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  • Journal Highlights

    The following are highlights from the current issues of RSNA’s two peer-reviewed journals.


    January 1, 2018

    Radiology
    Evidence Supporting LI-RADS Major Features for the CT and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

    Unlike other cancers, the definitive diagnosis and staging of hepatocellular carcinoma (HCC) is frequently based on imaging without mandatory histopathologic confirmation. This literature review of the Liver Imaging Reporting and Data System (LI-RADS) considered the major imaging criteria and evaluated the strength of the recommendations.

    In an article published online in Radiology (RSNA.org/Radiology), An Tang, MD, MSc, University of Montréal, Montréal, QC, Canada, and colleagues evaluated the major LI-RADS criteria including arterial phase hyperenhancement (APHE), observation diameter, washout appearance, capsule appearance and threshold growth. The authors summarized and assessed the quality of evidence supporting each LI-RADS major feature for the diagnosis of HCC, as well as of the LI-RADS imaging features suggesting malignancy other than HCC.

    Schematic of Observation

    Schematic of observation diameter indicating measurement conventions recommended in LI-RADS (arrows). LI-RADS schematic reproduced with permission from the American College of Radiology. (Radiology 2018;286(1):42–61) © RSNA 2018. All rights reserved. Printed with permission.

    Threshold growth should be a major criteria for diagnosis of HCC, even though indirect evidence and biologic plausibility indicate that growth is a feature of malignancy and helps to differentiate HCC from benign entities, according to the authors.

    For observational thresholds, the authors noted that it should be measured on the sequence or phase in which the margins are most sharply demarcated and in which there is no anatomic distortion and that it should not be measured in the arterial phase if the margins are clearly visualized on another phase or sequence.

    “While the selection of five major features was based on expert opinion, the literature review was performed to ensure that imaging-based diagnostic criteria were able to achieve near-100 percent specificity for the noninvasive diagnosis of HCC,” the authors write.

     

    This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only.

    Radiographics
    MR Imaging of Muscle Trauma: Anatomy, Biomechanics, Pathophysiology, and Imaging Appearance

    MRI is widely used for assessment of muscle injuries, including acute, subacute and chronic traumatic lesions, and can help illustrate how the injury relates to biomechanics, pathophysiology and the anatomy of the muscle. New grading systems for muscle injury, developed particularly for injured athletes, incorporate MRI assessment regarding injury and potential rehabilitation.

    In an article in the January issue of RadioGraphics (RSNA.org/RadioGraphics), Dyan V. Flores, MD, Philippine Orthopedic Center, Manila, and colleagues review the MRI features of muscle injuries and explain how the new comprehensive grading systems differ from the previous versions, especially for injured athletes.

    Unrecognized compartment syndrom

    Unrecognized compartment syndrome in a 33-year-old woman with foot drop and continuous pain after a fall 1 month earlier. (a) Axial T1-weighted MR image of the left calf shows mild bulging and minimal signal intensity increase in the anterior muscle compartment and effacement of intramuscular fat in the lateral compartment. (b) Axial T1-weighted fat-suppressed image after injection of intravenous contrast material shows disordered enhancement, with intense peripheral enhancement of the anterior (arrow) and lateral (arrowhead) compartments and large areas of central nonenhancement related to hypoperfusion and myonecrosis. The patient was treated with fasciotomy and débridement. (RadioGraphics 2018; 38;1:InPress) © RSNA 2018. All rights reserved. Printed with permission.

    New guidelines include the Munich Muscle Injury Classification, the Italian Society of Muscles, Ligaments and
    Tendons classification, the British Athletics Muscle Injury Classification and the MLG-R Classification created by Aspetar, an orthopedic and sports medicine hospital in Doha, Qatar, in cooperation with Futbol Club Barcelona, the Barcelona soccer team.

    “Grading systems for muscle injury are evolving rapidly and radiologists should be familiar with these newer systems, as imaging plays an increasingly important role in the diagnosis and management of the injured athlete,” the authors conclude.

     

    This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only.

    Radiology Podcasts

    Radiology Podcasts
    Radiology Podcasts

    Listen to former Radiology Editor Herbert Y. Kressel, MD, deputy editors and authors discuss the following articles in the November issue of Radiology at RSNA.org/Radiology-Podcasts.

    • “Intravenous Corticosteroid Premedication Administered 5 Hours before CT Compared with a Traditional 13-Hour Oral
      Regimen,” Benjamin M. Mervak, MD, and colleagues.
    • “Association between Testicular Microlithiasis and Testicular Neoplasia: Large Multicenter Study in a Pediatric Population,” Andrew T. Trout, MD, and colleagues.
    • “Diffusion and Intravoxel Incoherent Motion MR Imaging–based Virtual Elastography: A Hypothesis-generating Study in the Liver,” Denis Le Bihan, MD, PhD, and colleagues.

    RadioGraphics Podcasts

    Radiology Podcasts

    Listen to RadioGraphics Editor Jeffrey S. Klein, MD, and authors discuss the following articles in recent issues of RadioGraphics at pubs.RSNA.org/RG-Podcasts.

    • “2017 Version of LI-RADS for CT and MR Imaging: An Update,” Khaled M. Elsayes, MD, and colleagues.
    • “Adventures and Misadventures in Plastic Surgery and Soft-Tissue Implants,” Dana J. Lin, MD, and colleagues.
    • “Contrast-enhanced US Assessment of Focal Liver Lesions in Children,” Sudha A. Anupindi, MD, and colleagues.






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