Suresh Maximin

Hepatocellular Carcinoma: Review of Epidemiology, Screening, Imaging Diagnosis, Response Assessment, and Treatment.

Hepatocellular carcinoma is a common malignancy for which prevention, screening, diagnosis, treatment, and surveillance demand a multidisciplinary approach. Knowledge of the underlying pathophysiology as well as advances in clinical management should be employed by radiologists to effectively communicate with hepatologists, surgeons, and oncologists. In this review article, we present recent developments in the clinical management of hepatocellular carcinoma.

Current update on combined hepatocellular-cholangiocarcinoma

Combined hepatocellular-cholangiocarcinoma is a rare but unique primary hepatic tumor with characteristic histology and tumor biology. Recent development in genetics and molecular biology support the fact that combined hepatocellular-cholangiocarcinoma is closely linked with cholangiocarcinoma, rather than hepatocellular carcinoma. Combined hepatocellular cholangiocarcinoma tends to present with an more aggressive behavior and a poorer prognosis than either hepatocellular carcinoma or cholangiocarcinoma. An accurate preoperative diagnosis and aggressive treatment planning can play crucial roles in appropriate patient management.

Uncommon pancreatic tumors and pseudotumors

Abstract A heterogeneous group of uncommon neoplastic and non-neoplastic pancreatic pathologies exists that can mimic pancreatic adenocarcinoma. These “imitators” are unique and may demonstrate characteristic clinical and imaging features. Imaging characteristics of some of these diverse lesions are not well described in the literature, and erroneous diagnoses of these entities as pancreatic carcinoma may be responsible for unnecessary surgeries. Knowledge of these selected pancreatic pathologies is essential to facilitate optimal patient management.

Imaging evaluation of maternal complications associated with repeat cesarean deliveries.

The rate of cesarean deliveries continues to rise, while the rate of vaginal delivery after cesarean birth continues to decline. Many women now tend to undergo multiple cesarean deliveries, and therefore the associated chronic maternal morbidities are of growing concern. Accurate diagnosis of these conditions is crucial in maternal and fetal well-being. Many of these complications are diagnosed by imaging, and radiologists should be aware of the type and imaging appearances of these conditions.

Perceived Barriers to the Use of High-Fidelity Hands-On Simulation Training for Contrast Reaction Management: Why Programs are Not Using It.

Although subjective and objective benefits of high-fidelity simulation have been reported in medicine, there has been slow adoption in radiology. The purpose of our study was to identify the perceived barriers in the use of high-fidelity hands-on simulation for contrast reaction management training. An IRB exempt 32 questions online web survey was sent to 179 non-military radiology residency program directors listed in the Fellowship and Residency Electronic Interactive Database Access system (FREIDA). Survey questions included the type of contrast reaction management training, cost, time commitment of residents and faculty, and the reasons for not using simulation training. Responses from the survey were summarized as count (percentage), mean ± standard deviation (SD), or median (range). 84 (47%) of 179 programs responded, of which 88% offered CRM training. Most (72%) conducted the CRM training annually while only 4% conducted it more frequently. Didactic lecture was the most frequently used training modality (97%), followed by HFS (30%) and computer-based simulation (CBS) (19%); 5.5% used both HFS and CBS. Of the 51 programs that offer CRM training but do not use HFS, the most common reason reported was insufficient availability (41%). Other reported reasons included cost (33%), no access to simulation centers (33%), lack of trained faculty (27%) and time constraints (27%). Although high-fidelity hands-on simulation training is the best way to reproduce real-life contrast reaction scenarios, many institutions do not provide this training due to constraints such as cost, lack of access or insufficient availability of simulation labs, and lack of trained faculty. As a specialty, radiology needs to better address these barriers at both an institutional and national level.

Imaging of complications from hematopoietic stem cell transplant

Stem cell transplant has been the focus of clinical research for a long time given its potential to treat several incurable diseases like hematological malignancies, diabetes mellitus, and neuro-degenerative disorders like Parkinson disease. Hematopoietic stem cell transplantation (HSCT) is the oldest and most widely used technique of stem cell transplant. HSCT has not only been used to treat hematological disorders including hematological malignancies, but has also been found useful in treamtent of genetic, immunological, and solid tumors like neuroblastoma, lymphoma, and germ cell tumors. In spite of the rapid advances in stem cell technology, success rate with this technique has not been universal and many complications have also been seen with this form of therapy. The key to a successful HSCT therapy lies in early diagnosis and effective management of complications associated with this treatment. Our article aims to review the role of imaging in diagnosis and management of stem cell transplant complications associated with HSCT.

Tumoral Pulmonary Emboli From Angioinvasive Hepatocellular Carcinoma

Tumoral pulmonary emboli from hepatocellular carcinoma (HCC) have rarely been described, although invasion of the portal and hepatic venous systems is a well-known complication. HCC originating in a noncirrhotic liver in the absence of chronic hepatitis B infection is also uncommon. We present a case of a patient with chronic hepatitis C infection without hepatic cirrhosis who developed angioinvasive HCC with intracardiac extension and tumoral pulmonary emboli. Differential considerations, including combined HCC-cholangiocarcinoma, other hepatic mesenchymal tumors, and metastasis, are discussed. Owing to poor prognosis, no resection was attempted. Autopsy was performed because of the unusual clinical presentation, and immunohistochemistry of the hepatic tumor, the intracardiac extension, and the pulmonary emboli were concordant with hepatocellular origin. Even though definitive diagnosis may not affect patient outcome, it is important for radiologists and clinicians to be aware that angioinvasive HCC may arise in the absence of cirrhosis.

Multimodality Imaging of Pancreatic Arteriovenous Malformation

Arteriovenous malformation of the pancreas (PAVM) is a very rare entity, although it may be increasingly diagnosed with the expanding use of cross-sectional imaging of the abdomen. PAVM is characterized by a network of tangled vasculature within and surrounding all or part of the pancreas, resulting in the shunting of the arteries of the pancreas directly into the portal venous system. Here, we present a patient with chronic abdominal pain and pancreatitis found to have PAVM, based on the findings of computed tomography, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, and angiography. Differential considerations are discussed. Although PAVM is uncommon, it should be considered in the differential of patients with recurrent abdominal pain or gastrointestinal bleeding.

Understanding the Cost of Conflict and an Approach to Conflict-Management Design

INTRODUCTION Conflict is inevitable in human interactions. Its Latin stem, conflictus, means “the act of striking together.” It is defined as “competitive or opposing action of incompatibles: antagonistic state or action (as of divergent ideas, interests, or persons)” [1]. More than simple disagreement, features of conflict include intense negative feelings, poor communication, and active efforts to hinder the other side. Although not always apparent, the cost of conflict within organizations can be massive. Hidden costs include lost productivity from job dissatisfaction and stress, employee or faculty turnover, and time spent on conflict management. One study found that in 2008 in the United States, workers spent 2.8 hours per week dealing with conflict-related issues, which translated to a

Corporatized Radiology: From Down Under to Over Here?

359 billion loss [2]. Additional hidden costs are the lost collaboration due to failed relationships, weakened organizational effectiveness due to inadequate conflict management, and an increase in patient-care errors [3]. Considering the high costs, it would