Peiman Habibollahi

Can “Tumor-to-Cortex Echogenicity Ratio” Differentiate Angiomyolipomas from Other Hyper-Echoic Renal Masses

A retrospective study was performed to evaluate the diagnostic value of tumor-to-cortex echogenicity ratio (TCER) in the characterization of hyper-echoic renal masses. The radiology database was queried between 2012 and 2014 for hyper-echoic renal masses on the basis of defined exclusion and inclusion criteria. Each included mass was characterized as either an angiomyolipoma (AML) or a non-AML based on pre-defined criteria. The ratio of renal mass echogenicity to that of adjacent renal cortex (TCER) was calculated for each mass using commercially available software. A total of 70 masses in 65 patients were identified, including 49 AMLs. TCER values >2.26 were associated with a sensitivity and specificity of 81.6% and 71.4%, respectively, for diagnosis of AML. Moreover, TCER values >3.98 resulted in 100% specificity for AML diagnosis with a sensitivity of 28.6%. These findings suggest that the TCER may be a valuable tool for the characterization of hyper-echoic renal masses.

Definitive locoregional therapy (LRT) versus bridging LRT and liver transplantation with wait-and-not-treat approach for very early stage hepatocellular carcinoma

PURPOSE Since the change in the United Network for Organ Sharing (UNOS) policy excluding patients with very early stage hepatocellular carcinoma (veHCC, single tumor nodule <2 cm) from receiving Model for End-stage Liver Disease (MELD) exception points, patients eligible to receive liver transplantation (LT) who fall in this category are commonly treated with locoregional therapy (LRT) after progression to UNOS T2 stage (1 nodule of 2-5 cm or up to 3 nodules, none above 3 cm). The aim of the current study is to compare the outcomes of patients treated with bridging LRT and LT with wait-and-not-treat approach with patients treated with definitive LRT. METHODS A retrospective study has been performed on patients with veHCC evaluated in multidisciplinary liver tumor clinic of a large academic center between 2004-2011. Patients eligible for LT were assigned to the wait-and-not-treat group while patients who were not eligible were assigned to the definitive LRT group. Tumor size, time to treatment, severity of liver disease, recurrence and survival from time of detection were reviewed and recorded. RESULTS A total of 19 patients were identified and treated with definitive LRT while 57 patients were treated with bridging LRT prior to LT after disease progression to T2 stage. Patients in the definitive LRT group were older (70.4±10.2 years vs. 58.7±5.9 years, P < 0.001) and had more comorbid conditions compared with the wait-and-not-treat group. Mean survival for definitive LRT group at the end of 5 years was 34.3±6.0 months with a median of 30.3 months (95% CI, 5.7-55.0 months) compared with 48.7±2.6 months for the wait-and-not-treat group, respectively (median not reached). The 3- and 5-year survival rates were 53.3% and 33.3% for the definitive LRT group compared with 78.9% and 68.4% for the patients in the wait-and-not-treat group. Survival rate at the end of 5 years was significantly better for the wait-and-not-treat group (P = 0.013). CONCLUSION Based on the findings of current retrospective study, treating veHCC (UNOS T1 stage) patients listed for LT with bridging LRT after disease progression to T2 stage appears to be safe and effective with high 5-year survival rates.

Reporting of Inferior Vena Cava Filter Complications on CT: Impact of Standardized Macros.

OBJECTIVE The objective of our study was to report the effect of implementing standardized inferior vena cava filter (IVCF) macros on the reporting of IVCFs and filter-related complications in abdominal CT reports. MATERIALS AND METHODS Retrospective analysis was performed of all abdominal CT reports performed between October 2014 and January 2015 before implementation of IVCF macros (n = 5143). Duplicated examinations and studies requested specifically to evaluate known IVCFs were excluded. In March 2016, normal and abnormal standardized IVCF macros were implemented. Two radiologists reviewed all CT abdominal reports using IVCF macros between March 2016 to July 2016 to assess for missed IVCF complications. RESULTS Before the implementation of the IVCF macros, 146 of 5143 (2.8%) abdominal CT studies (89 men and 57 women; mean age, 59 years) showed an IVCF. After implementation of IVCF macros, 105 abdominal CT studies using the IVCF macros were analyzed (48 men and 57 women; mean age, 58 years), including 73 normal macros and 32 abnormal macros). The rate of reported caval penetration and filter element-organ interaction improved from 12% (9/73) to 57% (28/49) (p < 0.001) and from 0% (0/53) to 36% (9/25) (p < 0.001) before and after macro implementation, respectively. However, one filter fracture and two filter-associated thrombi were missed when using the IVCF macros. CONCLUSION Implementation of standardized IVCF macros improves reporting of IVCFs and IVCF-associated complications in abdominal CT reports.