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Most biphenotypic primary liver carcinomas have features of non-HCC malignancy and can be correctly categorized as such. Addition of ancillary features to major features may improve diagnostic accuracy over systems in which only major features are used.

LI-RADS v2017 introduces major changes to the diagnostic criteria for LR-M observations to better guide radiologists in the use of this malignant category designation. LR-M is intended to preserve the specificity of the LI-RADS algorithm for diagnosis of HCC while not losing sensitivity for diagnosis of malignancy. The purpose of this paper is to provide a brief background on LR-M, discuss the diagnostic criteria new to v2017, special considerations for its application, and management implications.

Purpose To compare the efficacy and major complication rate of radiofrequency (RF) and microwave (MW) ablation for the treatment of hepatocellular carcinoma (HCC). Materials and Methods This retrospective study included 69 tumors in 55 patients treated by RF, and 136 tumors in 99 patients treated by MW between 2001 and 2013. All tumors were diagnosed as HCC by standard imaging criteria. Both RF and MW ablation devices comprised straight 17-gauge applicators. Overall survival and rates of local tumor progression were evaluated using Kaplan-Meier techniques with Cox proportional hazard models, as well as competing risk regression of local tumor progression. Results RF and MW cohorts were similar in age (mean: 62 [range 23-88] and 61 [44-82] yr, respectively; p=0.22), MELD (8.8 and 9.6, respectively; p=0.24), and tumor size (2.4 [0.6-4.5] cm and 2.2 [0.5-4.2] cm, respectively; p=0.09). Median length of follow-up was 31 months for RF and 24 months for MW. The rate of local tumor progression was 17.7% with RF and 8.8% with MW. The corresponding HR from Cox and competing risk models were 2.17 [95% CI: 1.04-4.50] (p=0.04) and 2.01 [0.95-4.26] (p=0.07), respectively. There was improved survival for patients treated with MW, although this was not statistically significant (Cox HR 1.59 [0.91-2.77]; p=0.103). There were few major (≥ grade C) complications in either group (2 for RF, 1 for MW; p=0.28). Conclusion In this single center trial, treating HCC percutaneously with RF or MW ablation was associated with high primary efficacy and a durable response, with lower rates of local tumor progression noted after MW ablation.

Dual-energy CT significantly improved the conspicuity of the ischemic bowel compared with conventional CT by increasing attenuation differences between ischemic and perfused segments on low-kiloelectron volt and iodine material density images.