HCC Detection on Surveillance US: Comparing Focused Liver Protocol Using US LI-RADS Technical Guidelines to a General Complete Abdominal US Protocol.

OBJECTIVE: Focused US examinations of the liver in the routine hepatocellular carcinoma (HCC) screening reduce the time spent on evaluating other structures deemed irrelevant to the clinical setting. It is still unknown, however, if such a strategy may additionally improve the frequency of nodules detection. We aimed to assess the impact of an HCC surveillance program in high-risk patients by means of targeted liver US following LI-RADS technical guidelines in comparison to a complete upper abdominal scan. METHODS: In this IRB-approved, single-center, prospective study, patients at high-risk for HCC enrolled from 06/2016 to 09/2019 were randomly assigned to 1 of the 2 institutional protocols: Group A (targeted liver US) or Group B (complete upper abdominal scan). Twenty examiners with similar experience in abdominal US were randomly assigned to perform the examinations exclusively in 1 of the groups (10 in each group). Frequency of hepatic nodules between groups was compared by using Fisher's exact test. RESULTS: Four hundred and sixty-five patients were enrolled, with no significant differences in both groups regarding sex, age, etiology of liver disease, MELD scores, and alpha-fetoprotein levels. A significantly higher frequency of nodules detection was found in Group A (230 patients; 23 nodules detected; 10% of the sample) in comparison to Group B (235 patients; 3 nodules; 1.3% of the sample) (p <.001). Five patients in Group A and 1 in Group B were positive for HCC after full diagnostic work-up. CONCLUSION: Adopting an HCC screening program based on targeted liver US improved the detection of hepatic nodules among high-risk individuals.

Role of imaging in the diagnosis of vascular malformations vascular malformations.

Imaging evaluation of vascular malformations (VM) is paramount for proper diagnosis and treatment planning. These lesions often present as complex vascular masses with arterial, venous and lymphatic components, requiring the use of advanced imaging modalities for full anatomical characterization. Symptoms also depend of the location and flow characteristic of such lesions and range from: asymptomatic to severe forms of cardiac arteriovenous shunting. We present an overview of the diagnostic work-up of VM per most recent classification systems and describe imaging characteristics of such lesions at ultrasonography (US) and magnetic resonance imaging (MRI) as a diagnostic tool for work-up of such patients.

Impact of uterine contractility on quality of life of women undergoing uterine fibroid embolization.

BACKGROUND: Although changes in uterine contractility pattern after uterine fibroid embolization (UFE) has already been assessed by cine magnetic resonance imaging (MRI), their impact on quality of life outcomes has not been evaluated. The purpose of this study was to evaluate the impact of uterine contractility on the quality of life of women undergoing UFE measured by the Uterine Fibroid Symptom and Quality of Life questionnaire (UFS-QOL). RESULTS: A total of 26 patients were included. MRI scans were acquired 30-7 days before and 6 months after UFE for all patients. The UFS-QOL was applied in person on first MRI exam day and 1 year after UFE and the outcomes were analyzed according to the groups of evolution pattern of uterine contractility: Group A: Unchanged Uterine Contractility Pattern, 38%; Group B: Favorable Modified Uterine Contractility Pattern, 50%; and Group C: Loss of Uterine Contractility, 11%. All UFE patients presented a reduction in the mean score for symptoms and increase in mean scores on quality of life. All patients in this cohort presented a reduction in mean symptom score and increase in the mean score of quality of life subscales. Group A had more relevant complaints regarding their sense of self-confidence; Group B presented worse sexual function scores before UFE, which improved after UFE compared to Group A. CONCLUSIONS: Significant improvement in symptoms, quality of life, and uterine contractility was observed after UFE in women of reproductive age with symptomatic fibroids. Functional uterine contractility seems to have a positive impact on quality of life and sexual function in this population. LEVEL OF EVIDENCE: Level 3, Non-randomized controlled cohort/follow-up study.

Minimally invasive treatments for perforator vein insufficiency.

Incompetent superficial veins are the most common cause of lower extremity superficial venous reflux and varicose veins; however, incompetent or insufficient perforator veins are the most common cause of recurrent varicose veins after treatment, often unrecognized. Perforator vein insufficiency can result in pain, skin changes, and skin ulcers, and often merit intervention. Minimally invasive treatments have replaced traditional surgical treatments for incompetent perforator veins. Current minimally invasive treatment options include ultrasound guided sclerotherapy (USGS) and endovascular thermal ablation (EVTA) with either laser or radiofrequency energy sources. Advantages and disadvantages of each modality and knowledge on these treatments are required to adequately address perforator venous disease.

Safety of percutaneous tunneled hemodialysis catheter procedures in patients receiving concurrent clopidogrel therapy.

PURPOSE: Patients on clopidogrel are at increased risk of bleeding. This study was commenced to assess the incidence of bleeding in dialysis patients who underwent tunneled hemodialysis catheter procedures while on clopidogrel therapy. METHODS: This is a single center retrospective study of 25 (10 men, 15 women; median age 70) dialysis patients in whom clopidogrel could not be discontinued and underwent tunneled hemodialysis catheter insertion, removal or exchange between the period March 2010 to November 2011. The medical records of patients were reviewed and complications were classified according to the Society of Interventional Radiology system. Fifty-three procedures (22 insertions, 11 exchanges and 20 removals) were performed in these patients. The pre-procedural median platelet count, International Normalized Ratio and partial thromboplastin time were 195×103/dL (range 50-666), 1.1 (range 0.9-3.3) and 26.3 seconds (range 22.5-69.8) respectively. RESULTS AND CONCLUSIONS: Forty-six procedures were performed in patients on clopidogrel and aspirin treatment. Five procedures were performed in patients while on clopidogrel in combination with aspirin and warfarin, and two procedures were performed with patients on clopidogrel alone. There were no documented bleeding complications from tunneled hemodialysis catheter procedures performed in patients on concurrent clopidogrel therapy in our study. Further prospective assessment with a larger cohort is necessary in order to validate these findings.