of high-risk patients. METHODS: We performed a retrospective, longitudinal study of CT and MR radiographic reports (June 2013 - February 2017) with an assigned LI-RADS category. A final population of 757 individual scans and 212 high-risk patients had at least one LI-RADS 3 observation. Differences in observation time to progression between modalities were determined using uni- and multivariable analysis. RESULTS: Of the 212 patients with a LI-RADS 3 observation, 52 (25%) had progression to LI-RADS 5. Tp ranged from 64 - 818 days (median: 196 days). One hundred and three patients (49%) had MR and 109 patients (51%) had CT as their index study. Twenty-four patients with an MR index exam progressed to LI-RADS 5 during the follow-up interval, with progression rates of 22% (CI:13%-30%) at 1 year and 29% (CI:17%-40%) at 2 years. Twenty-eight patients with a CT index exam progressed to LI-RADS 5 during follow-up, with progression rates of 26% (CI:16%-35%) at 1 year and 31% (CI:19%-41%) at 2 years. Progression rates were not significantly different between patients whose LI-RADS 3 observation was initially diagnosed on MR vs CT (HR: 0.81, P = 0.44). DISCUSSION: MR and CT modalities are comparable for demonstrating progression from LI-RADS 3 to 5 for high risk patients.

Prophylactic hydration to protect renal function from intravascular iodinated contrast material.

Nijssen EC, Rennenberg RJ, Nelemans PJ, Essers BA, Janssen MM, Vermeeren MA, van Ommen V, Wildberger JE. (Departments of Radiology and Nuclear Medicine, Internal Medicine, Epidemiology, Clinical Epidemiology and Medical Technology Assessment, and Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.) Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): A prospective, randomised, phase 3, controlled, open-label, non-inferiority trial. Lancet 2017;389:1312-22.