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Focal liver lesions (FLLs) have become an increasingly common finding on abdominal imaging, especially asymptomatic and incidental liver lesions. Gastroenterologists and hepatologists often see these patients in consultation and make recommendations for management of multiple types of liver lesions, including hepatocellular adenoma, focal nodular hyperplasia, hemangioma, and hepatic cystic lesions including polycystic liver disease. Malignancy is important to consider in the differential diagnosis of FLLs, and healthcare providersmust be familiarwith the diagnosis andmanagement of FLLs. This American College of Gastroenterology practice guideline uses the best evidence available to make diagnosis and management recommendations for the most common FLLs. [ABSTRACT FROM AUTHOR]

Ambient light (AL) is an important factor to improve ultrasound pathology detection. However, there are no established room AL levels recommended during an ultrasound examination. We aim to examine the diagnostic accuracy using different intensity of AL for the detection of liver lesions in anonymised pre-recorded cine-clips. Eight ultrasound operators with 5–14 years' professional experiences were prospectively recruited to evaluate 51 randomised cine-clips directly from one ultrasound machine. These 15-s clips of the right lobe of the liver in longitudinal and transverse planes were meant to simulate the ultrasound examination. Operators reviewed all cine-clips and responded to two questions per cine-clip regarding their detection performance under 3 AL settings; 3, 15 and 25 lux, at one lighting per visit. A repeat visit under each AL was performed to assess for intra-operator variability. Each operator completed six visits in total, with at least a 2-day washout period. The operators' performance was compared against imaging reference standards from contrast CT/MRI for cine-clips with lesion and serial US for those without. AL with highest degree of diagnostic accuracy was found to be at 25 lux. Results from 8 operators revealed sensitivity ranged from 79% to 100%, specificity ranged from 94% to 100%. Positive and negative predictive values were up to 100% with AL at 25 lux. Both intra-and interrater reliability were excellent at 0.85–1.0 (0.79–0.98) and 0.98 (0.97, 0.99) respectively, with AL at 25 lux. This study proved that ambient light intensity affects the ultrasound operator detection of liver lesions on cine-clips. Identifying suitable AL levels will influence future ultrasound room construct. [ABSTRACT FROM AUTHOR]

Introduction: Diffusion-weighted imaging [DWI] plays a significant role in distinguishing liver lesions. This study focuses on the significance of apparent diffusion coefficient [ADC] values in distinguishing between benign and malignant liver lesions. Methods: A retrospective evaluation was conducted on patients who underwent liver MRI examinations at our clinic, and 378 liver lesions were found. The study comprised 141 women, 80 men, and 221 patients with liver lesions. The measured ADC values between benign and malignant lesions were compared. In addition, the lesion ADC value/CSF ADC value ratio was measured, and the relative ADC value was named. Results: 118 hemangiomas, 59 simple cysts, 67 hydatid cysts, 3 focal nodular hyperplasias, 9 abscesses, 28 hepatocellular carcinomas, 88 metastases, and 6 lymphomas were evaluated. Simple cysts and hemangiomas had the most elevated ADC values compared to all other liver lesions. The ADC values for liver lesions classified as benign had a mean of 2.10 x 10-3 mm2/s, while malignant ones had a lower mean of 0.75 x 10-3 mm2/s. The ADC values of malignant liver lesions were lower compared to the benign lesions. Conclusion: Using DWI combined with ADC values could be valuable in discerning between benign and malignant liver lesions. Besides, relative ADC values may also contribute to more objective results.

Abstract Background Contrast-enhanced ultrasound (CEUS) is considered as an efficient tool for focal liver lesion characterization, given it allows real-time scanning and provides dynamic tissue perfusion information. An accurate diagnosis of liver lesions with CEUS requires a precise interpretation of CEUS images. However,it is a highly experience dependent task which requires amount of training and practice. To help improve the constrains, this study aims to develop an end-to-end method based on deep learning to make malignancy diagnosis of liver lesions using CEUS. Methods A total of 420 focal liver lesions with 136 benign cases and 284 malignant cases were included. A deep learning model based on a two-dimensional convolution neural network, a long short-term memory (LSTM), and a linear classifier (with sigmoid) was developed to analyze the CEUS loops from different contrast imaging phases. For comparison, a 3D-CNN based method and a machine-learning (ML)-based time-intensity curve (TIC) method were also implemented for performance evaluation. Results Results of the 4-fold validation demonstrate that the mean AUC is 0.91, 0.88, and 0.78 for the proposed method, the 3D-CNN based method, and the ML-based TIC method, respectively. Conclusions The proposed CNN-LSTM method is promising in making malignancy diagnosis of liver lesions in CEUS without any additional manual features selection.

Background: Contrast-enhanced ultrasound (CEUS) is considered as an efficient tool for focal liver lesion characterization, given it allows real-time scanning and provides dynamic tissue perfusion information. An accurate diagnosis of liver lesions with CEUS requires a precise interpretation of CEUS images. However,it is a highly experience dependent task which requires amount of training and practice. To help improve the constrains, this study aims to develop an end-to-end method based on deep learning to make malignancy diagnosis of liver lesions using CEUS. Methods: A total of 420 focal liver lesions with 136 benign cases and 284 malignant cases were included. A deep learning model based on a two-dimensional convolution neural network, a long short-term memory (LSTM), and a linear classifier (with sigmoid) was developed to analyze the CEUS loops from different contrast imaging phases. For comparison, a 3D-CNN based method and a machine-learning (ML)-based time-intensity curve (TIC) method were also implemented for performance evaluation. Results: Results of the 4-fold validation demonstrate that the mean AUC is 0.91, 0.88, and 0.78 for the proposed method, the 3D-CNN based method, and the ML-based TIC method, respectively. Conclusions: The proposed CNN-LSTM method is promising in making malignancy diagnosis of liver lesions in CEUS without any additional manual features selection. [ABSTRACT FROM AUTHOR]

Bovine Fasciolosis poses significant public health problems and is of great concern for all livestock farmers. Studies on bovine Fasciolosis have been carried out in different abattoirs in Nigeria. However, there is no study on bovine fasciolosis at the Akinyele Central Abattoir, Ibadan. Our study aimed to determine the prevalence of bovine Fasciolosis and associated risk factors, the most prevalent Fasciola spp., fluke burden and severity of liver lesions, and the correlation between fluke burden and severity of liver lesions at the Akinyele Central Abattoir, Ibadan. A total of 640 slaughtered cattle were sampled over the course of a year. During the postmortem examination, the liver was examined for the presence of flukes, which were identified at the species level. The flukes in each liver were counted, and liver lesions were classified based on severity. The prevalence of bovine Fasciolosis was 20%, with Fasciola gigantica (78.1%) being the most common species. Fasciolosis in the wet season (26.5%) was significantly (P < 0.05) more prevalent than in the dry season (8.6%). The fluke burden of 3 to 20 flukes (65.6%) was the most prevalent. Most of the livers with Fasciolosis were moderately affected (50%). There was a moderate correlation between fluke burden and the severity of the liver lesion. Bovine fasciolosis is prevalent in Akinyele Central Abattoir, Ibadan, with season being the only identified risk factor. It is recommended that regular deworming be initiated for the control and prevention of bovine Fasciolosis before and after the rainy season.

Bovine Fasciolosis poses significant public health problems and is of great concern for all livestock farmers. Studies on bovine Fasciolosis have been carried out in different abattoirs in Nigeria. However, there is no study on bovine fasciolosis at the Akinyele Central Abattoir, Ibadan. Our study aimed to determine the prevalence of bovine Fasciolosis and associated risk factors, the most prevalent Fasciola spp., fluke burden and severity of liver lesions, and the correlation between fluke burden and severity of liver lesions at the Akinyele Central Abattoir, Ibadan. A total of 640 slaughtered cattle were sampled over the course of a year. During the postmortem examination, the liver was examined for the presence of flukes, which were identified at the species level. The flukes in each liver were counted, and liver lesions were classified based on severity. The prevalence of bovine Fasciolosis was 20%, with Fasciola gigantica (78.1%) being the most common species. Fasciolosis in the wet season (26.5%) was significantly (P < 0.05) more prevalent than in the dry season (8.6%). The fluke burden of 3 to 20 flukes (65.6%) was the most prevalent. Most of the livers with Fasciolosis were moderately affected (50%). There was a moderate correlation between fluke burden and the severity of the liver lesion. Bovine fasciolosis is prevalent in Akinyele Central Abattoir, Ibadan, with season being the only identified risk factor. It is recommended that regular deworming be initiated for the control and prevention of bovine Fasciolosis before and after the rainy season. [ABSTRACT FROM AUTHOR]

Background: The goals of this study was to evaluate the diagnostic capability of enhanced/unenhanced 18FFDG- PET/CT scans for identifying primary-secondary liver malignancies in terms of size and localization, to decide the quantitative impact of contrast agent on the SUVmax values of liver lesions and normal liver tissue, and to assess the impact in SUVmax metrics following contrast substance administration. Materials and Methods: This was a prospective research that included patients with suspicious primary and secondary hepatic cancers. Patients had non-enhanced & enhanced regional PET/CT examinations. The dimension, position, densities (HU), visually assessment outcome, and SUVmax values for all pathological lesions were recorded, as well as the HU and SUVmax data of normal hepatic tissue. Results: There were 97 liver lesions in total. Visually assessment outcome of lesions, the introduction of a contrast substance considerably enhanced the HU and SUVmax measurements for normal hepatic tissue. The HU measurements for lesions bigger than 1cm increased statistically significantly, as did the SUVmax levels of centralized lesions bigger than 1cm. The attenuation adjustment procedures, resulted in an average inaccuracy in computed SUVmax values at the ratio of %5 for normal liver tissue and %6 for all hepatic pathologies following the contrast substance delivery. Conclusions: The inclusion of contrast substance increases the identification, localization, and characterization of the liver lesions with PET/CT substantially. [ABSTRACT FROM AUTHOR]

Hepatoblastoma is a rare malignant tumor. One case of hepatoblastoma per 1 million of children under the age of 15 is diagnosed annually in the Republic of Kazakhstan (RK), which corresponds to 5–6 cases per year. In 90% of cases the tumor is diagnosed in children under the age of 5 and has two peaks of incidence: the first peak at birth or within the first month of life, and the second peak between the ages of 16 and 18 months. The cases involving patients older than 5 years are extremely rare. The paper reports the case of female patient, who was diagnosed with hepatoblastoma in the age not typical for malignant neoplasms of this type. The review of hepatoblastoma epidemiology, possible risk factors, clinical manifestations, diagnosis and treatment methods is provided in this issue.

Liver imaging encompasses a broad spectrum of diseases in different clinical backgrounds. The available literature is vast and reported data often lacks standardization. Because of all these issues, the differential diagnosis and the characterization of liver lesions can be challenging for the beginner. The aim of this narrative review is to provide the basics for an algorithm approach to liver lesions on cross-sectional imaging. First, some tips for the optimization of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) protocols will be provided. Liver Imaging Reporting and Data System (LI-RADS, version 2018) working group is proposing the adoption of their standardized lexicon beyond the original target population of LI-RADS (i.e., liver cirrhosis). Thus, the main imaging findings will be defined following the LI-RADS lexicon. Since the contrast study is the most important for lesion characterization, this narrative review separates the lesions into avascular, hypovascular, and hypervascular, with a focus on chronic liver disease (CLD) and hepatocellular carcinoma (HCC). [ABSTRACT FROM AUTHOR]

Background: The liver is primarily or secondarily involved by numerous vascular, metabolic, infectious, and neoplastic processes resulting in formation of focal liver masses, and the detection of such focal liver lesions is frequently accomplished with sonography. However, the categorization a liver mass as benign or malignant on ultrasound has always been a diagnostic dilemma. Objective: This study aimed to assess if the addition of compression sonoelastography to conventional B-mode ultrasound aided in diagnostic accuracy of the focal hepatic lesions. Materials and Methods: We evaluated B-mode characteristics of 52 liver lesions followed by calculation of their strain values on compression sonoelastography. The lesions were categorized as benign or malignant by ascertaining a cutoff strain value and the comparison was made with the histopathological diagnosis/contrast-enhanced computed tomography characteristics of the lesions. Results: The mean strain index value of malignant hepatic lesions (2.12 ± 1.06) was statistically higher than the benign lesions (0.92 ± 1.06) with 2-tailed P = 0.002. The sensitivity, specificity, and positive and negative predictive values of compression sonoelastography in diagnosing a malignant pathology were 74.4%, 88.9%, 94.6%, and 46.7%, respectively, and the additional evaluation of B-mode features yielded higher sensitivity (95.4% vs. 83.7%) and negative predictive value (75% vs. 46.7%). Conclusion: Compression sonoelastography is an efficient and beneficial complementary tool to B-mode imaging in evaluating solid liver lesions.

Background: The liver is primarily or secondarily involved by numerous vascular, metabolic, infectious, and neoplastic processes resulting in formation of focal liver masses, and the detection of such focal liver lesions is frequently accomplished with sonography. However, the categorization a liver mass as benign or malignant on ultrasound has always been a diagnostic dilemma. Objective: This study aimed to assess if the addition of compression sonoelastography to conventional B-mode ultrasound aided in diagnostic accuracy of the focal hepatic lesions. Materials and Methods: We evaluated B-mode characteristics of 52 liver lesions followed by calculation of their strain values on compression sonoelastography. The lesions were categorized as benign or malignant by ascertaining a cutoff strain value and the comparison was made with the histopathological diagnosis/contrast-enhanced computed tomography characteristics of the lesions. Results: The mean strain index value of malignant hepatic lesions (2.12 ± 1.06) was statistically higher than the benign lesions (0.92 ± 1.06) with 2-tailed P = 0.002. The sensitivity, specificity, and positive and negative predictive values of compression sonoelastography in diagnosing a malignant pathology were 74.4%, 88.9%, 94.6%, and 46.7%, respectively, and the additional evaluation of B-mode features yielded higher sensitivity (95.4% vs. 83.7%) and negative predictive value (75% vs. 46.7%). Conclusion: Compression sonoelastography is an efficient and beneficial complementary tool to B-mode imaging in evaluating solid liver lesions. [ABSTRACT FROM AUTHOR]

Background: Computed tomography is a standard imaging procedure for the detection of liver lesions, such as metastases, which can often be small and poorly contrasted, and therefore hard to detect. Advances in image reconstruction have shown promise in reducing image noise and improving low-contrast detectability. Purpose: To examine a novel, specialized, model-based iterative reconstruction (MBIR) technique for improved low-contrast liver lesion detection. Material and Methods: Patient images with reported poorly contrasted focal liver lesions were retrospectively reconstructed with the low-contrast attenuating algorithm (FIRST-LCD) from primary raw data. Liver-to-lesion contrast, signal-to-noise, and contrast-to-noise ratios for background and liver noise for each lesion were compared for all three FIRST-LCD presets with the established hybrid iterative reconstruction method (AIDR-3D). An additional visual conspicuity score was given by two experienced radiologists for each lesion. Results: A total of 82 lesions in 57 examinations were included in the analysis. All three FIRST-LCD algorithms provided statistically significant increases in liver-to-lesion contrast, with FIRSTMILD showing the largest increase (40.47 HU in AIDR-3D; 45.84 HU in FIRSTMILD; P < 0.001). Substantial improvement was shown in contrast-to-noise metrics. Visual analysis of the lesions shows decreased lesion visibility with all FIRST methods in comparison to AIDR-3D, with FIRSTSTR showing the closest results (P < 0.001). Conclusion: Objective image metrics show promise for MBIR methods in improving the detectability of low-contrast liver lesions; however, subjective image quality may be perceived as inferior. Further improvements are necessary to enhance image quality and lesion detection. [ABSTRACT FROM AUTHOR]

The aim of this work is to review the utility of the use of contrast ultrasound in the characterization of liver lesions. We do a brief description of the ultrasound contrast, its adverse effects and its contraindications as well as the specific techniques that allow the detection of the produced signal of microbubbles, as well as its use in liver lesions that are usually incidental findings during abdominal ultrasound, the European and North-American guidelines recommend the use of contrast ultrasound for the appropriate characterization of an injury and, in this way, it is possible to avoid performing more expensive and less accessible diagnostic techniques. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to use artificial intelligence (AI) to facilitate peer review for detection of missed suspicious liver lesions (SLLs) on CT pulmonary angiographic (CTPA) examinations.Methods: This retrospective study included 1 month of consecutive CTPA examinations from a multisite teleradiology practice. Visual classification (VC) software analyzed images for the presence (+) or absence (-) of SLLs (>1 cm, >20 Hounsfield units). Separately, a natural language processing (NLP) algorithm evaluated corresponding reports for description (+) of an SLL or lack thereof (-). Studies containing possible missed SLLs (VC+/NLP-) were reviewed by three abdominal radiologists in a two-step adjudication process to confirm if an SLL was missed by the interpreting radiologist. The number of VC+/NLP- cases, the number of images needing radiologist review, and the number of cases with confirmed missed SLLs were recorded. Interobserver agreement for SLLs was calculated for the radiologist readers.Results: A total of 2,573 CTPA examinations were assessed, and 136 were classified as potentially containing missed SLLs (VC+/NLP-). After radiologist review, 13 cases with missed SLLs were confirmed, representing 0.5% of analyzed CT studies. Using AI, the ratio of CT studies requiring review to missed SLLs identified was 10:1; the ratio without the help of AI would be at least 66:1. Among the 136 cases reviewed by radiologists, interobserver agreement for SLLs was excellent (κ = 0.91).Conclusions: AI can accelerate meaningful peer review by rapidly assessing thousands of examinations to identify potentially clinically significant errors. Although radiologist involvement is necessary, the amount of effort required after initial AI screening is dramatically reduced. [ABSTRACT FROM AUTHOR]

Background and Aims: To investigate the frequency of different benign and malignant focal liver lesions (FLLs) in relation to clinical and sonographic features among patients with liver cirrhosis (LC) and newly detected FLLs. Methods: This study was a retrospective analysis of 225 cirrhotic patients with newly detected FLLs who underwent hepatic ultrasound (US) examinations at our university hospital from 2011 to 2022. The diagnosis of FLLs was based on histology and/or consensus radiological criteria, in accordance with the current diagnostic guidelines. The FLLs were classified into benign (bFLLs) or malignant (mFLLs) lesions and the latter group was subclassified into HCC and non-HCC mFLLs. The frequency, clinical parameters, and sonographic features of the different groups were examined and compared. Results: Of the 225 FLLs, 154 (68.4%) were mFLLs and 71 (31.6%) bFLLs. HCC was the most frequent subcategory of FLLs (132; 58.7%). There were (22; 9.8%) non-HCC mFLLs with 11 (4.9%) metastases and 11 (4.9%) non-HCC primary liver tumors. Regenerative nodules (RNs) were the most frequent form of bFLLs (25; 11.1%), followed by simple cysts (22; 9.8%) and hemangiomas (14; 6.2%). The other bFLLs (10; 14.1%) were fat deposition/sparing (5), hematomas (2), abscesses (2), and echinococcal cysts (1). The distribution of bFLLs and HCC and non-HCC mFLLs varied significantly according to the clinical scenarios. HCC mFLLs were more frequent in males (p = 0.001), in those with no history of active non-hepatic primary malignant disease (NHPMD) (p < 0.001), in those with a hepatitis B or C etiology of LC (p = 0.002), when located in the right lobe (p = 0.008), and when portal vein thrombosis was present (p = 0.03). Conclusion: In cirrhotic patients with newly detected FLLs, the non-HCC etiology was more frequently diagnosed in lesions that were located in the left lobe, in females, and in patients with a history of active NHPMD. Thus, the lower frequency of HCC in the abovementioned groups demonstrated that a cautious implementation of the current consensus radiological criteria would be required for these groups, particularly in patients with an active NHPMD, given the fact that the consensus criteria were not validated in these populations. A more active diagnostic approach may ultimately be needed for these patients. Large prospective studies are needed to validate these findings. [ABSTRACT FROM AUTHOR]

BackgroundMedical imaging is critical in clinical practice, and high value radiological reports can positively assist clinicians. However, there is a lack of methods for determining the value of reports.ObjectiveThe purpose of this study was to establish an ensemble learning classification model using natural language processing (NLP) applied to the Chinese free text of radiological reports to determine their value for liver lesion detection in patients with colorectal cancer (CRC).MethodsRadiological reports of upper abdominal computed tomography (CT) and magnetic resonance imaging (MRI) were divided into five categories according to the results of liver lesion detection in patients with CRC. The NLP methods including word segmentation, stop word removal, and n-gram language model establishment were applied for each dataset. Then, a word-bag model was built, high-frequency words were selected as features, and an ensemble learning classification model was constructed. Several machine learning methods were applied, including logistic regression (LR), random forest (RF), and so on. We compared the accuracy between priori choosing pertinent word strings and our machine language methodologies.ResultsThe dataset of 2790 patients included CT without contrast (10.2%), CT with/without contrast (73.3%), MRI without contrast (1.8%), and MRI with/without contrast (14.6%). The ensemble learning classification model determined the value of reports effectively, reaching 95.91% in the CT with/without contrast dataset using XGBoost. The logistic regression, random forest, and support vector machine also achieved good classification accuracy, reaching 95.89%, 95.04%, and 95.00% respectively. The results of XGBoost were visualized using a confusion matrix. The numbers of errors in categories I, II and V were very small. ELI5 was used to select important words for each category. Words such as “no abnormality”, “suggest”, “fatty liver”, and “transfer” showed a relatively large degree of positive correlation with classification accuracy. The accuracy based on string pattern search method model was lower than that of machine learning.ConclusionsThe learning classification model based on NLP was an effective tool for determining the value of radiological reports focused on liver lesions. The study made it possible to analyze the value of medical imaging examinations on a large scale.

Abstract Background Echinococcus is a worldwide zoonosis, primarily causing liver lesions. Accidentally detected, these lesions enter the differential diagnosis of a tumor, including metastasis. This situation is especially challenging in patients with colorectal cancer, as both diseases affect mainly the liver. Case presentation We report two patients with a newly diagnosed colorectal cancer. Pre- and intraoperatively radiological imaging revealed hepatic lesions which were resected on suspicion of colorectal cancer metastasis. Histology showed granulomatous lesions with characteristic parasitic membrane consistent with an echinococcal cyst. The diagnosis was confirmed by specific polymerase chain reaction. Conclusions Focal hypoechoic liver lesion in patients with colorectal cancer should be primarily considered as a liver metastasis and resected whenever feasible. Other uncommon etiologies, including parasitic lesion as echinococcal cysts, should be taken in consideration, as this could lead to major changes of the management and prognosis of the affected patients.

Multi-phase enhanced computed tomography (MPECT) translation from plain CT can help doctors to detect the liver lesion and prevent patients from the allergy during MPECT examination. Existing CT translation methods directly learn an end-to-end mapping from plain CT to MPECT, ignoring the crucial clinical domain knowledge. As clinicians subtract the plain CT from MPECT images as subtraction image to highlight the contrast-enhanced regions and further to facilitate liver disease diagnosis in the clinical diagnosis, we aim to exploit this domain knowledge for automatic CT translation. To this end, we propose a Mask-Aware Transformer (MAFormer) with structure invariant loss for CT translation, which presents the first effort to exploit this domain knowledge for CT translation. Specifically, the proposed MAFormer introduces a mask estimator to predict the subtraction image from the plain CT image. To integrate the subtraction image into the network, the MAFormer devises a Mask-Aware Transformer based Normalization (MATNorm) as normalization layer to highlight the contrast-enhanced regions and capture the long-range dependencies among these regions. Moreover, aiming to preserve the biological structure of CT slices, a structure invariant loss is designed to extract the structural information and minimize the structural similarity between the plain and synthetic CT images to ensure the structure invariant. Extensive experiments have proven the effectiveness of the proposed method and its superiority to the state-of-the-art CT translation methods. Source code is to be released. • The proposed MAFormer presents the first work to exploit subtraction image for CT translation. • The proposed MATNorm combines the subtraction image with plain CT image through transformer. • To preserve the CT structure, we introduce a structure invariant loss between plain and synthetic CT images. • We manually collect MPECT dataset with complete four phases, i.e., plain, arterial, portal venous and delayed phases. • Quantitative and qualitative results prove the effectiveness of our method and its superiority to current methods. [ABSTRACT FROM AUTHOR]

Many types of mycotoxins are found in food sources contaminated with fungi, and if these are ingested in large quantities or over a long period, they can affect the health of humans and domestic animals. Berberine (BBR) is a plant alkaloid with multiple pharmacological functions. This study aimed to investigate the effect of different levels of the plant alkaloid BBR on reducing toxic effects of aflatoxin B1 (AFB) and ochratoxin A (OTA) in broilers by examining performance characteristics, blood biochemistry, antioxidant systems, ileum morphology, and histopathology of the liver. The experiment was performed with 288 Ross 308 broilers reared in floor pens for 42 d in a randomized design with 9 treatments. Each treatment was replicated 4 times, and each replicate contained 8 chicks. Experimental treatments included (1) negative control diet with no additives (NC); (2) NC + 2 ppm AFB (positive control AFB; PCAFB); (3) NC + 2 ppm OTA (positive control OTA; PCOTA); (4) PCAFB + 200 mg/kg BBR; (5) PCAFB + 400 mg/kg BBR; (6) PCAFB + 600 mg/kg BBR; (7) PCOTA + 200 mg/kg BBR; (8) PCOTA + 400 mg/kg BBR; and (9) PCOTA + 600 mg/kg BBR. Compared with NC, feeding PCAFB and PCOTA diets reduced average daily feed intake, weight gain, serum concentrations of superoxide dismutase, glutathione peroxidase, and the length and width of ileum villi (P < 0.05). At the same time, these parameters increased in birds fed PCAFB or PCOTA diets supplemented with 600 mg/kg of BBR (P < 0.05). Feeding PCAFB and PCOTA diets increased feed conversion ratio (FCR), serum aspartate aminotransferase (AST), lactate dehydrogenase (LDH), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT) activities, serum urea, and liver lesions compared with NC. By contrast, compared with PCAFB and PCOTA, adding 600 mg/kg BBR decreased FCR, AST, LDH, ALT, and GGT activities, urea, and liver lesions (P < 0.05). Overall, supplementation with 600 mg/kg BBR may improve growth performance, liver function, and antioxidant status of broilers fed diets contaminated with AFB and OTA.

To evaluate the frequency and significance of incidental liver lesions identified on MR enterography (MRE) examinations to determine if dedicated sequences for liver evaluation are necessary in the routine MRE protocol. A retrospective departmental database search identified 353 adult (212 women and 141 men; mean [±SD] age, 41.4 [17.0] years; range 18.1–91.9 years) MRE examinations performed in 2017. Radiology reports were reviewed for the presence and characterization of liver lesions, follow-up recommendation, and known malignancy. Follow-up cross-sectional imaging reports were reviewed for liver lesion stability. A senior abdominal radiologist with expertise in liver imaging categorized liver lesions as benign, indeterminate, or malignant and re-characterized indeterminate lesions using follow-up imaging as benign or malignant. Seventy-nine MRE (22.4%) described liver lesions and follow-up imaging was recommended in 4/79 (5.1%). Seventy-six liver lesions (96.2%) were characterized as benign (cysts/hemangiomas) on routine interpretation and expert review. One of these was recommended for follow-up imaging on initial report, which was characterized as hemangioma by expert review. The remaining 3 lesions (3.8%) were characterized as indeterminate both by initial report and expert radiologist review but re-characterized as benign after reviewing follow-up examinations. All incidental liver lesions identified on MRE in our cohort were benign. Therefore, additional sequences evaluating the liver are unnecessary for routine MRE. • Seventy-nine MRE (22.4%) described liver lesions and follow-up imaging was recommended in 4/79 (5.1%). • All incidental liver lesions identified on MRE in our cohort were benign. [ABSTRACT FROM AUTHOR]

This study aimed to determine the occurrence of liver lesions in slaughtered sheep and goat with specific reference to the prevalence, breed, age, sex and month influence on liver lesion and also the pathological changes and its effect on the cost. This study involves a 3 months period (October and December 2015) weekly inspection of 2044 slaughtered sheep and goat, 824 were purposively examined, of which 75 were partially condemned and 36 samples out of the partially condemned were used for histopathological analysis. Lesions recorded were granuloma, necrosis, degeneration, cystic vacuole and some with no lesion. Age, sex and breeds had significant influence (p>0.05) on the prevalence of liver lesions in sheep and goat. West African dwarf was the most susceptible breed. The ages in both species (sheep and goats) above 2 - 3 years were most susceptible to liver lesions. Goats were more susceptible than sheep and within the 3 months study the abattoir loss GH¢ 1125 due to liver lesion Economic loss due to liver condemnation estimated has showed there is much to be done to save loss incomes from liver condemnation. Good husbandry practices, proper feeding and good veterinary care should be given to small ruminants in order to minimize liver disease in small ruminants in Ghana. [ABSTRACT FROM AUTHOR]

Objective: Racial disparities are associated with increased healthcare costs and suboptimal resource utilization. We sought to evaluate racial disparities in the therapeutic management of liver lesions. Materials and Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for patients presenting with a liver lesion who had surgical resection (SR) or an ablative procedure (AP). Univariable and multivariable analysis were performed to identify disparities in the treatment rendered. A regression model was constructed to evaluate demographic characteristics favoring AP. Results: Between 2005 and 2016, 8,706 patients were diagnosed with a liver lesion, 7,290 (84%) had SR and 1,416 (16%) had AP. Compared to SR, the AP cohort had a higher number of Native Americans (0.5% vs. 2%; p

Background and Aims: To investigate the frequency of different benign and malignant focal liver lesions (FLLs) in relation to clinical and sonographic features among patients with liver cirrhosis (LC) and newly detected FLLs. Methods: This study was a retrospective analysis of 225 cirrhotic patients with newly detected FLLs who underwent hepatic ultrasound (US) examinations at our university hospital from 2011 to 2022. The diagnosis of FLLs was based on histology and/or consensus radiological criteria, in accordance with the current diagnostic guidelines. The FLLs were classified into benign (bFLLs) or malignant (mFLLs) lesions and the latter group was subclassified into HCC and non-HCC mFLLs. The frequency, clinical parameters, and sonographic features of the different groups were examined and compared. Results: Of the 225 FLLs, 154 (68.4%) were mFLLs and 71 (31.6%) bFLLs. HCC was the most frequent subcategory of FLLs (132; 58.7%). There were (22; 9.8%) non-HCC mFLLs with 11 (4.9%) metastases and 11 (4.9%) non-HCC primary liver tumors. Regenerative nodules (RNs) were the most frequent form of bFLLs (25; 11.1%), followed by simple cysts (22; 9.8%) and hemangiomas (14; 6.2%). The other bFLLs (10; 14.1%) were fat deposition/sparing (5), hematomas (2), abscesses (2), and echinococcal cysts (1). The distribution of bFLLs and HCC and non-HCC mFLLs varied significantly according to the clinical scenarios. HCC mFLLs were more frequent in males (p = 0.001), in those with no history of active non-hepatic primary malignant disease (NHPMD) (p < 0.001), in those with a hepatitis B or C etiology of LC (p = 0.002), when located in the right lobe (p = 0.008), and when portal vein thrombosis was present (p = 0.03). Conclusion: In cirrhotic patients with newly detected FLLs, the non-HCC etiology was more frequently diagnosed in lesions that were located in the left lobe, in females, and in patients with a history of active NHPMD. Thus, the lower frequency of HCC in the abovementioned groups demonstrated that a cautious implementation of the current consensus radiological criteria would be required for these groups, particularly in patients with an active NHPMD, given the fact that the consensus criteria were not validated in these populations. A more active diagnostic approach may ultimately be needed for these patients. Large prospective studies are needed to validate these findings.

Background: Echinococcus is a worldwide zoonosis, primarily causing liver lesions. Accidentally detected, these lesions enter the differential diagnosis of a tumor, including metastasis. This situation is especially challenging in patients with colorectal cancer, as both diseases affect mainly the liver.Case Presentation: We report two patients with a newly diagnosed colorectal cancer. Pre- and intraoperatively radiological imaging revealed hepatic lesions which were resected on suspicion of colorectal cancer metastasis. Histology showed granulomatous lesions with characteristic parasitic membrane consistent with an echinococcal cyst. The diagnosis was confirmed by specific polymerase chain reaction.Conclusions: Focal hypoechoic liver lesion in patients with colorectal cancer should be primarily considered as a liver metastasis and resected whenever feasible. Other uncommon etiologies, including parasitic lesion as echinococcal cysts, should be taken in consideration, as this could lead to major changes of the management and prognosis of the affected patients. [ABSTRACT FROM AUTHOR]

Calcified liver lesions are caused by a wide variety of factors. The most common lesions are inflammatory liver lesions followed by benign and malignant neoplasms. Hemangioma, one of the most common benign hepatic neoplasm in adults, often contains calcifications, in up to 20% of cases secondary to fibrosis and thrombosis of blood vessels. These calcifications are typically large, coarse, and located in the center of the lesions. Liver metastases, the most common malignant lesions found in the noncirrhotic liver, may contain areas of calcification. Radiologists should be aware of morphologic imaging features of calcified liver lesions to help differentiate benign from malignant lesions. Liver biopsy should be offered when the diagnosis is doubtful.

Incidental liver masses are commonly identified on imaging performed for other indications. Since the prevalence of benign focal liver lesions in adults is high, even in patients with primary malignancy, accurate characterization of incidentally detected lesions is of paramount clinical importance. This document reviews utilization of various imaging modalities for characterization of incidentally detected liver lesions, discussed in the context of several clinical scenarios. For each clinical scenario, a summary of current evidence supporting the use of a given diagnostic modality is reported. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Incidental liver masses are commonly identified on imaging performed for other indications. Since the prevalence of benign focal liver lesions in adults is high, even in patients with primary malignancy, accurate characterization of incidentally detected lesions is of paramount clinical importance. This document reviews utilization of various imaging modalities for characterization of incidentally detected liver lesions, discussed in the context of several clinical scenarios. For each clinical scenario, a summary of current evidence supporting the use of a given diagnostic modality is reported. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Ultrasound is the most commonly used imaging modality in clinical practice because it is a nonionizing, low-cost, and portable point-of-care imaging tool that provides real-time images. Artificial intelligence (AI)-powered ultrasound is becoming more mature and getting closer to routine clinical applications in recent times because of an increased need for efficient and objective acquisition and evaluation of ultrasound images. Because ultrasound images involve operator-, patient-, and scanner-dependent variations, the adaptation of classical machine learning methods to clinical applications becomes challenging. With their self-learning ability, deep-learning (DL) methods are able to harness exponentially growing graphics processing unit computing power to identify abstract and complex imaging features. This has given rise to tremendous opportunities such as providing robust and generalizable AI models for improving image acquisition, real-time assessment of image quality, objective diagnosis and detection of diseases, and optimizing ultrasound clinical workflow. In this report, the authors review current DL approaches and research directions in rapidly advancing ultrasound technology and present their outlook on future directions and trends for DL techniques to further improve diagnosis, reduce health care cost, and optimize ultrasound clinical workflow. [ABSTRACT FROM AUTHOR]

Abstract In this work we present a novel system for generation of virtual PET images using CT scans. We combine a fully convolutional network (FCN) with a conditional generative adversarial network (GAN) to generate simulated PET data from given input CT data. The synthesized PET can be used for false-positive reduction in lesion detection solutions. Clinically, such solutions may enable lesion detection and drug treatment evaluation in a CT-only environment, thus reducing the need for the more expensive and radioactive PET/CT scan. Our dataset includes 60 PET/CT scans from Sheba Medical center. We used 23 scans for training and 37 for testing. Different schemes to achieve the synthesized output were qualitatively compared. Quantitative evaluation was conducted using an existing lesion detection software, combining the synthesized PET as a false positive reduction layer for the detection of malignant lesions in the liver. Current results look promising showing a 28% reduction in the average false positive per case from 2.9 to 2.1. The suggested solution is comprehensive and can be expanded to additional body organs, and different modalities. Highlights • An automated method to synthesize PET images from CT images is proposed. • A combination of cGAN and FCN is shown to achieve the best performance. • Custom loss function is shown to improve performance in clinically important regions. • Results are provided showing improvement in existing lesion detection frameworks when using the virtual-PET images. [ABSTRACT FROM AUTHOR]

An 84-year-old man presented to a rural hospital in Australia with haemodynamic instability and abdominal pain. Investigation revealed haemorrhage from a lesion in his liver—an incidental finding of a hepatocellular carcinoma. Initial resuscitation and damage control surgery was performed at the peripheral hospital prior to transfer to a tertiary centre 386 km away for the second stage of management. The second stage of management included interventional radiological embolization of the bleeding liver vessel and subsequent resection of the liver tumour. This was all undertaken with new policies in place to limit the spread of infection at the peak of the COVID-19 epidemic. [ABSTRACT FROM AUTHOR]