Ahmed Sobieh

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

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

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

Purpose The authors sought to test if there was a difference in key pelvic floor measurements obtained during MR defecography at-rest, i.e., H-line, M-line and anorectal angle (ARA), before and after rectal gel administration. The authors also sought to determine if any observed differences would affect the interpretation of the defecography studies. Methods Institutional Review Board approval was obtained. An abdominal fellow retrospectively reviewed the images of all patients who underwent MRI defecography at our institution from January 2018 through June 2021. The H-line, M-line and ARA values were remeasured on T2-weighted sagittal images, with and without rectal gel for each patient. Results One hundred and eleven (111) studies were included in the analysis. 18% (N = 20) of patients satisfied the criterion for pelvic floor widening before gel administration based on H-line measurement. This increased to 27% (N = 30) after rectal gel (p = 0.08). 14.4% (N = 16) met the M-line measurement criterion for pelvic floor descent before gel administration. This increased to 38.7% after rectal gel (N = 43) (p < 0.001). 67.6% (N = 75) demonstrated an abnormal ARA prior to administration of rectal gel. This decreased to 58.6% (N = 65) after rectal gel administration (p = 0.07). The overall reporting discrepancies incurred by the presence or absence of rectal gel were 16.2%, 29.7% and 23.4% for H-line, M-line and ARA, respectively. Conclusion The instillation of gel during MR defecography can cause significant changes to the observed pelvic floor measurements at-rest. This in turn can influence the interpretation of defecography studies. Graphical abstract