Predictors of need for endovascular intervention in hepatic trauma.

PURPOSE: Non-operative management of hepatic trauma with adjunctive hepatic arterial embolization (HAE) is widely accepted. Despite careful patient selection utilizing CTA, a substantial proportion of angiograms are negative for arterial injury and no HAE is performed. This study aims to determine which CT imaging findings and clinical factors are associated with the presence of active extravasation on subsequent angiography in patients with hepatic trauma. MATERIALS AND METHODS: The charts of 243 adults who presented with abdominal trauma and underwent abdominal CTA followed by conventional angiography were retrospectively reviewed. Of these patients, 49 had hepatic injuries on CTA. Hepatic injuries were graded using the American association for the surgery of trauma (AAST) CT classification, and CT images were assessed for active contrast extravasation, arterial pseudoaneurysm, sentinel clot, hemoperitoneum, laceration in-volving more than 2 segments, and laceration involving specific anatomic landmarks (porta hepatis, hepatic veins, and gallbladder fossa). Medical records were reviewed for pre- and post-angiography blood pressures, hemoglobin levels, and transfusion requirements. Angiographic images and reports were reviewed for hepatic arterial injury and performance of HAE. RESULTS: In multivariate analysis, AAST hepatic injury grade was significantly associated with increased odds of HAE (Odds ratio: 2.5, 95% CI 1.1, 7.1, p = 0.049). Univariate analyses demonstrated no significant association between CT liver injury grade, CT characteristics of liver injury, or pre-angiographic clinical data with need for HAE. CONCLUSION: In patients with hepatic trauma, prediction of need for HAE based on CT findings alone is challenging; such patients require consideration of both clinical factors and imaging findings.

Comparative Analysis of Safety and Efficacy of Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma in Patients with and without Pre-Existing Transjugular Intrahepatic Portosystemic Shunts.

PURPOSE: To compare the safety and efficacy of transarterial chemoembolization for hepatocellular carcinoma (HCC) in patients with and without transjugular intrahepatic portosystemic shunts (TIPS). MATERIALS AND METHODS: This single-institution study included a retrospective review of 50 patients who underwent transarterial chemoembolization for HCC between January 2010 and April 2017. Twenty-five patients had preexisting TIPS, and 25 patients were selected to control for age, sex, and target tumor size. Baseline median Model for End-Stage Liver Disease (MELD; 13 TIPS, 9 control; P < .001) and albumin-bilirubin (ALBI; 3 TIPS, 2 control; P < .001) differed between groups. Safety was assessed on the basis of Common Terminology Criteria for Adverse Events (CTCAE) and change in MELD and ALBI grade assessed between 3 and 6 months. Efficacy was assessed by tumor response and time to progression (TTP). RESULTS: There was 1 severe adverse event (CTCAE grade >2) in the TIPS group. There was no difference in the change in MELD or ALBI grade. Although there was no difference in tumor response (P = .19), more patients achieved a complete response in the control group (19/25, 76%) than in the TIPS group (13/25, 52%). There was no difference in TTP (P = .82). At 1 year, 2 patients in the control group and 3 patients in the TIPS group received a liver transplant. Seven patients died in the TIPS group. CONCLUSIONS: Transarterial chemoembolization is as safe and effective in patients with TIPS as in patients without TIPS, despite worse baseline liver function. Severe adverse events are rare and may be transient.

Inter- and intrareader agreement for categorization of background parenchymal enhancement at baseline and after training.

OBJECTIVE: Background parenchymal enhancement (BPE) refers to enhancing fibroglandular tissue on initial contrast-enhanced MR images. BPE appears to impact the rate of abnormal MRI interpretation and may correlate with breast cancer risk. There are now minimal data as to the uniformity of radiologists' BPE assessments and no data as to whether training improves agreement. Therefore, for this study, we sought to assess interreader agreement for BPE at baseline and after dedicated training. MATERIALS AND METHODS: This study included 119 breast MRI examinations performed in 119 patients (mean age, 47 years; age range, 25-79 years) in 2008. One week before training, four fellowship-trained breast imagers with 2-12 years' experience independently recorded BPE on a 4-point scale as follows: 1 (minimal, ≤ 25%), 2 (mild, 26-50%), 3 (moderate, 51-75%), or 4 (marked, > 75%). The same 119 cases were reread in a new random order within 1 week and at least 3 weeks after training. Interreader agreement and intrareader agreement were assessed using kappa coefficients. RESULTS: With training, interreader agreement increased from fair (κ = 0.36) to moderate (κ = 0.48). Improvement was sustained at 3 weeks after training (κ = 0.45). Intrareader agreement between time points 2 and 3 (κ: mean, 0.79; range, 0.56-0.98) was greater than between time points 1 and 2 (κ: mean, 0.62; range, 0.45-0.84), indicating readers learned and retained. CONCLUSION: Initial interreader agreement for BPE was fair among breast radiologists but achieved sustained improvement with training, highlighting the importance of education and inclusion of standardized BPE categories in a reference atlas.

Aberrant arterial supply to uterine fibroids from branches of the superior mesenteric artery.

Two patients, aged 48 and 45 years, were treated for symptomatic uterine fibroids with not only embolization of both uterine but also both ovarian arteries. Note was made of other collateral arterial supply via branches of the superior mesenteric artery (SMA). The two identified SMA branches were embolized for the first patient, but no embolization was deemed necessary for the other patient.

Craniofacial melorheostosis.

Melorheostosis is a rare benign disease of cortical bone most frequently presenting as peripheral hyperostosis with a characteristic "melting wax" appearance on conventional radiographs. The disease most frequently affects the appendicular skeleton and is seen only rarely in the craniofacial bones. We discuss a case of melorheostosis in the nasal cavity and skull base with an atypical radiographic appearance and suggest findings that may differentiate craniofacial melorheostosis from more common entities in this region.