Liver segmental volumes and their relationship with 5-year prognostication.

PURPOSE: This study aimed to analyze the predictive value of caudate to right lobe ratio (CRL-R) and liver segmental volume ratio (LSVR) for chronic liver disease (CLD) on routine abdominal CT scans and their association with 5-year decompensation- and transplant-free survival. METHOD: This retrospective study included 108 patients without CLD and 98 patients with biopsy-proven CLD. All patients underwent abdominal CT scans between 03/2015 and 08/2017. Patients with CLD were divided into three groups: early CLD (F0-F2; eCLD; n = 40), advanced CLD (F3-F4; aCLD; n = 20), and aCLD with clinically significant portal hypertension (aCLDPH; n = 38). CRL-R and LSVR were compared between groups using Kruskal-Wallis test and ROC analysis to determine cutoff-values. 5-year decompensation- and transplant-free survival were assessed by Kaplan-Meier curve analysis. RESULTS: CRL-R and LSVR were significantly different between all groups (p < 0.001). A CRL-R cutoff-value of > 0.99 predicted aCLD with a sensitivity of 69% and a specificity of 80% (AUC = 0.75, p < 0.001), while LSVR > 0.37 had a sensitivity of 67% and a specificity of 84% (AUC = 0.80, p < 0.001). CLD-patients with both CRL-R > 0.99 and LSVR > 0.37 had a significantly lower probability of 5-year decompensation-free survival (31%) as well as lower probability of 5-year transplant-free survival (41%) than those with a CRL-R < 0.99 and/or LSVR < 0.37 (70%, 62%, p = 0.006, p = 0.038). CONCLUSION: CRL-R and LSVR showed a high predictive value for CLD on routine abdominal CT scans. In patients with CLD, both CRL-R and LSVR may be combined and are associated with 5-year decompensation-free and transplant-free survival.

Liver MRI susceptibility-weighted imaging (SWI) compared to T2* mapping in the presence of steatosis and fibrosis.

PURPOSE: To show that both susceptibility-weighted imaging (SWI) and T2*-mapping are dependent on liver steatosis, which should be taken into account when using these parameters to grade liver fibrosis and cirrhosis. METHODS: In this prospective study, a total of 174 patients without focal liver disease underwent multiparametric MRI at 3 T including SWI, T1- and T2* mapping, proton density fat fraction (PDFF) quantification and MR elastography. SWI, T2* and T1 were measured in the liver (4 locations), as well as in paraspinal muscles, to calculate the liver-to-muscle ratio (LMR). Liver and LMR values were compared among patients with different steatosis grades (PDFF < 5%, 5-10%, 10-20% and >20%), patients with normal, slightly increased and increased liver stiffness (<2.8 kPa, 2.8-3.5 kPa and >3.5 kPa, respectively). ANOVA with Bonferroni-corrected post hoc tests as well as a multivariate analysis were used to compare values among groups and parameters. RESULTS: SWI and T2* both differed significantly among groups with different steatosis grades (p < 0.001). However, SWI allowed a better differentiation among liver fibrosis grades (p < 0.001) than did T2* (p = 0.05). SWI LMR (p < 0.001) and T2* LMR (p = 0.036) showed a similar performance in differentiating among liver fibrosis grades. CONCLUSION: SWI and T2*-mapping are strongly dependent on the liver steatosis grades. Nevertheless, both parameters are useful predictors for liver fibrosis when using a multiparametric approach.

What you should know about prophylaxis and treatment of radiographic and magnetic resonance contrast medium extravasation.

In addition to anaphylactic reactions induced by contrast media (CM), extravasation is an adverse reaction that occurs immediately, requires special treatment, and attention. Since radiologists are often not familiar with either prophylactic or treatment modalities, the goal of this paper is to summarize the major facts and recommendations with respect to CM extravasation under practical clinical aspects.

Mode of Delivery and Pregnancy Outcome in Women with Congenital Heart Disease.

BACKGROUND: Advances in cardiac surgery and congenital cardiology have led to an increasing number of women with congenital heart disease (CHD) reaching childbearing age. In general, cardiologists recommend vaginal delivery for women with CHD to avoid complications from Caesarean section as many women with CHD tolerate vaginal delivery well. METHODS AND RESULTS: This is a single-center study comparing mode of delivery, pregnancy outcome, indications for Caesarean section and induction of labor between women with and without CHD. A historical cohort study was conducted including 116 patients with CHD. An individual threefold matching with 348 women without CHD was carried out. Caesarean section was performed in 46.6% of pregnancies with CHD (33.6% without CHD, P = 0.012). Primary Caesarean section increases with severity of CHD (P = 0.036), 33.3% of women with CHD had primary planned Caesarean section due to cardiac reasons. Induction of labor was performed in 45.7% of attempted vaginal deliveries in women with CHD (27.9% without CHD, P = 0.001). Lower mean birth weight (P = 0.004) and Small for Gestational Age (SGA) (P < 0.001) were more common in women with CHD. One CHD patient suffered from postpartum hemorrhage. CONCLUSIONS: Concerns about maternal deterioration resulting in higher rates of induction of labor seem unjustified in most cases. Along with a possible reduction of Caesarean section on maternal request, a reduction of planned vaginal delivery may be expedient in reducing the rate of Caesarean section in women with CHD.