Reproducibility of LI-RADS treatment response algorithm for hepatocellular carcinoma after locoregional therapy.

PURPOSE: To determine inter-reader agreement in categorizing hepatocellular carcinoma (HCC) treated with locoregional therapy using the Liver Imaging Reporting and Data System (LI-RADS) treatment response (LR-TR) algorithm. MATERIALS AND METHODS: A total of 93 patients with a total of 112 HCC nodules that were treated using thermal ablation or transarterial chemoembolization were prospectively included. There were 79 men and 14 women with a mean age of 55±2.6 (SD)years (range: 48-63years). All patients underwent magnetic resonance imaging (MRI) examination of the liver and MR images were analyzed by two independent observers. Treated HCC nodules were categorized into four groups according to LR-TR scoring system including: (i) LR-TR non-evaluable (treated, response not evaluable); (ii) LR-TR nonviable (treated, probably or definitively not viable); (iii) LR-TR equivocal (treated, equivocally viable) and (iv) LR-TR viable (treated, probably or definitively viable). The inter-observer agreement in LR-TR categorization was assessed using the kappa statistics. RESULTS: There was excellent inter-observer agreement between the two reviewers for overall treated HCC according to LR-TR algorithm (kappa=0.938; 95% CI: 0.89-1.00; P=0.001) with 97.31% agreement. The LR-TR categories by both reviewers were non-viable (77/112; 69.6% and 76/112; 67.9%), viable (30/112; 26.8% and 32/112; 27.7%) and equivocal (5/112; 4.4% and 4/112; 3.6%). There was excellent inter-observer agreement for LR-TR nonviable (kappa=0.938; 95% CI: 0.87-1.0; P=0.001) with 97.3% agreement, LR-TR viable (kappa=0.955; 95% CI: 0.89-1.00; P=0.001) with 98.2% agreement and good inter-observer agreement for LR-TR equivocal (kappa=0.700; 95% CI: 0.28-1.0; P=0.001) with 97.3% agreement. CONCLUSION: LR-TR algorithm conveys high degrees of inter-observer agreement for the evaluation of treatment response of HCC after thermal ablation and transarterial chemoembolization.

Serum leptin and homeostasis model assessment-IR as novel predictors of early liver fibrosis in chronic hepatitis B virus infection.

BACKGROUND: The relationship between hepatitis B virus (HBV) infection, leptin and insulin resistance remains unclear. We hypothesised links between serum leptin and insulin resistance in non-diabetic patients with chronic viral hepatitis B infection and their relation to liver fibrosis. METHODS: We recruited 190 untreated patients with chronic HBV infection and 72 healthy controls. Serum leptin, fasting glucose, insulin, liver function tests (LFTs), C-peptide and Homeostasis model assessment-IR (HOMA-IR) were measured/calculated by ELISA and standard techniques. RESULTS: Serum leptin, C-peptide (both P < 0.001), HOMA-IR (P = 0.021) and several LFTs were increased in patients with chronic HBV-infection. In multivariate regression analysis, both HOMA-IR (P = 0.003) and leptin (P = 0.002) were significant independent predictors of HBV infection. There were significant positive correlations (P < 0.01) between leptin and HOMA-IR (r = 0.81), between serum leptin and METAVIR activity (r = 0.95), and between HOMA-IR and BMI (r = 0.75), fasting glucose (r = 0.005), and fasting insulin (r = 0.81). Several LFTs, glucose and insulin correlated modestly (r = 0.61-0.69, P < 0.05) with leptin. CONCLUSION: Serum leptin may be related to the rate of fibrosis progression in nondiabetic patients with chronic HBV infection. Follow-up by serial measurement of serum leptin and HOMA-IR in non diabetic HBV-infected patients may be used as a non-invasive marker of early liver fibrosis.

Eastern Canadian Colorectal Cancer Consensus Conference 2013: emerging therapies in the treatment of pancreatic, rectal, and colorectal cancers.

The annual Eastern Canadian Colorectal Cancer Consensus Conference held in Montreal, Quebec, 17-19 October 2013, marked the 10-year anniversary of this meeting that is attended by leaders in medical, radiation, and surgical oncology. The goal of the attendees is to improve the care of patients affected by gastrointestinal malignancies. Topics discussed during the conference included pancreatic cancer, rectal cancer, and metastatic colorectal cancer.

Low b-value (black blood) respiratory-triggered fat-suppressed single-shot spin-echo echo-planar imaging (EPI) of the liver: comparison of image quality at 1.5 and 3 T.

AIM: To compare echo-planar imaging (EPI) of the liver at 1.5 and 3 T. MATERIALS AND METHODS: Under a waiver from the institutional review board, 46 patients underwent respiratory-triggered fat-suppressed b = 50 s/mm(2) EPI at 1.5 or 3 T between 2010-2013. Thirty liver lesions were included with no therapy performed between studies. Signal- and contrast-to-noise ratios (SNR/CNR) were compared using a paired t-test. Two blinded readers independently assessed EPI at 1.5 and 3 T in two separate reading sessions for image quality by hepatic region and the presence and severity of artefacts. Results were compared using the Wilcoxon sign rank test. Interobserver agreement was assessed using Cohen's kappa statistic. RESULTS: There was no difference in mean SNR/CNR at 3 T (20.26 ± 10.25/9.55 ± 15.78); compared to 1.5 T (21.96 ± 9.75/5.35 ± 7.89); p = 0.43 and p = 0.09, respectively. Image quality was better at 1.5 T for all hepatic regions (p < 0.001). Image quality was poor or suboptimal at 3 T in 57% of regions studied, compared to 5.6% at 1.5 T. With the exception of image blur (p = 0.27), all artefacts were more prevalent at 3 T with higher rates of image distortion (p < 0.001), failed fat suppression (p = 0.002), ghosting (p < 0.001), parallel imaging artefact (p < 0.001), and shading (p < 0.001). Interobserver agreement was moderate (κ = 0.43-0.53). CONCLUSION: Fat-suppressed low b-value EPI of the liver is significantly better at 1.5 T compared to 3 T.

Sepsis-related acute kidney injury: a protective effect of drotrecogin alpha (activated) treatment?

BACKGROUND: Drotrecogin alpha activated (DrotAA) is licensed for treatment of patients with severe sepsis and organ failure. Among the latter, acute kidney injury (AKI), defined as the persistence of oligo-anuria following adequate resuscitation, is one of the most apprehended. We conducted a prospective, observational, and controlled study to test the hypothesis that DrotAA beneficially affected the evolution and outcome of AKI, complicating acute sepsis-induced cardiopulmonary failure. METHODS: Forty-six patients were studied. Thirty subjects received standard treatment for sepsis without DrotAA. In the remaining 16 patients, DrotAA was added as a continuous infusion of 24 microg/kg/h for 96 h. RESULTS: Mean age, causes of sepsis, and severity/organ failure scores were comparable between patients treated with or without DrotAA. Mortality at 28 days was high and comparable between both treatment groups (56% vs. 69%, DrotAA vs. no DrotAA; P=0.5). When oligo-anuria was present at the start of the study, it persisted during treatment in all patients, with no significant difference between groups. Both treatment groups presented with baseline mean daily fractional excretion of sodium values >2% that remained high during the observation period, regardless of whether DrotAA was given or not. Kidney histology showed a preserved renal architecture with tubular necrosis in all specimens. Similar glomerular, tubulo-interstitial, and vascular alterations were present in both treatment groups. CONCLUSION: In this small cohort of patients with severe sepsis who received adjuvant DrotAA treatment, no effect on urine output, tubular function, or mortality could be demonstrated.

Influence of display quality on radiologists' performance in the detection of lung nodules on radiographs.

The purpose of this study was to evaluate the influence of display quality on radiologists' performance in the detection of lung nodules. Display systems with various technical properties were considered based on their general availability in a radiology department. Their quality was assessed by physical tests. Multireader-multicase receiver operating characteristic (ROC) analysis was used to evaluate observer performance. The area under the curve (Az) was used as a metric for detectability of simulated lung nodules with diameters of 5 mm and 10 mm, and peak contrast values ranging from 0.1 (subtle) to 0.4 (evident) that were digitally superimposed on normal chest radiographs. Three experienced radiologists interpreted a batch of 60 radiographs on five different display systems; four monitors (two liquid crystal display (LCD) and two cathode ray tube (CRT) monitors) and one printed hardcopy. The physical tests showed superior performance of the two LCD monitors. ROC analysis resulted in the following Az scores: LCD-5MP Az = 0.78, hardcopy Az = 0.77, LCDc-2MP Az = 0.75, CRT-5MP Az = 0.72 and CRTc-1MP Az = 0.71. Difference in Az scores between the LCD-5MP monitor and both the CRT-5MP (p = 0.04) and CRTc-1MP (p = 0.01) monitors was significant. The primary class CRT-5MP monitor that showed reduced observer performance failed to comply with physical acceptance requirements. Luminance response was particularly observed to be insufficient. The results indicate that a quality assurance program has the potential to detect non-optimised display systems that could otherwise result in reduced observer performance.

Inadequacy of the one-dimensional fit-model formula for ultrasound volume assessment of the thyroid gland.

The aim of our study is to assess the best fit-model to assess the thyroid gland formula with a calibrated, automated method namely multi-detector CT to evaluate the most correct fit model in measuring thyroid gland volume.

Diffusion-weighted MR imaging of intracerebral masses: comparison with conventional MR imaging and histologic findings.

BACKGROUND AND PURPOSE: The purposes of this study were to find the role of diffusion-weighted MR imaging in characterizing intracerebral masses and to find a correlation, if any, between the different parameters of diffusion-weighted imaging and histologic analysis of tumors. The usefulness of diffusion-weighted imaging and apparent diffusion coefficient (ADC) maps in tumor delineation was evaluated. Contrast with white matter and ADC values for tumor components with available histology were also evaluated. METHODS: Twenty patients with clinical and routine MR imaging/CT evidence of intracerebral neoplasm were examined with routine MR imaging and echo-planar diffusion-weighted imaging. The routine MR imaging included at least the axial T2-weighted fast spin-echo and axial T1-weighted spin-echo sequences before and after contrast enhancement. The diffusion-weighted imaging included an echo-planar spin-echo sequence with three b values (0, 300, and 1200 s/mm(2)), sensitizing gradient in the z direction, and calculated ADC maps. The visual comparison of routine MR images with diffusion-weighted images for tumor delineation was performed as was the statistical analysis of quantitative diffusion-weighted imaging parameters with histologic evaluation. RESULTS: For tumors, the diffusion-weighted images and ADC maps of gliomas were less useful than the T2-weighted spin-echo and contrast-enhanced T1-weighted spin-echo images in definition of tumor boundaries. Additionally, in six cases of gliomas, neither T2-weighted spin-echo nor diffusion-weighted images were able to show a boundary between tumor and edema, which was present on contrast-enhanced T1-weighted and/or perfusion echo-planar images. The ADC values of solid gliomas, metastases, and meningioma were in the same range. In two cases of lymphomas, there was a good contrast with white matter, with strongly reduced ADC values. For infection, the highest contrast on diffusion-weighted images and lowest ADC values were observed in association with inflammatory granuloma and abscess. CONCLUSION: Contrary to the findings of previous studies, we found no clear advantage of diffusion-weighted echo-planar imaging in the evaluation of tumor extension. The contrast between gliomas, metastases, meningioma, and white matter was generally lower on diffusion-weighted images and ADC maps compared with conventional MR imaging. Unlike gliomas, the two cases of lymphomas showed hyperintense signal on diffusion-weighted images whereas the case of cerebral abscess showed the highest contrast on diffusion-weighted images with very low ADC values. Further study is required to find out whether this may be useful in the differentiation of gliomas and metastasis from lymphoma and abscess.

Silent iodine prophylaxis in Western Europe only partly corrects iodine deficiency; the case of Belgium.

OBJECTIVE: Belgium is one of the Western European countries in which no program of iodine-deficiency correction using iodized salt has been implemented, in spite of well-documented mild iodine deficiency. In 1995, the median urinary iodine concentration was 55 microg/l (normal: 100-200) and the prevalence of goiter was 11% (normal: below 5%) in representative samples of schoolchildren aged 6-12 years. Based on these results, the authors of the present study and others had emphasized to health professionals and to the public the necessity for iodine supplementation. The objective of this study was to evaluate as to whether these efforts had resulted in an improvement in the status of iodine nutrition. DESIGN: We performed a national survey of the status of iodine nutrition in Belgium based on the determination of thyroid volume, obtained by ultrasonography, and urinary iodine concentrations in schoolchildren. METHODS: A mobile van equipped with an ultrasound instrument, a computer and a deep-freeze visited 23 schools selected from across the country. The sample included 2855 schoolchildren (1365 boys and 1490 girls) aged 6-12 years. RESULTS: The results show a homogeneous situation in the whole country, with a median urinary iodine concentration of 80 microg/l and a goiter prevalence of 5.7%. Urinary iodine slightly decreases with age in girls and reaches a critical value of 59 microg/l at the age of 12 years, together with a goiter prevalence of 18.4%. CONCLUSION: Iodine nutrition has improved slightly in Belgium but mild iodine deficiency continues, with public-health consequences. The improvement indicates silent iodine prophylaxis, as no official salt-iodization measures have been taken. Silent iodine prophylaxis only partly corrects iodine deficiency in Western Europe. Active measures, including the implementation of a program of salt iodization, are urgently required.

Prevalence of thyroid hemiagenesis: ultrasound screening in normal children.

UNLABELLED: While performing a systematic ultrasound study of the thyroid gland volume for the evaluation of iodine deficiency in 2845 normal Belgian school children, we found an absence of the left lobe in 6 children (4 girls and 2 boys). There was no association with other thyroid malformations or dysfunction. CONCLUSION: This first systematic ultrasound evaluation of thyroid hemiagenesis in normal children established a prevalence of thyroid hemiagenesis of 0.2% and confirmed the female predominance and higher incidence of agenesis of the left lobe.

Use of diffusion-weighted MR imaging in differential diagnosis between intracerebral necrotic tumors and cerebral abscesses.

The differential diagnosis between intracerebral necrotic tumors and cerebral abscesses is frequently impossible with conventional MR imaging. We report two cases of cerebral abscesses that showed high signal on diffusion-weighted echo planar imaging and a strongly reduced apparent diffusion coefficient. This appearance was not present in our cases of necrotic/cystic gliomas (eight cases) and necrotic metastases (two cases). We believe that diffusion-weighted MR imaging may be a diagnostic clue in cases of cerebral "ring-enhancing" masses.