Purpose To compare the diagnostic accuracy of MR elastography and anatomic MR imaging features in the diagnosis of severe hepatic fibrosis and cirrhosis. Materials and Methods Three readers independently assessed presence of morphological changes associated with hepatic fibrosis in 72 patients with liver biopsy including: caudate to right lobe ratios, nodularity, portal venous hypertension (PVH) stigmata, posterior hepatic notch, expanded gallbladder fossa and right hepatic vein caliber. Three readers measured shear stiffness values using quantitative shear stiffness maps (elastograms). Sensitivity, specificity and diagnostic accuracy of stiffness values and each morphological feature were calculated. Inter-reader agreement was summarized using weighted kappa statistics. Intra-class correlation coefficient was used to assess inter-reader reproducibility of stiffness measurements. Binary logistic regression was used to assess inter-reader variability for dichotomized stiffness values and each morphological feature. Results Using 5.9 kPa as a cut-off for differentiating F3–F4 from F0–2 stages, overall sensitivity, specificity and diagnostic accuracy for MR elastography were 85.4%, 88.4 % and 87% respectively. Overall inter-reader agreement for stiffness values was substantial, with insignificant difference (p=0.74) in the frequency of differentiating F3–4 from F0–2 fibrosis. Only hepatic nodularity and PVH stigmata showed moderately high overall accuracy of 69.4% and 72.2%. Inter-reader agreement was substantial only for PVH stigmata, moderate for C/R m, deep notch and expanded gallbladder fossa. Only posterior hepatic notch (p=0.82) showed no significant difference in reader rating. Conclusion MR elastography is a non-invasive, accurate and reproducible technique compared with conventional features of detecting severe hepatic fibrosis.

Based on the results of this study the three common causes of ARF are acute tubular necrosis (ATN, 38%), acute glumerulonephritis (24%) and hemolytic uremic syndrome (24.1%). The overall mortality rate among our patients was 24.7%, with the highest risk group being those patients suffering from ischemic ATN. In addition, the correlation (p<0.0005) between the etiology and mortality rate was particularly high in patients with ischemic ATN. Mortality was also high (68%) in children younger than 2 years. Multiple regression models revealed that among those factors that significantly differed between the survivors and nonsurvivors, only the necessity of dialysis (p<0.0005), the use of mechanical ventilation (p=0.05) and disseminated intravascular coagulation (p=0.038) can be regarded as independent determinants of ARF prognosis in children.

Improvements in radiologic imaging technology and therapeutic options available for management of tumors have necessitated the revision of guidelines for the imaging-based assessment of tumor response to therapy. The purpose of this article is to familiarize radiologists with the modifications to the Response Evaluation Criteria in Solid Tumors (RECIST) that have been incorporated in the latest version of the guidelines, RECIST 1.1. The most important differences between this version and the previous one, RECIST 1.0, include reductions in the maximum number of lesions per patient and per organ that may be targeted for measurement, augmentation of the criteria defining progressive disease, additional guidelines for reporting findings of lesions that are too small to measure and for measuring lesions that appear to have fragmented or coalesced at follow-up imaging, new criteria for characterizing lymphadenopathy, new criteria for selecting bone lesions and cystic lesions as targets for measurement, and the inclusion of findings at positron emission tomography among the indicators of disease response.

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