Contrast-enhanced US Liver Imaging Reporting and Data System (LI-RADS) could resolve some indeterminate liver observations (categorized as LR-4 and LR-M at CT or MRI), having a particularly high clinical effect for observations measuring at least 20 mm.

Purpose: To determine the diagnostic accuracy of combining CEUS and CT/MRI LI-RADS major imaging features for the improved categorization of liver observations indeterminate on both CT/MRI and CEUS. Materials and methods: A retrospective analysis using a database from a prospective study conducted at 11 centers in North America and Europe from 2018 to 2022 included a total of 109 participants at risk for HCC who had liver observations with indeterminate characterization (LR3, LR-4, and LR-M) on both CEUS and CT/MRI. The individual CEUS and CT/MRI LI-RADS major features were extracted from the original study and analyzed in various combinations. Reference standards included biopsy, explant histology, and follow-up CT/MRI. The diagnostic performance of the combinations of LI-RADS major features for definitive diagnosis of HCC was calculated. A reverse, stepwise logistical regression sub-analysis was also performed. Results: This study included 114 observations indeterminate on both CT/MRI and CEUS. These observations were categorized as LR-3 (n = 37), LR-4 (n = 41), and LR-M (n = 36) on CT/MRI and LR-3 (n = 48), LR-4 (n = 36), LR-M (n = 29), and LR-TIV (n = 1) on CEUS. Of them, 43.0% (49/114) were confirmed as HCC, 37.3% (43/114) non-malignant, and 19.3% (22/114) non-hepatocellular malignancies. The highest diagnostic accuracy among the combinations of imaging features was achieved in CT/MRI LR-3 observations, where the combination of CEUS arterial phase hyper-enhancement (APHE) + CT/MRI APHE had 96.7% specificity, 75.0% positive predictive value (PPV), and 86.5% accuracy for HCC. Conclusion: The combination of LI-RADS major features on CT/MRI and CEUS showed higher specificity, PPV, and accuracy compared to individual modalities' assessments, particularly for CT/MRI LR-3 observations.

Background: The use of beta-blockers in the perioperative period has been widely investigated due to their potential to reduce the risk of major adverse cardiovascular and cerebrovascular events (MACCE) and mortality; yet their overall impact on various postoperative outcomes remains debated. This study constitutes a systematic review and meta-analysis of the impact of beta-blockers on mortality, MI, stroke, and other adverse effects such as hypotension and bradycardia in patients undergoing non-cardiac surgery. Methods: A comprehensive systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. Searches were performed across PubMed, Cochrane, Web of Science, Scopus, EMBASE, and CINAHL databases; we included randomized controlled trials and cohort and case-control studies published from 1999 to 2024. Results: This meta-analysis included data from 28 studies encompassing 1,342,430 patients. Perioperative beta-blockers were associated with a significant increase in stroke risk (RR 1.42, 95% CI: 1.03 to 1.97, p = 0.03, I² = 62%). However, no statistically significant association was found between beta-blocker use and mortality (RR 0.62, 95% CI: 0.38 to 1.01, p = 0.05, I² = 100%). Subgroup analyses revealed a protective effect on mortality for patients with high risks, such as patients with a history of atrial fibrillation, chronic heart failure, and other arrhythmias. For myocardial infarction (RR 0.82, 95% CI: 0.53 to 1.28, p = 0.36, I² = 86%), a reduction in events was observed in the subgroup of randomized controlled trials. Beta-blockers significantly increased the risk of hypotension (RR 1.46, 95% CI: 1.26 to 1.70, p < 0.01, I² = 25%) and bradycardia (RR 2.26, 95% CI: 1.37 to 3.74, p < 0.01, I² = 64%). Conclusions: Perioperative beta-blockers show increasing rates of stroke events following non-cardiac surgery but do not significantly impact the incidence of MI or mortality. The increased risks of hypotension and bradycardia necessitate careful patient selection and monitoring. Future research should aim to refine patient selection criteria and optimize perioperative management to balance the benefits and risks of beta-blocker use in surgical settings.

Background: Psoriasis, a chronic inflammatory skin disorder, is associated with an elevated risk of cardiovascular diseases due to shared inflammatory pathways. This meta‐analysis evaluates the efficacy of statins, known for their lipid‐lowering and anti‐inflammatory properties, in managing psoriasis severity. Methods: A systematic search was conducted following Preferred Reporting Items for Systematic reviews and meta‐analysis guidelines across PubMed, Cochrane, Web of Science, Scopus, EMBASE, and CINAHL databases up to October 2024. Randomized clinical trials comparing statins with placebo or alternative treatments in adult psoriasis patients were included. The primary outcome was the Psoriasis Area and Severity Index (PASI) score or symptom improvement. Results: Out of 11,894 identified articles, 10 randomized clinical trials were included in the final analysis. Data from eight studies with 638 observations revealed a standardized mean difference (SMD) of −0.36 (95% confidence intervals [CI]: −0.72 to 0.00; p = 0.05; I ² = 52.0% [95% CI: 0.0% to 79.5%]) for PASI scores, indicating a beneficial effect of statins on psoriasis severity, although not statistically significant. Subgroup analysis demonstrated significant effects for topical administration (SMD = −0.82; 95% CI: −1.47 to −0.16; I ² = 0%). Secondary outcomes, measured using the Dermatology Life Quality Index (DLQI), were assessed in three studies (232 observations) and showed an SMD of 0.24 (95% CI: −0.09 to 0.57; p = 0.1; I ² = 0%), indicating no significant improvement in DLQI scores. Analysis of high‐sensitivity C‐reactive protein (hsCRP) from two studies (164 observations) revealed an SMD of −0.12 (95% CI: −0.42 to 0.18; p = 0.44; I ² = 0%), indicating no significant reduction in systemic inflammation. Conclusions: While statins may reduce psoriasis severity, the meta‐analysis did not show statistically significant improvements in PASI scores, except for topical application, and found no significant benefits in DLQI or hsCRP levels. Variability across studies and small sample sizes are notable limitations. Future research with larger cohorts and extended follow‐ups is warranted to clarify the potential role of statins in psoriasis management.

Ultrasound triggered microbubble destruction (UTMD) has been shown to sensitize tumors to radiation. This study evaluated the feasibility, safety, and efficacy of using UTMD for radiosensitization in participants with intrahepatic cholangiocarcinoma (ICC) and/or metastatic disease to the liver (MDL) receiving Yttrium-90 transarterial radioembolization (Y90-TARE). This was a prospective single-center IRB-approved clinical trial. Participants received four contrast ultrasound sessions: 1-2 weeks prior to Y90-TARE, 1-4 h post-treatment, and 1 week and 2 weeks post-Y90-TARE. The control group consisted of 1:1 nearest-neighbor propensity score matched historical controls participants that received Y90-TARE as part of standard-of-care. Safety was evaluated through general lab values, physiological monitoring and adverse events. Treatment response was determined by a 1-6 month CT/MRI and evaluated using modified Response Evaluation Criteria in Solid Tumors (mRECIST). Final analysis included 15 participants in each group. There were no differences in general lab values between groups (p > 0.15). In study participants, there were no differences in physiological monitoring between pre and post UTMD sessions (p > 0.20). There was a trend toward a better response distribution in the study group compared to the control group (study group: 0 % progressive disease (0/14), 29 % participants with stable disease (4/14), 21 % participants with partial response (3/14), 50 % participants with complete response (7/14) and control group: 33 % participants with progressive disease (5/15), 27 % with stable disease (4/15), 13 % with partial response (2/15), 27 % with complete response (4/15) when evaluating long-term imaging, p = 0.06). The addition of UTMD in participants that received Y90-TARE was feasible, safe, and might deliver improved treatment response.

Objectives: Contrast‐enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI‐RADS) is used to definitively diagnose hepatocellular carcinoma (HCC) in patients at risk. However, the user variability associated with CEUS LI‐RADS has not been validated in North American and European patients. This study aims to evaluate the inter‐reader agreements of CEUS LI‐RADS features for, and final categorization of, HCC in patients at risk.Methods: This retrospective multicenter clinical study used the database of a previous prospective multinational study, evaluating the accuracy of CEUS LI‐RADS for HCC diagnosis in patients at risk. All cases were first evaluated by a site physician performing/supervising the CEUS examination. Randomly selected cases were re‐evaluated by a blinded central reader. Final diagnosis was confirmed with the reference standard, which was a composite of imaging tests and histology. Cohen's kappa test was used to evaluate inter‐reader agreement.Results: This study included 150 liver nodules and 58.0% (87/150) were confirmed as HCC, 4.7% (7/150) non‐HCC malignancies, 22.7% (34/150) had no confirmed final diagnosis, and 14.7% (22/150) were nonmalignant. Inter‐reader agreements were substantial for CEUS LI‐RADS categorization (κ = 0.61; 95% confidence interval [CI]: 0.51–0.71) and major features assessment (ranged κ = 0.64–0.78), LR‐5 (κ = 0.65; 95% CI: 0.52–0.77), and LR‐M (κ = 0.67; 95% CI: 0.44–0.90), while for LR‐1 and LR‐2 categorization was almost perfect (κ = 0.85; 95% CI: 0.65–1.00).Conclusion: Our study reported a substantial inter‐reader agreement for overall CEUS LI‐RADS categorization, especially for LR‐5 and LR‐M, and major imaging features of HCC, further confirming CEUS LI‐RADS as a valuable and reliable tool for diagnosis of HCC.