This invited review discusses recent advancements and prospects in locoregional therapy (LRT) for hepatocellular carcinoma (HCC), a leading cause of cancer mortality globally. The epidemiology of HCC is shifting toward nonviral etiologies, prompting a focus on early surveillance and personalized treatment approaches. Updated international guidelines, such as the Barcelona Clinic Liver Cancer (BCLC) staging system, American Association for Study of Liver Disease (AASLD) guideline, and European Association for the Study of the Liver (EASL) now recognize LRT-including transarterial embolization, ablation, and radiotherapy-as cornerstone therapies in curative and downstaging strategies for HCC at multiple stages. The article reviews novel transarterial and ablative technologies, including advanced dosimetry for radioembolization, innovative embolic agents, and emerging nonthermal ablation modalities like irreversible electroporation and pulsed electric field ablation, all aimed at increasing precision, local delivery, minimizing systemic exposure. Additionally, combination approaches integrating LRT with immunotherapy are highlighted, reflecting the evolving understanding of HCC's tumor-immune microenvironment. Progress in robotic guidance, fusion imaging, and imageable radioembolics is also explored. Ongoing and future clinical trials will further define the optimal use of these evolving modalities. Overall, LRT continues to expand as a minimally invasive, indispensable backbone in multidisciplinary HCC management.
BACKGROUND:Penetrating traumatic brain injury (pTBI) affects civilian and military populations resulting in significant morbidity, mortality, and health care costs. No up-to-date and evidence-based guidelines exist to assist modern medical and surgical management of these complex injuries. METHODS:A preliminary literature search informed a need for updated guidelines. Methodologists experienced in TBI guidelines supported 2 co-chairs, a diverse steering committee and three expert working groups. Over half of our panelists were active service military or military veterans and they addressed twenty-six Key Questions (KQs). We searched Ovid MEDLINE®, EMBASE, and Cochrane CENTRAL from inception to August 31, 2022, reference lists, and clinical trial registries. Penetrating, perforating and tangential penetrating brain injuries were included. Predefined criteria were used to identify studies; pre-specified methods were used to assess study quality and strength of evidence for key outcomes. Effects were analyzed qualitatively and quantitatively where appropriate. RESULTS:125 studies provided evidence and another 80 studies provided contextual data for these guidelines. In general there was a paucity of literature and most of the identified evidence was judged to be high risk of bias due to study design. We did not identify any studies meeting inclusion criteria for 12 KQs. The highest quality evidence, rated moderate in strength, was identified for four KQs that covered: cerebral angiography vs computed tomography angiography, the relationship between bihemispheric injury in adult pTBI and mortality, the ability of the Surviving Penetrating Injury to the Brain (SPIN) score to predict mortality, and the relationship between infection and cerebrospinal fluid fistula. Evidence for most KQs came from case series. CONCLUSIONS:The development of up-to-date evidence and consensus based clinical care guidelines and algorithms for pTBI provide guidance to care providers in the prehospital and emergency medicine, surgical and intensive care settings. Few moderately strong conclusions on the benefit of specific management strategies for penetrating brain injury could be made. Detailed reporting of patient outcomes in future studies could advance the field by providing greater evidence for specific treatments by patient population, mechanism of injury, severity of injury, and specific interventions employed.
Cardiac MRI allows for a comprehensive assessment of myocardial structure, function and tissue characteristics. Here we describe a foundational vision system for cardiac MRI, capable of representing the breadth of human cardiovascular disease and health. Our deep-learning model is trained via self-supervised contrastive learning, in which visual concepts in cine-sequence cardiac MRI scans are learned from the raw text of the accompanying radiology reports. We train and evaluate our model on data from four large academic clinical institutions in the United States. We additionally showcase the performance of our models on the UK BioBank and two additional publicly available external datasets. We explore emergent capabilities of our system and demonstrate remarkable performance across a range of tasks, including the problem of left-ventricular ejection fraction regression and the diagnosis of 39 different conditions such as cardiac amyloidosis and hypertrophic cardiomyopathy. We show that our deep-learning system is capable of not only contextualizing the staggering complexity of human cardiovascular disease but can be directed towards clinical problems of interest, yielding impressive, clinical-grade diagnostic accuracy with a fraction of the training data typically required for such tasks.
Background The management of incidental adnexal lesions encountered at CT depends on the diagnosis, but little evidence supports CT diagnosis of most adnexal lesion types. Purpose To evaluate the interreader agreement and CT diagnosis of incidentally discovered adnexal lesions. Materials and Methods This institutional review board-approved, multi-institutional, multireader retrospective study conducted from January 1, 2022, to June 30, 2023, included patients who had malignant ovarian lesions with metastases (n = 8) and without metastases (n = 8), simple cysts (n = 6), dermoids (n = 9), hydrosalpinx (n = 5), benign cystadenomas and/or cystadenofibromas (n = 10), hemorrhagic cysts (n = 8), endometriomas (n = 6), ovarian fibromas (n = 5), leiomyomas (n = 5), and peritoneal inclusion cysts (n = 5) detected at CT. Nine members of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease-Focused Panel, blinded to the final diagnosis, independently reviewed the CT images and used the American College of Radiology white paper to determine the most likely diagnosis. A 2 × 2 factorial random-effects model was used to calculate the mean adjusted accuracy and disparity among the readers. Interreader agreement was calculated using a Gwet AC1 test. Results In total, 75 patients (mean age, 50 years ± 16 [SD]) were included. The mean adjusted accuracy and interreader agreement were highest for dermoids (99% and 0.97, respectively), malignant ovarian lesions with metastases (94% and 0.90), and simple cysts (86% and 0.64). The mean adjusted accuracy for all other lesion types was less than 72%, with fair to moderate interreader agreement. Overall, readers more accurately diagnosed malignant lesions (82%) than benign lesions (52%) (P < .001). Readers recorded a benign diagnosis when a malignant lesion was present 28% of the time (20 of 72) (P < .001) when there were no metastases. Conclusion Readers' mean adjusted accuracy was greatest for dermoids, malignant ovarian lesions with metastases, and simple cysts at CT, with substantial to almost perfect interreader agreement; all other lesions were challenging, and a substantial number of malignant ovarian lesions were misdiagnosed as benign. © RSNA, 2026.
BACKGROUND:Transanal total mesorectal excision (taTME) facilitates sphincter preservation in low rectal cancer. Preliminary results and functional outcomes from the North American multicenter phase II taTME trial (NCT03144765) have been published. Three-year outcomes are reported. METHODS:Patients with stage I to III rectal adenocarcinoma were enrolled across 11 centers (2017-2022). Endpoints included TME grade, 3-year overall survival, disease-free survival, cancer-specific survival, recurrence, late (beyond 90 d) complications, and stoma-free survival. Surveillance followed National Comprehensive Cancer Network guidelines, with pelvic magnetic resonance imaging (MRI) at 3 years to assess for pelvic sidewall recurrence when possible. Kaplan-Meier analysis assessed oncologic outcomes. RESULTS:One hundred patients underwent taTME for tumors at a median of 5.8 cm from the anal verge, with intersphincteric resection in 36% and handsewn anastomosis in 54%. Median follow-up was 50.9 months. Late complications occurred in 32 patients, including 21 severe (Clavien-Dindo ≥3). Late anastomotic complications occurred in 5 patients; one required surgical revision. Estimated 3-year overall survival, cancer-specific survival, and disease-free survival were 93.7%, 96.6%, and 84.6%, respectively. Distant recurrence occurred in 15 patients (median: 17.6 months), most commonly in the lung and liver. Locoregional recurrence occurred in 2 patients. Preoperative N stage, lymph node yield, tumor deposits, and perineural invasion were associated with recurrence. Among 100 patients diverted at taTME, 97% were stoma-free at 3 years; 4 patients later underwent secondary diversion. CONCLUSIONS:Three-year outcomes of this multicenter trial support the safety and efficacy of taTME in resectable mid and low rectal tumors, with outcomes comparable to contemporary studies. Longer-term oncologic and functional outcomes are needed.
