Introduction: The present study aims to compare low-kV CT reconstructed with MBIR technique with MRI in detecting high-risk stigmata and worrisome features in patients with pancreatic cystic lesions. Methods: We retrospective enrolled 75 patients who underwent low-kV CT with contrast media injec-tion for general abdominal disorders and MRI with MRCP sequences. The reviewer, blinded to clinical and histopathological data, recorded the overall number of pancreatic cystic lesions, size, location, presence of calcifications, septa, or solid enhancing or non-enhancing components, main pancreatic duct (MPD) communication, and MPD dilatation. Mean differences with 95% limits of agreement, ICC, and kappa statistics were used to compare CT and MRI. Results: More pancreatic cystic lesions were detected with MRI than with CT, however, the ICC value of 0.81 suggested a good agreement. According to the evaluated target lesion, a very good agreement (ICC = 0.98) was found regarding the diameter (21.4 mm CT vs 21.8 mm MRI), the location (kappa = 0.90), the detection of MPD dilatation (kappa = 1), the presence of septa (kappa = 0.86) and the MPD communication (kappa = 0.87). A moderate agreement on the assessment of enhanced components was noted (kappa = 0.44), while there was only a fair agreement about the presence of calcifications (kappa = 0.87). Conclusion: MDCT can be considered almost equivalent to MRI with MRCP in the evaluation of worri-some features and high-risk stigmata, offering detailed morphologic features helpful for their characterization. Implications for practice: Even if MRI is considered the reference standard in pancreatic cystic lesions characterization, CT can be considered a useful tool as a first-line imaging technique to identify worri-some features and high-risk stigmata. (c) 2020 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

OBJECTIVES:Portal vein thrombosis (PVT) is a frequent complication of cirrhosis. Benefit, safety, and duration of anticoagulant treatment in this setting are controversial issues. The aim of this study was to analyze the course of PVT in a large cohort of cirrhotic patients undergoing or not anticoagulation therapy. METHODS:The data of 182 patients who presented between January 2008 and March 2016 with cirrhosis and PVT with at least 3 months of follow-up after the first PVT detection were analyzed. Eighty-one patients received anticoagulants and 101 were untreated per physician discretion. RESULTS:The extension of the thrombosis decreased by >50% in 46 (56.8%, with complete recanalization in 31/46) patients under anticoagulation and in 26 (25.7%) untreated patients. Of the 46 patients who underwent recanalization, 17 (36%) suffered recurrent thrombosis after stopping anticoagulation therapy. Kaplan-Meier analysis showed a higher survival rate in the treated group (p = 0.010). At multivariate analysis, anticoagulation was an independent factor associated with longer survival (HR:0.30, CI:0.10-0.91, p = 0.014). The Child-Turcotte-Pugh classes B/C negatively influenced survival (hazard ratio, (HR):3.09, confidence interval (CI):1.14-8.36, p = 0.027 for Child-Turcotte-Pugh B and HR:9.27, CI:2.67-32.23, p < 0.001 for Child-Turcotte-Pugh C). Bleeding complications occurred in 22 (21.8%) untreated and 16 (19.7%) treated patients, but in only four cases was it judged to be related to the anticoagulant treatment. No death was reported as a consequence of the bleeding events. CONCLUSIONS:Anticoagulant treatment is a safe and effective treatment leading to partial or complete recanalization of the portal venous system in 56.8% of cases, improving the survival of patients with cirrhosis and PVT. Discontinuation of the therapy is associated with a high rate of PVT recurrence.

Introduction: To determine the prognostic value of CT-perfusion (CT-p) imaging in evaluation of blood flow changes related to therapeutics effects of sorafenib, by quantitative analysis of tumor vascularization. Materials and methods: Eighty-one CT-p study were performed in 22 patients with histoloigcally proven HCC treated with antiangiogenetic therapy. CT-p were performed at baseline and during treatment follow-up(every 3 months) on 256 multidetectorCT (iCT, Philips), with following parameters:100 Kv,100 mAs;16 dynamic slices/scan;40 dynamic scans;50 ml of contrast medium.Target lesions and surrounding parenchyma were evaluated using a dedicated software which generated a quantitative colour map of vascularization. Following perfusion parameters were considered: Hepatic perfusion(HP);Arterial Perfusion(AP);Blood volume(BV);Hepatic Perfusion Index(HPI) and Time to Peak(TTP) and statistically compared between responders (complete response,stable disease or partial response) and non responders. Results: Percentage variation of perfusion parameters (ΔHP), from baseline to follow-up study, was assessed and correlated with response classified according to mRECIST progression criteria. Responders group showed a significant reduction of values in HCC target lesions after anti-angiogenic therapy (HP 29.4±23.7vs51.9±16.8; AP 29.8±25.5vs52.2±17.9;p< 0.01), in comparison to non-responders which demonstrated an increase or no significant variation after treatment (HP 42.5±28.3 vs 38.5±11.8;AP 37.5±22.6 vs 35.9±11.2). Moreoever, p-CT values were significantly higher(p=0.05) at baseline in responders compared to the non-responders. When patients were stratified into mRECIST, a higher survival rate was observed in the responder group compared to the non-responder (48.6%vs28.6%). Conclusion: The identification of response predictors, by quantitative analysis of perfusion parameters, might help clinicians in selection of patients who may benefit from targeted-therapy,allowing for optimization of individualized treatment.

PURPOSE:To correctly define through Magnetic Resonance Imaging (MRI), diagnosis, staging and prognosis of the adductor longus (AL) acute lesions and to identify a correlation between Return to Play (RTP) and sport-related injury predisposing conditions and complications. MATERIALS AND METHODS:Twenty professional football players with acute groin pain and clinical suspicion of AL injury subsequent to sport's activity were evaluated. MRI examinations were performed by one and reviewed by other two radiologists with more than 10 years of experience. Lesions were stratified according to both Munich consensus statement and British Athletics Muscle Injury Classification (BAMIC). Patients were monitored until clinical recovery occurred. RESULTS:According to the Munich consensus statement, 75% of lesions were defined as type 3 and 25%as type 4; while according to the BAMIC, 45% were considered as Grade 1, 20% as Grade 2, 10% as Grade 3, and 25% as Grade 4. RTP was 1-2 weeks for minor lesions (45%), 4-6 weeks for moderate lesions (30%), and more than 6 weeks for complete lesions (25%). Both BAMIC and Munich consensus significantly correlated with RTP (R = 0.958 and 0.974, respectively). The extent of gap was the only independent prognosticator of RTP always present in all three different models of multivariate analysis (p < 0.006, p < 0.002, and p < 0.001, respectively). CONCLUSIONS:MRI represents the gold standard imaging technique for the evaluation of AL due to its ability not only to recognize but also to classify acute lesions and define patient's prognosis. MRI is also useful to detect potential predisposing conditions and complications, which may correlate with RTP.

Aim: To assess whether Gd-EOB-DTPA enhanced-MRI study is useful to determine liver function in comparison to Child Pugh (CP), Model for End-stage Liver Disease (MELD) and biochemical test. Materials and methods: We retrospectively reviewed all Gd-EOB-DTPA enhanced-MRI studies performed, between May 2011 and September 2017, to characterize focal liver lesion. Patients were divided in study and control group according to the presence/absence of liver cirrhosis. Signal intensity was calculated as the rate of liver-to-muscle ratio on contrast-enhanced T1-GE sequences in portal (SI-POR) and hepatobiliary phase (SI-HEP) and than normalized for liver volume (SI-POR/LV and SI-HEP/LV). Results: A total of 303 Gd-EOB-DTPA enhanced-MRI studies, performed in 221 consecutive patients, were included. Cirrhosis was present in 191 (63.0%) MRI studies. SI-HEP was significantly lower in cirrhotic than in non-cirrhotic patients( 0.55±0.29 vs 0.66±0.40,p=0.004), while no difference was found in SI-POR. SI-HEP progressively decreased from CP-A group to CP-C group (0.59±0.28 to 0.25±0.19, p< 0.0001) and from MELD≤10 to MELD 19-24(0.58±0.30 to 0.54±0.49, p=0.773). SI-HEP had a good performance in distinguishing CP-A from CP-B/C patients (AUC=0.75; 95%CI=0.66-0.83). Among biochemical parameters a moderate correlation was found between SI-HEP and total bilirubin (R=-0.324), GOT (R=-0318) and albumin (R= 0.320). Comparable results were observed when SI-HEP was normalized for liver volume. Conclusion: SI-HEP of Gd-EOB-DTPA enhanced-MRI studies can be effectively used to evaluate liver function. In clinical practice MRI could be performed both to correctly characterize liver lesions and to assess the severity of liver disease especially in the perspective of surgical treatment.

To describe magnetic resonance imaging (MRI) characteristics of soleus muscle injuries in symptomatic professional football players stratified according to both the Munich consensus statement and the British Athletics Muscle Injury Classification (BAMIC), and to investigate the association between specific MRI features and the “return to play” (RTP).

Introduction: Liver Imaging Reporting and Data System (LI-RADS) attempts to standardize the interpretation of liver lesions detected at computed tomography (CT) and magnetic resonance (MR) in cirrhotic patients on surveillance for hepatocellular carcinoma (HCC), stratifying them on the probability of HCC (categories LR3, LR4 and LR5 as intermediate probability, probably and definitely HCC, respectively).

Purpose: Imaging-guided percutaneous fine needle aspiration biopsy (FNAB) is routinely used for the diagnosis of pulmonary lesions. Computed tomography (CT) is the most common imaging modality used for guidance followed by ultrasound (US).

Background The prevalence of non-alcoholic fatty liver disease (NAFLD) is growing and the disease can progress to hepatocellular carcinoma (HCC). Only scant clinical information on HCC in NAFLD is available.

Background: Hepatocellular carcinoma (HCC) often arises in the context of very well-preserved liver function, expressed by a Child-Turcotte-Pugh (CTP) class A, which comprises only two scores, 5 and 6. Recent published data identified a new CTP score, named 0, defined by fulfilling all the subsequent criteria: albumin ≥ 4 g/dL, bilirubin ≤ 0.8 mg/dL, prothrombin time prolongation < 0 s, no ascites, no encephalopathy. In an Asiatic population, this subgroup of HCC patients with very well-preserved liver function had a better outcome compared to the CTP class A patients.

Background and aim: Combined hepatocellular-cholangiocarcinoma (CHC) is a rare primary liver cancer being reported in cirrhotic patients. Non-invasive differentiation between hepatocellular carcinoma (HCC) and other malignant nodules found in cirrhosis is critical. Contrast-enhanced ultrasound (CEUS) has been excluded from EASL/AASLD guidelines due to its difficulty in distinguishing HCC from intrahepatic cholangiocarcinoma. Scant data exist about contrast-enhancement appearance of CHC on cirrhosis. Aim was to evaluate the enhancement pattern in the vascular phases of CHC on cirrhosis at CEUS, CT or MRI. Secondary aim was the rate of CHC at risk of misdiagnosis for HCC.

Background and aims: The intermediate stage of Barcelona Clinic Liver Cancer staging system (BCLC-B) for hepatocellular carcinoma (HCC) includes a very heterogeneous population of patients in terms of cancer burden (no limits in tumor size and number) and liver function (Child-Pugh class A and B). European and American guidelines recommend transarterial chemoembolization (TACE), a palliative therapy, as first-line treatment for all these patients. However, some of them could benefit from curative treatments (liver transplant, resection, percutaneous ablation), while TACE may be useless or contraindicated for others. This multicenter study aims at assessing the treatment performed in a large cohort of BCLC-B patients and its impact on survival in clinical practice.

Introduction: Trans-catheter arterial chemo-embolization (TACE) is the first-line therapy recommended by western guidelines for intermediate hepatocellular carcinoma (HCC); however, in clinical practice, such patients are often referred to surgical teams for evaluation and treatment. After making a decision under uncertainty, physicians may discover that the alternative approach would have been preferable, imparting a sense of regret. Regret theory postulates that the optimal choice would be the one associated with the least amount of regret, in the case it is proven wrong.

Background: Hepatocellular carcinoma (HCC) is the leading death cause amongst cirrhotic patients.

Background: Liver transplantation (LT) priority assessment strictly based on 3-months dropout estimation creates both an unbalance between patients with and without hepatocellular carcinoma (HCC), and penalizes post LT outcomes.The aim of this study was to describe an alternative model able to re-establish allocation equity between HCC and no-HCC patients using 5-year transplant benefit as the common endpoint.Methods: We enrolled consecutive adult patients with chronic end-stage liver disease entering the waiting list (WL) for LT (WL group = 2697) and undergoing LT (LT group = 1702) during the period 2004-2009 in the North Italian Transplant program area.Two independent multivariable regressions (WL and LT models) were created to measure the prognostic power of model for end stage liver disease (MELD) in patients with and without HCC.The models were also adjusted for the following covariates: recipient age, sex, and aetiology, re-transplant, donor age.For the WL model we used competing risk multivariable analysis.Hazard ratio (HR, 95% confidence intervals) were finally included in a Markov model to calculate 5-year survival benefit in different subgroups.Results: WL competing risk model: MELD significantly predicted survival in both HCC (1.075, 1.043-1.110)and non-HCC (1.061, 1.053-1.080)patients.LT Cox model: MELD significantly predicted survival in both HCC (1.042, 1.007-1.075)and non-HCC (1.038, 1.018-1.058)patients.Benefit model: the survival benefit of LT at each MELD point was higher in HCC than non-HCC patients (Figure1).ORAL PRESENTATIONS score is able to refine prognostic prediction capacity in the intermediate HCC stage.

Purpose: Histological recurrence after ortotopic liver transplantation (OLT) for HCV-related cirrhosis is present in the large majority of patients within one year. Fibrosis progresses to cirrhosis within 5 years in 30% of transplant recipients, leading to a 5-years patient survival of about 70%. The aim of the present study was to evaluate the prognostic value of transient elastography (TE, Fibroscan, Echosense) in patients submitted to OLT for HCV-related cirrhosis.

Purpose: Ultrasonography, performed by clinicians at the bed-side, is a useful tool to answer focused clinical questions, a practice termed “echoscopy”. Undergraduate ultrasound training has not been uniformly formalized yet in this setting. Aims of the study were to assess feasibility of a focused ultrasound training for undergraduate students and the possibility to deliver effective teaching by condensed courses.