Clinical utility of ancillary features (AFs) in contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS^®) is yet to be established. In this study, we assessed the diagnostic yield of CEUS LI-RADS and AFs in hepatocellular carcinoma (HCC). We retrospectively included patients with risk factors for HCC and newly diagnosed focal liver lesions (FLL). All lesions have been categorized according to the CEUS LI-RADS v2017 by an experienced sonographer blinded to clinical data and to the final diagnosis. From a total of 143 patients with 191 FLL, AFs favoring HCC were observed in 19.8% cases as hypoechoic rim and in 16.7% cases as nodule-in nodule architecture. From the total of 141 HCC cases, 83.6% were correctly classified: 57.4%- LR-5 and 26.2%- LR-4. In 9.21% cases, CEUS indicated LR-M; 2.12% cases- LR-3. The LR-5 category was 96.2% predictive (PPV) of HCC. LR-5 had 60.4% sensitivity and 93.6% specificity. PPV for primitive malignancy (LR-4 + LR-5) was 95.7%, with 88% sensitivity, 89.3% specificity and 88.4% accuracy for HCC. LR-4 category had 94.8% PPV and 26.2% sensitivity. CEUS LR4 + LR5 had 81,8% sensitivity for HCCs over 2 cm and 78.57% sensitivity for smaller HCCs. CEUS LR-5 remains an excellent diagnostic tool for HCC, despite the size of the lesion. The use of AFs might improve the overarching goal of LR-5 + LR-4 diagnosis of high specificity for HCC and exclusion of non-HCC malignancy.

In this paper, we aimed to evaluate clinical and imagistic features, and also to provide a diagnostic algorithm for patients presenting with gastrointestinal involvement from hepatocellular carcinoma (HCC). We conducted a systematic search on the PubMed, Scopus and Web of Science databases to identify and collect papers oncases of HCC with gastrointestinal involvement. This search was last updated on 29 April 2022. One hundred and twenty-three articles were included, corresponding to 197 patients. The majority of the patients were male (87.30%), with a mean age of 61.21 years old. The analysis showed large HCCs located mainly in the right hepatic lobe, and highly elevated alfa-fetoprotein (mean = 15,366.18 ng/mL). The most frequent etiological factor was hepatitis B virus (38.57%). Portal vein thrombosis was present in 27.91% of cases. HCC was previously treated in most cases by transarterial chemoembolization (32.99%) and surgical resection (28.93%). Gastrointestinal lesions, developed mainly through direct invasion and hematogenous routes, were predominantly detected in the stomach and duodenum in equal measure—27.91%. Gastrointestinal bleeding was the most common presentation (49.74%). The main diagnostic tools were esophagogastroduodenoscopy (EGD) and computed tomography. The mean survival time was 7.30 months. Gastrointestinal involvement in HCC should be included in the differential diagnosis of patients with underlying HCC and gastrointestinal manifestations or pathological findings in EGD.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is recognized as a systemic condition that is associated with an increased prevalence of chronic kidney disease (CKD), independent of classical risk factors. This review explores MASLD and metabolic kidney dysfunction, emphasizing lipotoxicity, emerging biomarkers, and liver–kidney fat imaging techniques. Renal fat is discussed as an ectopic lipid depot that may contribute to kidney vulnerability in the same cardiometabolic milieu as MASLD. In this context, lipotoxicity, a phenomenon intensively studied in MASLD, can affect multiple nephron segments, promoting fibrosis and, ultimately, CKD. Hepatokines may support the concept of a liver–kidney metabolic axis, but human data remain limited. Tubular biomarkers show promise for detecting early renal injury, but lack validation in large populations. Hepatic steatosis is quantified through multiple validated imaging techniques such as ultrasound, elastography, and magnetic resonance imaging (MRI). In contrast, renal fat imaging studies are limited and heterogeneous, and still lack standardization. In MASLD, an integrated hepatorenal assessment is warranted to capture the full burden of the disease.

Background: Advanced stages of peripheral arterial disease, particularly chronic limb-threatening ischemia, are characterized by unfavorable limb outcomes and a substantial risk of major amputation. Clinical evaluation traditionally focuses on arterial obstruction; however, venous dysfunction may coexist and contribute to local limb pathophysiology in advanced PAD, remaining insufficiently recognized in routine practice. Methods: We performed a retrospective cohort analysis of consecutive patients with advanced peripheral arterial disease managed at the First Surgical Clinic of the Emergency County Clinical Hospital of Craiova over a five-year period (January 2020 to December 2024). Venous disease was defined using a clinically oriented composite definition incorporating imaging-confirmed venous pathology, prior deep venous thrombosis, and persistent lower-limb edema attributable to venous dysfunction. Arterial disease severity was assessed using multimodal imaging. Analyses were performed at both patient and limb levels to evaluate associations between venous disease, arterial severity markers, and clinical outcomes. Results: Among 241 patients (482 limbs), concomitant venous disease was identified in 68.9% at the patient level and was predominantly unilateral. At the limb level, venous disease was significantly associated with markers of severe arterial involvement, including inflow disease, higher segment occlusion scores, impaired tibial runoff, and absence of a patent pedal arch. Despite greater arterial severity, patients with venous disease exhibited a lower unadjusted rate of major amputation compared with those without venous involvement. Conclusions: Concomitant venous disease is highly prevalent in patients with advanced PAD and is closely linked to arterial disease severity. These findings suggest that venous dysfunction represents an integral component of advanced limb-threatening ischemia rather than an isolated comorbidity. Incorporating clinically oriented venous assessment may improve understanding of limb pathophysiology and support a more integrated arterio-venous approach to advanced PAD management.

Preoperative risk stratification for laparoscopic cholecystectomy (LC) remains imperfect, particularly in patients with chronic inflammatory remodeling and biliary anatomic variants. Existing tools often focus on acute presentations or intraoperative variables, resulting in uncertainty on how congenital anatomy, recurrent biliary colic, and cystic pediculitis interact. We synthesize a hypothesis-generating conceptual framework and propose an illustrative candidate preoperative rubric for future validation. We performed a structured narrative review of PubMed, Scopus, and Web of Science (January 1990–December 2024; last search: 15 December 2024). Eligible primary studies evaluated clinical history, imaging-defined anatomy, inflammatory biomarkers, and/or operative outcomes (conversion, intraoperative complications, or operative difficulty) in the setting of LC. Acute cholecystitis and chronic/elective cohorts were interpreted separately during the narrative synthesis. Two reviewers screened titles/abstracts and assessed full texts using predefined inclusion/exclusion criteria; due to heterogeneity, no meta-analysis and no formal risk-of-bias tool were applied. The literature supports a plausible vicious cycle in which biliary anatomic variants may impair drainage and promote stasis, recurrent biliary colic, and chronic inflammation, ultimately leading to fibrosis/pediculitis and a “frozen” Calot’s triangle. We translate these signals into an illustrative candidate rubric (0–16 points) spanning three domains: clinical history (0–6), imaging (0–6), and inflammatory biomarkers (0–4). Weights and cut-offs (low: 0–4; moderate: 5–9; high: 10–16) were chosen a priori for conceptual clarity and are not data-derived. This review provides a conceptual map and a candidate variable set to support hypothesis generation, standardized data collection, and staged validation. The rubric is not validated and must not be used for clinical decision-making. Planned next steps include feasibility-oriented derivation, followed by prospective multicenter external validation and impact assessment.

Hepatic cirrhosis represents the most advanced stage of any chronic liver disease characterized by progressive fibrosis. We report the case of a patient with carcinoma of the uncinate process of the pancreas and an occult form of liver cirrhosis. We concluded, based on the bioclinical profile, that the jaundice syndrome had an underlying mixed mechanism, obstructive and hepatic. Although, the clinical suspicion of pancreatic cancer was backed up by ultrasound, computed tomography and magnetic resonance imaging, we did not obtain, through these imaging investigations, any indicative features of liver cirrhosis. In order to further evaluate the presence of liver cirrhosis, we assessed liver stiffness using two non-invasive methods: Transient Elastography and Real Time Tissue Elastography (RTE). We observed highly suggestive features of liver cirrhosis only through RTE, although its diagnostic accuracy still needs large validation studies. Intraoperative assessment confirmed the diagnosis of liver cirrhosis, changing also the type of surgical approach and patient prognosis.