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Background Various limitations have impacted research evaluating reader agreement for Liver Imaging Reporting and Data System (LI-RADS). Purpose To assess reader agreement of LI-RADS in an international multicenter multireader setting using scrollable images. Materials and Methods This retrospective study used deidentified clinical multiphase CT and MRI and reports with at least one untreated observation from six institutions and three countries; only qualifying examinations were submitted. Examination dates were October 2017 to August 2018 at the coordinating center. One untreated observation per examination was randomly selected using observation identifiers, and its clinically assigned features were extracted from the report. The corresponding LI-RADS version 2018 category was computed as a rescored clinical read. Each examination was randomly assigned to two of 43 research readers who independently scored the observation. Agreement for an ordinal modified four-category LI-RADS scale (LR-1, definitely benign; LR-2, probably benign; LR-3, intermediate probability of malignancy; LR-4, probably hepatocellular carcinoma [HCC]; LR-5, definitely HCC; LR-M, probably malignant but not HCC specific; and LR-TIV, tumor in vein) was computed using intraclass correlation coefficients (ICCs). Agreement was also computed for dichotomized malignancy (LR-4, LR-5, LR-M, and LR-TIV), LR-5, and LR-M. Agreement was compared between research-versus-research reads and research-versus-clinical reads. Results The study population consisted of 484 patients (mean age, 62 years ± 10 [SD]; 156 women; 93 CT examinations, 391 MRI examinations). ICCs for ordinal LI-RADS, dichotomized malignancy, LR-5, and LR-M were 0.68 (95% CI: 0.61, 0.73), 0.63 (95% CI: 0.55, 0.70), 0.58 (95% CI: 0.50, 0.66), and 0.46 (95% CI: 0.31, 0.61) respectively. Research-versus-research reader agreement was higher than research-versus-clinical agreement for modified four-category LI-RADS (ICC, 0.68 vs 0.62, respectively; P = .03) and for dichotomized malignancy (ICC, 0.63 vs 0.53, respectively; P = .005), but not for LR-5 (P = .14) or LR-M (P = .94). Conclusion There was moderate agreement for LI-RADS version 2018 overall. For some comparisons, research-versus-research reader agreement was higher than research-versus-clinical reader agreement, indicating differences between the clinical and research environments that warrant further study. © RSNA, 2023 Supplemental material is available for this article. See also the editorials by Johnson and Galgano and Smith in this issue.

The Liver Imaging Reporting and Data System (LI-RADS®) is a comprehensive system for standardizing the terminology, technique, interpretation, reporting, and data collection of liver observations in individuals at high risk for hepatocellular carcinoma (HCC). LI-RADS is supported and endorsed by the American College of Radiology (ACR). Upon its initial release in 2011, LI-RADS applied only to liver observations identified at CT or MRI. It has since been refined and expanded over multiple updates to now also address ultrasound-based surveillance, contrast-enhanced ultrasound for HCC diagnosis, and CT/MRI for assessing treatment response after locoregional therapy. The LI-RADS 2018 version was integrated into the HCC diagnosis, staging, and management practice guidance of the American Association for the Study of Liver Diseases (AASLD). This article reviews the major LI-RADS updates since its 2011 inception and provides an overview of the currently published LI-RADS algorithms.

The Liver Imaging and Reporting Data System (LI-RADS) is a comprehensive system for standardizing the terminology, technique, interpretation, reporting, and data collection of liver imaging with the overarching goal of improving communication, clinical care, education, and research relating to patients at risk for or diagnosed with hepatocellular carcinoma (HCC). In 2018, the American Association for the Study of Liver Diseases (AASLD) integrated LI-RADS into its clinical practice guidance for the imaging-based diagnosis of HCC. The harmonization between the AASLD and LI-RADS diagnostic imaging criteria required minor modifications to the recently released LI-RADS v2017 guidelines, necessitating a LI-RADS v2018 update. This article provides an overview of the key changes included in LI-RADS v2018 as well as a look at the LI-RADS v2018 diagnostic algorithm and criteria, technical recommendations, and management suggestions. Substantive changes in LI-RADS v2018 are the removal of the requirement for visibility on antecedent surveillance ultrasound for LI-RADS 5 (LR-5) categorization of 10-19 mm observations with nonrim arterial phase hyper-enhancement and nonperipheral "washout", and adoption of the Organ Procurement and Transplantation Network definition of threshold growth (≥ 50% size increase of a mass in ≤ 6 months). Nomenclatural changes in LI-RADS v2018 are the removal of -us and -g as LR-5 qualifiers.

Repetitive sensory stimulation has been shown to induce neuroplasticity in sensory cortical circuits, at least under certain conditions. We measured the plasticity‐inducing effect of repetitive contrast‐reversal‐sweep steady‐state visual‐evoked potential (ssVEP) stimuli, hoping to employ the ssVEP's high signal‐to‐noise electrophysiological readout in the study of human visual cortical neuroplasticity. Steady‐state VEP contrast‐sweep responses were measured daily for 4 days (four 20‐trial blocks per day, 20 participants). No significant neuroplastic changes in response amplitude were observed either across blocks or across days. Furthermore, response amplitudes were stable within‐participant, with measured across‐block and across‐day coefficients of variation (CV = SD/mean) of 15–20 ± 2% and 22–25 ± 2%, respectively. Steady‐state VEP response phase was also highly stable, suggesting that temporal processing delays in the visual system vary by at most 2–3 ms across blocks and days. While we fail to replicate visual stimulation‐dependent cortical plasticity, we show that contrast‐sweep steady‐state VEPs provide a stable human neurophysiological measure well suited for repeated‐measures longitudinal studies. Repetitive visual sensory stimulation can be harnessed experimentally to study neuroplasticity processes in humans, but existing methods show inconsistent effects. We attempted to measure neuroplastic effects of repetitive contrast‐sweep steady‐state visual evoked potential stimuli but found no evidence for changes in response amplitude with this stimulus paradigm. Instead, we found high within‐subject stability of response amplitude and phase, indicating that ssVEP contrast response functions are exceptionally well suited for repeated‐measures longitudinal studies. [ABSTRACT FROM AUTHOR]

Cobalt complexes that undergo charge-transfer induced spin-transitions or valence tautomerism from low spin CoIII to high spin (HS) CoII are potential candidates for magneto-optical switches. We use M2,3-edge X-ray absorption near-edge structure (XANES) spectroscopy with 40 fs time resolution to measure the excited-state dynamics of CoIII(Cat-N-SQ)(Cat-N-BQ), where Cat-N-BQ and Cat-N-SQ are the singly and doubly reduced forms of the 2-(2-hydroxy-3,5-di-tert-butylphenyl-imino)-4,6-di-tert-butylcyclohexa-3,5-dienone ligand. The extreme ultraviolet probe pulses, produced using a tabletop high-harmonic generation light source, measure 3p → 3d transitions and are sensitive to the spin and oxidation state of the Co center. Photoexcitation at 525 nm produces a low-spin CoII ligand-to-metal charge transfer state which undergoes intersystem crossing to high-spin CoII in 67 fs. Vibrational cooling from this hot HS CoII state competes on the hundreds-of-fs time scale with back-intersystem crossing to the ground state, with 60% of the population trapped in a cold HS CoII state for 24 ps. Ligand field multiplet simulations accurately reproduce the ground-state spectra and support the excited-state assignments. This work demonstrates the ability of M2,3-edge XANES to measure ultrafast photophysics of molecular Co complexes. [ABSTRACT FROM AUTHOR]

Induction of remission in biologic-experienced individuals with moderate to severe Crohn’s disease (CD) can be a challenge. We hereby present a case of CD with secondary non-response to infliximab. Adding methotrexate and switching to ustekinumab plus methotrexate did not stop the inflammatory process. Therefore, combination therapy with two classes of biologics consisting of ustekinumab and adalimumab plus methotrexate was initiated. He achieved clinical remission in 4 weeks and remained on triple therapy for 6 months which was subsequently tailored to adalimumab/methotrexate combination therapy due to insurance restriction on ustekinumab. He remained in remission for the duration of follow-up, 14 months after initiation of triple therapy and 8 months after switching to methotrexate/adalimumab biologic monotherapy. Triple therapy with anti-TNF, IL-12/23 inhibitor and methotrexate could potentially be an option for induction of remission in biologic-experienced individuals with good initial clinical response to anti-TNF agents. [ABSTRACT FROM AUTHOR]