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Fowler KJ, Chernyak V. What Is in a Name: Understanding the Nomenclature Updates for Fatty Liver Disease. Radiology 2024; 310:e232771. [PMID: 38226880 DOI: 10.1148/radiol.232771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Affiliation(s)
- Kathryn J Fowler
- From the Department of Radiology, University of California San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C.)
| | - Victoria Chernyak
- From the Department of Radiology, University of California San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C.)
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Huang EY, Reeves JJ, Broderick RC, Serra JL, Goldhaber NH, An JY, Fowler KJ, Hosseini M, Sandler BJ, Jacobsen GR, Horgan S, Clary BM. Distinguishing characteristics of xanthogranulomatous cholecystitis and gallbladder adenocarcinoma: a persistent diagnostic dilemma. Surg Endosc 2024; 38:348-355. [PMID: 37783778 DOI: 10.1007/s00464-023-10461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/06/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis which can resemble gallbladder adenocarcinoma (GAC) on preoperative imaging and present technical challenges in the performance of cholecystectomy. We examined our experience with each pathology to identify distinguishing characteristics that may guide patient counseling and surgical management. METHODS A retrospective review of all pathologically confirmed cases of XGC and GAC following cholecystectomy between 2015 and 2021 at a single institution was performed. Clinical, biochemical, radiographic, and intraoperative features were compared. RESULTS There were 37 cases of XGC and 20 cases of GAC. Patients with GAC were older (mean 70.3 years vs 58.0, p = 0.01) and exclusively female (100% vs 45.9%, p < 0.0001). There were no significant differences in accompanying symptoms between groups (nausea/vomiting, fevers, or jaundice). The mean maximum white blood cell count was elevated for XGC compared to GAC (16.4 vs 8.6 respectively, p = 0.044); however, there were no differences in the remainder of the biochemical profile, including bilirubin, liver transaminases, CEA, and CA 19-9. The presence of an intraluminal mass (61.1% vs 9.1%, p = 0.0001) and lymphadenopathy (18.8%. vs 0.0%, p = 0.045) were associated with malignancy, whereas gallbladder wall thickening as reported on imaging (87.9% vs 38.9%, p = 0.0008) and gallstones (76.5% vs. 50.0%, p = 0.053) were more often present with XGC. Cases of XGC more often had significant adhesions/inflammation (83.8% vs 55.0%, p = 0.03). CONCLUSION Clinical features that may favor benign chronic cholecystitis over gallbladder adenocarcinoma include younger age, male gender, current or prior leukocytosis, and the absence of an intraluminal mass or lymphadenopathy. Laparoscopic cholecystectomy is a safe surgical option for equivocal presentations. Intraoperative frozen section or intentional staging of more extensive procedures based upon final histopathology are valuable surgical strategies.
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Affiliation(s)
- Estella Y Huang
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA.
| | - James J Reeves
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA
| | - Ryan C Broderick
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA
| | - Joaquin L Serra
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA
| | - Nicole H Goldhaber
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA
| | - Julie Y An
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | - Kathryn J Fowler
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | - Mojgan Hosseini
- Department of Pathology, University of California, San Diego, San Diego, CA, USA
| | - Bryan J Sandler
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA
| | - Garth R Jacobsen
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA
| | - Santiago Horgan
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, San Diego, CA, 92093-0740, USA
| | - Bryan M Clary
- Division of Surgical Oncology, Department of Surgery, University of California, San Diego, San Diego, CA, USA
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Hassan OT, Behr SC, Ohliger MA, Fowler KJ, Gill RM, Fidelman N, Mehta N, Choi HH. Per-patient Negative Predictive Value of the CT and MRI Liver Imaging Reporting and Data System Version 2018 Treatment Response Algorithm for Hepatocellular Carcinoma. Radiology 2023; 309:e222776. [PMID: 38112541 DOI: 10.1148/radiol.222776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Background The Liver Imaging Reporting and Data System version 2018 (LI-RADS) treatment response algorithm (TRA) is a high-specificity, lower-sensitivity grading system to diagnose hepatocellular carcinoma (HCC) and recurrence after local-regional therapy. However, the emphasis on specificity can result in disease understaging, potentially leading to poorer posttransplant outcomes. Purpose To determine the negative predictive value (NPV) of pretransplant CT and MRI assessment for viable HCC on a per-patient basis using the LI-RADS TRA, considering explant pathology as the reference standard. Materials and Methods Patient records from 218 consecutive adult patients from a single institution with HCC who underwent liver transplant from January 2011 to November 2017 were retrospectively reviewed. Two readers blinded to the original report reviewed immediate (within 90 days) pretransplant imaging and characterized observations according to the LI-RADS TRA. Based on this, patients with LR-4, LR-5, or LR-TR (treatment response) viable tumors were designated as viable tumor; patients with solely LR-3 or LR-TR equivocal tumors were designated as equivocal; and patients with only LR-TR nonviable lesions were designated as no viable disease. Patients were designated as within or outside the Milan criteria. These per-patient designations were compared with the presence of viable disease at explant pathology. Fisher exact test was used to compare the differences between CT and MRI. Weighted κ values were used to calculate interreader reliability. Results Final study sample consisted of 206 patients (median age, 61 years [IQR, 57-65 years]; 157 male patients and 49 female patients). Per-patient LI-RADS TRA assessment of pretransplant imaging had an NPV of 32% (95% CI: 27, 38) and 26% (95% CI: 20, 33) (readers 1 and 2, respectively) for predicting viable disease. Seventy-five percent (reader 1) and 77% (reader 2) of patients deemed equivocal had residual tumors at explant pathology. Weighted interreader reliability was substantial (κ = 0.62). Conclusion Patient-based stratification of viable, equivocal, and nonviable disease at pretransplant CT or MRI, based on LI-RADS TRA, demonstrated low negative predictive value in excluding HCC at explant pathology. © RSNA, 2023 See also the editorial by Tamir and Tau in this issue.
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Affiliation(s)
- Omar T Hassan
- From the Departments of Radiology (O.T.H., S.C.B., M.A.O., H.H.C.), Pathology (R.M.G.), Interventional Radiology (N.F.), and Hepatology and Liver Transplantation (N.M.), University of California San Francisco, 513 Parnassus Ave, Rm S257, San Francisco, CA 94143; and Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.)
| | - Spencer C Behr
- From the Departments of Radiology (O.T.H., S.C.B., M.A.O., H.H.C.), Pathology (R.M.G.), Interventional Radiology (N.F.), and Hepatology and Liver Transplantation (N.M.), University of California San Francisco, 513 Parnassus Ave, Rm S257, San Francisco, CA 94143; and Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.)
| | - Michael A Ohliger
- From the Departments of Radiology (O.T.H., S.C.B., M.A.O., H.H.C.), Pathology (R.M.G.), Interventional Radiology (N.F.), and Hepatology and Liver Transplantation (N.M.), University of California San Francisco, 513 Parnassus Ave, Rm S257, San Francisco, CA 94143; and Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.)
| | - Kathryn J Fowler
- From the Departments of Radiology (O.T.H., S.C.B., M.A.O., H.H.C.), Pathology (R.M.G.), Interventional Radiology (N.F.), and Hepatology and Liver Transplantation (N.M.), University of California San Francisco, 513 Parnassus Ave, Rm S257, San Francisco, CA 94143; and Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.)
| | - Ryan M Gill
- From the Departments of Radiology (O.T.H., S.C.B., M.A.O., H.H.C.), Pathology (R.M.G.), Interventional Radiology (N.F.), and Hepatology and Liver Transplantation (N.M.), University of California San Francisco, 513 Parnassus Ave, Rm S257, San Francisco, CA 94143; and Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.)
| | - Nicholas Fidelman
- From the Departments of Radiology (O.T.H., S.C.B., M.A.O., H.H.C.), Pathology (R.M.G.), Interventional Radiology (N.F.), and Hepatology and Liver Transplantation (N.M.), University of California San Francisco, 513 Parnassus Ave, Rm S257, San Francisco, CA 94143; and Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.)
| | - Neil Mehta
- From the Departments of Radiology (O.T.H., S.C.B., M.A.O., H.H.C.), Pathology (R.M.G.), Interventional Radiology (N.F.), and Hepatology and Liver Transplantation (N.M.), University of California San Francisco, 513 Parnassus Ave, Rm S257, San Francisco, CA 94143; and Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.)
| | - Hailey H Choi
- From the Departments of Radiology (O.T.H., S.C.B., M.A.O., H.H.C.), Pathology (R.M.G.), Interventional Radiology (N.F.), and Hepatology and Liver Transplantation (N.M.), University of California San Francisco, 513 Parnassus Ave, Rm S257, San Francisco, CA 94143; and Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.)
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Jiang H, Yang C, Chen Y, Wang Y, Wu Y, Chen W, Ronot M, Chernyak V, Fowler KJ, Bashir MR, Song B. Development of a Model including MRI Features for Predicting Advanced-stage Recurrence of Hepatocellular Carcinoma after Liver Resection. Radiology 2023; 309:e230527. [PMID: 37934100 DOI: 10.1148/radiol.230527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Background Identifying patients at high risk for advanced-stage hepatocellular carcinoma (HCC) recurrence after liver resection may improve patient survival. Purpose To develop a model including MRI features for predicting postoperative advanced-stage HCC recurrence. Materials and Methods This single-center, retrospective study includes consecutive adult patients who underwent preoperative contrast-enhanced MRI and curative-intent resection for early- to intermediate-stage HCC (from December 2011 to April 2021). Three radiologists evaluated 52 qualitative features on MRI scans. In the training set, Fine-Gray proportional subdistribution hazard analysis was performed to identify clinical, laboratory, imaging, pathologic, and surgical variables to include in the predictive model. In the test set, the concordance index (C-index) was computed to compare the developed model with current staging systems. The Kaplan-Meier survival curves were compared using the log-rank test. Results The study included 532 patients (median age, 54 years; IQR, 46-62 years; 465 male patients), 302 patients from the training set (median age, 54 years; IQR, 46-63 years; 265 male patients), and 128 patients from the test set (median age, 53 years; IQR, 46-63 years; 108 male patients). Advanced-stage recurrence was observed in 38 of 302 (12.6%) and 15 of 128 (11.7%) of patients from the training and test sets, respectively. Serum neutrophil count (109/L), tumor size (in centimeters), and arterial phase hyperenhancement proportion on MRI scans were associated with advanced-stage recurrence (subdistribution hazard ratio range, 1.16-3.83; 95% CI: 1.02, 7.52; P value range, <.001 to .02) and included in the predictive model. The model showed better test set prediction for advanced-stage recurrence than four staging systems (2-year C-indexes, 0.82 [95% CI: 0.74, 0.91] vs 0.63-0.68 [95% CI: 0.52, 0.82]; P value range, .001-.03). Patients at high risk for HCC recurrence (model score, ≥15 points) showed increased advanced-stage recurrence and worse all-stage recurrence-free survival (RFS), advanced-stage RFS, and overall survival than patients at low risk for HCC recurrence (P value range, <.001 to .02). Conclusion A model combining serum neutrophil count, tumor size, and arterial phase hyperenhancement proportion predicted advanced-stage HCC recurrence better than current staging systems and may identify patients at high risk. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Tsai and Mellnick in this issue.
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Affiliation(s)
- Hanyu Jiang
- From the Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China (H.J., C.Y., Y.C., Y. Wang, W.C., B.S.); JD.com, Beijing, China (Y. Wu); Université Paris Cité, UMR 1149, CRI, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.); Department of Radiology, Center for Advanced Magnetic Resonance in Medicine, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, Sanya People's Hospital, Sanya, China (B.S.)
| | - Chongtu Yang
- From the Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China (H.J., C.Y., Y.C., Y. Wang, W.C., B.S.); JD.com, Beijing, China (Y. Wu); Université Paris Cité, UMR 1149, CRI, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.); Department of Radiology, Center for Advanced Magnetic Resonance in Medicine, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, Sanya People's Hospital, Sanya, China (B.S.)
| | - Yidi Chen
- From the Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China (H.J., C.Y., Y.C., Y. Wang, W.C., B.S.); JD.com, Beijing, China (Y. Wu); Université Paris Cité, UMR 1149, CRI, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.); Department of Radiology, Center for Advanced Magnetic Resonance in Medicine, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, Sanya People's Hospital, Sanya, China (B.S.)
| | - Yanshu Wang
- From the Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China (H.J., C.Y., Y.C., Y. Wang, W.C., B.S.); JD.com, Beijing, China (Y. Wu); Université Paris Cité, UMR 1149, CRI, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.); Department of Radiology, Center for Advanced Magnetic Resonance in Medicine, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, Sanya People's Hospital, Sanya, China (B.S.)
| | - Yuanan Wu
- From the Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China (H.J., C.Y., Y.C., Y. Wang, W.C., B.S.); JD.com, Beijing, China (Y. Wu); Université Paris Cité, UMR 1149, CRI, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.); Department of Radiology, Center for Advanced Magnetic Resonance in Medicine, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, Sanya People's Hospital, Sanya, China (B.S.)
| | - Weixia Chen
- From the Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China (H.J., C.Y., Y.C., Y. Wang, W.C., B.S.); JD.com, Beijing, China (Y. Wu); Université Paris Cité, UMR 1149, CRI, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.); Department of Radiology, Center for Advanced Magnetic Resonance in Medicine, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, Sanya People's Hospital, Sanya, China (B.S.)
| | - Maxime Ronot
- From the Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China (H.J., C.Y., Y.C., Y. Wang, W.C., B.S.); JD.com, Beijing, China (Y. Wu); Université Paris Cité, UMR 1149, CRI, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.); Department of Radiology, Center for Advanced Magnetic Resonance in Medicine, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, Sanya People's Hospital, Sanya, China (B.S.)
| | - Victoria Chernyak
- From the Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China (H.J., C.Y., Y.C., Y. Wang, W.C., B.S.); JD.com, Beijing, China (Y. Wu); Université Paris Cité, UMR 1149, CRI, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.); Department of Radiology, Center for Advanced Magnetic Resonance in Medicine, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, Sanya People's Hospital, Sanya, China (B.S.)
| | - Kathryn J Fowler
- From the Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China (H.J., C.Y., Y.C., Y. Wang, W.C., B.S.); JD.com, Beijing, China (Y. Wu); Université Paris Cité, UMR 1149, CRI, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.); Department of Radiology, Center for Advanced Magnetic Resonance in Medicine, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, Sanya People's Hospital, Sanya, China (B.S.)
| | - Mustafa R Bashir
- From the Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China (H.J., C.Y., Y.C., Y. Wang, W.C., B.S.); JD.com, Beijing, China (Y. Wu); Université Paris Cité, UMR 1149, CRI, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.); Department of Radiology, Center for Advanced Magnetic Resonance in Medicine, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, Sanya People's Hospital, Sanya, China (B.S.)
| | - Bin Song
- From the Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China (H.J., C.Y., Y.C., Y. Wang, W.C., B.S.); JD.com, Beijing, China (Y. Wu); Université Paris Cité, UMR 1149, CRI, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F.); Department of Radiology, Center for Advanced Magnetic Resonance in Medicine, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, Sanya People's Hospital, Sanya, China (B.S.)
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Roudenko A, Berman Z, Cornman-Homonoff J, Halin N, Kleedehn M, Fowler KJ, Mendiratta-Lalla M, Chernyak V, Sirlin CB, Cunha GM. Locoregional Therapy of Hepatocellular Carcinoma: Reporting Recommendations from the Liver Imaging Reporting and Data System and Society of Interventional Radiology Reporting Committees to Improve Assessment of Response. J Vasc Interv Radiol 2023; 34:2042-2044. [PMID: 37557980 DOI: 10.1016/j.jvir.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
| | - Zachary Berman
- Department of Radiology, Interventional Radiology Section, University of California San Diego, San Diego, CA
| | - Joshua Cornman-Homonoff
- Department of Radiology, Interventional Radiology Section, Yale New Haven Hospital, New Haven, CT
| | - Neil Halin
- Consulting Interventional Radiologist, Baystate Interventional Radiology, Baystate Medical Center, Newton, MA
| | - Mark Kleedehn
- Department of Radiology, Interventional Radiology Section, University of Wisconsin, Madison, WI
| | - Kathryn J Fowler
- Department of Radiology, University of California San Diego, San Diego, CA
| | | | - Victoria Chernyak
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Claude B Sirlin
- Department of Radiology, University of California San Diego, San Diego, CA
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Weinstein S, Kim DH, Fowler KJ, Birkholz JH, Cash BD, Cilenti E, Dane B, Horvat N, Kambadakone AR, Korngold EK, Liu PS, Lo BM, McCrary M, Mellnick V, Pietryga JA, Santillan CS, Zukotynski K, Carucci LR. ACR Appropriateness Criteria® Left Lower Quadrant Pain: 2023 Update. J Am Coll Radiol 2023; 20:S471-S480. [PMID: 38040465 DOI: 10.1016/j.jacr.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
The differential diagnosis for left lower quadrant pain is wide and conditions range from the benign and self-limited to life-threatening surgical emergencies. Along with patient history, physical examination, and laboratory tests, imaging is often critical to limit the differential diagnosis and identify life-threatening abnormalities. This document will discuss the guidelines for the appropriate use of imaging in the initial workup for patients who present with left lower quadrant pain, patients with suspected diverticulitis, and patients with suspected complications from diverticulitis. 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 process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California, San Diego, San Diego, California
| | - James H Birkholz
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Elizabeth Cilenti
- MedStar Georgetown University Hospital, Washington, District of Columbia, Primary care physician
| | - Bari Dane
- NYU Grossman School of Medicine, New York, New York
| | - Natally Horvat
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Marion McCrary
- Duke Signature Care, Durham, North Carolina; American College of Physicians
| | - Vincent Mellnick
- Mallinckrodt Institute of Radiology, Saint Louis, Missouri; Committee on Emergency Radiology-GSER
| | - Jason A Pietryga
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Katherine Zukotynski
- McMaster University, Hamilton, Ontario, Canada; Commission on Nuclear Medicine and Molecular Imaging
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Jiang H, Qin Y, Wei H, Zheng T, Yang T, Wu Y, Ding C, Chernyak V, Ronot M, Fowler KJ, Chen W, Bashir MR, Song B. Prognostic MRI features to predict postresection survivals for very early to intermediate stage hepatocellular carcinoma. Eur Radiol 2023:10.1007/s00330-023-10279-x. [PMID: 37870624 DOI: 10.1007/s00330-023-10279-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES Contrast-enhanced MRI can provide individualized prognostic information for hepatocellular carcinoma (HCC). We aimed to investigate the value of MRI features to predict early (≤ 2 years)/late (> 2 years) recurrence-free survival (E-RFS and L-RFS, respectively) and overall survival (OS). MATERIALS AND METHODS Consecutive adult patients at a tertiary academic center who received curative-intent liver resection for very early to intermediate stage HCC and underwent preoperative contrast-enhanced MRI were retrospectively enrolled from March 2011 to April 2021. Three masked radiologists independently assessed 54 MRI features. Uni- and multivariable Cox regression analyses were conducted to investigate the associations of imaging features with E-RFS, L-RFS, and OS. RESULTS This study included 600 patients (median age, 53 years; 526 men). During a median follow-up of 55.3 months, 51% of patients experienced recurrence (early recurrence: 66%; late recurrence: 34%), and 17% died. Tumor size, multiple tumors, rim arterial phase hyperenhancement, iron sparing in solid mass, tumor growth pattern, and gastroesophageal varices were associated with E-RFS and OS (largest p = .02). Nonperipheral washout (p = .006), markedly low apparent diffusion coefficient value (p = .02), intratumoral arteries (p = .01), and width of the main portal vein (p = .03) were associated with E-RFS but not with L-RFS or OS, while the VICT2 trait was specifically associated with OS (p = .02). Multiple tumors (p = .048) and radiologically-evident cirrhosis (p < .001) were the only predictors for L-RFS. CONCLUSION Twelve visually-assessed MRI features predicted postoperative E-RFS (≤ 2 years), L-RFS (> 2 years), and OS for very early to intermediate-stage HCCs. CLINICAL RELEVANCE STATEMENT The prognostic MRI features may help inform personalized surgical planning, neoadjuvant/adjuvant therapies, and postoperative surveillance, thus may be included in future prognostic models. KEY POINTS • Tumor size, multiple tumors, rim arterial phase hyperenhancement, iron sparing, tumor growth pattern, and gastroesophageal varices predicted both recurrence-free survival within 2 years and overall survival. • Nonperipheral washout, markedly low apparent diffusion coefficient value, intratumoral arteries, and width of the main portal vein specifically predicted recurrence-free survival within 2 years, while the VICT2 trait specifically predicted overall survival. • Multiple tumors and radiologically-evident cirrhosis were the only predictors for recurrence-free survival beyond 2 years.
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Affiliation(s)
- Hanyu Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yun Qin
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hong Wei
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tianying Zheng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ting Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yuanan Wu
- Department of Technology, JD.Com, Inc, Beijing, China
| | - Chengyu Ding
- Department of Technology, ShuKun (BeiJing) Technology Co., Ltd, Beijing, China
| | - Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Maxime Ronot
- Université Paris Cité, UMR 1149, CRI, Paris & Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Kathryn J Fowler
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Weixia Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Mustafa R Bashir
- Department of Radiology, Center for Advanced Magnetic Resonance in Medicine, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA.
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Department of Radiology, Sanya People's Hospital, Sanya, 572000, Hainan, China.
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Fowler KJ, Venkatesh SK, Obuchowski N, Middleton MS, Chen J, Pepin K, Magnuson J, Brown KJ, Batakis D, Henderson WC, Shankar SS, Kamphaus TN, Pasek A, Calle RA, Sanyal AJ, Loomba R, Ehman R, Samir AE, Sirlin CB, Sherlock SP. Repeatability of MRI Biomarkers in Nonalcoholic Fatty Liver Disease: The NIMBLE Consortium. Radiology 2023; 309:e231092. [PMID: 37815451 PMCID: PMC10625902 DOI: 10.1148/radiol.231092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/30/2023] [Accepted: 08/29/2023] [Indexed: 10/11/2023]
Abstract
Background There is a need for reliable noninvasive methods for diagnosing and monitoring nonalcoholic fatty liver disease (NAFLD). Thus, the multidisciplinary Non-invasive Biomarkers of Metabolic Liver disease (NIMBLE) consortium was formed to identify and advance the regulatory qualification of NAFLD imaging biomarkers. Purpose To determine the different-day same-scanner repeatability coefficient of liver MRI biomarkers in patients with NAFLD at risk for steatohepatitis. Materials and Methods NIMBLE 1.2 is a prospective, observational, single-center short-term cross-sectional study (October 2021 to June 2022) in adults with NAFLD across a spectrum of low, intermediate, and high likelihood of advanced fibrosis as determined according to the fibrosis based on four factors (FIB-4) index. Participants underwent up to seven MRI examinations across two visits less than or equal to 7 days apart. Standardized imaging protocols were implemented with six MRI scanners from three vendors at both 1.5 T and 3 T, with central analysis of the data performed by an independent reading center (University of California, San Diego). Trained analysts, who were blinded to clinical data, measured the MRI proton density fat fraction (PDFF), liver stiffness at MR elastography (MRE), and visceral adipose tissue (VAT) for each participant. Point estimates and CIs were calculated using χ2 distribution and statistical modeling for pooled repeatability measures. Results A total of 17 participants (mean age, 58 years ± 8.5 [SD]; 10 female) were included, of which seven (41.2%), six (35.3%), and four (23.5%) participants had a low, intermediate, or high likelihood of advanced fibrosis, respectively. The different-day same-scanner mean measurements were 13%-14% for PDFF, 6.6 L for VAT, and 3.15 kPa for two-dimensional MRE stiffness. The different-day same-scanner repeatability coefficients were 0.22 L (95% CI: 0.17, 0.29) for VAT, 0.75 kPa (95% CI: 0.6, 0.99) for MRE stiffness, 1.19% (95% CI: 0.96, 1.61) for MRI PDFF using magnitude reconstruction, 1.56% (95% CI: 1.26, 2.07) for MRI PDFF using complex reconstruction, and 19.7% (95% CI: 15.8, 26.2) for three-dimensional MRE shear modulus. Conclusion This preliminary study suggests that thresholds of 1.2%-1.6%, 0.22 L, and 0.75 kPa for MRI PDFF, VAT, and MRE, respectively, should be used to discern measurement error from real change in patients with NAFLD. ClinicalTrials.gov registration no. NCT05081427 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Kozaka and Matsui in this issue.
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Affiliation(s)
| | | | - Nancy Obuchowski
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Michael S. Middleton
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Jun Chen
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Kay Pepin
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Jessica Magnuson
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Kathy J. Brown
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Danielle Batakis
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Walter C. Henderson
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Sudha S. Shankar
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Tania N. Kamphaus
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Alex Pasek
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Roberto A. Calle
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Arun J. Sanyal
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Rohit Loomba
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Richard Ehman
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
| | - Anthony E. Samir
- From the Liver Imaging Group (K.J.F., M.S.M., D.B., W.C.H., C.B.S.)
and Department of Hepatology (R.L.), University of California–San Diego,
6206 Lakewood St, San Diego, CA 92122; Department of Radiology, Mayo Clinic,
Rochester, Minn (S.K.V., J.C., K.P., J.M., K.J.B., R.E.); Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (N.O.); Pfizer
Research and Development, Pfizer, Inc, Sacramento, Calif (S.S.S.); Foundation
for the National Institutes of Health, North Bethesda, Md (T.N.K., A.P.);
Regeneron Pharmaceuticals, Inc, Tarrytown, NY (R.A.C.); Department of
Gastroenterology, Virginia Commonwealth University, Richmond, Va (A.J.S.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.E.S.);
and Department of Imaging Alliances, Pfizer, Inc, New York, NY (S.P.S.)
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Fowler KJ, Bashir MR. The current status of imaging in liver fibrosis. Nat Rev Gastroenterol Hepatol 2023; 20:628-629. [PMID: 37537333 DOI: 10.1038/s41575-023-00833-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
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10
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Liu X, Tan SBM, Awiwi MO, Jang HJ, Chernyak V, Fowler KJ, Shaaban AM, Sirlin CB, Furlan A, Marks RM, Elsayes KM. Imaging Findings in Cirrhotic Liver: Pearls and Pitfalls for Diagnosis of Focal Benign and Malignant Lesions. Radiographics 2023; 43:e230043. [PMID: 37651277 DOI: 10.1148/rg.230043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Cirrhosis is the end stage of chronic liver disease and causes architectural distortion and perfusional anomalies. It is a major risk factor for developing hepatocellular carcinoma (HCC). Common disease entities in noncirrhotic livers, such as hemangiomas, can be rare in cirrhotic livers, and benign entities such as confluent hepatic fibrosis and focal nodular hyperplasia-like lesions may mimic the appearance of malignancies,. HCC usually has typical imaging characteristics, such as the major features established by the Liver Imaging Reporting and Data System. However, HCC can also have a spectrum of atypical or uncommon appearances, such as cystic HCC, hypovascular HCC, or macroscopic fat-containing HCC. HCCs with certain genetic mutations such as CTNNB-1-mutated HCC can harbor unique imaging features not seen in other types of HCC. In addition, malignancies that are less common than HCC, such as cholangiocarcinoma and metastases, which can be difficult to differentiate, can still occur in cirrhotic livers. Atypical imaging features of benign and malignant lesions can be challenging to accurately diagnose. Therefore, familiarity with these features and an understanding of the prevalence of disease entities in cirrhotic livers are key in the daily practice of radiologists for evaluation of cirrhotic livers. The authors illustrate the typical and atypical features of benign and malignant lesions in cirrhosis and discuss the technical pitfalls and unique advantages associated with various imaging modalities in assessing cirrhotic livers, including noncontrast and contrast-enhanced US, CT, and MRI. Work of the U.S. Government published under an exclusive license with the RSNA. Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Xiaoyang Liu
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Stephanie B M Tan
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Muhammad O Awiwi
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Hyun-Jung Jang
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Victoria Chernyak
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Kathryn J Fowler
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Akram M Shaaban
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Claude B Sirlin
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Alessandro Furlan
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Robert M Marks
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Khaled M Elsayes
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
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Kadi D, Yamamoto MF, Lerner EC, Jiang H, Fowler KJ, Bashir MR. Imaging prognostication and tumor biology in hepatocellular carcinoma. J Liver Cancer 2023; 23:284-299. [PMID: 37710379 PMCID: PMC10565542 DOI: 10.17998/jlc.2023.08.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy, and represents a significant global health burden with rising incidence rates, despite a more thorough understanding of the etiology and biology of HCC, as well as advancements in diagnosis and treatment modalities. According to emerging evidence, imaging features related to tumor aggressiveness can offer relevant prognostic information, hence validation of imaging prognostic features may allow for better noninvasive outcomes prediction and inform the selection of tailored therapies, ultimately improving survival outcomes for patients with HCC.
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Affiliation(s)
- Diana Kadi
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Marilyn F. Yamamoto
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Emily C. Lerner
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Hanyu Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kathryn J. Fowler
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Mustafa R. Bashir
- Department of Radiology, Duke University, Durham, NC, USA
- Division of Hepatology, Department of Medicine, Duke University, Durham, NC, USA
- Center for Advanced Magnetic Resonance Development, Duke University, Durham, NC, USA
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Ichikawa S, Sirlin CB, Cunha GM, Wolfson T, Fowler KJ, Morisaka H, Onohara K, Shimizu T, Omiya Y, Sugiyama H, Okumura A, Onishi H. Inter-observer agreement and accuracy of LI-RADS v2018 for differentiating tumor in vein from bland thrombus using gadoxetic acid-enhanced magnetic resonance imaging. Abdom Radiol (NY) 2023; 48:2557-2569. [PMID: 37246973 DOI: 10.1007/s00261-023-03964-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE To assess inter-observer agreement and accuracy of LI-RADS v2018 for differentiating tumor in vein (TIV) from bland thrombus on gadoxetic acid-enhanced magnetic resonance imaging (Gx-MRI). Secondarily, to determine whether a multi-feature model improves accuracy compared to LI-RADS. METHODS We retrospectively identified consecutive patients at risk for hepatocellular carcinoma with venous occlusion(s) reported on Gx-MRI. Five radiologists independently classified each occlusion as TIV or bland thrombus using the LI-RADS TIV criterion (enhancing soft tissue in vein). They also evaluated imaging features suggestive of TIV or bland thrombus. Intra-class correlation coefficient (ICC) was calculated for individual features. A multi-feature model was developed based on consensus scores of features with > 5% consensus prevalence and > 0.40 ICC. Sensitivity and specificity of the LI-RADS criterion and of the cross-validated multi-feature model were compared. RESULTS Ninety-eight patients with 103 venous occlusions (58 TIV, 45 bland thrombus) were included. The LI-RADS criterion provided 0.63 ICC and, depending on the reader, 0.62-0.93 sensitivity and 0.87-1.00 specificity. Five other features had > 5% consensus prevalence and > 0.40 ICC, including three LI-RADS suggestive features and two non-LI-RADS features. The optimal multi-feature model incorporated the LI-RADS criterion and one LI-RADS suggestive feature (occluded or obscured vein contiguous with malignant parenchymal mass). After cross-validation, the multi-feature model did not improve sensitivity or specificity compared to the LI-RADS criterion (P = 0.23 and 0.25, respectively). CONCLUSION Using Gx-MRI, the LI-RADS criterion for TIV provides substantial inter-observer agreement, variable sensitivity, and high specificity for differentiating TIV from bland thrombus. A cross-validated multi-feature model did not improve diagnostic performance.
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Affiliation(s)
- Shintaro Ichikawa
- Department of Radiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan.
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Guilherme Moura Cunha
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory (CASL), San Diego Supercomputer Center at UCSD, San Diego, CA, USA
| | - Kathryn J Fowler
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Hiroyuki Morisaka
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Kojiro Onohara
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Tatsuya Shimizu
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Yoshie Omiya
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroki Sugiyama
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Akihiro Okumura
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan
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Luk L, Lowy AM, Li K, Fowler KJ, Wang ZJ, Kamel IR, Liau J. Pancreatic Cyst Surveillance: Who, Why, How? Radiology 2023; 308:e222778. [PMID: 37489987 DOI: 10.1148/radiol.222778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Pancreatic cystic lesions (PCLs) are widely prevalent and commonly encountered in abdominal radiology. Some PCLs can be definitively identified at imaging as benign subtypes or those with malignant potential, while others remain indeterminate. Notably, the degree of malignant potential and natural history of the most common subtype, branch-duct intraductal papillary mucinous neoplasms, are not clearly established. In the work-up of PCLs, patients may further be identified as high-risk individuals who are at elevated risk of pancreatic ductal adenocarcinoma due to familial and genetic factors. This review describes current PCL surveillance and management guidelines and highlights ongoing controversies and future directions to aid radiologists in their daily practice.
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Affiliation(s)
- Lyndon Luk
- From the Department of Radiology, Columbia University, New York, NY (L.L.); Departments of Surgery (A.M.L., K.L.) and Radiology (K.J.F., J.L.), University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103-8756; Department of Radiology, University of California San Francisco, San Francisco, Calif (Z.J.W.); and Department of Radiology, Johns Hopkins University, Baltimore, Md (I.R.K.)
| | - Andrew M Lowy
- From the Department of Radiology, Columbia University, New York, NY (L.L.); Departments of Surgery (A.M.L., K.L.) and Radiology (K.J.F., J.L.), University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103-8756; Department of Radiology, University of California San Francisco, San Francisco, Calif (Z.J.W.); and Department of Radiology, Johns Hopkins University, Baltimore, Md (I.R.K.)
| | - Kevin Li
- From the Department of Radiology, Columbia University, New York, NY (L.L.); Departments of Surgery (A.M.L., K.L.) and Radiology (K.J.F., J.L.), University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103-8756; Department of Radiology, University of California San Francisco, San Francisco, Calif (Z.J.W.); and Department of Radiology, Johns Hopkins University, Baltimore, Md (I.R.K.)
| | - Kathryn J Fowler
- From the Department of Radiology, Columbia University, New York, NY (L.L.); Departments of Surgery (A.M.L., K.L.) and Radiology (K.J.F., J.L.), University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103-8756; Department of Radiology, University of California San Francisco, San Francisco, Calif (Z.J.W.); and Department of Radiology, Johns Hopkins University, Baltimore, Md (I.R.K.)
| | - Zhen J Wang
- From the Department of Radiology, Columbia University, New York, NY (L.L.); Departments of Surgery (A.M.L., K.L.) and Radiology (K.J.F., J.L.), University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103-8756; Department of Radiology, University of California San Francisco, San Francisco, Calif (Z.J.W.); and Department of Radiology, Johns Hopkins University, Baltimore, Md (I.R.K.)
| | - Ihab R Kamel
- From the Department of Radiology, Columbia University, New York, NY (L.L.); Departments of Surgery (A.M.L., K.L.) and Radiology (K.J.F., J.L.), University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103-8756; Department of Radiology, University of California San Francisco, San Francisco, Calif (Z.J.W.); and Department of Radiology, Johns Hopkins University, Baltimore, Md (I.R.K.)
| | - Joy Liau
- From the Department of Radiology, Columbia University, New York, NY (L.L.); Departments of Surgery (A.M.L., K.L.) and Radiology (K.J.F., J.L.), University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103-8756; Department of Radiology, University of California San Francisco, San Francisco, Calif (Z.J.W.); and Department of Radiology, Johns Hopkins University, Baltimore, Md (I.R.K.)
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Hong CW, Chernyak V, Choi JY, Lee S, Potu C, Delgado T, Wolfson T, Gamst A, Birnbaum J, Kampalath R, Lall C, Lee JT, Owen JW, Aguirre DA, Mendiratta-Lala M, Davenport MS, Masch W, Roudenko A, Lewis SC, Kierans AS, Hecht EM, Bashir MR, Brancatelli G, Douek ML, Ohliger MA, Tang A, Cerny M, Fung A, Costa EA, Corwin MT, McGahan JP, Kalb B, Elsayes KM, Surabhi VR, Blair K, Marks RM, Horvat N, Best S, Ash R, Ganesan K, Kagay CR, Kambadakone A, Wang J, Cruite I, Bijan B, Goodwin M, Cunha GM, Tamayo-Murillo D, Fowler KJ, Sirlin CB. Erratum for: A Multicenter Assessment of Interreader Reliability of LI-RADS Version 2018 for MRI and CT. Radiology 2023; 308:e239018. [PMID: 37489994 PMCID: PMC10374935 DOI: 10.1148/radiol.239018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
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Hong CW, Chernyak V, Choi JY, Lee S, Potu C, Delgado T, Wolfson T, Gamst A, Birnbaum J, Kampalath R, Lall C, Lee JT, Owen JW, Aguirre DA, Mendiratta-Lala M, Davenport MS, Masch W, Roudenko A, Lewis SC, Kierans AS, Hecht EM, Bashir MR, Brancatelli G, Douek ML, Ohliger MA, Tang A, Cerny M, Fung A, Costa EA, Corwin MT, McGahan JP, Kalb B, Elsayes KM, Surabhi VR, Blair K, Marks RM, Horvat N, Best S, Ash R, Ganesan K, Kagay CR, Kambadakone A, Wang J, Cruite I, Bijan B, Goodwin M, Moura Cunha G, Tamayo-Murillo D, Fowler KJ, Sirlin CB. A Multicenter Assessment of Interreader Reliability of LI-RADS Version 2018 for MRI and CT. Radiology 2023; 307:e222855. [PMID: 37367445 PMCID: PMC10315518 DOI: 10.1148/radiol.222855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background Various limitations have impacted research evaluating reader agreement for Liver Imaging Reporting and Data System (LI-RADS). Purpose To assess reader agreement of LI-RADS in an international multicenter multireader setting using scrollable images. Materials and Methods This retrospective study used deidentified clinical multiphase CT and MRI and reports with at least one untreated observation from six institutions and three countries; only qualifying examinations were submitted. Examination dates were October 2017 to August 2018 at the coordinating center. One untreated observation per examination was randomly selected using observation identifiers, and its clinically assigned features were extracted from the report. The corresponding LI-RADS version 2018 category was computed as a rescored clinical read. Each examination was randomly assigned to two of 43 research readers who independently scored the observation. Agreement for an ordinal modified four-category LI-RADS scale (LR-1, definitely benign; LR-2, probably benign; LR-3, intermediate probability of malignancy; LR-4, probably hepatocellular carcinoma [HCC]; LR-5, definitely HCC; LR-M, probably malignant but not HCC specific; and LR-TIV, tumor in vein) was computed using intraclass correlation coefficients (ICCs). Agreement was also computed for dichotomized malignancy (LR-4, LR-5, LR-M, and LR-TIV), LR-5, and LR-M. Agreement was compared between research-versus-research reads and research-versus-clinical reads. Results The study population consisted of 484 patients (mean age, 62 years ± 10 [SD]; 156 women; 93 CT examinations, 391 MRI examinations). ICCs for ordinal LI-RADS, dichotomized malignancy, LR-5, and LR-M were 0.68 (95% CI: 0.61, 0.73), 0.63 (95% CI: 0.55, 0.70), 0.58 (95% CI: 0.50, 0.66), and 0.46 (95% CI: 0.31, 0.61) respectively. Research-versus-research reader agreement was higher than research-versus-clinical agreement for modified four-category LI-RADS (ICC, 0.68 vs 0.62, respectively; P = .03) and for dichotomized malignancy (ICC, 0.63 vs 0.53, respectively; P = .005), but not for LR-5 (P = .14) or LR-M (P = .94). Conclusion There was moderate agreement for LI-RADS version 2018 overall. For some comparisons, research-versus-research reader agreement was higher than research-versus-clinical reader agreement, indicating differences between the clinical and research environments that warrant further study. © RSNA, 2023 Supplemental material is available for this article. See also the editorials by Johnson and Galgano and Smith in this issue.
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Affiliation(s)
- Cheng William Hong
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Victoria Chernyak
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Jin-Young Choi
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Sonia Lee
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Chetan Potu
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Timoteo Delgado
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Tanya Wolfson
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Anthony Gamst
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Jason Birnbaum
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Rony Kampalath
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Chandana Lall
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - James T Lee
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Joseph W Owen
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Diego A Aguirre
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Mishal Mendiratta-Lala
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Matthew S Davenport
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - William Masch
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Alexandra Roudenko
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Sara C Lewis
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Andrea Siobhan Kierans
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Elizabeth M Hecht
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Mustafa R Bashir
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Giuseppe Brancatelli
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Michael L Douek
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Michael A Ohliger
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - An Tang
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Milena Cerny
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Alice Fung
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Eduardo A Costa
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Michael T Corwin
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - John P McGahan
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Bobby Kalb
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Khaled M Elsayes
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Venkateswar R Surabhi
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Katherine Blair
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Robert M Marks
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Natally Horvat
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Shaun Best
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Ryan Ash
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Karthik Ganesan
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Christopher R Kagay
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Avinash Kambadakone
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Jin Wang
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Irene Cruite
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Bijan Bijan
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Mark Goodwin
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Guilherme Moura Cunha
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Dorathy Tamayo-Murillo
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Kathryn J Fowler
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
| | - Claude B Sirlin
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.)
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Quek J, Tan DJH, Chan KE, Lim WH, Ng CH, Ren YP, Koh TK, Teh R, Xiao J, Fu C, Syn N, Teng M, Muthiah M, Fowler KJ, Sirlin CB, Loomba R, Huang DQ. Quality Assessment of Ultrasound and Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance: A Systematic Review and Meta-Analysis. Dig Dis 2023; 41:757-766. [PMID: 37231918 DOI: 10.1159/000531016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/14/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION To achieve early detection and curative treatment options, surveillance imaging for hepatocellular carcinoma (HCC) must remain of quality and without substantial limitations in liver visualization. However, the prevalence of limited liver visualization during HCC surveillance imaging has not been systematically assessed. Utilizing a systematic review and meta-analytic approach, we aimed to determine the prevalence of limited liver visualization during HCC surveillance imaging. METHODS MEDLINE and Embase electronic databases were searched to identify published data on liver visualization limitations of HCC surveillance imaging. An analysis of proportions was pooled using a generalized linear mixed model with Clopper-Pearson intervals. Risk factors were analysed using a generalized mixed model with a logit link and inverse variance weightage. RESULTS Of 683 records, 10 studies (7,131 patients) met inclusion criteria. Seven studies provided data on liver visualization limitations on ultrasound (US) surveillance exams: prevalence of limited liver visualization was 48.9% (95% CI: 23.5-74.9%) in the overall analysis and 59.2% (95% CI: 24.2-86.9%) in a sensitivity analysis for cirrhotic patients. Meta-regression determined that non-alcoholic fatty liver disease was associated with limited liver visualization on US. Four studies provided data for liver visualization limitations in abbreviated magnetic resonance imaging (aMRI), with inadequate visualization ranging from 5.8% to 19.0%. One study provided data for complete MRI and none for computed tomography. CONCLUSION A substantial proportion of US exams performed for HCC surveillance provide limited liver visualization, especially in cirrhosis, which may hinder detection of small observations. Alternative surveillance strategies including aMRI may be appropriate for patients with limited US visualization.
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Affiliation(s)
- Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yi Ping Ren
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Teng Kiat Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Readon Teh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clarissa Fu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Margaret Teng
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Kathryn J Fowler
- Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Rohit Loomba
- Division of Gastroenterology, NAFLD Research Center, University of California at San Diego, La Jolla, California, USA
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
- Division of Gastroenterology, NAFLD Research Center, University of California at San Diego, La Jolla, California, USA
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Ronot M, Chernyak V, Burgoyne A, Chang J, Jiang H, Bashir M, Fowler KJ. Imaging to Predict Prognosis in Hepatocellular Carcinoma: Current and Future Perspectives. Radiology 2023; 307:e221429. [PMID: 37014244 DOI: 10.1148/radiol.221429] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
The focus of hepatocellular carcinoma (HCC) research for many years has been on noninvasive diagnosis. Standardized systematic algorithms composed of combinations of precise features now serve as diagnostic imaging markers of HCC and constitute a major innovation for liver imaging. In clinical practice, the diagnosis of HCC is based primarily on imaging and secondarily on pathologic analysis if the imaging features are not specific. Whereas accurate diagnosis is essential, the next phase of innovation for HCC will likely encompass predictive and prognostic markers. HCC is a biologically heterogeneous malignancy because of complex molecular, pathologic, and patient-level factors that impact the outcomes of treatment. In recent years, there have been many advances in systemic therapy to augment and extend the existing large cache of local and regional options. However, the guideposts for treatment decisions are neither sophisticated nor individualized. This review provides an overview of prognosis in HCC from the patient to the imaging feature level with a focus on future directions toward more individualized treatment guidance.
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Affiliation(s)
- Maxime Ronot
- From the Department of Radiology, Université Paris Cité, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Departments of Medical Oncology (A.B.) and Internal Medicine (J.C.), University of California-San Diego, La Jolla, Calif; Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Department of Radiology, Duke University Medical Center, Durham, NC (M.B.); and Department of Radiology, University of California-San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F.)
| | - Victoria Chernyak
- From the Department of Radiology, Université Paris Cité, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Departments of Medical Oncology (A.B.) and Internal Medicine (J.C.), University of California-San Diego, La Jolla, Calif; Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Department of Radiology, Duke University Medical Center, Durham, NC (M.B.); and Department of Radiology, University of California-San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F.)
| | - Adam Burgoyne
- From the Department of Radiology, Université Paris Cité, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Departments of Medical Oncology (A.B.) and Internal Medicine (J.C.), University of California-San Diego, La Jolla, Calif; Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Department of Radiology, Duke University Medical Center, Durham, NC (M.B.); and Department of Radiology, University of California-San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F.)
| | - Jeremy Chang
- From the Department of Radiology, Université Paris Cité, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Departments of Medical Oncology (A.B.) and Internal Medicine (J.C.), University of California-San Diego, La Jolla, Calif; Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Department of Radiology, Duke University Medical Center, Durham, NC (M.B.); and Department of Radiology, University of California-San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F.)
| | - Hanyu Jiang
- From the Department of Radiology, Université Paris Cité, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Departments of Medical Oncology (A.B.) and Internal Medicine (J.C.), University of California-San Diego, La Jolla, Calif; Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Department of Radiology, Duke University Medical Center, Durham, NC (M.B.); and Department of Radiology, University of California-San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F.)
| | - Mustafa Bashir
- From the Department of Radiology, Université Paris Cité, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Departments of Medical Oncology (A.B.) and Internal Medicine (J.C.), University of California-San Diego, La Jolla, Calif; Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Department of Radiology, Duke University Medical Center, Durham, NC (M.B.); and Department of Radiology, University of California-San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F.)
| | - Kathryn J Fowler
- From the Department of Radiology, Université Paris Cité, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Departments of Medical Oncology (A.B.) and Internal Medicine (J.C.), University of California-San Diego, La Jolla, Calif; Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Department of Radiology, Duke University Medical Center, Durham, NC (M.B.); and Department of Radiology, University of California-San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F.)
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Fowler KJ, Chernyak V, Ronot M, Vilgrain V, Kitao A, Lee JM, Motosugi U, Song B, Jiang H, Sirlin CB, Bashir MR. Hepatocellular Carcinoma: It Is Time to Focus on Prognosis. Radiology 2023; 307:e220884. [PMID: 37014249 PMCID: PMC10140632 DOI: 10.1148/radiol.220884] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- Kathryn J Fowler
- From the Department of Radiology, University of California San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F., C.B.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Department of Radiology, Université Paris Cité, Paris, France (M.R., V.V.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R., V.V.); Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); Department of Radiology, Kofu Kyoritsu Hospital, Kofu, Japan (U.M.); Department of Radiology, West China Hospital, Chengdu, China (B.S., H.J.); and Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.)
| | - Victoria Chernyak
- From the Department of Radiology, University of California San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F., C.B.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Department of Radiology, Université Paris Cité, Paris, France (M.R., V.V.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R., V.V.); Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); Department of Radiology, Kofu Kyoritsu Hospital, Kofu, Japan (U.M.); Department of Radiology, West China Hospital, Chengdu, China (B.S., H.J.); and Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.)
| | - Maxime Ronot
- From the Department of Radiology, University of California San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F., C.B.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Department of Radiology, Université Paris Cité, Paris, France (M.R., V.V.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R., V.V.); Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); Department of Radiology, Kofu Kyoritsu Hospital, Kofu, Japan (U.M.); Department of Radiology, West China Hospital, Chengdu, China (B.S., H.J.); and Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.)
| | - Valerie Vilgrain
- From the Department of Radiology, University of California San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F., C.B.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Department of Radiology, Université Paris Cité, Paris, France (M.R., V.V.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R., V.V.); Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); Department of Radiology, Kofu Kyoritsu Hospital, Kofu, Japan (U.M.); Department of Radiology, West China Hospital, Chengdu, China (B.S., H.J.); and Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.)
| | - Azusa Kitao
- From the Department of Radiology, University of California San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F., C.B.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Department of Radiology, Université Paris Cité, Paris, France (M.R., V.V.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R., V.V.); Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); Department of Radiology, Kofu Kyoritsu Hospital, Kofu, Japan (U.M.); Department of Radiology, West China Hospital, Chengdu, China (B.S., H.J.); and Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.)
| | - Jeong Min Lee
- From the Department of Radiology, University of California San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F., C.B.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Department of Radiology, Université Paris Cité, Paris, France (M.R., V.V.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R., V.V.); Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); Department of Radiology, Kofu Kyoritsu Hospital, Kofu, Japan (U.M.); Department of Radiology, West China Hospital, Chengdu, China (B.S., H.J.); and Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.)
| | - Utaroh Motosugi
- From the Department of Radiology, University of California San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F., C.B.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Department of Radiology, Université Paris Cité, Paris, France (M.R., V.V.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R., V.V.); Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); Department of Radiology, Kofu Kyoritsu Hospital, Kofu, Japan (U.M.); Department of Radiology, West China Hospital, Chengdu, China (B.S., H.J.); and Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.)
| | - Bin Song
- From the Department of Radiology, University of California San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F., C.B.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Department of Radiology, Université Paris Cité, Paris, France (M.R., V.V.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R., V.V.); Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); Department of Radiology, Kofu Kyoritsu Hospital, Kofu, Japan (U.M.); Department of Radiology, West China Hospital, Chengdu, China (B.S., H.J.); and Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.)
| | - Hanyu Jiang
- From the Department of Radiology, University of California San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F., C.B.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Department of Radiology, Université Paris Cité, Paris, France (M.R., V.V.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R., V.V.); Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); Department of Radiology, Kofu Kyoritsu Hospital, Kofu, Japan (U.M.); Department of Radiology, West China Hospital, Chengdu, China (B.S., H.J.); and Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.)
| | - Claude B Sirlin
- From the Department of Radiology, University of California San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F., C.B.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Department of Radiology, Université Paris Cité, Paris, France (M.R., V.V.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R., V.V.); Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); Department of Radiology, Kofu Kyoritsu Hospital, Kofu, Japan (U.M.); Department of Radiology, West China Hospital, Chengdu, China (B.S., H.J.); and Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.)
| | - Mustafa R Bashir
- From the Department of Radiology, University of California San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F., C.B.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Department of Radiology, Université Paris Cité, Paris, France (M.R., V.V.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R., V.V.); Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); Department of Radiology, Kofu Kyoritsu Hospital, Kofu, Japan (U.M.); Department of Radiology, West China Hospital, Chengdu, China (B.S., H.J.); and Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.)
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Fowler KJ. Gastrointestinal Imaging: What Has Shaped and What Will Shape Our Field Going Forward. Radiology 2023; 307:e223251. [PMID: 36916893 DOI: 10.1148/radiol.223251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Kathryn J Fowler
- From the Department of Diagnostic Radiology, Division of Body Imaging, University of California-San Diego, 6206 Lakewood St, San Diego, CA 92122
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Chernyak V, Fowler KJ, Do RKG, Kamaya A, Kono Y, Tang A, Mitchell DG, Weinreb J, Santillan CS, Sirlin CB. LI-RADS: Looking Back, Looking Forward. Radiology 2023; 307:e222801. [PMID: 36853182 PMCID: PMC10068888 DOI: 10.1148/radiol.222801] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/09/2023] [Accepted: 01/23/2023] [Indexed: 03/01/2023]
Abstract
Since its initial release in 2011, the Liver Imaging Reporting and Data System (LI-RADS) has evolved and expanded in scope. It started as a single algorithm for hepatocellular carcinoma (HCC) diagnosis with CT or MRI with extracellular contrast agents and has grown into a multialgorithm network covering all major liver imaging modalities and contexts of use. Furthermore, it has developed its own lexicon, report templates, and supplementary materials. This article highlights the major achievements of LI-RADS in the past 11 years, including adoption in clinical care and research across the globe, and complete unification of HCC diagnostic systems in the United States. Additionally, the authors discuss current gaps in knowledge, which include challenges in surveillance, diagnostic population definition, perceived complexity, limited sensitivity of LR-5 (definite HCC) category, management implications of indeterminate observations, challenges in reporting, and treatment response assessment following radiation-based therapies and systemic treatments. Finally, the authors discuss future directions, which will focus on mitigating the current challenges and incorporating advanced technologies. Tha authors envision that LI-RADS will ultimately transform into a probability-based system for diagnosis and prognostication of liver cancers that will integrate patient characteristics and quantitative imaging features, while accounting for imaging modality and contrast agent.
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Affiliation(s)
- Victoria Chernyak
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Kathryn J. Fowler
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Richard K. G. Do
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Aya Kamaya
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Yuko Kono
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - An Tang
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Donald G. Mitchell
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Jeffrey Weinreb
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Cynthia S. Santillan
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Claude B. Sirlin
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
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21
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Barahman M, Grunvald E, Prado PJ, Bussandri A, Henderson WC, Wolfson T, Fowler KJ, Sirlin CB. Erratum to: Point-of-care magnetic resonance technology to measure liver fat: Phantom and first-in-human pilot study (Magn Reson Med. 2022;88:1794-1805). Magn Reson Med 2023; 89:1281. [PMID: 36484224 DOI: 10.1002/mrm.29555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mark Barahman
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Eduardo Grunvald
- Division of General Internal Medicine, Department of Medicine, University of California San Diego, San Diego, California, USA.,Division of Minimally Invasive Surgery, Department of Surgery, Bariatric and Metabolic Institute, University of California San Diego, San Diego, California, USA
| | | | | | - Walter C Henderson
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Tanya Wolfson
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Kathryn J Fowler
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
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22
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Chang J, Ajmera V, Fowler KJ, Burgoyne A. Etiologies of cirrhosis by ethnicities of patients with hepatocellular carcinoma. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
515 Background: Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide. While there are several factors that can impact patient outcomes, ethnicity remains a major contributor towards disease incidence and the expected clinical course. There are various etiologies that can lead to the development of HCC among different ethnic groups, though further studies are required to identify the most pertinent risk factors in recent years. Methods: This was a single center, retrospective study in HCC patients to identify differences in cirrhosis etiologies based on ethnicity. All patients were diagnosed with HCC between March 2014 and April 2022. Possible causes of cirrhosis included alcohol, hepatitis B virus (HBV), hepatitis C virus (HCV), nonalcoholic fatty liver disease (NAFLD), and other chronic liver disease. Results: A total of 276 patients were included in this study. For ethnic background, there were 97 Latino, 97 White, 50 Asian, 16 Black, and 16 patients of other ethnicities. With regards to significant differences in the etiologies of cirrhosis, 58 patients (59.8%) of White ethnicity were found to have cirrhosis related to HCV compared to 71 patients (39.7%) of all other ethnic groups (p = 0.002). In addition, when comparing Latino to non-Latino patients, there was a greater proportion of patients with cirrhosis due to NAFLD (24.7% vs 10.1%, p = 0.002) and cirrhosis from alcohol consumption (24.7% vs 10.1%, p = 0.002). HBV also varied significantly by ethnicity with 16 Asian patients (32%) found to have HBV cirrhosis compared to 5 patients (2.2%) of other ethnic groups (p <0.001). See table for additional details. Conclusions: Our study demonstrates significant differences in the cirrhosis etiologies of HCC patients depending on ethnicity. With the incidence and mortality rates of HCC continuing to rise worldwide, it is important for clinicians to be aware of these differences so that the appropriate preventative measures can be pursued.[Table: see text]
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Affiliation(s)
| | | | - Kathryn J Fowler
- University of California San Diego Department of Radiology, San Diego, CA
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23
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Shen W, Middleton MS, Cunha GM, Delgado TI, Wolfson T, Gamst A, Fowler KJ, Alazraki A, Trout AT, Ohliger MA, Shah SN, Bashir MR, Kleiner DE, Loomba R, Neuschwander-Tetri BA, Sanyal AJ, Zhou J, Sirlin CB, Lavine JE. Changes in abdominal adipose tissue depots assessed by MRI correlate with hepatic histologic improvement in non-alcoholic steatohepatitis. J Hepatol 2023; 78:238-246. [PMID: 36368598 PMCID: PMC9852022 DOI: 10.1016/j.jhep.2022.10.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND & AIMS Non-alcoholic steatohepatitis (NASH) is prevalent in adults with obesity and can progress to cirrhosis. In a secondary analysis of prospectively acquired data from the multicenter, randomized, placebo-controlled FLINT trial, we investigated the relationship between reduction in adipose tissue compartment volumes and hepatic histologic improvement. METHODS Adult participants in the FLINT trial with paired liver biopsies and abdominal MRI exams at baseline and end-of-treatment (72 weeks) were included (n = 76). Adipose tissue compartment volumes were obtained using MRI. RESULTS Treatment and placebo groups did not differ in baseline adipose tissue volumes, or in change in adipose tissue volumes longitudinally (p = 0.107 to 0.745). Deep subcutaneous adipose tissue (dSAT) and visceral adipose tissue volume reductions were associated with histologic improvement in NASH (i.e., NAS [non-alcoholic fatty liver disease activity score] reductions of ≥2 points, at least 1 point from lobular inflammation and hepatocellular ballooning, and no worsening of fibrosis) (p = 0.031, and 0.030, respectively). In a stepwise logistic regression procedure, which included demographics, treatment group, baseline histology, baseline and changes in adipose tissue volumes, MRI hepatic proton density fat fraction (PDFF), and serum aminotransferases as potential predictors, reductions in dSAT and PDFF were associated with histologic improvement in NASH (regression coefficient = -2.001 and -0.083, p = 0.044 and 0.033, respectively). CONCLUSIONS In adults with NASH in the FLINT trial, those with greater longitudinal reductions in dSAT and potentially visceral adipose tissue volumes showed greater hepatic histologic improvements, independent of reductions in hepatic PDFF. CLINICAL TRIAL NUMBER NCT01265498. IMPACT AND IMPLICATIONS Although central obesity has been identified as a risk factor for obesity-related disorders including insulin resistance and cardiovascular disease, the role of central obesity in non-alcoholic steatohepatitis (NASH) warrants further clarification. Our results highlight that a reduction in central obesity, specifically deep subcutaneous adipose tissue and visceral adipose tissue, may be related to histologic improvement in NASH. The findings from this analysis should increase awareness of the importance of lifestyle intervention in NASH for clinical researchers and clinicians. Future studies and clinical practice may design interventions that assess the reduction of deep subcutaneous adipose tissue and visceral adipose tissue as outcome measures, rather than simply weight reduction.
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Affiliation(s)
- Wei Shen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA;; Institute of Human Nutrition, College of Physicians & Surgeons, Columbia University Irving Medical Center; NY, USA;; Columbia Magnetic Resonance Research Center (CMRRC), Columbia University, USA.
| | - Michael S Middleton
- Liver Imaging Group, Department of Radiology, UCSD School of Medicine, San Diego, CA, USA
| | | | - Timoteo I Delgado
- Liver Imaging Group, Department of Radiology, UCSD School of Medicine, San Diego, CA, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory (CASL), San Diego Supercomputer Center at UCSD, San Diego, CA, USA
| | - Anthony Gamst
- Computational and Applied Statistics Laboratory (CASL), San Diego Supercomputer Center at UCSD, San Diego, CA, USA;; Department of Mathematics, UCSD, San Diego, CA, USA
| | - Kathryn J Fowler
- Liver Imaging Group, Department of Radiology, UCSD School of Medicine, San Diego, CA, USA
| | - Adina Alazraki
- Emory University School of Medicine, Department of Radiology and Imaging Sciences and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Shetal N Shah
- Section of Abdominal Imaging and Nuclear Medicine Department, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA;; Center for Advanced Magnetic Resonance Development, (CAMRD), Department of Radiology, Duke University Medical Center, Durham, NC, USA;; Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, Department of Medicine, University of California-San Diego, La Jolla, CA, USA
| | | | | | - Jane Zhou
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, UCSD School of Medicine, San Diego, CA, USA
| | - Joel E Lavine
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA;; Institute of Human Nutrition, College of Physicians & Surgeons, Columbia University Irving Medical Center; NY, USA
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24
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Chang J, Fowler KJ, Tamayo P, Burgoyne A. Responses to first-line systemic therapies in patients with hepatocellular carcinoma with TERT promoter mutations. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
589 Background: The treatment landscape of advanced hepatocellular carcinoma (HCC) has made significant advances with the use of oral multikinase inhibitors and immunotherapy-containing regimens. However, there is minimal data with regards to which biomarkers may predict treatment responses in this population. The increased use of next-generation sequencing (NGS) has identified the most frequent mutations in HCC, including TERT promoter mutations which are found in up to 65% of patients. With the high frequency of these mutations, additional studies are needed to investigate their associations with treatment outcomes. Methods: Our team performed a retrospective study to determine the association between TERT promoter mutations in HCC and responses to first-line systemic therapies. All patients in this study underwent NGS testing on tumor tissue or peripheral blood samples. Responses to treatment were determined by imaging at least 6 weeks after the start of systemic therapy. Results: There were 128 HCC patients included in this study with TERT promoter mutations found in 72 patients (56.3%). All patients received first-line therapy with either an immunotherapy-based regimen or oral multikinase inhibitor monotherapy (lenvatinib or sorafenib). When looking at responses to all first-line therapies, patients with TERT promoter mutations were found to have significantly higher rates of disease progression (PD) compared to those without TERT promoter mutations (34.7% vs 17.9%, p = 0.04). In addition, when stratifying responses by type of systemic therapy, the TERT promoter-mutated population had notably higher rates of PD with immunotherapy regimens compared to patients without TERT mutations (34.6% vs 10.8%, p = 0.01). In contrast, there was no significant difference in rates of PD with oral multikinase inhibitor monotherapy between TERT mutated and TERT non-mutated individuals (35% vs 31.6%, p = 1). See table for further details. Conclusions: In this study, HCC patients with TERT promoter mutations were found to have significantly higher rates of PD to first-line therapies and, specifically, immunotherapy-containing regimens. Given the prevalence of these mutations in the HCC population, further investigation is needed to clarify this association and its impact on patient survival.[Table: see text]
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Affiliation(s)
| | - Kathryn J Fowler
- University of California San Diego Department of Radiology, San Diego, CA
| | - Pablo Tamayo
- UC San Diego Moores Cancer Center, San Diego, CA
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25
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Kierans AS, Chernyak V, Mendiratta-Lala M, Sirlin CB, Hecht EM, Fowler KJ. The Organ Procurement and Transplantation Network hepatocellular carcinoma classification: Alignment with Liver Imaging Reporting and Data System, current gaps, and future direction. Liver Transpl 2023; 29:206-216. [PMID: 37160075 DOI: 10.1002/lt.26570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 01/25/2023]
Abstract
The Organ Procurement and Transplantation Network (OPTN) updated its allocation policy for liver transplantation to align with the Liver Imaging Reporting and Data System (LI-RADS) for the diagnosis of hepatocellular carcinoma (HCC). LI-RADS computed tomography/magnetic resonance imaging algorithm had achieved congruency with the American Association for the Study of Liver Diseases (AASLD) HCC Practice Guidance in 2018, and therefore, alignment of OPTN, LI-RADS, and AASLD unifies HCC diagnostic approaches. The two changes to the OPTN HCC classification are adoption of LI-RADS terminology or lexicon for HCC major imaging features as well as the modification of OPTN Class-5A through the adoption of LI-RADS-5 criteria. However, despite this significant milestone, the OPTN allocation policy may benefit from further refinements such as adoption of treatment response assessment criteria after locoregional therapy and categorization criteria for lesions with atypical imaging appearances that are not specific for HCC. In this review, we detail the changes to the OPTN HCC classification to achieve alignment with LI-RADS, discuss current limitations of the OPTN classification, and explore future directions.
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Affiliation(s)
- Andrea S Kierans
- Department of Radiology , Weill Cornell Medical College , New York , New York , USA
| | - Victoria Chernyak
- Department of Radiology , Memorial Sloan Kettering Cancer Center , New York , New York , USA
| | | | - Claude B Sirlin
- Department of Radiology , University of California San Diego , La Jolla , California , USA
| | - Elizabeth M Hecht
- Department of Radiology , Weill Cornell Medical College , New York , New York , USA
| | - Kathryn J Fowler
- Department of Radiology , University of California San Diego , La Jolla , California , USA
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26
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Fowler KJ, Bashir MR, Fetzer DT, Kitao A, Lee JM, Jiang H, Kielar AZ, Ronot M, Kamaya A, Marks RM, Elsayes KM, Tang A, Sirlin CB, Chernyak V. Universal Liver Imaging Lexicon: Imaging Atlas for Research and Clinical Practice. Radiographics 2023; 43:e239001. [PMID: 36701248 DOI: 10.1148/rg.239001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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27
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Kierans AS, Lafata KJ, Ludwig DR, Burke LMB, Chernyak V, Fowler KJ, Fraum TJ, McGinty KA, McInnes MDF, Mendiratta-Lala M, Cunha GM, Allen BC, Hecht EM, Jaffe TA, Kalisz KR, Ranathunga DS, Wildman-Tobriner B, Cardona DM, Aslam A, Gaur S, Bashir MR. Comparing Survival Outcomes of Patients With LI-RADS-M Hepatocellular Carcinomas and Intrahepatic Cholangiocarcinomas. J Magn Reson Imaging 2023; 57:308-317. [PMID: 35512243 DOI: 10.1002/jmri.28218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND There is a sparsity of data evaluating outcomes of patients with Liver Imaging Reporting and Data System (LI-RADS) (LR)-M lesions. PURPOSE To compare overall survival (OS) and progression free survival (PFS) between hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA) meeting LR-M criteria and to evaluate factors associated with prognosis. STUDY TYPE Retrospective. SUBJECTS Patients at risk for HCC with at least one LR-M lesion with histologic diagnosis, from 8 academic centers, yielding 120 patients with 120 LR-M lesions (84 men [mean age 62 years] and 36 women [mean age 66 years]). FIELD STRENGTH/SEQUENCE A 1.5 and 3.0 T/3D T1 -weighted gradient echo, T2 -weighted fast spin-echo. ASSESSMENT The imaging categorization of each lesion as LR-M was made clinically by a single radiologist at each site and patient outcome measures were collected. STATISTICAL TESTS OS, PFS, and potential independent predictors were evaluated by Kaplan-Meier method, log-rank test, and Cox proportional hazard model. A P value of <0.05 was considered significant. RESULTS A total of 120 patients with 120 LR-M lesions were included; on histology 65 were HCC and 55 were iCCA. There was similar median OS for patients with LR-M HCC compared to patients with iCCA (738 days vs. 769 days, P = 0.576). There were no significant differences between patients with HCC and iCCA in terms of sex (47:18 vs. 37:18, P = 0.549), age (63.0 ± 8.4 vs. 63.4 ± 7.8, P = 0.847), etiology of liver disease (P = 0.202), presence of cirrhosis (100% vs. 100%, P = 1.000), tumor size (4.73 ± 3.28 vs. 4.75 ± 2.58, P = 0.980), method of lesion histologic diagnosis (P = 0.646), and proportion of patients who underwent locoregional therapy (60.0% vs. 38.2%, P = 0.100) or surgery (134.8 ± 165.5 vs. 142.5 ± 205.6, P = 0.913). Using multivariable analysis, nonsurgical compared to surgical management (HR, 4.58), larger tumor size (HR, 1.19), and higher MELD score (HR, 1.12) were independently associated with worse OS. DATA CONCLUSION There was similar OS in patients with LR-M HCC and LR-M iCCA, suggesting that LR-M imaging features may more closely reflect patient outcomes than histology. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Andrea S Kierans
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Kyle J Lafata
- Department of Radiology, Duke University, Durham, NC, USA.,Department of Radiation Oncology, Duke University, Durham, NC, USA.,Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Lauren M B Burke
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Victoria Chernyak
- Department of Radiology, Beth Israel Deaconess Medical Center and Montefiore Medical Center, New York, NY, USA
| | - Kathryn J Fowler
- Department of Radiology, University California San Diego, San Diego, CA, USA
| | - Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Katrina A McGinty
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Matthew D F McInnes
- Department of Radiology, the Ottawa Hospital Research Institute Clinical Epidemiology Program, University of Ottawa, Ottawa, Canada
| | | | | | - Brian C Allen
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Elizabeth M Hecht
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Tracy A Jaffe
- Department of Radiology, Duke University, Durham, NC, USA
| | - Kevin R Kalisz
- Department of Radiology, Duke University, Durham, NC, USA
| | | | | | | | - Anum Aslam
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Sonia Gaur
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University, Durham, NC, USA.,Department of Radiology, University of North Carolina, Chapel Hill, NC, USA.,Department of Radiology, Center for Advanced Magnetic Resonance Development, Duke University, Durham, NC, USA
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28
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Fowler KJ, Bashir MR, Fetzer DT, Kitao A, Lee JM, Jiang H, Kielar AZ, Ronot M, Kamaya A, Marks RM, Elsayes KM, Tang A, Sirlin CB, Chernyak V. Universal Liver Imaging Lexicon: Imaging Atlas for Research and Clinical Practice. Radiographics 2023; 43:e220066. [PMID: 36427260 DOI: 10.1148/rg.220066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The use of standardized terms in assessing and reporting disease processes has well-established benefits, such as clear communication between radiologists and other health care providers, improved diagnostic accuracy and reproducibility, and the enhancement and facilitation of research. Recently, the Liver Imaging Reporting and Data System (LI-RADS) Steering Committee released a universal liver imaging lexicon. The current version of the lexicon includes 81 vetted and precisely defined terms that are relevant to acquisition of images using all major liver imaging modalities and contrast agents, as well as lesion- and organ-level features. Most terms in the lexicon are applicable to all patients undergoing imaging of the liver, and only a minority of the terms are strictly intended to be used for patients with high risk factors for hepatocellular carcinoma. This pictorial atlas familiarizes readers with the liver imaging lexicon and includes discussion of general concepts, providing sample definitions, schematics, and clinical examples for a subset of the terms in the liver imaging lexicon. The authors discuss general, technical, and imaging feature terms used commonly in liver imaging, with the goal of illustrating their use for clinical and research applications. Work of the U.S. Government published under an exclusive license with the RSNA. Online supplemental material is available for this article.
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Affiliation(s)
- Kathryn J Fowler
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Mustafa R Bashir
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - David T Fetzer
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Azusa Kitao
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Jeong Min Lee
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Hanyu Jiang
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Ania Z Kielar
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Maxime Ronot
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Aya Kamaya
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Robert M Marks
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Khaled M Elsayes
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - An Tang
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Claude B Sirlin
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Victoria Chernyak
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
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Kambadakone AR, Santillan CS, Kim DH, Fowler KJ, Birkholz JH, Camacho MA, Cash BD, Dane B, Felker RA, Grossman EJ, Korngold EK, Liu PS, Marin D, McCrary M, Pietryga JA, Weinstein S, Zukotynski K, Carucci LR. ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update. J Am Coll Radiol 2022; 19:S445-S461. [PMID: 36436969 DOI: 10.1016/j.jacr.2022.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
This document focuses on imaging in the adult and pregnant populations with right lower quadrant (RLQ) abdominal pain, including patients with fever and leukocytosis. Appendicitis remains the most common surgical pathology responsible for RLQ abdominal pain in the United States. Other causes of RLQ pain include right colonic diverticulitis, ureteral stone, and infectious enterocolitis. Appropriate imaging in the diagnosis of appendicitis has resulted in decreased negative appendectomy rate from as high as 25% to approximately 1% to 3%. Contrast-enhanced CT remains the primary and most appropriate imaging modality to evaluate this patient population. MRI is approaching CT in sensitivity and specificity as this technology becomes more widely available and utilization increases. Unenhanced MRI and ultrasound remain the diagnostic procedures of choice in the pregnant patient. MRI and ultrasound continue to perform best in the hands of the experts. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Avinash R Kambadakone
- Division Chief, Abdominal Imaging, Massachusetts General Hospital, Boston, Massachusetts; Medical Director, Martha's Vineyard Hospital Imaging.
| | - Cynthia S Santillan
- Vice Chair of Clinical Operations, University of California, San Diego, San Diego, California
| | - David H Kim
- Panel Chair; Vice Chair of Education, Department of Radiology, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California, San Diego, San Diego, California. ACR LI-RADS; Division Chief, SAR Portfolio Director; RSNA Radiology Senior DE
| | - James H Birkholz
- Divisional Director, Quality and Safety (Abdominal Imaging), Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. Radiology Representative to the Interdisciplinary Dysmotility (GIMIG) Conference
| | - Marc A Camacho
- The University of South Florida Morsani College of Medicine, Tampa, Florida; Committee on Emergency Radiology-GSER
| | - Brooks D Cash
- Chief of Gastroenterology, Hepatology, and Nutrition Division, University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Bari Dane
- Director of Body CT, Abdominal Imaging; Director of Quality and Safety Outpatient Imaging, NYU Grossman School of Medicine, New York, New York
| | - Robin A Felker
- Associate Clerkship Director for Internal Medicine, Georgetown University; Primary care physician, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Eric J Grossman
- Medical Director, Multi-Specialty Clinic, Santa Barbara Cottage Hospital, Santa Barbara, California; American College of Surgeons
| | - Elena K Korngold
- Section Chief, Body Imaging, Chair, Department of Radiology Promotion and Tenure Committee, Oregon Health and Science University, Portland, Oregon
| | - Peter S Liu
- Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | - Marion McCrary
- Associate Director of Duke GME Coaching, Duke Signature Care, Durham, North Carolina; American College of Physicians; Governor-Elect, American College of Physicians North Carolina Chapter
| | | | | | - Katherine Zukotynski
- Co-Associate Chair for Research, Department of Radiology, McMaster University, Hamilton, Ontario, Canada; Commission on Nuclear Medicine and Molecular Imaging
| | - Laura R Carucci
- Specialty Chair; Section Chief Abdominal Imaging, Director of MRI and CT, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Garcia EM, Pietryga JA, Kim DH, Fowler KJ, Chang KJ, Kambadakone AR, Korngold EK, Liu PS, Marin D, Moreno CC, Panait L, Santillan CS, Weinstein S, Wright CL, Zreloff J, Carucci LR. ACR Appropriateness Criteria® Hernia. J Am Coll Radiol 2022; 19:S329-S340. [PMID: 36436960 DOI: 10.1016/j.jacr.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Abdominopelvic hernias are common clinical entities composed of a wide variety of congenital, traumatic, and iatrogenic etiologies. Any weakness in the body wall may result in hernia of cavity contents with concomitant risks of morbidity and mortality. Presentations may be specific, palpable body wall mass/bulge, or vague, nonspecific pain through bowel obstruction. This document focuses on initial imaging of the adult population with signs of symptoms prompting suspicion of abdominopelvic hernia. Imaging of the abdomen and pelvis to evaluate defects is essential for prompt diagnosis and treatment. Often CT and ultrasound are the first-line modalities to quickly evaluate the abdomen and pelvis, providing for accurate diagnoses and management of patients. MRI protocols may be useful as first-line imaging studies, especially in patients with orthopedic instrumentation. Although often performed, abdominal radiographs and fluorographic procedures may provide indirect evidence of hernias but are usually not indicated for initial diagnosis of hernia. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Board Member, Taubman Museum of Art.
| | - Jason A Pietryga
- Division Chief, Emergency Radiology at UNC Chapel Hill, Chapel Hill North Carolina; and University of Alabama at Birmingham, Birmingham, Alabama
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin; and Vice-Chair of Education, University of Wisconsin Department of Radiology
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California; Chair ACR LI-RADS; Division Chief, SAR Portfolio Director, RSNA Radiology Senior Deputy Editor
| | - Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts; Section Chief of Abdominal Imaging, Director of MRI, Chair of Committee on C-RADS
| | - Avinash R Kambadakone
- Massachusetts General Hospital, Boston, Massachusetts; Division Chief, Abdominal Imaging, Massachusetts General Hospital and Medical Director, Martha's Vineyard Hospital Imaging
| | - Elena K Korngold
- Section Chief, Body Imaging/Chair, Department of Radiology Promotion and Tenure Committee; Oregon Health and Science University, Portland, Oregon
| | - Peter S Liu
- Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | - Lucian Panait
- President, Minnesota Hernia Center, Minneapolis, Minnesota; American College of Surgeons; American Hernia Society (member of the Technology and Value Assessment Committee); Practice Advisory Committee Member, American Hernia Society
| | - Cynthia S Santillan
- Vice-Chair of Clinical Operations, Department of Radiology, University of California San Diego, San Diego, California
| | | | | | - Jennifer Zreloff
- Georgia, Primary Care Physician, Emory University, Atlanta, Georiga; Medical Director, Seavey General Medicine Clinic; Assistant Director of Innovation Seavey Comprehensive Internal Medicine Clinic, Emory University, Atlanta, Georgia
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Section Chief Abdominal Imaging, Director of MRI and CT
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Chernyak V, Fowler KJ. Introduction to the special section on quantitative imaging. Abdom Radiol (NY) 2022; 47:2969. [PMID: 35962223 DOI: 10.1007/s00261-022-03637-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, NYC, NY, USA.
| | - Kathryn J Fowler
- Department of Radiology, University of Califormia San Diego, San Diego, CA, USA
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Fowler KJ, Santymire RM. Characterizing zoo-housed Bactrian camel (Camelus bactrianus) reproduction using gonadal steroid metabolite analysis in feces. Domest Anim Endocrinol 2022; 80:106721. [PMID: 35349824 DOI: 10.1016/j.domaniend.2022.106721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 11/17/2022]
Abstract
Millions of people globally depend on camelids, which demands an increased knowledge of their reproduction. We used zoo-housed Bactrian camels (Camelus bactrianus) to better understand camelid reproductive physiology. Our specific objectives were to: 1) validate the use of fecal hormone metabolite analysis to characterize camel reproductive physiology during sexual maturity and pregnancy; and 2) determine the influence of season on male and female reproduction. We collected fecal samples from 1 male and 3 females housed at Lincoln Park Zoo (Chicago, IL, USA) 1 to 2 times per week for 3.5 years. Extracted hormones were analyzed using enzyme immunoassays for progestogen (FPM), estrogen (FEM), and androgen (FAM) metabolite concentrations. One female sexually matured during our study as evidenced by increased FEM baseline. Results demonstrated seasonal effects on male androgen production with FAMs higher (P < 0.05) January to June (mean ± SEM: 664.6 ± 22.6 ng/g wet feces), compared to July to December (401.6 ± 17.5 ng/g wet feces). One female experienced a persistent corpus luteum, a reproductive abnormality, which was identified by prolonged elevated FPM. FPMs increased during pregnancy for two females (452.9 ± 24.9 and 294.4 ± 19.8 ng/g wet feces) with a gestation of 404 d and 442 d, respectively. The third female never conceived. The FEMs varied (P < 0.05) during the year with no clear seasonal patterns (monthly mean range: 213.1-371.0 ng/g wet feces). Fecal hormone metabolite analysis is a validated method for assessing male seasonality and female pregnancy in the Bactrian camel and can for their management and conservation in zoos and the wild.
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Affiliation(s)
- K J Fowler
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, IL 60607; Davee Center for Epidemiology and Endocrinology, Lincoln Park Zoo, Chicago, IL 60614.
| | - R M Santymire
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, IL 60607; Davee Center for Epidemiology and Endocrinology, Lincoln Park Zoo, Chicago, IL 60614; Biology Department, Georgia State University, Atlanta, GA 30302
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Chang J, Ajmera V, Fowler KJ, Ting S, Tamayo P, Burgoyne A. Prevalence of underlying cirrhosis etiologies in hepatocellular carcinoma patients of Hispanic versus non-Hispanic ethnicity. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e16163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16163 Background: While the incidence and rates of mortality are in decline for the vast majority of cancers, those of hepatocellular carcinoma (HCC) continue to increase. Forecasts from the Surveillance, Epidemiology, and End Results (SEER) database suggest that the Hispanic population will have the highest incidence rate of HCC in the United States by the end of this decade. As a result, further studies are needed to identify specific risk factors for the development of HCC in this ethnic group. Methods: This was a retrospective, single center study conducted in Southern California to identify the prevalence of underlying cirrhosis etiologies in HCC patients of Hispanic versus non-Hispanic ethnicity. Causes of cirrhosis included nonalcoholic fatty liver disease (NAFLD), viral hepatitis, alcohol, and other chronic liver disease. The designation of NAFLD cirrhosis was assigned to patients in whom there was an exclusion of viral hepatitis B, viral hepatitis C, significant alcohol consumption, other etiology of chronic liver disease, and who had the presence of fatty liver on imaging or were diagnosed with cirrhosis with a concomitant metabolic risk factor (diabetes mellitus, hypertension, hyperlipidemia, or obesity). Results: A total of 165 patients were included in this study. There were 57 patients of Hispanic ethnicity and 108 patients of non-Hispanic ethnicity. No significant differences in age or gender were found between the two groups. When analyzing the prevalence of cirrhosis etiologies, 17 patients (29.8%) of Hispanic background were found to have underlying NAFLD cirrhosis compared to 10 patients (9.3%) of non-Hispanic background (p = 0.001). In contrast, 67 patients (62%) in the non-Hispanic group had diagnoses of cirrhosis associated with viral hepatitis B or C compared to 22 patients (38.6%) in the Hispanic group (p = 0.005). There was no significant difference in the prevalence of alcoholic cirrhosis (24.6% vs 13%, p = 0.08), cirrhosis due to other chronic liver disease (1.8% vs 2.8%, p = 1), or HCC without cirrhosis (5.3% vs 13%, p = 0.178) between Hispanic and non-Hispanic patients, respectively (Table). Conclusions: There were significantly higher rates of NAFLD cirrhosis identified in HCC patients of Hispanic ethnicity compared to those of non-Hispanic ethnicity. With the continually rising incidence rate of HCC in this patient group, it is important for providers to be aware of this association so that appropriate surveillance and prevention strategies may be pursued.[Table: see text]
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Affiliation(s)
| | | | - Kathryn J Fowler
- University of California San Diego Department of Radiology, San Diego, CA
| | | | - Pablo Tamayo
- UC San Diego Moores Cancer Center, San Diego, CA
| | - Adam Burgoyne
- Univ Of California-San Diego School of Medcn, San Diego, CA
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Chang J, Ryan JS, Ajmera V, Fowler KJ, Ting S, Tamayo P, Burgoyne A. Immunotherapy treatment responses in hepatocellular carcinoma patients with nonalcoholic fatty liver disease cirrhosis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e16199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16199 Background: Primary liver cancer is the third most frequent cause of cancer-related death worldwide, with hepatocellular carcinoma (HCC) composing 75% of cases. Recent preclinical models suggest that immunotherapy targeting programmed cell death protein 1 (PD-1) leads to CD8+ T-cell activation but not tumor regression in nonalcoholic fatty liver disease (NAFLD) induced HCC. However, additional studies are required to understand the response of NAFLD-associated HCC patients to PD-1 and programmed death-ligand 1 (PD-L1) therapies. Methods: Our team conducted a retrospective, single center study to determine the best responses to anti-PD-1/PD-L1 containing regimens in patients with HCC and underlying NAFLD cirrhosis. There were 2 groups included in this study: patients with HCC associated with NAFLD cirrhosis and those who had HCC without NAFLD cirrhosis. All patients included in this study received either an anti-PD-1/PD-L1 targeted agent as monotherapy or combined with other systemic treatment. Radiologic evaluations were conducted between February 2018 and January 2022. Results: There were 81 patients were included in this study: 15 in the NAFLD cirrhosis HCC group and 66 in the HCC group without NAFLD cirrhosis. When determining the best responses to anti-PD-1/PD-L1 therapies, 6 patients (40%) with HCC and NAFLD cirrhosis had disease progression as their best responses versus 7 patients (10.6%) who had HCC without NAFLD cirrhosis (risk ratio 3.8, p = 0.012). Furthermore, in the HCC group without NAFLD cirrhosis, 59 patients (89.4%) experienced disease control (defined as stable disease, partial response, or complete response) from anti-PD-1/PD-L1 containing regimens compared to 9 patients (60%) in the NAFLD cirrhosis-related HCC group (risk ratio 1.5, p = 0.012). No significant differences were found in gender, patient age, or treatment regimens received between the two groups. See the table below for details on immunotherapy regimens and treatment responses. Conclusions: In this study, HCC patients with NAFLD cirrhosis experienced significantly higher rates of disease progression as the best response to anti-PD-1/PD-L1 therapies compared to HCC patients without NAFLD cirrhosis. As the use of immunotherapy in the HCC population continues to expand, additional prospective studies are necessary to clarify the impact of underlying liver disease on treatment response.[Table: see text]
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Affiliation(s)
| | | | | | - Kathryn J Fowler
- University of California San Diego Department of Radiology, San Diego, CA
| | | | - Pablo Tamayo
- UC San Diego Moores Cancer Center, San Diego, CA
| | - Adam Burgoyne
- Univ Of California-San Diego School of Medcn, San Diego, CA
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Barahman M, Grunvald E, Prado PJ, Bussandri A, Henderson WC, Wolfson T, Fowler KJ, Sirlin CB. Point-of-care magnetic resonance technology to measure liver fat: Phantom and first-in-human pilot study. Magn Reson Med 2022; 88:1794-1805. [PMID: 35611691 DOI: 10.1002/mrm.29304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To assess feasibility and accuracy of point-of-care (POC) NMR-proton density fat fraction (PDFF) in phantoms and in a human pilot study in a POC setting. METHODS POC NMR (LiverScope, Livivos, San Diego CA) PDFF measurements were obtained of certified phantoms with known PDFF values (0%-40%). In an institutional review board-approved, Health Insurance Portability and Accountability Act-compliant prospective human study, a convenience sample of participants from an obesity clinic was enrolled (November 2020 to June 2021). The inclusion criteria required body mass index (BMI) = 27-40 kg/m2 and willingness to undergo POC NMR and MRI-PDFF measurements. Liver PDFF was measured by POC NMR and, within 35 days after, by a confounder corrected CSE MRI PDFF acquisition and reconstruction method. The adverse events were documented and linear regression analyses were performed. RESULTS POC NMR-PDFF measurements agreed with known phantom PDFF values (R2 = 0.99). Fourteen participants were enrolled in the pilot human study. MRI-PDFF could not be obtained in 4 participants (claustrophobia reaction, n = 3, exceeded size of MR scanner bore, n = 1). POC NMR was unevaluable in 2 participants (insufficient signal penetration depth, n = 1, failure to comply with instructions, n = 1). Technical success was 11 of 13 (85%) for POC NMR PDFF. In 7 participants (4 female; 31-74 years old; median BMI 35 kg/m2 ), MRI-PDFF (range, 2.8%-18.1%), and POC NMR-PDFF (range, 3%-25.2%), agreed with R2 = 0.94. POC NMR had no adverse events. CONCLUSION POC NMR measures PDFF accurately in phantoms and, in a first-in-human pilot study, is feasible and accurate in adults with obesity. Further testing to determine precision and accuracy across larger and more diverse cohorts is needed.
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Affiliation(s)
- Mark Barahman
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Eduardo Grunvald
- Division of General Internal Medicine, Department of Medicine, University of California San Diego, San Diego, California, USA.,Bariatric and Metabolic Institute, Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA
| | | | | | - Walter C Henderson
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Tanya Wolfson
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Kathryn J Fowler
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, California, USA
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Shah A, Sadowski EA, Thomas K, Fowler KJ, Do RKG, D'Souza S, Ramchandani P, Jha P. Gender and racial diversity among plenary session speakers at the Society of Abdominal Radiology Annual Meetings: a five-year assessment. Abdom Radiol (NY) 2022; 47:2545-2551. [PMID: 35596777 PMCID: PMC9226100 DOI: 10.1007/s00261-022-03548-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the gender and racial diversity of plenary session speakers in the annual meetings of Society of Abdominal Radiology (SAR) over 2016 to 2020. MATERIALS AND METHODS The brochures of the SAR annual meetings were reviewed for plenary session speakers and titles. Publicly available institutional profiles and social media were reviewed by the investigator in order to infer gender and race. Gender assessments were men, women, transgender men, transgender women or gender non-binary. Race was classified as White, Black or African American, American Indians and Alaskan Natives, Asian, Native Hawaiian and Pacific Islander and Multiracial. Statistical analysis was performed using chi square and T-tests. RESULTS Based on self-reported data, the SAR has 64% male and 36% female members. Over 2016-2020, plenary session speakers were more likely to be men [69.6% (183/263)] than women [30.4% (80/263)] (p-value = 0.0007). No speakers could be reliably identified as transgender, gender non-binary or gender expansive. In 2016, there were 24% women plenary speakers. This proportion was 28% in 2017, 33% in 2018 and 36% in 2019, and 30% in 2020. When assessing racial distribution, white speakers accounted for the majority of plenary speakers, ranging from 61 to 78%. Asians speakers accounted for 22 to 35%. There were no Black and African American, American Indian & Alaskan Native, Native Hawaiian & Pacific Islander plenary speakers (0%). Multiracial speakers were represented from 2018 to 2020, accounting for 2-4% speakers (p-value < 0.0001). CONCLUSIONS Plenary speakers at SAR Annual Meetings from 2016-2020 were more likely to be men, but with the proportion of women presenters increasing over time. White speakers represented the majority of plenary session speakers, followed by Asians. No plenary session speakers were identified as Black or African American or Native Americans.
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Affiliation(s)
- Amani Shah
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA, 94143-0628, USA
| | - Elizabeth A Sadowski
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Kerry Thomas
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn J Fowler
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Richard Kinh Gian Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Parvati Ramchandani
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Priyanka Jha
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA, 94143-0628, USA.
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Korngold EK, Moreno C, Kim DH, Fowler KJ, Cash BD, Chang KJ, Gage KL, Gajjar AH, Garcia EM, Kambadakone AR, Liu PS, Macomber M, Marin D, Pietryga JA, Santillan CS, Weinstein S, Zreloff J, Carucci LR. ACR Appropriateness Criteria® Staging of Colorectal Cancer: 2021 Update. J Am Coll Radiol 2022; 19:S208-S222. [PMID: 35550803 DOI: 10.1016/j.jacr.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/19/2022]
Abstract
Preoperative imaging of rectal carcinoma involves accurate assessment of the primary tumor as well as distant metastatic disease. Preoperative imaging of nonrectal colon cancer is most beneficial in identifying distant metastases, regardless of primary T or N stage. Surgical treatment remains the definitive treatment for colon cancer, while organ-sparing approach may be considered in some rectal cancer patients based on imaging obtained before and after neoadjuvant treatment. 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.
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Affiliation(s)
- Elena K Korngold
- Oregon Health and Science University, Portland, Oregon; Section Chief, Body Imaging; Chair, P&T Committee; Modality Chief, CT.
| | - Courtney Moreno
- Emory University, Atlanta, Georgia; Chair America College of Radiology CT Colonography Registry Committee
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin; Vice Chair of Education (University of Wisconsin Dept of Radiology)
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California; ACR LI-RADS Working Group Chair
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association; Chief of GI, UTHealth
| | - Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts; Director of MRI, Associate Chief of Abdominal Imaging; ACR Chair of Committee on C-RADS
| | - Kenneth L Gage
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Aakash H Gajjar
- PRiSMA Proctology Surgical Medicine & Associates, Houston, Texas; American College of Surgeons
| | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Avinash R Kambadakone
- Massachusetts General Hospital, Boston, Massachusetts; Division Chief, Abdominal Imaging, Massachusetts General Hospital; Medical Director, Martha's Vineyard Hospital Imaging
| | - Peter S Liu
- Cleveland Clinic, Cleveland, Ohio; Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland OH
| | | | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | - Cynthia S Santillan
- University of California San Diego, San Diego, California; Vice Chair of Clinical Operations for Department of Radiology
| | - Stefanie Weinstein
- University of California San Francisco, San Francisco, California; Associate Chief of Radiology, San Francisco VA Health Systems
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Director MR and CT at VCUHS; Section Chief Abdominal Imaging VCUHS
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Huang DQ, Fowler KJ, Liau J, Cunha GM, Louie AL, An JY, Bettencourt R, Jung J, Gitto Z, Hernandez C, Lopez SJ, Gupta H, Sirlin CB, Marks RM, Loomba R. Comparative efficacy of an optimal exam between ultrasound versus abbreviated MRI for HCC screening in NAFLD cirrhosis: A prospective study. Aliment Pharmacol Ther 2022; 55:820-827. [PMID: 35229334 PMCID: PMC9762322 DOI: 10.1111/apt.16844] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/05/2022] [Accepted: 02/11/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Retrospective studies report that visualisation of the liver may be severely limited using ultrasound (US), potentially contributing to diminished sensitivity for detection of hepatocellular carcinoma (HCC) among patients with nonalcoholic fatty liver disease (NAFLD) and cirrhosis, but there are limited prospective data. AIMS To compare liver visualisation scores prospectively for US and abbreviated hepatobiliary phase (HBP) magnetic resonance imaging (AMRI) in a cohort of participants with NAFLD cirrhosis and a clinical indication for HCC surveillance. METHODS This prospective multicenter study included 54 consecutive participants (67% women) with NAFLD cirrhosis who underwent contemporaneous US as well as HBP-AMRI with gadoxetic acid. Primary outcome was the proportion of imaging examinations with severe limitations in liver visualisation (visualisation score C) compared head-to-head between US and AMRI. RESULTS The mean (± standard deviation) age was 63.3 years (±8.4) and body mass index was 32.0 kg/m2 (±6.0). Nineteen participants (35%) had severe visualisation limitations on US, compared with 10 (19%) with AMRI, p < 0.0001. Nine (17%) participants had <90% of the liver visualised on US, compared with only 1 (2%) participant with AMRI, p < 0.0001. Obesity was a strong and independent predictor for severe visualisation limitation on US (OR 5.1, CI 1.1-23.1, p = 0.03), after adjustment for age, sex and ethnicity. CONCLUSION More than one-third of participants with NAFLD cirrhosis had severe visualisation limitations on US for HCC screening, compared with one-sixth on AMRI. US adequacy should be reported in all clinical studies and when suboptimal then AMRI may be considered for HCC screening.
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Affiliation(s)
- Daniel Q. Huang
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California, USA
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Kathryn J. Fowler
- Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Joy Liau
- Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Guilherme M. Cunha
- Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Ashley L. Louie
- Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Julie Y. An
- Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Ricki Bettencourt
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California, USA
| | - Jinho Jung
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California, USA
| | - Zachary Gitto
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California, USA
| | - Christie Hernandez
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California, USA
| | - Scarlett J. Lopez
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California, USA
| | - Hersh Gupta
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California, USA
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Robert M. Marks
- Department of Radiology, Naval Medical Center San Diego, San Diego, California, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California, USA
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California at San Diego, San Diego, California, USA
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Jung J, Han A, Madamba E, Bettencourt R, Loomba RR, Boehringer AS, Andre MP, Erdman JW, O'Brien WD, Fowler KJ, Sirlin CB, Loomba R. Direct Comparison of Quantitative US versus Controlled Attenuation Parameter for Liver Fat Assessment Using MRI Proton Density Fat Fraction as the Reference Standard in Patients Suspected of Having NAFLD. Radiology 2022; 304:75-82. [PMID: 35348378 DOI: 10.1148/radiol.211131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background MRI-derived proton density fat fraction (PDFF) is an accurate, reliable, and safe biologic marker for use in the noninvasive diagnosis of hepatic steatosis in patients with nonalcoholic fatty liver disease (NAFLD). Because of the cost and limited availability of MRI, it is necessary to develop an accurate method to diagnose NAFLD with potential point-of-care access. Purpose To compare the diagnostic accuracy of the quantitative US (QUS) fat fraction (FF) estimator with that of the controlled attenuation parameter (CAP) in the diagnosis of NAFLD using contemporaneous MRI-derived PDFF as the reference standard. Materials and Methods Participants with or suspected of having NAFLD were prospectively recruited at the NAFLD Research Center between July 2015 and July 2019. All participants underwent MRI-derived PDFF measurement, transient elastography with CAP measurement, and QUS. QUS FF was derived using computed QUS parameters from the acquired radiofrequency US data using a calibrated reference phantom. The area under the receiver operating characteristic curve (AUC) was calculated to assess the accuracy of QUS FF and CAP in the diagnosis of hepatic steatosis (defined as MRI-derived PDFF ≥ 5%). AUCs were compared using the DeLong test. Results A total of 123 participants were included (mean age, 52 years ± 13 [SD]; 67 [54%] women). Of these participants, 100 (81%) had MRI-derived PDFF of 5% or more. QUS FF had a significantly higher AUC for diagnosis of NAFLD than did CAP (0.92 [95% CI: 0.87, 0.98] vs 0.79 [95% CI: 0.67, 0.90], P = .03). QUS FF had a sensitivity of 98% (98 of 100) and a specificity of 48% (11 of 23). CAP had a sensitivity of 87% (87 of 100) and a specificity of 57% (13 of 23). Conclusion The quantitative US fat fraction estimator is more accurate than the controlled attenuation parameter in the diagnosis of hepatic steatosis in patients with or suspected of having nonalcoholic fatty liver disease. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Ito in this issue.
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Affiliation(s)
- Jinho Jung
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Aiguo Han
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Egbert Madamba
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Ricki Bettencourt
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Rohan R Loomba
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Andrew S Boehringer
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Michael P Andre
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - John W Erdman
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - William D O'Brien
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Kathryn J Fowler
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Claude B Sirlin
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Rohit Loomba
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
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Sanyal AJ, Shankar SS, Calle RA, Samir AE, Sirlin CB, Sherlock SP, Loomba R, Fowler KJ, Dehn CA, Heymann H, Kamphaus TN. Non-Invasive Biomarkers of Nonalcoholic Steatohepatitis: the FNIH NIMBLE project. Nat Med 2022; 28:430-432. [PMID: 35145308 PMCID: PMC9588405 DOI: 10.1038/s41591-021-01652-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Arun J. Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | | | - Anthony E. Samir
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, , University of California, San Diego, San Diego, CA, USA
| | | | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - Kathryn J. Fowler
- Liver Imaging Group, Department of Radiology, , University of California, San Diego, San Diego, CA, USA
| | | | - Helen Heymann
- Foundation for the National Institutes of Health, North Bethesda, MD, USA
| | - Tania N. Kamphaus
- Foundation for the National Institutes of Health, North Bethesda, MD, USA
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Levy AD, Liu PS, Kim DH, Fowler KJ, Bharucha AE, Chang KJ, Cilenti E, Gage KL, Garcia EM, Kambadakone AR, Korngold EK, Marin D, Moreno C, Pietryga JA, Santillan CS, Weinstein S, Wexner SD, Carucci LR. ACR Appropriateness Criteria® Anorectal Disease. J Am Coll Radiol 2021; 18:S268-S282. [PMID: 34794588 DOI: 10.1016/j.jacr.2021.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 01/06/2023]
Abstract
This review summarizes the relevant literature for the selection of the initial imaging in 4 clinical scenarios in patients with suspected inflammatory disease or postoperative complication of the anorectum. These clinical scenarios include suspected perianal fistula or abscess; rectovesicular or rectovaginal fistula; proctitis or pouchitis; and suspected complication following proctectomy, coloproctectomy, or colectomy with a pouch or other anastomosis. The appropriateness of imaging modalities as they apply to each clinical scenario is rated as usually appropriate, may be appropriate, and usually not appropriate to assist the selection of the most appropriate imaging modality in the corresponding clinical scenarios of anorectal disease. 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.
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Affiliation(s)
| | - Angela D Levy
- Medstar Georgetown University Hospital, Washington, District of Columbia.
| | - Peter S Liu
- Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland, Ohio
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California; and Founder, Advisory Board Quantix Bio
| | - Adil E Bharucha
- Chair of the Neurogastroenterology Section, Chair of Research Compliance Subcommittee, and Medical Director, Office of Clinical Trials, Mayo Clinic Rochester, Minnesota; and American Gastroenterological Association
| | - Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts
| | - Elizabeth Cilenti
- Medstar Georgetown University Hospital, Washington, District of Columbia, Primary care physician
| | - Kenneth L Gage
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; SECJNMMI Member-at-Large
| | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Avinash R Kambadakone
- Massachusetts General Hospital, Boston, Massachusetts; Taubman Museum of Art Board Member; and Past-President VA Rad Society
| | - Elena K Korngold
- Section Chief, Abdominal Imaging, Oregon Health and Science University, Portland, Oregon
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | - Courtney Moreno
- Emory University, Atlanta, Georgia; Chair ACR CTC Registry Committee; and Executive Council American Roentgen Ray Society
| | - Jason A Pietryga
- University of Alabama at Birmingham, Birmingham, Alabama; Associate Editor Hollow Organ GI
| | - Cynthia S Santillan
- Chief, Body Imaging Division and Vice-Chair, Clinical Operations for Radiology, University of California San Diego, San Diego, California
| | | | - Steven D Wexner
- Cleveland Clinic Florida, Weston, Florida; Editor-in-Chief, Surgery Journal; American College of Surgeons PAC Board; and Managing Member, Unique Surgical Innovations
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Director of CT and MRI at VCU, Section Chief, Abdominal Imaging at VCU
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Cunha GM, Fowler KJ. Automated Liver Segmentation for Quantitative MRI Analysis. Radiology 2021; 302:355-356. [PMID: 34783598 DOI: 10.1148/radiol.2021212306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Guilherme Moura Cunha
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195-0005 (G.M.C.); and Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, Calif (K.J.F.)
| | - Kathryn J Fowler
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195-0005 (G.M.C.); and Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, Calif (K.J.F.)
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Stine JG, Munaganuru N, Barnard A, Wang JL, Kaulback K, Argo CK, Singh S, Fowler KJ, Sirlin CB, Loomba R. Change in MRI-PDFF and Histologic Response in Patients With Nonalcoholic Steatohepatitis: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol 2021; 19:2274-2283.e5. [PMID: 32882428 PMCID: PMC7914285 DOI: 10.1016/j.cgh.2020.08.061] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Magnetic resonance imaging proton density fat fraction (MRI-PDFF) offers promise as a non-invasive biomarker of treatment response in early-phase nonalcoholic steatohepatitis (NASH) trials. We performed a systematic review to quantify the association between a ≥ 30% reduction in MRI-PDFF and histologic response in NASH. METHODS We searched the Cochrane Library, Embase, Medline and trial registries through May 2020 for early-phase clinical trials that incorporated MRI-PDFF and examined histologic response following intervention in adults with NASH. Subjects were classified as MRI-PDFF responders (relative decline in liver fat ≥30%) or non-responders (relative decline in liver fat <30%). MRI-PDFF responders versus non-responders were compared. Primary outcome was histologic response defined as a 2-point improvement in NAFLD Activity Score with at least 1-point improvement in lobular inflammation or ballooning. Secondary outcome was NASH resolution. Proportions and random effects odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated. RESULTS Seven studies met inclusion criteria, comprising 346 subjects (median age 51 years; 59% female; 46% with diabetes). MRI-PDFF responders were significantly more likely to have a histologic response (51% vs 14%, P < .001; OR 6.98, 95% CI 2.38-20.43, P < .001) and NASH resolution (41% vs 7%, P < .001; OR 5.45, 95% CI 1.53-19.46, P = .009) compared to non-responders. CONCLUSIONS This meta-analysis demonstrates that a ≥30% relative decline in MRI-PDFF is associated with higher odds of histologic response and NASH resolution. These results support the use of MRI-PDFF in non-invasive monitoring of treatment response in early-phase NASH clinical trials and provide helpful data for sample-size estimation for histology-based assessment.
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Affiliation(s)
- Jonathan G. Stine
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey PA, USA,Department of Public Health Sciences, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey PA, USA,Liver Center, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey PA, USA,Cancer Institute, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey PA, USA
| | | | - Abbey Barnard
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Jennifer L. Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Curtis K. Argo
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Siddarth Singh
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Kathryn J. Fowler
- Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Rohit Loomba
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Diego, La Jolla, California; Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; NAFLD Research Center, University of California, San Diego, La Jolla, California.
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Qu Y, Middleton MS, Loomba R, Glaser KJ, Chen J, Hooker JC, Wolfson T, Covarrubias Y, Valasek MA, Fowler KJ, Zhang YN, Sy E, Gamst AC, Wang K, Mamidipalli A, Schwimmer JB, Song B, Reeder SB, Yin M, Ehman RL, Sirlin CB. Magnetic resonance elastography biomarkers for detection of histologic alterations in nonalcoholic fatty liver disease in the absence of fibrosis. Eur Radiol 2021; 31:8408-8419. [PMID: 33899143 PMCID: PMC8530863 DOI: 10.1007/s00330-021-07988-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate associations between histology and hepatic mechanical properties measured using multiparametric magnetic resonance elastography (MRE) in adults with known or suspected nonalcoholic fatty liver disease (NAFLD) without histologic fibrosis. METHODS This was a retrospective analysis of 88 adults who underwent 3T MR exams including hepatic MRE and MR imaging to estimate proton density fat fraction (MRI-PDFF) within 180 days of liver biopsy. Associations between MRE mechanical properties (mean shear stiffness (|G*|) by 2D and 3D MRE, and storage modulus (G'), loss modulus (G″), wave attenuation (α), and damping ratio (ζ) by 3D MRE) and histologic, demographic and anthropometric data were assessed. RESULTS In univariate analyses, patients with lobular inflammation grade ≥ 2 had higher 2D |G*| and 3D G″ than those with grade ≤ 1 (p = 0.04). |G*| (both 2D and 3D), G', and G″ increased with age (rho = 0.25 to 0.31; p ≤ 0.03). In multivariable regression analyses, the association between inflammation grade ≥ 2 remained significant for 2D |G*| (p = 0.01) but not for 3D G″ (p = 0.06); age, sex, or BMI did not affect the MRE-inflammation relationship (p > 0.20). CONCLUSIONS 2D |G*| and 3D G″ were weakly associated with moderate or severe lobular inflammation in patients with known or suspected NAFLD without fibrosis. With further validation and refinement, these properties might become useful biomarkers of inflammation. Age adjustment may help MRE interpretation, at least in patients with early-stage disease. KEY POINTS • Moderate to severe lobular inflammation was associated with hepatic elevated shear stiffness and elevated loss modulus (p =0.04) in patients with known or suspected NAFLD without liver fibrosis; this suggests that with further technical refinement these MRE-assessed mechanical properties may permit detection of inflammation before the onset of fibrosis in NAFLD. • Increasing age is associated with higher hepatic shear stiffness, and storage and loss moduli (rho = 0.25 to 0.31; p ≤ 0.03); this suggests that age adjustment may help interpret MRE results, at least in patients with early-stage NAFLD.
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Affiliation(s)
- Yali Qu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, 92093-0888, USA
| | - Michael S Middleton
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, 92093-0888, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
- Department of Family Medicine and Public Health, University of California at San Diego, La Jolla, CA, USA
| | - Kevin J Glaser
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Jun Chen
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Jonathan C Hooker
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, 92093-0888, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory, the San Diego Supercomputer Center, University of California at San Diego, La Jolla, CA, USA
| | - Yesenia Covarrubias
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, 92093-0888, USA
| | - Mark A Valasek
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Kathryn J Fowler
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, 92093-0888, USA
| | - Yingzhen N Zhang
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, 92093-0888, USA
| | - Ethan Sy
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, 92093-0888, USA
| | - Anthony C Gamst
- Computational and Applied Statistics Laboratory, the San Diego Supercomputer Center, University of California at San Diego, La Jolla, CA, USA
| | - Kang Wang
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, 92093-0888, USA
| | - Adrija Mamidipalli
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, 92093-0888, USA
| | - Jeffrey B Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California at San Diego, La Jolla, CA, USA
- Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Bin Song
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Scott B Reeder
- Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin, Madison, WI, USA
| | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, 92093-0888, USA.
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An JY, Fowler KJ. Accurate Prostate Volumes from Manual Calculations-A Comparison of PI-RADS v2 and v2.1 Measurement Techniques. Acad Radiol 2021; 28:1557-1558. [PMID: 34078573 PMCID: PMC10374411 DOI: 10.1016/j.acra.2021.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/18/2022]
Abstract
There is a theoretical risk of volume overestimation if prostate AP dimension is taken on axial imaging given the anatomic obliquity of the gland on axial plane. This is analogous to slicing a salami sausage diagonally rather than perpendicularly to obtain larger slices. The most recent PI-RADS update (v2.1) now recommends obtaining the anterior-posterior measurement on sagittal imaging to mitigate the theoretical risk of the so called "salami effect" when using the ellipsoid formula for volume calculations. The authors of the recent article Comparison of PI-RADS Versions 2.0 and 2.1 for MRI-based Calculation of the Prostate Volume found the theoretical "salami effect" may not be as significant as originally thought, and perhaps slight overestimation of the AP diameter on axial measurements may yield more accurate volume estimates. Future validation studies are needed for to validate their findings. In this contemporary study, there is excellent interreader agreement among radiologist' three dimensional measurements-confirming manual calculation can be reliably replicated in practice settings where of software-based segmentation tools are not available.
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Affiliation(s)
- Julie Y An
- Department of Radiology, University of California San Diego, San Diego, 9500 Gilman Drive, 0888 California.
| | - Kathryn J Fowler
- Department of Radiology, University of California San Diego, San Diego, 9500 Gilman Drive, 0888 California
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Fowler KJ, Burgoyne A, Fraum TJ, Hosseini M, Ichikawa S, Kim S, Kitao A, Lee JM, Paradis V, Taouli B, Theise ND, Vilgrain V, Wang J, Sirlin CB, Chernyak V. Pathologic, Molecular, and Prognostic Radiologic Features of Hepatocellular Carcinoma. Radiographics 2021; 41:1611-1631. [PMID: 34597222 DOI: 10.1148/rg.2021210009] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is a malignancy with variable biologic aggressiveness based on the tumor grade, presence or absence of vascular invasion, and pathologic and molecular classification. Knowledge and understanding of the prognostic implications of different pathologic and molecular phenotypes of HCC are emerging, with therapeutics that promise to provide improved outcomes in what otherwise remains a lethal cancer. Imaging has a central role in diagnosis of HCC. However, to date, the imaging algorithms do not incorporate prognostic features or subclassification of HCC according to its biologic aggressiveness. Emerging data suggest that some imaging features and further radiologic, pathologic, or radiologic-molecular phenotypes may allow prediction of the prognosis of patients with HCC. An invited commentary by Bashir is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Kathryn J Fowler
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Adam Burgoyne
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Tyler J Fraum
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Mojgan Hosseini
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Shintaro Ichikawa
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Sooah Kim
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Azusa Kitao
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Jeong Min Lee
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Valérie Paradis
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Bachir Taouli
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Neil D Theise
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Valérie Vilgrain
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Jin Wang
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Claude B Sirlin
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Victoria Chernyak
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
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Consul N, Sirlin CB, Chernyak V, Fetzer DT, Masch WR, Arora SS, Do RKG, Marks RM, Fowler KJ, Borhani AA, Elsayes KM. Imaging Features at the Periphery: Hemodynamics, Pathophysiology, and Effect on LI-RADS Categorization. Radiographics 2021; 41:1657-1675. [PMID: 34559586 DOI: 10.1148/rg.2021210019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Liver lesions have different enhancement patterns at dynamic contrast-enhanced imaging. The Liver Imaging Reporting and Data System (LI-RADS) applies the enhancement kinetic of liver observations in its algorithms for imaging-based diagnosis of hepatocellular carcinoma (HCC) in at-risk populations. Therefore, careful analysis of the spatial and temporal features of these enhancement patterns is necessary to increase the accuracy of liver mass characterization. The authors focus on enhancement patterns that are found at or around the margins of liver observations-many of which are recognized and defined by LI-RADS, such as targetoid appearance, rim arterial phase hyperenhancement, peripheral washout, peripheral discontinuous nodular enhancement, enhancing capsule appearance, nonenhancing capsule appearance, corona enhancement, and periobservational arterioportal shunts-as well as peripheral and periobservational enhancement in the setting of posttreatment changes. Many of these are considered major or ancillary features of HCC, ancillary features of malignancy in general, features of non-HCC malignancy, features associated with benign entities, or features related to treatment response. Distinction between these different patterns of enhancement can help with achieving a more specific diagnosis of HCC and better assessment of response to local-regional therapy. ©RSNA, 2021.
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Affiliation(s)
- Nikita Consul
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Claude B Sirlin
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Victoria Chernyak
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - David T Fetzer
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - William R Masch
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Sandeep S Arora
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Richard K G Do
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Robert M Marks
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Kathryn J Fowler
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Amir A Borhani
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Khaled M Elsayes
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
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Marks RM, Fowler KJ, Bashir MR. MR Imaging of Diffuse Liver Disease. Magn Reson Imaging Clin N Am 2021; 29:347-358. [PMID: 34243922 DOI: 10.1016/j.mric.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The liver performs many vital functions for the human body. It stores essential vitamins and minerals, such as iron and vitamins A, D, K, and B12. It synthesizes proteins, such as blood clotting factors, albumin, and glycogen, as well as cholesterol, carbohydrates, and triglycerides. Additionally, it acts as a detoxifier, metabolizing and helping to clear alcohol, drugs, and ammonia. Typical MR imaging protocols for liver imaging include T2-weighted, chemical shift imaging, and precontrast and postcontrast T1-weighted sequences. This article discussed MR imaging of diffuse liver diseases and their typical imaging findings.
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Affiliation(s)
- Robert M Marks
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA 92134, USA; Department of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Kathryn J Fowler
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA 92103, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University, Box 3808, Durham, NC 27710, USA
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M Cunha G, Fowler KJ, Roudenko A, Taouli B, Fung AW, Elsayes KM, Marks RM, Cruite I, Horvat N, Chernyak V, Sirlin CB, Tang A. How to Use LI-RADS to Report Liver CT and MRI Observations. Radiographics 2021; 41:1352-1367. [PMID: 34297631 DOI: 10.1148/rg.2021200205] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Primary liver cancer is the fourth leading cause of cancer-related deaths worldwide, with hepatocellular carcinoma (HCC) comprising the vast majority of primary liver malignancies. Imaging plays a central role in HCC diagnosis and management. As a result, the content and structure of radiology reports are of utmost importance in guiding clinical management. The Liver Imaging Reporting and Data System (LI-RADS) provides guidance for standardized reporting of liver observations in patients who are at risk for HCC. LI-RADS standardized reporting intends to inform patient treatment and facilitate multidisciplinary communication and decisions, taking into consideration individual clinical factors. Depending on the context, observations may be reported individually, in aggregate, or as a combination of both. LI-RADS provides two templates for reporting liver observations: in a single continuous paragraph or in a structured format with keywords and imaging findings. The authors clarify terminology that is pertinent to reporting, highlight the benefits of structured reports, discuss the applicability of LI-RADS for liver CT and MRI, review the elements of a standardized LI-RADS report, provide guidance on the description of LI-RADS observations exemplified with two case-based reporting templates, illustrate relevant imaging findings and components to be included when reporting specific clinical scenarios, and discuss future directions. An invited commentary by Yano is available online. Online supplemental material is available for this article. Work of the U.S. Government published under an exclusive license with the RSNA.
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Affiliation(s)
- Guilherme M Cunha
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Kathryn J Fowler
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Alexandra Roudenko
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Bachir Taouli
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Alice W Fung
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Khaled M Elsayes
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Robert M Marks
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Irene Cruite
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Natally Horvat
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Victoria Chernyak
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Claude B Sirlin
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - An Tang
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
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Hong CW, Cui JY, Batakis D, Xu Y, Wolfson T, Gamst AC, Schlein AN, Negrete LM, Middleton MS, Hamilton G, Loomba R, Schwimmer JB, Fowler KJ, Sirlin CB. Repeatability and accuracy of various region-of-interest sampling strategies for hepatic MRI proton density fat fraction quantification. Abdom Radiol (NY) 2021; 46:3105-3116. [PMID: 33609166 DOI: 10.1007/s00261-021-02965-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate repeatability of ROI-sampling strategies for quantifying hepatic proton density fat fraction (PDFF) and to assess error relative to the 9-ROI PDFF. METHODS This was a secondary analysis in subjects with known or suspected nonalcoholic fatty liver disease who underwent MRI for magnitude-based hepatic PDFF quantification. Each subject underwent three exams, each including three acquisitions (nine acquisitions total). An ROI was placed in each hepatic segment on the first acquisition of the first exam and propagated to other acquisitions. PDFF was calculated for each of 511 sampling strategies using every combination of 1, 2, …, all 9 ROIs. Intra- and inter-exam intra-class correlation coefficients (ICCs) and repeatability coefficients (RCs) were estimated for each sampling strategy. Mean absolute error (MAE) was estimated relative to the 9-ROI PDFF. Strategies that sampled both lobes evenly ("balanced") were compared with those that did not ("unbalanced") using two-sample t tests. RESULTS The 29 enrolled subjects (23 male, mean age 24 years) had mean 9-ROI PDFF 11.8% (1.1-36.3%). With more ROIs, ICCs increased, RCs decreased, and MAE decreased. Of the 60 balanced strategies with 4 ROIs, all (100%) achieved inter- and intra-exam ICCs > 0.998, 55 (92%) achieved intra-exam RC < 1%, 50 (83%) achieved inter-exam RC < 1%, and all (100%) achieved MAE < 1%. Balanced sampling strategies had higher ICCs and lower RCs, and lower MAEs than unbalanced strategies in aggregate (p < 0.001 for comparisons between balanced vs. unbalanced strategies). CONCLUSION Repeatability improves and error diminishes with more ROIs. Balanced 4-ROI strategies provide high repeatability and low error.
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