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As the incidence of hepatocellular carcinoma (HCC) and subsequent treatments with liver‐directed therapies rise, the complexity of assessing lesion response has also increased. The Liver Imaging Reporting and Data Systems (LI‐RADS) treatment response algorithm (LI‐RADS TRA) was created to standardize the assessment of response after locoregional therapy (LRT) on contrast‐enhanced CT or MRI. Originally created based on expert opinion, these guidelines are currently undergoing revision based on emerging evidence. While many studies support the use of LR‐TRA for evaluation of HCC response after thermal ablation and intra‐arterial embolic therapy, data suggest a need for refinements to improve assessment after radiation therapy. In this manuscript, we review expected MR imaging findings after different forms of LRT, clarify how to apply the current LI‐RADS TRA by type of LRT, explore emerging literature on LI‐RADS TRA, and highlight future updates to the algorithm. Evidence Level: 3. Technical Efficacy: Stage 2. [ABSTRACT FROM AUTHOR]

Background: There is a sparsity of data evaluating outcomes of patients with Liver Imaging Reporting and Data System (LI‐RADS) (LR)‐M lesions. Purpose: To compare overall survival (OS) and progression free survival (PFS) between hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA) meeting LR‐M criteria and to evaluate factors associated with prognosis. Study Type: Retrospective. Subjects: Patients at risk for HCC with at least one LR‐M lesion with histologic diagnosis, from 8 academic centers, yielding 120 patients with 120 LR‐M lesions (84 men [mean age 62 years] and 36 women [mean age 66 years]). Field Strength/Sequence: A 1.5 and 3.0 T/3D T1‐weighted gradient echo, T2‐weighted fast spin‐echo. Assessment: The imaging categorization of each lesion as LR‐M was made clinically by a single radiologist at each site and patient outcome measures were collected. Statistical Tests: OS, PFS, and potential independent predictors were evaluated by Kaplan–Meier method, log‐rank test, and Cox proportional hazard model. A P value of <0.05 was considered significant. Results: A total of 120 patients with 120 LR‐M lesions were included; on histology 65 were HCC and 55 were iCCA. There was similar median OS for patients with LR‐M HCC compared to patients with iCCA (738 days vs. 769 days, P = 0.576). There were no significant differences between patients with HCC and iCCA in terms of sex (47:18 vs. 37:18, P = 0.549), age (63.0 ± 8.4 vs. 63.4 ± 7.8, P = 0.847), etiology of liver disease (P = 0.202), presence of cirrhosis (100% vs. 100%, P = 1.000), tumor size (4.73 ± 3.28 vs. 4.75 ± 2.58, P = 0.980), method of lesion histologic diagnosis (P = 0.646), and proportion of patients who underwent locoregional therapy (60.0% vs. 38.2%, P = 0.100) or surgery (134.8 ± 165.5 vs. 142.5 ± 205.6, P = 0.913). Using multivariable analysis, nonsurgical compared to surgical management (HR, 4.58), larger tumor size (HR, 1.19), and higher MELD score (HR, 1.12) were independently associated with worse OS. Data Conclusion: There was similar OS in patients with LR‐M HCC and LR‐M iCCA, suggesting that LR‐M imaging features may more closely reflect patient outcomes than histology. Evidence Level: 3 Technical Efficacy: Stage 5 [ABSTRACT FROM AUTHOR]

Our aim was to determine the effect of wearing a surgical mask on the number and type of dictation errors in unedited radiology reports. IRB review was waived for this prospective matched-pairs study in which no patient data was used. Model radiology reports (n = 40) simulated those typical for an academic medical center. Six randomized radiologists dictated using speech-recognition software with and without a surgical mask. Dictations were compared to model reports and errors were classified according to type and severity. A statistical model was used to demonstrate that error rates for all types of errors were greater when masks are worn compared to when they are not (unmasked: 21.7 ± 4.9 errors per 1000 words, masked: 27.1 ± 2.2 errors per 1000 words; adjusted p < 0.0001). A sensitivity analysis was performed, excluding a reader with a large number of errors. The sensitivity analysis found a similar difference in error rates for all types of errors, although significance was attenuated (unmasked: 16.9 ± 1.9 errors per 1000 words, masked: 20.1 ± 2.2 errors per 1000 words; adjusted p = 0.054). We conclude that wearing a mask results in a near-significant increase in the rate of dictation errors in unedited radiology reports created with speech-recognition, although this difference may be accentuated in some groups of radiologists. Additionally, we find that most errors are minor single incorrect words and are unlikely to result in a medically relevant misunderstanding. [ABSTRACT FROM AUTHOR]

Locoregional therapies can be offered to hepatocellular carcinoma patients as a bridge to transplant, to downstage disease burden for transplant eligibility, or for disease control to prolong survival. Systemic therapies also play a large role in HCC treatment, occasionally in conjunction with other methods. This manuscript reviews the various treatment options for HCC with a historically noncurative intent. [ABSTRACT FROM AUTHOR]

Purpose: To perform a systematic review and meta-analysis using individual patient data to investigate the diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS) Treatment Response (TR) algorithm for detecting incomplete necrosis on pathology. Methods: PubMed and EMBASE were searched from Jan 1, 2017 until October 14, 2020. Studies reporting diagnostic accuracy of LI-RADS TR algorithm on CT or MRI for detecting incomplete necrosis on pathology as a reference standard were included. Sensitivity and specificity were pooled using random-effects model. Subgroup analyses were performed for locoregional treatment (LRT) type and imaging modality. Results: Six studies (393 patients, 534 lesions) were included. Pooled sensitivity was 0.56 (95% confidence interval [CI] 0.43–0.69) and specificity was 0.91 (95%CI 0.84–0.96). Pooled sensitivity was highest using arterial phase hyperenhancement (APHE) (0.67 [95%CI 0.51–0.81]), followed by washout (0.43 [95%CI 0.26–0.62]) and enhancement similar to pretreatment (0.24 [95%CI 0.15–0.36]). Among lesions with incomplete necrosis, 2% (95%CI 0.00–0.05) manifested as washout but no APHE; 0% (95% CI 0.00–0.02) as enhancement similar to pretreatment without both APHE and washout. Pooled sensitivity was lower after ablation than embolization (0.42 [95%CI, 0.28–0.57] vs. 0.65 [95%CI, 0.53–0.77], p = 0.033). MRI and CT were comparable (p = 0.783 and 0.290 for sensitivity and specificity). Conclusions: LI-RADS TR algorithm shows moderate sensitivity and high specificity for detecting incomplete necrosis after LRT. APHE is the dominant criterion, a washout contributes to small but meaningful extent, while the contribution of enhancement similar to pretreatment may be negligible. LRT type may affect performance of the algorithm. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) offers unique management challenges as it commonly occurs in the setting of underlying chronic liver disease. The management of HCC is directed primarily by the clinical stage. The most commonly used staging system is the Barcelona-Clinic Liver Cancer system, which considers tumor burden based on imaging, liver function and the patient's performance status. Early-stage HCC can be managed with therapies of curative intent including surgical resection, liver transplantation, and ablative therapies. This manuscript reviews the various treatment options for HCC with a curative intent, such as locablative therapy types, surgical resection, and transplant. Indications, contraindications and outcomes of the various treatment options are reviewed. Multiple concepts relating to liver transplant are discussed including Milan criteria, OPTN policy, MELD exception points, downstaging to transplant and bridging to transplant. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and feasibility of ultrasound-guided intralesional injection of Talimogene laherparepvec (Imlygic, T-VEC) in patients with advanced non-palpable melanoma. Materials and Methods: Fourteen consecutive patients (mean age, 67.9 years ± 13.0; range, 40–88; 12 males) with unresectable, locally advanced melanoma underwent ultrasound-guided intralesional injections of T-VEC (July 2016–March 2020) into subcutaneous lesions. Tumor response to the injection was evaluated at the last follow-up. Technical success and complication rates were recorded. Results: The T-VEC injection was technically successful in all patients with all lesions successfully punctured (100%). The mean number of lesions, injection cycles, and injection volumes were 4.1 ± 2.6 (1–9), 6.5 ± 3.0 (3–12), and 2.6 mL ± 1.4 (1–4 mL), respectively. During the follow-up period (mean, 21.0 months ± 13.4; range 1–43.6 months), complete remission, partial remission, persistent disease, and disease progression were observed in 6 (42.9%), 3 (21.4%), 1 (7.1%), and 4 (28.6%) patients, respectively. Post-treatment symptoms observed in 9 patients (64.3%), including fever (n = 2), fatigue (n = 1), headache (n = 1), pain (n = 1), mouth sores (n = 1), and flu-like symptoms (n = 3). No injection-related complications occurred in all procedures. Conclusion: Intralesional injection of T-VEC for non-palpable metastases under ultrasound guidance is safe and feasible in patients with advanced melanoma. [ABSTRACT FROM AUTHOR]

Background Considerable interest exists in comparison between healthcare systems across multiple countries, especially where cost enters the discussion. Purpose To evaluate the relationship between radiologists' income, receipts for studies, and academic performance across multiple countries. Material and Methods The annual income of radiologists and receipts for computed tomography (CT) and magnetic resonance imaging (MRI) were obtained based on a survey sent to expert radiologists practicing in 23 countries of varying developmental status. Articles published in generalist radiology journals determined the academic performance of each country. Results Among the developed countries, Canada has the highest estimated annual income for both private ($700,000/year) and university radiologists ($600,000/year) while Spain has the lowest income for private practice ($68,000/year) and Portugal has the lowest income for university practice ($57,300/year). Among the developing countries, Saudi Arabia has the highest incomes for both private ($210,000/year) and university ($140,000/year) radiologists and Vietnam has the lowest incomes for both private ($30,000/year) and university ($6,000/year) radiologists. Total receipts for CT and MRI studies ranged from $80/study (Portugal) to $1000/study (USA) in developed countries, and ranged from $30/study (Egypt) to $700/study (Saudi Arabia) in developing countries. A moderate correlation ( r = 0.482) was seen between radiologist's income and the receipts for combined practice in all countries. The radiology journal academic quotient was highest in The Netherlands among developed countries, and Turkey among developing countries. Conclusion A relatively broad range of radiologists' income is observed among developed and developing countries, which shows correlation with the receipts for advanced imaging studies. Countries with an acceptable compromise between income, receipts, and academic performance, may be the best models for other countries to emulate. [ABSTRACT FROM AUTHOR]

Pelvic computed tomography angiography (CTA) prior to prostatic artery embolization is a beneficial tool for preprocedural planning to increase the likelihood of success during what can be a challenging procedure. Additionally, the same CTA images can be used for calculating the baseline prostate volume as well as for intraprocedural anatomic guidance, adding to the value of the scan. This article discusses the technique used for pelvic CTA and its role in preprocedural assessment of the pelvic vasculature prior to prostatic artery embolization. [ABSTRACT FROM AUTHOR]