Imaging Requirements for Utilization of T2*-Weighted Magnetic Resonance Imaging for Identification of Hepatocellular Carcinoma in Cirrhosis: Effect of Hepatic Iron Content.

PURPOSE: To evaluate the impact of the level of inherent hepatic iron deposition on the ability of multiecho T2*-weighted magnetic resonance imaging (T2*WI) to identify hepatocellular carcinoma. This is relevant to the ancillary features described in the Liver Imaging Reporting and Data System reporting system. METHODS: This retrospective review identified liver transplant patients with a preoperative magnetic resonance imaging at 1.5 T including gradient-recalled echo T2*WI (echo time, 9.5, 19.3, 29.0 milliseconds). A blinded, randomized reading was performed by a single reader of each of the images at each echo time. Hepatic iron content (HIC) was calculated for each participant and compared with the results of the blinded read. RESULTS: Ninety-eight HCCs were identified on explant pathology in 73 participants. Of these, 57 HCCs (58%) were identified on T2*WI. However, no HCCs were visible in participants with HIC < 1.0 mg/g. For participants with HIC > 1.0 mg/g, 57 (88%) of 65 HCCs were visible. CONCLUSIONS: Most of HCCs can be identified on T2*WI without gadolinium; however, performance is significantly affected by background HIC.

Extraurinary Incidental Findings on CT for Hematuria: The Radiologist's Role and Downstream Cost Analysis.

OBJECTIVE: The purposes of this study of patients who underwent CT for hematuria were to understand how radiologists' recommendations regarding incidental findings affect their management, assess long-term outcomes from important incidental findings, and calculate estimates of downstream costs. MATERIALS AND METHODS: A retrospective analysis was performed of 1295 patients who underwent CT for hematuria from 2004 to 2006 at our institution. Incidental findings outside the urinary tract were recorded and imaging reports categorized on the basis of recommendations, interpretations, and actions of radiologists. Patients with important incidental findings were followed for 6-8 years. Costs related to incidental findings were estimated and tallied. RESULTS: Two hundred fourteen important findings were found in 143 of 1295 patients, with 93 patients undergoing clinical follow-up, including 30 patients who underwent invasive procedures leading to 154 hospital days and 16 operations (group 1). In 63 patients, no invasive procedures were performed (group 2). Costs were higher in group 1 than in group 2, and the average per-patient cost for all 1295 patients was $385. In group 1, 95% of recommendations were followed compared with 80% in group 2. There was probable therapeutic benefit in 25 of 143 (17%) patients. There were serious complications in six of 143 (4.2%) patients, including death in two of 143 (1.4%). CONCLUSION: Radiologists' recommendations were generally followed for important incidental findings. These recommendations can direct the most cost-efficient and effective care for incidental findings. Although some patients with incidental findings had probable benefit, others incurred morbidity or mortality. A small number of invasive procedures resulted in substantial costs in this symptomatic population. Costs averaged over the entire population were higher than have been previously reported.