The US Liver Imaging Reporting and Data System (LI-RADS) was released in 2017 and is the newest of the four American College of Radiology (ACR) LI-RADS algorithms. US LI-RADS provides standardized terminology, technical recommendations, and a reporting framework for US examinations performed for screening or surveillance in patients at risk for developing hepatocellular carcinoma (HCC). The appropriate patient population for screening and surveillance includes individuals who are at risk for developing HCC but do not have known or suspected cancer. This includes patients with cirrhosis from any cause and subsets of patients with chronic hepatitis B virus infection in the absence of cirrhosis. In an HCC screening or surveillance study, US LI-RADS recommends assigning two scores that apply to the entire study: the US category, which determines follow-up, and a visualization score, which communicates the expected level of sensitivity of the examination but does not affect management. Three US categories are possible: US-1 negative, a study with no evidence of HCC; US-2 subthreshold, a study in which an observation less than 10 mm is depicted that is not definitely benign; and US-3 positive, a study in which an observation greater than or equal to 10 mm or a new thrombus in vein is identified, for which diagnostic contrastmaterial-enhanced imaging is recommended. Three visualization scores are possible: A (no or minimal limitations), B (moderate limitations), and C (severe limitations).

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Rationale and objectives: Several commercially available breast tissue markers are promoted as being sonographically visible, allowing for subsequent targeting using ultrasound. The aim of this study was to compare the visibility of selected sonographic markers with the use of tissue phantoms. Materials and methods: Seven different markers were deployed into chicken and beef tissue phantoms, including a non‐sonographically enhanced marker used as a baseline. Six participants assessed their sonographic visibility and needle targeted the markers using ultrasound. The sonographic visibility of each marker was graded, with scores corrected for accuracy following mammographic review of needle targeting position. Results: Only four of the six “ultrasound enhanced” markers demonstrated statistically significant greater visibility than the non‐sonographically designed marker (P range < 0.001 to 0.04). Marker size (P < 0.001) and composition (P < 0.004) were shown to be contributing factors, with the composition of the BiomarC™ (Carbon Medical Technologies Inc, St Paul, MN, USA) demonstrating the highest conspicuity adjusted for length. Conclusion: There is significant variance in the visibility of breast tissue markers purported to be visible on ultrasound. Marker size, composition and possibly shape are contributory factors, with the utilisation of non‐metallic components associated with improved conspicuity. Our study provides a basis for further determination of optimal marker qualities, and we recommend evaluation with a larger sample size and an “in‐vivo” technique.

Non-bacterial thrombotic endocarditis (NBTE), also known as marantic endocarditis, has been reported to occur in 0.3-9.3% of the adult population at autopsy. NBTE associated with malignancy is an underrecognised cause of thromboembolic disorders. The clinical spectrum encountered and investigation results can be non-specific, often mimicking other acute conditions such as infective endocarditis. We describe the case of a 34-year-old woman with non-localising and multifocal neurological symptoms, who was subsequently diagnosed with NBTE secondary to a resectable primary lung adenocarcinoma.

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