Radiology

Perfluorobutane CEUS with Kupffer phase matches MRI for small HCC in high-risk patients

This multicenter study included 365 high-risk patients with 399 liver observations ≤20 mm undergoing perfluorobutane CEUS and MRI. CEUS strategy B, incorporating Kupffer-phase hypoenhancement, improved sensitivity versus strategy A (65.9% vs 57.1%) without meaningful specificity loss (91.8% vs 93.9%). Strategy B showed similar sensitivity and specificity to MRI LI-RADS 2018 for diagnosing small HCC in this cohort. In noncirrhotic patients, both CEUS strategies maintained very high specificity compared with cirrhotic patients, without a sensitivity penalty. 1

Intracranial vessel wall MRI frequently reclassifies ischemic stroke etiology

Among 316 ischemic stroke patients undergoing intracranial high-resolution vessel wall MRI, TOAST etiologic classification changed in 17%. Presumed atheromatous strokes increased from 28.2% to 38.3%, and undetermined strokes decreased from 50.9% to 35.4% after vessel wall imaging. Reclassification rates were similar whether MRI was triggered by intracranial stenosis or initially undetermined etiology. Therapeutic management was modified in 7% of patients on the basis of vessel wall findings. 2

Iodinated contrast CT not associated with worse outcomes in hospitalized AKI

This prospective observational study followed 481 hospitalized adults with established AKI undergoing CT with (n=282) or without (n=188) intravenous contrast. After inverse probability weighting, 7-day renal recovery was higher in the contrast group than the noncontrast group (61.7% vs 47.3%; OR 1.7, p=0.05). Secondary outcomes, including 72-hour renal improvement, dialysis initiation, length of stay, and in-hospital mortality, were similar between groups. Propensity-matched analyses yielded consistent findings, while higher AKI stage and acute tubular injury predicted poorer recovery irrespective of contrast. 3