Tumor-like conditions that mimic liver tumors - Diagnostic and Interventional Radiology

Objectives: Liver transplant (LT) is an effective treatment for hepatocellular carcinoma (HCC) in appropriately selected patients. Locoregional therapy (LRT) is often performed to extend a patient’s eligibility for LT. Imaging has a modest sensitivity of approximately 40–77% for detecting pathologically viable HCC in post-LRT patients. The impact on overall survival (OS) and disease-free survival (DFS) is unclear. We hypothesize that Liver Imaging Reporting & Data Systems Treatment Response (LI-RADS TR) category is equivalently correlated with long-term survival and overall disease-free progression when compared to explant pathology findings. We additionally hypothesize that neoadjuvant LRT can improve OS and DFS in LT patients initially within MC. Methods: Patients found to have HCC on explant between January 2005 and December 2021 were included. A total of 167 patients were divided into treatment (any pre-LT LRT except for Y-90 therapy) and control (no pre-LT LRT) groups. Of the patients who received pre-LT LRT, imaging studies were reviewed by two abdominal radiologists using 2018 LI-RADS criteria. Statistical analysis was performed using Kaplan-Meier survival curves and Cox proportional hazard models to assess OS and DFS. Results: No statistically significant difference in OS or DFS (p = 0.23 and p = 0.22 respectively) was initially found. Given significant difference in age between the groups (p < 0.0001), Cox proportional hazard models were used to adjust for age with statistical significance reached for better OS and DFS in the treatment group (p = 0.05 and p = 0.05 respectively). Contrary to our hypothesis, there was no difference between treatment response groups regarding overall survival or disease-free survival, presumably because of low number of HCC recurrences in our patient population (4%). Conclusion: Despite not reaching statistical significance, LI-RADS TR categorization demonstrates a good interreader agreement (Kappa 0.6), helping radiologists feel comfortable that modest sensitivity of the LI-RADS TR treatment response category for detecting pathologically active malignancy does not confer a negative clinical outcome.

Background: In recent years, endovascular repair has outpaced open repair of blunt traumatic aortic injury (TAI), calling for updated evaluation of severity grading systems to ensure continued efficacy in guiding clinical decision-making. Methods: A retrospective review assessed all adult presentations of blunt thoracic TAI to a single institution from 2005 through 2018. Associations of severity grade with demographics, presentation variables, intervention, and outcomes were analyzed. Results: Thirty-eight patients were included in the analysis. Repair (all endovascular) was pursued in 20 (53%) patients. By grade, 0% of grade 1, 20% of grade 2, 82% of grade 3, and 0% of grade 4 injuries were repaired. Hospital mortality was 16%, and median hospital length of stay was 18 days (IQR 9, 28). Conclusions: A uniform four-grade severity grading system continues to be useful in guiding clinical management for TAI in an environment that is increasingly utilizing endovascular repair.