Optimizing LI-RADS: ancillary features screened from LR-3/4 categories can improve the diagnosis of HCC on MRI.

OBJECTIVE: To determine the high-efficiency ancillary features (AFs) screened from LR-3/4 lesions and the HCC/non-HCC group and the diagnostic performance of LR3/4 observations. MATERIALS AND METHODS: We retrospectively analyzed a total of 460 patients (with 473 nodules) classified into LR-3-LR-5 categories, including 311 cases of hepatocellular carcinoma (HCC), 6 cases of non-HCC malignant tumors, and 156 cases of benign lesions. Two faculty abdominal radiologists with experience in hepatic imaging reviewed and recorded the major features (MFs) and AFs of the Liver Imaging Reporting and Data System (LI-RADS). The frequency of the features and diagnostic performance were calculated with a logistic regression model. After applying the above AFs to LR-3/LR-4 observations, the sensitivity and specificity for HCC were compared. RESULTS: The average age of all patients was 54.24 ± 11.32 years, and the biochemical indicators ALT (P = 0.044), TBIL (P = 0.000), PLT (P = 0.004), AFP (P = 0.000) and Child‒Pugh class were significantly higher in the HCC group. MFs, mild-moderate T2 hyperintensity, restricted diffusion and AFs favoring HCC in addition to nodule-in-nodule appearance were common in the HCC group and LR-5 category. AFs screened from the HCC/non-HCC group (AF-HCC) were mild-moderate T2 hyperintensity, restricted diffusion, TP hypointensity, marked T2 hyperintensity and HBP isointensity (P = 0.005, < 0.001, = 0. 032, p < 0.001, = 0.013), and the AFs screened from LR-3/4 lesions (AF-LR) were restricted diffusion, mosaic architecture, fat in mass, marked T2 hyperintensity and HBP isointensity (P < 0.001, = 0.020, = 0.036, < 0.001, = 0.016), which were not exactly the same. After applying AF-HCC and AF-LR to LR-3 and LR-4 observations in HCC group and Non-HCC group, After the above grades changed, the diagnostic sensitivity for HCC were 84.96% using AF-HCC and 85.71% using AF-LR, the specificity were 89.26% using AF-HCC and 90.60% using AF-LR, which made a significant difference (P = 0.000). And the kappa value for the two methods of AF-HCC and AF-LR were 0.695, reaching a substantial agreement. CONCLUSION: When adjusting for LR-3/LR-4 lesions, the screened AFs with high diagnostic ability can be used to optimize LI-RADS v2018; among them, AF-LR is recommended for better diagnostic capabilities.

Hepatic Involvement in Acquired Immunodeficiency Syndrome-Associated Kaposi's Sarcoma: A Descriptive Analysis on CT, MRI, and Ultrasound.

Purpose: To retrospectively analyse the different imaging manifestations of acquired immunodeficiency syndrome-associated hepatic Kaposi's sarcoma (AIDS-HKS) on CT, MRI, and Ultrasound. Patients and Methods: Eight patients were enrolled in the study. Laboratory tests of liver function were performed. The CT, MRI, and Ultrasound manifestations were reviewed by two radiologists and two sonographers, respectively. The distribution and imaging signs of AIDS-HKS were evaluated. Results: AIDS-HKS patients commonly presented multiple lesions, mainly distributed around the portal vein on CT, MRI, and Ultrasound. AIDS-HKS presented as ring enhancement in the arterial phase on contrast-enhanced CT and MRI scanning, and nodules gradually strengthen in the portal venous phase and the delayed phase. AIDS-HKS presented as intrahepatic bile duct dilatation and bile duct wall thickening around the lesion. Five patients (62.5%, 5/8) were followed up. After chemotherapy, the lesions were completely relieved (60.0%), or decreased (40.0%). Conclusion: AIDS-HKS presented as multiple nodular lesions with different imaging features. The combination of different imaging methods was helpful for the imaging diagnosis of AIDS-HKS.

T2-weighted imaging and dynamic contrast­enhanced imaging in predicting the prognosis in patients with acute-on-chronic liver failure.

BACKGROUND: Acute-on-chronic liver failure (ACLF) is a syndrome with high 28- and 90-day mortality rates. Magnetic resonance imaging (MRI) has been widely used to diagnose and evaluate liver disease. Our purpose is to determine the value of the imaging features derived from Gd-DTPA-enhanced MRI for predicting the poor outcome of patients with ACLF and develop a clinically practical radiological score. METHODS: This retrospective study comprised 175 ACLF patients who underwent Gd-DTPA-enhanced abdominal MRI from January 2017 to December 2021. The primary end-point was 90-day mortality. Imaging parameters, such as diffuse hyperintense of the liver on T2WI, patchy enhancement of the liver at the arterial phase, uneven enhancement of the liver at the portal vein phase, gallbladder wall edema, periportal edema, ascites, esophageal and gastric varix, umbilical vein patefac, portal vein thrombosis, and splenomegaly were screened. Cox proportional hazard regression models were used to evaluate prognostic factors and develop a prediction model. The accuracy of the model was evaluated by receiver operating characteristic (ROC) curves. RESULTS: During the follow-up period, 31 of the 175 ACLF patients died within 90 days. In the multivariate analysis, three imaging parameters were independently associated with survival: diffuse hyperintense on T2WI (p = 0.007; HR = 3.53 [1.40-8.89]), patchy enhancement at the arterial phase (p = 0.037; HR = 2.45 [1.06-5.69]), moderate ascites (vs. mild) (p = 0.006; HR = 4.12 [1.49-11.36]), and severe ascites (vs. mild) (p = 0.005; HR = 4.29 [1.57-11.71]). A practical radiological score was proposed, based on the presence of diffuse hyperintense (7 points), patchy enhancement (5 points), and ascites (6, 8, and 8 points for mild, moderate, and severe, respectively). Further analysis showed that a cut-off at 14 points was optimum to distinguish high-risk (score > 14) from the low-risk group (score ≤ 14) for 90-day survival and demonstrated a mean area under the ROC curve of 0.774 in ACLF patients. CONCLUSIONS: Gd-DTPA-enhanced MR imaging features can predict poor outcomes in patients with ACLF, based on which we proposed a clinically practical radiological score allowing stratification of the 90-day survival.

The Enhancement of Hepatic Parenchyma and Portal Vein in different CLD Groups: A Comparative Study of Gadoxetic Acid and Gadopentetate Dimeglumine.

BACKGROUND: Chronic liver disease (CLD) will affect the enhancement of hepatic parenchyma and portal vein on abdominal-enhanced MRI. OBJECTIVE: To investigate the difference in liver parenchyma and portal vein enhancement in patients with CLD of different liver function grades between Gd- EOB-DTPA and Gd-DPTA in the portal venous phase (PVP). METHODS: This retrospective study included 218 patients with CLD who had undergone abdominal enhanced MRI from January 2019 to June 2020. Patients with various degrees of liver dysfunction were identified with Child-Turcotte-Pugh and albumin-bilirubin grade. Two readers measured the precontrast and PVP signal intensities of liver parenchyma, portal vein, spleen, and psoas muscle. Relative liver enhancement, liver-to-spleen contrast index, portal vein image contrast, and portal vein-to-liver contrast were calculated. RESULTS: The relative enhancement of liver parenchyma was significantly lower for the Gd-EOB-DTPA group in any degree of liver function than the Gd- DTPA group in the PVP. The Gd-EOB-DTPA group showed significantly lower portal vein-to-liver contrast in the overall study population, CTP class B, and ALBI grade 2 patients compared to the group of Gd-DTPA at PVP. No significant difference was noted in the portal vein image contrast between the two contrast agents, regardless of CTP and ALBI grading. CONCLUSION: In CLD patients, Gd-EOB-DTPA yielded lower liver parenchymal enhancement and similar portal vein image contrast compared to Gd-DTPA in the PVP. Portal vein-to-liver contrast in the Gd-EOB-DTPA group was lower in the CTP class B and ALBI grade 2 subgroups compared to the Gd- DTPA group.

Long-Term Follow-Up Study of COVID-19: Evaluation on Thin-Slice CT.

Purpose: To retrospectively analyse the CT imaging during the long-term follow-up of COVID-19 patients after discharge. Patients and Methods: A total of 122 patients entered the study group. All patients underwent CT examinations. The CT images, which included distribution and imaging signs, were evaluated by two chest radiologists. Laboratory examinations included routine blood work, biochemical testing, and SARS-CoV-2 antibody screening. Statistical methods include chi-square, Fisher's exact test, one-way analysis of variance, rank sum test and logistic regression by SPSS 17.0. Results: There were 22 (18.0%) patients in the mild group, 74 (60.7%) patients in the moderate group, and 26 (21.3%) patients in the severe-critical group. The median follow-up interval was 405 days (378.0 days, 462.8 days). Only monocytes, prothrombin activity, and γ-glutamyltransferase showed significant differences among the three groups. We found that the more severe the patient's condition, the more SARS-CoV-2 IgG antibodies existed. Only 11 patients (11.0%) showed residual lesions on CT. The CT manifestations included irregular linear opacities in nine cases (9.0%), reticular patterns in six cases (6.0%), and GGOs in five cases (5.0%). Conclusion: The proportion of residual lesions on CT in COVID-19 patients was significantly reduced after long-term follow-up. The patients' age and disease conditions were positively correlated with residual lesions.

CT appearances, patterns of progression, and follow-up of COVID-19: evaluation on thin-section CT.

BACKGROUND: To retrospectively analyze CT appearances and progression pattern of COVID-19 during hospitalization, and analyze imaging findings of follow-up on thin-section CT. METHODS: CT findings of 69 patients with COVID-19 were evaluated on initial CT, peak CT, and pre-discharge CT. CT pattern were divided into four types on CT progression. Lesion percentage of pulmonary lobe (lobe score) was graded. Correlation analysis was made between scores and intervals. 53 patients were followed up by CT. RESULTS: Among 69 patients, 33.3% exhibited improvement pattern, 65.2% peak pattern, 1.5% deterioration pattern, and 0% fluctuation pattern. The lobe scores were positively correlated with most of intervals. It was more common to observe consolidation, pleural thickening and pleural effusion on the peak CT, and irregular line and reticulation on pre-discharge CT. The peak-initial interval were shortened when the initial CT with consolidation and pleural thickening. The intervals were extended when the irregular lines appeared on peak CT and reticulation on pre-discharge CT. Among 53 follow-up patients, 37.7% showed normal chest CT, and 62.3% showed viral pneumonia remained that mainly included GGO (100.0%) and irregular lines (33.3%). CONCLUSIONS: COVID-19 displayed different appearances on CT as progressing. The peak pattern was the most common progression pattern. The CT appearances showed closely related to the intervals. The COVID-19 pneumonia can be remained or completely absorbed on CT with follow-up.

Chest CT Evaluation of 11 Persistent Asymptomatic Patients with SARS-CoV-2 Infection.

In total, 11 asymptomatic carriers who underwent nasal or oropharyngeal swab tests for SARS-CoV-2 after being in close contact with patients who developed symptomatic 2019 coronavirus disease (COVID-19) were enrolled in this study. The chest multidetector computed tomography (CT) images of the enrolled patients were qualitatively and quantitatively analyzed. The findings of the first chest CT were normal in 3 (27.3%) patients, 2 of whom were aged below 15 years. The lesions of 2 (18.2%) patients involved 1 lobe with unifocal presence. Subpleural lesions were observed in 7 (63.6%) patients. Ground glass opacity (GGO) was the most common sign observed in 7 (63.6%) patients. Crazy-paving pattern and consolidation were detected in 2 (18.2%) and 4 (36.4%) patients, respectively. Based on deep learning and quantitative analysis, the mean volume of intrapulmonary lesions in the first CT image was 85.73 ± 84.46 cm3. In patients with positive findings on CT images, the average interval between positive real-time reverse transcriptase polymerase chain reaction assay and peak volume on CT images was 5.1 ± 3.1 days. In conclusion, typical CT findings can be detected in over 70% of asymptomatic SARS-CoV-2 carriers. The initial presentation is typically GGO along the subpleural regions and bronchi, which absorbs in approximately 5 days.

CT imaging and pathological basis of linear shadow connecting pulmonary segmental artery to horizontal fissure.

To investigate the computed tomography (CT) imaging and pathological basis of the linear shadows connecting pulmonary segmental arteries to horizontal fissure (hereinafter referred to as "linear shadow") on thin-slice CT.Collect 127 clinical cases to analyze the display and morphology of linear shadows on the thin-slice CT and to measure their length, thickness, and angle. Collect 11 autopsy specimens of coal worker's pneumoconiosis to conduct an imaging and pathology basis control study for the linear shadows.There is no correlation between the linear shadow and gender, age, and smoking history. Linear shadows are observed in 54.33% of patients. 93.33% of those linear shadows are straight lines. Generally, the lengths are less than 10 mm, the thicknesses are around 1 mm, and the scopes of angles are wide, range from acute angles to obtuse angles. The linear shadow is a banded structure consisting of loose connective tissue, small blood vessels, and small lymphatic vessels due to the visceral pleura recessed and fused into the lung.Linear shadows are intrinsic to the lung. The linear shadows consist of loose connective tissue, small blood vessels, and small lymphatic vessels.

CT findings of COVID-19 in follow-up: comparison between progression and recovery.

PURPOSE: We aimed to retrospectively analyze the imaging changes detected in the follow-up of coronavirus disease 2019 (COVID-19) patients on thin-section computed tomography (CT). METHODS: We included 54 patients diagnosed with COVID-19. The mean interval between the initial and follow-up CT scans was 7.82±3.74 days. Patients were divided into progression and recovery groups according to their outcomes. We evaluated CT images in terms of distribution of lesions and imaging manifestations. The manifestations included ground-glass opacity (GGO), crazy-paving pattern, consolidation, irregular line, and air bronchogram sign. RESULTS: COVID-19 lesions showed mainly subpleural distribution, which was accompanied by bronchovascular bundle distribution in nearly 30% of the patients. The lower lobes of both lungs were the most commonly involved. In the follow-up, the progression group showed more involvement of the upper lobe of the left lung than the recovery group. GGO was the most common sign. As the disease progressed, round GGO decreased and patchy GGO increased. On follow-up CT, consolidation increased in the progression group while decreasing in the recovery group. Air bronchogram sign was more commonly observed at the initial examination (90.9%) than at follow-up (30%) in the recovery group, but there was no significant change in the progression group. Pleural effusion and lymphadenopathy were absent in the initial examination, but pleural effusion was observed in three cases after follow-up. CONCLUSION: As COVID-19 progressed, round GGOs tended to evolve into patchy GGOs, consolidation increased, and pleural effusion could be occasionally observed. As COVID-19 resolved, the crazy-paving pattern and air bronchogram significantly decreased.

Imaging Features of Coronavirus disease 2019 (COVID-19): Evaluation on Thin-Section CT.

RATIONALE AND OBJECTIVES: To retrospectively analyze the chest imaging findings in patients with coronavirus disease 2019 (COVID-19) on thin-section CT. MATERIALS AND METHODS: Fifty-three patients with confirmed COVID-19 infection underwent thin-section CT examination. Two chest radiologists independently evaluated the imaging in terms of distribution, ground-glass opacity (GGO), consolidation, air bronchogram, stripe, enlarged mediastinal lymph node, and pleural effusion. RESULTS: Fourty-seven cases (88.7%) had findings of COVID-19 infection, and the other six (11.3%) were normal. Among the 47 cases, 78.7% involved both lungs, and 93.6% had peripheral infiltrates distributed along the subpleural area. All cases showed GGO, 59.6% of which were round and 40.4% patchy. Other imaging features included "crazy-paving pattern" (89.4%), consolidation (63.8%), and air bronchogram (76.6%). Air bronchograms were observed within GGO (61.7%) and consolidation (70.3%). Neither enlarged mediastinal lymph nodes nor pleural effusion were present. Thirty-three patients (62.3%) were followed an average interval of 6.2 ± 2.9 days. The lesions increased in 75.8% and resorbed in 24.2% of patients. CONCLUSION: COVID-19 showed the pulmonary lesions in patients infected with COVID-19 were predominantly distributed peripherally in the subpleural area.

MRI findings of AIDS-related giant facial Kaposi's sarcoma: A case report.

RATIONALE: Kaposi's sarcoma (KS) is the most common malignant tumor in HIV-infected people and occurs mainly in the skin, mucous membranes, and lymph nodes. Approximately 33% of the initial skin manifestations of AIDS and approximately 35% to 79% of KS occur during disease progression. Otherwise, AIDS-related facial KS that was simultaneously examined by magnetic resonance imaging (MRI) is rare. PATIENT CONCERNS: This case was a 30-year-old male homosexual, with left facial nodule for 14 months, and HIV infection was diagnosed 1 month previously. The patient was admitted to hospital because the nodule gradually expanded from 0.2 to 10.0 cm in diameter. Ultrasound examination showed edema of the subcutaneous tissue of the left facial mass, and the boundary was not clear between lesion and normal tissues. Magnetic resonance imaging (MRI) indicated that the left facial mass showed low signal intensity on T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI), and a small amount of high signal intensity was seen in it. Diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) showed low signal intensity. After enhanced scan, the tumor showed uneven enhancement. DIAGNOSES: The pathological biopsy indicated KS. INTERVENTIONS: The patient began chemotherapy with the intravenous drip infusion of Doxorubicin Hydrochloride Liposome. OUTCOMES: The facial KS decreased and the facial swelling was relieved. LESSONS: MRI could not only provide the diagnostic basis of KS for the therapy, but also could accurately determine the scope of the disease.

Linear shadows that connect oblique fissures and costal pleurae on the superior segments of lower lobes: evaluating the imaging findings on thin-slice lung CT.

OBJECTIVE: To retrospectively analyse the imaging findings of the linear shadows that connect the oblique fissures and the costal pleurae on the superior segments of the lower lobes on thin-slice lung CT. MATERIALS AND METHODS: Thin-slice CT scans of 221 cases of normal lungs and 86 abnormal lungs were collected. The parameters of the imaging observations included the existence of the superior segmental linear shadow, its morphology, length, and starting position, bird-beak sign, and adjacent structures on the pleural end. RESULTS: The linear shadows were more common on the left lower lobe (43.44%) than on the right side (19.46%). The pleural origins of the linear shadows were mainly located above the carina (69.78%); the adjacent structure on the left lung was the descending aorta (70.83%), and for the right lung, it was next to the thoracic vertebrae (60.47%). In the presence of pulmonary lobectomy or atelectasis, the linear shadows could be extended, which could pull the oblique fissures and costal pleurae to form the bird-beak sign. CONCLUSION: The linear shadows on the superior segments of the lower lobes are common structures fixing the oblique fissures. Recognition of the linear shadows can help radiologists distinguish normal structures from abnormal ones.

AIDS-related non-Hodgkin lymphoma: imaging feature analysis of 27 cases and correlation with pathologic findings.

BACKGROUND: Some tumor types are related to HIV, including non-Hodgkin lymphoma (NHL). The morbidity and mortality of NHL has remained high, even after highly active antiretroviral therapy (HAART) was introduced. We collected cases of AIDS with NHL, and evaluated the imaging features and strategies for diagnosis. MATERIALS AND METHODS: There were 27 patients with AIDS and tumors confirmed by pathology. There were 9 patients with Burkitt lymphoma, 16 with diffuse large B cell lymphomas (DLBCLs), and 2 with primary central nervous system (PCNS) lymphomas. All of the patients underwent a series of imaging studies. Three radiologists analyzed the images, and any disagreement was discussed until consensus was reached. RESULTS: The radiologic manifestations of AIDS with NHL were mainly masses and lymphadenopathy, 3 patients having one mass and 12 two or more masses. 7 patients had lymphadenopathy in one site and 3patients had lymphadenopathy in two or more sites. Coarse mucosal folds, thickening of the gastrointestinal wall, and lumen narrowing were typical manifestations of NHL within the gastrointestinal tract. There were 4 patients with masses and 5 with lymphadenopathy inthe 9 with Burkitt lymphoma, and 11 patients with masses 5 with lymphadenopathy in the 16 with DLBCLs. CONCLUSION: NHL is a malignancy that usually occurs in patients with AIDS. Imaging is an important method by which to evaluate lesions, masses, and lymphadenopathy. Fine needle aspiration biopsy and stereotaxis biopsy are useful methods by which to diagnose NHL.