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1.
Radiology ; 313(1): e232749, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39377679

RESUMEN

Background CT deep learning image reconstruction (DLIR) improves image quality by reducing noise compared with adaptive statistical iterative reconstruction-V (ASIR-V). However, objective assessment of low-contrast lesion detectability is lacking. Purpose To investigate low-contrast detectability of hypoattenuating liver lesions on CT scans reconstructed with DLIR compared with CT scans reconstructed with ASIR-V in a patient and a phantom study. Materials and Methods This single-center retrospective study included patients undergoing portal venous phase abdominal CT between February and May 2021 and a low-contrast-resolution phantom scanned with the same protocol. Four reconstructions (ASIR-V at 40% strength [ASIR-V 40] and DLIR at three strengths) were generated. Five radiologists qualitatively assessed the images using the five-point Likert scale for image quality, lesion diagnostic confidence, conspicuity, and small lesion (≤1 cm) visibility. Up to two key lesions per patient, confirmed at histopathologic testing or at prior or follow-up imaging studies, were included. Lesion-to-background contrast-to-noise ratio was calculated. Interreader variability was analyzed. Intergroup qualitative and quantitative metrics were compared between DLIR and ASIR-V 40 using proportional odds logistic regression models. Results Eighty-six liver lesions (mean size, 15 mm ± 9.5 [SD]) in 50 patients (median age, 62 years [IQR, 57-73 years]; 27 [54%] female patients) were included. Differences were not detected for various qualitative low-contrast detectability metrics between ASIR-V 40 and DLIR (P > .05). Quantitatively, medium-strength DLIR and high-strength DLIR yielded higher lesion-to-background contrast-to-noise ratios than ASIR-V 40 (medium-strength DLIR vs ASIR-V 40: odds ratio [OR], 1.96 [95% CI: 1.65, 2.33]; high-strength DLIR vs ASIR-V 40: OR, 5.36 [95% CI: 3.68, 7.82]; P < .001). Low-contrast lesion attenuation was reduced by 2.8-3.6 HU with DLIR. Interreader agreement was moderate to very good for the qualitative metrics. Subgroup analysis based on lesion size of larger than 1 cm and 1 cm or smaller yielded similar results (P > .05). Qualitatively, phantom study results were similar to those in patients (P > .05). Conclusion The detectability of low-contrast liver lesions was similar on CT scans reconstructed with low-, medium-, and high-strength DLIR and ASIR-V 40 in both patient and phantom studies. Lesion-to-background contrast-to-noise ratios were higher for DLIR medium- and high-strength reconstructions compared with ASIR-V 40. © RSNA, 2024 Supplemental material is available for this article.


Asunto(s)
Aprendizaje Profundo , Neoplasias Hepáticas , Fantasmas de Imagen , Interpretación de Imagen Radiográfica Asistida por Computador , Tomografía Computarizada por Rayos X , Humanos , Femenino , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos , Masculino , Persona de Mediana Edad , Neoplasias Hepáticas/diagnóstico por imagen , Anciano , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Hígado/diagnóstico por imagen
2.
Eur Radiol ; 2024 Jul 24.
Artículo en Inglés | MEDLINE | ID: mdl-39046499

RESUMEN

OBJECTIVES: To perform a multi-reader comparison of multiparametric dual-energy computed tomography (DECT) images reconstructed with deep-learning image reconstruction (DLIR) and standard-of-care adaptive statistical iterative reconstruction-V (ASIR-V). METHODS: This retrospective study included 100 patients undergoing portal venous phase abdominal CT on a rapid kVp switching DECT scanner. Six reconstructed DECT sets (ASIR-V and DLIR, each at three strengths) were generated. Each DECT set included 65 keV monoenergetic, iodine, and virtual unenhanced (VUE) images. Using a Likert scale, three radiologists performed qualitative assessments for image noise, contrast, small structure visibility, sharpness, artifact, and image preference. Quantitative assessment was performed by measuring attenuation, image noise, and contrast-to-noise ratios (CNR). For the qualitative analysis, Gwet's AC2 estimates were used to assess agreement. RESULTS: DECT images reconstructed with DLIR yielded better qualitative scores than ASIR-V images except for artifacts, where both groups were comparable. DLIR-H images were rated higher than other reconstructions on all parameters (p-value < 0.05). On quantitative analysis, there was no significant difference in the attenuation values between ASIR-V and DLIR groups. DLIR images had higher CNR values for the liver and portal vein, and lower image noise, compared to ASIR-V images (p-value < 0.05). The subgroup analysis of patients with large body habitus (weight ≥ 90 kg) showed similar results to the study population. Inter-reader agreement was good-to-very good overall. CONCLUSION: Multiparametric post-processed DECT datasets reconstructed with DLIR were preferred over ASIR-V images with DLIR-H yielding the highest image quality scores. CLINICAL RELEVANCE STATEMENT: Deep-learning image reconstruction in dual-energy CT demonstrated significant benefits in qualitative and quantitative image metrics compared to adaptive statistical iterative reconstruction-V. KEY POINTS: Dual-energy CT (DECT) images reconstructed using deep-learning image reconstruction (DLIR) showed superior qualitative scores compared to adaptive statistical iterative reconstruction-V (ASIR-V) reconstructed images, except for artifacts where both reconstructions were rated comparable. While there was no significant difference in attenuation values between ASIR-V and DLIR groups, DLIR images showed higher contrast-to-noise ratios (CNR) for liver and portal vein, and lower image noise (p value < 0.05). Subgroup analysis of patients with large body habitus (weight ≥ 90 kg) yielded similar findings to the overall study population.

3.
AJR Am J Roentgenol ; 222(5): e2330720, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38353447

RESUMEN

BACKGROUND. The 2022 Society of Radiologists in Ultrasound (SRU) consensus conference recommendations for small gallbladder polyps support management that is less aggressive than earlier approaches and may help standardize evaluation of polyps by radiologists. OBJECTIVE. The purpose of the present study was to assess the interreader agreement of radiologists in applying SRU recommendations for management of incidental gallbladder polyps on ultrasound. METHODS. This retrospective study included 105 patients (75 women and 30 men; median age, 51 years) with a gallbladder polyp on ultrasound (without features highly suspicious for invasive or malignant tumor) who underwent cholecystectomy between January 1, 2003, and January 1, 2021. Ten abdominal radiologists independently reviewed ultrasound examinations and, using the SRU recommendations, assessed one polyp per patient to assign risk category (extremely low risk, low risk, or indeterminate risk) and make a possible recommendation for surgical consultation. Five radiologists were considered less experienced (< 5 years of experience), and five were considered more experienced (≥ 5 years of experience). Interreader agreement was evaluated. Polyps were classified pathologically as nonneoplastic or neoplastic. RESULTS. For risk category assignments, interreader agreement was substantial among all readers (k = 0.710), less-experienced readers (k = 0.705), and more-experienced readers (k = 0.692). For surgical consultation recommendations, inter-reader agreement was substantial among all readers (k = 0.795) and more-experienced readers (k = 0.740) and was almost perfect among less-experienced readers (k = 0.811). Of 10 readers, a median of 5.0 (IQR, 2.0-8.0), 4.0 (IQR, 2.0-7.0), and 0.0 (IQR, 0.0-0.0) readers classified polyps as extremely low risk, low risk, and indeterminate risk, respectively. Across readers, the percentage of polyps classified as extremely low risk ranged from 32% to 72%; as low risk, from 24% to 65%; and as indeterminate risk, from 0% to 8%. Of 10 readers, a median of zero change to 0 (IQR, 0.0-1.0) readers recommended surgical consultation; the percentage of polyps receiving a recommendation for surgical consultation ranged from 4% to 22%. Of a total of 105 polyps, 102 were nonneo-plastic and three were neoplastic (all benign). Based on readers' most common assessments for nonneoplastic polyps, the risk category was extremely low risk for 53 polyps, low risk for 48 polyps, and indeterminate risk for one polyp; surgical consultation was recommended for 16 polyps. CONCLUSION. Ten abdominal radiologists showed substantial agreement for polyp risk categorizations and surgical consultation recommendations, although areas of reader variability were identified. CLINICAL IMPACT. The findings support the overall reproducibility of the SRU recommendations, while indicating opportunity for improvement.


Asunto(s)
Hallazgos Incidentales , Pólipos , Ultrasonografía , Humanos , Femenino , Masculino , Persona de Mediana Edad , Pólipos/diagnóstico por imagen , Pólipos/cirugía , Estudios Retrospectivos , Ultrasonografía/métodos , Adulto , Enfermedades de la Vesícula Biliar/diagnóstico por imagen , Enfermedades de la Vesícula Biliar/cirugía , Anciano , Variaciones Dependientes del Observador , Radiólogos , Sociedades Médicas , Consenso , Guías de Práctica Clínica como Asunto
4.
J Comput Assist Tomogr ; 48(4): 628-639, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38626751

RESUMEN

ABSTRACT: Neuroendocrine neoplasms (NENs) are a diverse group of tumors that express neuroendocrine markers and primarily affect the lungs and digestive system. The incidence of NENs has increased over time due to advancements in imaging and diagnostic techniques. Effective management of NENs requires a multidisciplinary approach, considering factors such as tumor location, grade, stage, symptoms, and imaging findings. Treatment strategies vary depending on the specific subtype of NEN. In this review, we will focus on treatment strategies and therapies including the information relevant to clinicians in order to undertake optimal management and treatment decisions, the implications of different therapies on imaging, and how to ascertain their possible complications and treatment effects.


Asunto(s)
Tumores Neuroendocrinos , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/terapia , Humanos , Diagnóstico por Imagen/métodos , Derivación y Consulta
8.
Can Assoc Radiol J ; 70(1): 96-103, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30691569

RESUMEN

PURPOSE: In suspected spondylodiscitis and vertebral osteomyelitis, computed tomography (CT)-guided biopsies are often performed to determine a causative organism and guide antimicrobial therapy. The aim of this study is to determine the diagnostic culture yield of CT-guided biopsies performed in cases of suspected spinal infections. METHODS: A literature search of PubMed and MEDLINE up to April 2017 was performed for keywords "CT guided vertebral biopsy infection," "CT-guided spine biopsy infection," "CT guided spine biopsy yield," and "CT guided vertebral biopsy yield." Inclusion criteria primarily consisted of studies exclusively using CT-guided biopsies in cases of suspected infectious lesions only. After study selection, published articles were analysed to determine diagnostic culture yield. Descriptive statistics were applied. RESULTS: 220 search results were screened; 11 met our inclusion criteria and were reviewed. In total, 647 biopsies of suspected infectious spinal lesions were performed. Positive cultures were obtained in 241 cases. Upon excluding one paper's skewed results, the net pooled results culture yield was 33%. Several cultures grew multiple organisms, leading to a total of 244 species identified. Most common isolated organisms include Staphylococcus aureus (n = 83), coagulase-negative Staphylococcus (n = 45), and Mycobacteria (n = 38). CONCLUSIONS: The diagnostic culture yield of CT-guided biopsies in cases of suspected spinal infection is 33%. In the majority of cases, a causative organism is not identified. This suggests that improvements can be made in biopsy technique and specimen transfer to optimize culture yield and increase the clinical value of the procedure.


Asunto(s)
Discitis/diagnóstico por imagen , Osteomielitis/diagnóstico por imagen , Radiografía Intervencional/métodos , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/patología , Tomografía Computarizada por Rayos X/métodos , Discitis/patología , Humanos , Biopsia Guiada por Imagen , Osteomielitis/patología , Reproducibilidad de los Resultados
9.
J Vasc Interv Radiol ; 29(3): 328-334, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29221922

RESUMEN

PURPOSE: To analyze technique, outcomes, and complications of a large series of pediatric percutaneous nephrostomy (PCN) procedures performed at 4 tertiary pediatric centers. MATERIALS AND METHODS: Retrospective multicenter study of PCNs performed during an 11-year period. Six hundred seventy-five PCNs were performed on 441 patients (median age: 4 y, range: 1 d-18 y, median weight: 17 kg, range: 0.7-112 kg); 31% were younger than 1 year. The most frequent indications for PCN procedures included hydronephrosis (57%), calculus (14%), and infection (12%). Forty-five percent of patients had severe and 32% had moderate hydronephrosis. RESULTS: Technical success was 99% (n = 668); 7 failures occurred from lost access, during tract dilatation (n = 5) and during staghorn calculi without dilatation (n = 2). General anesthesia was used in 73% of procedures. Combined ultrasound and fluoroscopy was used in 98% of procedures. Of the 668 procedures, 561 (84%) were primary nephrostomy insertions, and 107 (16%) were a variety of exchanges (secondary catheter insertions). Twenty-four of 675 (4%) were transplanted kidneys. Access sites included lower (47%), mid (28%), and upper (12%) poles and pelvis (11%). Catheters were predominantly 7-8 French (n = 352). The mean catheter dwell time was 25 days (0-220 d). Total primary catheter days were 14,482, with an additional 2,241 days after secondary procedures. Follow-up in 653/668 (98%) procedures documented elective removal (79%) and salvage procedures (21%), which included wire exchange (8.7%), nephroureteral stent/catheter conversion (8.8%), and tube upsizing (3.5%). Periprocedural complications occurred in 30/668 (4.5%) procedures: 1 major (0.1%) self-limiting hematuria requiring transfusion and 29 (4.4%) minor complications. CONCLUSIONS: PCN is safe and successful in children of all ages, with few major complications. PCN in children is associated with specific technical challenges and requires ongoing management tailored to the very young to achieve good outcomes.


Asunto(s)
Nefrostomía Percutánea/métodos , Enfermedades Urológicas/cirugía , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Radiografía Intervencional , Estudios Retrospectivos , Resultado del Tratamiento
11.
J Vasc Interv Radiol ; 26(11): 1669-72.e1, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26505938

RESUMEN

High-flow ports have been used for apheresis in adults. The purpose of this study was to demonstrate the efficacy of ports for apheresis in children and to survey satisfaction of patients and their families with their use. A retrospective review of clinical details was combined with a prospective assessment of the experience of patients and their families. Eight patients (mean age, 10.4 y; mean weight, 35 kg) had nine ports placed for long-term apheresis. All 246 treatment sessions were completed successfully. Access difficulties occurred in eight of 246 sessions (3%). Alarms occurred in 40 of 246 sessions (16%), resulting in delays in 10 of 246 sessions (4%). A survey of early experience indicated overall satisfaction with and a preference for ports for apheresis.


Asunto(s)
Oclusión con Balón/instrumentación , Oclusión con Balón/métodos , Eliminación de Componentes Sanguíneos/instrumentación , Eliminación de Componentes Sanguíneos/métodos , Prótesis Vascular , Catéteres de Permanencia , Adolescente , Oclusión con Balón/efectos adversos , Eliminación de Componentes Sanguíneos/efectos adversos , Niño , Preescolar , Enfermedad Crónica , Femenino , Humanos , Masculino , Estudios Retrospectivos , Resultado del Tratamiento
12.
J Vasc Interv Radiol ; 25(8): 1265-71, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24837979

RESUMEN

PURPOSE: To report the technical success and complication rates for double J ureteric stent placements by interventional radiologists in children. MATERIALS AND METHODS: A retrospective analysis of double J ureteric stents placed between January 2001 and December 2011 was conducted. Data collected included patient demographics, procedural details (indication, double J stent size, access approach, concurrent procedures), technical and functional success, tube dwell time, and procedure-related complications. Descriptive statistics were employed. Placement of 59 double J ureteric stents was attempted in 49 procedures performed on 35 pediatric patients (26 boys and 9 girls) with a mean age of 7.3 years (range, 22 d-17.9 y; median age, 4 y) and a mean weight of 22 kg (range, 2.5-70 kg). RESULTS: There were 44 de novo double J stent insertion attempts: 20 one-stage procedures (17 anterograde, 3 retrograde through the urethra) and 24 two-stage anterograde procedures through an existing nephrostomy tube. There were 15 exchanges; 11 were anterograde, and 4 were retrograde (2 urethral, 2 Mitrofanoff). Of 49 procedures, 15 were performed as combined procedures with a urologist. Technical success was 95% (56 of 59), and primary functional success was 95% (53 of 56). Complications included two minor complications occurring during the procedure and four complications occurring after the procedure. CONCLUSIONS: Image-guided insertion of a double J ureteric stent is an effective treatment for pediatric urologic obstructive conditions. The procedure is both technically and functionally successful in a high percentage of pediatric patients.


Asunto(s)
Implantación de Prótesis/instrumentación , Radiografía Intervencional , Stents , Uréter/diagnóstico por imagen , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Grupo de Atención al Paciente , Diseño de Prótesis , Implantación de Prótesis/efectos adversos , Radiografía Intervencional/efectos adversos , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
13.
Abdom Radiol (NY) ; 49(8): 2812-2832, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38832942

RESUMEN

Gender-affirming surgery (GAS) is increasingly being performed. GAS is tailored to the patient leading to a diverse spectrum of radiologic post-operative findings. Radiologists who are unfamiliar with expected anatomic alterations after GAS may misdiagnose important complications leading to adverse patient outcomes. This collaborative multi-institutional review aims to: Describe relevant embryology and native anatomy. Describe relevant Gender-Affirming Surgery (GAS) techniques and expected neo-anatomy with associated complications, including common terminology. Review expected imaging appearance of neo-anatomy/postoperative findings. Review multi-modality [ultrasound, plain film, retrograde urethrogram, computed tomography] emergent imaging findings. Understand unique patient evaluation and imaging protocol considerations in the GAS population. Discuss pearls and pitfalls of imaging in the acute post-GAS setting.


Asunto(s)
Complicaciones Posoperatorias , Humanos , Complicaciones Posoperatorias/diagnóstico por imagen , Femenino , Cirugía de Reasignación de Sexo , Masculino , Servicio de Urgencia en Hospital
14.
Abdom Radiol (NY) ; 49(5): 1699-1715, 2024 05.
Artículo en Inglés | MEDLINE | ID: mdl-38578323

RESUMEN

Cholangiocarcinoma (CCA), a highly aggressive primary liver cancer arising from the bile duct epithelium, represents a substantial proportion of hepatobiliary malignancies, posing formidable challenges in diagnosis and treatment. Notably, the global incidence of intrahepatic CCA has seen a rise, necessitating a critical examination of diagnostic and management strategies, especially due to presence of close imaging mimics such as hepatocellular carcinoma (HCC) and combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA). Hence, it is imperative to understand the role of various imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), elucidating their strengths, and limitations in diagnostic precision and staging accuracy. Beyond conventional approaches, there is emerging significance of functional imaging tools including positron emission tomography (PET)-CT and diffusion-weighted (DW)-MRI, providing pivotal insights into diagnosis, therapeutic assessment, and prognostic evaluation. This comprehensive review explores the risk factors, classification, clinical features, and role of imaging in the holistic spectrum of diagnosis, staging, management, and restaging for CCA, hence serving as a valuable resource for radiologists evaluating CCA.


Asunto(s)
Neoplasias de los Conductos Biliares , Colangiocarcinoma , Humanos , Colangiocarcinoma/diagnóstico por imagen , Neoplasias de los Conductos Biliares/diagnóstico por imagen , Estadificación de Neoplasias , Diagnóstico Diferencial
15.
Pediatr Radiol ; 43(8): 1009-16, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23417230

RESUMEN

Retrograde radiologic gastrostomy is one of several techniques used for placing a gastrostomy and is a common technique used in children. The use of a retention anchor suture (RAS) is an important component of this procedure. This pictorial essay explores the normal course and passage of the RAS, as well as abnormal migration, various complications and the implications of the RAS with regard to MRI safety.


Asunto(s)
Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/patología , Gastrostomía/efectos adversos , Gastrostomía/instrumentación , Imagen por Resonancia Magnética/métodos , Anclas para Sutura/efectos adversos , Niño , Preescolar , Femenino , Humanos , Masculino , Resultado del Tratamiento
16.
Radiol Clin North Am ; 61(4): 595-608, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-37169426

RESUMEN

Ovarian sex cord-stromal tumors (OSCSTs) are a rare group of ovarian neoplasms that can be benign or malignant. They are classified into pure sex cord tumors, pure stromal tumors, and mixed SCST. The most common malignant OSCSTs are adult granulosa cell tumors. In contrast to the more common ovarian epithelial malignancies, OSCSTs present in younger patients, often at early stages, with better prognoses. Imaging features are variable, and pathology is required for diagnosis. However, certain tumors demonstrate characteristic imaging appearances that can be useful in narrowing the differential diagnosis.


Asunto(s)
Tumor de Células de la Granulosa , Neoplasias Ováricas , Tumores de los Cordones Sexuales y Estroma de las Gónadas , Adulto , Femenino , Humanos , Tumores de los Cordones Sexuales y Estroma de las Gónadas/diagnóstico por imagen , Tumores de los Cordones Sexuales y Estroma de las Gónadas/patología , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/patología , Tumor de Células de la Granulosa/diagnóstico por imagen , Tumor de Células de la Granulosa/patología , Pelvis
17.
Abdom Radiol (NY) ; 47(9): 3174-3188, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-34302185

RESUMEN

Imaging plays an important role in the diagnosis and treatment of women with uterine cervical and endometrial cancers. Quantitative imaging, through MRI, PET/CT, and hybrid PET/MRI, allows for characterization of primary tumors beyond anatomic and qualitative descriptors. MRI diffusion-weighted imaging (DWI) yields an apparent diffusion coefficient (ADC), which can be applied in both the pre-and post-treatment assessment of uterine tumors. PET/CT assesses metabolic activity, and measurement of tumor standardized uptake value (SUV) is a useful metric in the staging of uterine malignancies. Hybrid PET/MRI is an emerging modality that combines the soft tissue contrast of MRI with the molecular imaging capability of PET. This review provides an overview of these quantitative imaging modalities, and their current and potential roles in the assessment of uterine cervical and cancer.


Asunto(s)
Neoplasias Endometriales , Tomografía Computarizada por Tomografía de Emisión de Positrones , Imagen de Difusión por Resonancia Magnética/métodos , Neoplasias Endometriales/diagnóstico por imagen , Femenino , Fluorodesoxiglucosa F18 , Humanos , Imagen por Resonancia Magnética/métodos , Tomografía de Emisión de Positrones/métodos , Radiofármacos
18.
Abdom Radiol (NY) ; 44(12): 4028-4036, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31555846

RESUMEN

PURPOSE: To assess guideline compliance and quality of hepatocellular carcinoma, (HCC) diagnostic imaging within community hospitals (CH) and their Tertiary referral center (TRC) in a moderately high incidence region. METHODS: Initial diagnostic workup CT/MRI scans of 251 patients (122 CH, 112 TRC, 17 Non-TRC academic) with HCC over a 15-month period were assessed for Liver reporting and Data System (LI-RADS) guideline compliance. 269 scans (182 CT, 87 MRI) were qualitatively evaluated by 2 independent blinded radiologists for arterial timing, overall image quality, noise and sharpness, with quantification of interobserver variability. The contrast enhancement ratio (CER) for the largest HCC on each scan was calculated using pre- and post-contrast images. RESULTS: 103/104 (99%) of TRC and 44/78 (56%) of CH CTs adhered to LI-RADS imaging guidelines (P < 0.0001). Lack of delayed phase accounted for 32/34 (94%) of noncompliant CH CTs. Regarding MRI, 19/19 (100%) of TRC and 60/68 (88%) of CH scans were adherent (P = 0.12). For both modalities, overall image quality, noise and sharpness were rated significantly higher for TRC than CH. There was moderate interobserver agreement with intraclass correlation coefficient of 0.73, 0.70 and 0.63, respectively. Arterial-phase timing was rated adequate for CT in 75/104 TRC (72%) and 10/68 (14%) CH scans (P < 0.0001) and for MRI in 8/19 (42%) TRC and 23/68 (33%) CH scans (P = 0.17). The CER was significantly higher for TRC versus CH (2.9 vs. 1.9, P < 0.001) and MRI (0.9 vs. 0.7, P = 0.03). CONCLUSIONS: Community hospital HCC diagnostic scans significantly lag in critical quality parameters of tumor enhancement, arterial phase timing, perceived image quality, and LI-RADS CT technique compliance compared to a TRC.


Asunto(s)
Carcinoma Hepatocelular/diagnóstico por imagen , Diagnóstico por Imagen/normas , Hospitales Comunitarios , Neoplasias Hepáticas/diagnóstico por imagen , Calidad de la Atención de Salud , Adulto , Anciano , Carcinoma Hepatocelular/epidemiología , Medios de Contraste , Femenino , Adhesión a Directriz , Humanos , Incidencia , Neoplasias Hepáticas/epidemiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Centros de Atención Terciaria , Tomografía Computarizada por Rayos X
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