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Nerves and neuropathies of the upper limb
Abstracts managed as HCC without histological confirmation. CEUS LI-RADS also includes a separate category (LR-M) for observations that are definitely or probably malignant, but with imaging features not specific for HCC. The differential diagnosis for such lesions includes atypical HCC and intrahepatic cholangiocarcinoma (ICC); biopsy may be needed to distinguish these possibilities. LR-TIV (tumor in vein) is assigned for observations with definite tumor in vein, even if a parenchymal component is not identified at imaging; biopsy is not needed to confirm the vascular invasion but may be needed to determine the underlying tumor type. The presentation will summarize the updated version of CEUS-LI-RADS (v2018). References: 1. Dietrich CF, Averkiou M, Nielsen MB, Barr RG, Burns PN, Calliada F, Cantisani V, et al. How to perform Contrast-Enhanced Ultrasound (CEUS). Ultrasound Int Open 2018;4:E2-E15. 2. Lyshchik A, Kono Y, Dietrich CF, Jang HJ, Kim TK, Piscaglia F, Vezeridis A, et al. Contrast-enhanced ultrasound of the liver: technical and lexicon recommendations from the ACR CEUS LIRADS working group. Abdom Radiol (NY) 2018;43:861-879. 3. Wilson SR, Lyshchik A, Piscaglia F, Cosgrove D, Jang HJ, Sirlin C, Dietrich CF, et al. CEUS LI-RADS: algorithm, implementation, and key differences from CT/MRI. Abdom Radiol (NY) 2018;43:127-142. 4. Dietrich CF, Potthoff A, Helmberger T, Ignee A, Willmann JK, Group CL-RW. [Contrast-enhanced ultrasound: Liver Imaging Reporting and Data System (CEUS LI-RADS)]. Z Gastroenterol 2018;56:499-506.
The association of US LI-RADS visualization score and diagnostic outcome of US-guided percutaneous biopsy in patients at risk for hepatocellular carcinomas Sang Hyun Choi, Ji Hun Kang, So Yeon Kim, So Jung Lee Asan Medical Center, Seoul, South Korea Purpose: We aimed to determine the association of ultrasound (US) Liver Imaging Reporting and Data System (LI-RADS) visualization score and diagnostic outcome of US-guided percutaneous biopsy in patients at risk for hepatocellular carcinomas (HCCs). Methods: In this retrospective study, we included 156 focal hepatic lesions in 156 patients who underwent US-guided percutaneous coreneedle biopsy between January and September 2016. According to the US LI-RADS version 2017, we assigned US LI-RADS visualization score (A, B, or C) for each exam. Final diagnoses were determined using pathologic reports and categorized into two groups, i.e., diagnostic and non-diagnostic results. Univariate and multivariate analysis were performed to determine the risk factor for non-diagnostic results, including US LI-RADS visualization score and other clinical covariates. Results: Of the 156 lesions, 137 (87.8%) were diagnostic and 19 (12.2%) were non-diagnostic results. In the univariate analysis, US LI-RADS visualization score B or C had a significantly higher non-diagnostic result rate than visualization score A (33.3% vs. 3.6%, P < .001). Lesion size 3 cm (P = .023) and subcapsular location (P = .003) were also significantly associated with diagnostic outcome. In the multivariate logistic regression analysis, US LI-RADS visualization score B or C (odds ratio [OR] = 10.6, 95% confidence interval [CI] = 3.1 35.9, P < .001) and subcapsular location (OR = 4.84, 95% CI = 1.5 15.5, P = .008) were independent risk factors for non-diagnostic results. Conclusion: US-guided percutaneous biopsy resulted in a high diagnostic yield for focal hepatic lesions in patients at risk for HCCs. US LI-RADS visualization score B or C and subcapsular location of a lesion were independent risk factors for non-diagnostic biopsy results.
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Utility of Sonazoid-enhanced ultrasound-guided liver tumor biopsy for next-generation sequencing-based clinical sequencing Yuji Eso, Atsushi Takai, Ken Takahashi, Yoshihide Ueda, Hiroshi Seno Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan Introduction: Recent advances in next-generation sequencing (NGS) technologies allow for evaluation of genetic alterations in various cancer-related genes in daily clinical practice. Archival formalin-fixed paraffin-embedded (FFPE) tumor tissue is often used for NGS-based clinical sequencing assays; however, the success rate of NGS assays using archival FFPE tumor tissue is reported to be lower than that using fresh tumor tissue. We aimed to evaluate the feasibility and safety of Sonazoid-enhanced ultrasound (SEUS)-guided liver tumor biopsy for NGS-based multiplex gene assays. Methods: We compared the success rate of NGS assays between archival FFPE tumor tissues and SEUS-guided liver tumor biopsy tissues, and summarized the treatment progresses of the patients. Results: NGS assays using SEUS-guided liver biopsy samples were successful in all patients (22/22), whereas the success rate with archival FFPE tumor tissue was 84.8% (151/178, p<0.05). At least one potentially actionable genetic alteration was identified from the SEUS-guided liver biopsy samples in 20 of 22 patients. Among the 18 patients with actionable genetic alterations targetable with FDA-approved drugs, 8 initiated mutation-driven targeted therapies. Of these 8 patients, 4 achieved partial response or stable disease for at least 4 months, and 3 were not assessable for response due to short exposure. There were no biopsyrelated complications requiring additional treatment. Conclusion: Our findings suggest that SEUS-guided liver tumor biopsy is a useful and safe method for obtaining high-quality samples for NGS-based clinical sequencing. In cases with metastatic liver tumors, SEUS-guided biopsy should be considered to provide accurate and optimal sequencing results for patients.
SESSION 8A: MSK & RHEUMATOLOGY Nerves and neuropathies of the upper limb Thomas Moritz Consultant Radiologist, Canterbury District Health Board, Christchurch, New Zealand Peripheral neuropathies are very common in the general population. The diagnosis and management is frequently challenging, partly because of limitations of established diagnostic methods, especially in terms of anatomical detail and examination flexibility. This frequently leaves patients with significant diagnostic delay, associated morbidity and unnecessary or excessive surgical intervention. High-Resolution ultrasound (HRUS) is an evolving technique that has been shown to provide excellent information about anatomy and pathology of peripheral nerves, is highly flexible, bedside and therefore an ideal addition to the diagnostic toolkit in peripheral neuropathy patients. It gives the examiner the possibility for direct patient interaction and dynamic examination technique, two techniques especially crucial for examining extremity nerves. At the same time it is easy to learn and highly rewarding. This presentation is meant as an introduction to upper limb nerve ultrasound, giving you an overview of upper limb nerve anatomy from an ultrasound perspective, basic examination technique and common pathology of upper limb nerves, using instructive cases and illustrations.
The association of US LI-RADS visualization score and diagnostic outcome of US-guided percutaneous biopsy in patients at risk for hepatocellular carcinomas Sang Hyun Choi, Ji Hun Kang, So Yeon Kim, So Jung Lee Asan Medical Center, Seoul, South Korea Purpose: We aimed to determine the association of ultrasound (US) Liver Imaging Reporting and Data System (LI-RADS) visualization score and diagnostic outcome of US-guided percutaneous biopsy in patients at risk for hepatocellular carcinomas (HCCs). Methods: In this retrospective study, we included 156 focal hepatic lesions in 156 patients who underwent US-guided percutaneous coreneedle biopsy between January and September 2016. According to the US LI-RADS version 2017, we assigned US LI-RADS visualization score (A, B, or C) for each exam. Final diagnoses were determined using pathologic reports and categorized into two groups, i.e., diagnostic and non-diagnostic results. Univariate and multivariate analysis were performed to determine the risk factor for non-diagnostic results, including US LI-RADS visualization score and other clinical covariates. Results: Of the 156 lesions, 137 (87.8%) were diagnostic and 19 (12.2%) were non-diagnostic results. In the univariate analysis, US LI-RADS visualization score B or C had a significantly higher non-diagnostic result rate than visualization score A (33.3% vs. 3.6%, P < .001). Lesion size 3 cm (P = .023) and subcapsular location (P = .003) were also significantly associated with diagnostic outcome. In the multivariate logistic regression analysis, US LI-RADS visualization score B or C (odds ratio [OR] = 10.6, 95% confidence interval [CI] = 3.1 35.9, P < .001) and subcapsular location (OR = 4.84, 95% CI = 1.5 15.5, P = .008) were independent risk factors for non-diagnostic results. Conclusion: US-guided percutaneous biopsy resulted in a high diagnostic yield for focal hepatic lesions in patients at risk for HCCs. US LI-RADS visualization score B or C and subcapsular location of a lesion were independent risk factors for non-diagnostic biopsy results.
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Utility of Sonazoid-enhanced ultrasound-guided liver tumor biopsy for next-generation sequencing-based clinical sequencing Yuji Eso, Atsushi Takai, Ken Takahashi, Yoshihide Ueda, Hiroshi Seno Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan Introduction: Recent advances in next-generation sequencing (NGS) technologies allow for evaluation of genetic alterations in various cancer-related genes in daily clinical practice. Archival formalin-fixed paraffin-embedded (FFPE) tumor tissue is often used for NGS-based clinical sequencing assays; however, the success rate of NGS assays using archival FFPE tumor tissue is reported to be lower than that using fresh tumor tissue. We aimed to evaluate the feasibility and safety of Sonazoid-enhanced ultrasound (SEUS)-guided liver tumor biopsy for NGS-based multiplex gene assays. Methods: We compared the success rate of NGS assays between archival FFPE tumor tissues and SEUS-guided liver tumor biopsy tissues, and summarized the treatment progresses of the patients. Results: NGS assays using SEUS-guided liver biopsy samples were successful in all patients (22/22), whereas the success rate with archival FFPE tumor tissue was 84.8% (151/178, p<0.05). At least one potentially actionable genetic alteration was identified from the SEUS-guided liver biopsy samples in 20 of 22 patients. Among the 18 patients with actionable genetic alterations targetable with FDA-approved drugs, 8 initiated mutation-driven targeted therapies. Of these 8 patients, 4 achieved partial response or stable disease for at least 4 months, and 3 were not assessable for response due to short exposure. There were no biopsyrelated complications requiring additional treatment. Conclusion: Our findings suggest that SEUS-guided liver tumor biopsy is a useful and safe method for obtaining high-quality samples for NGS-based clinical sequencing. In cases with metastatic liver tumors, SEUS-guided biopsy should be considered to provide accurate and optimal sequencing results for patients.
SESSION 8A: MSK & RHEUMATOLOGY Nerves and neuropathies of the upper limb Thomas Moritz Consultant Radiologist, Canterbury District Health Board, Christchurch, New Zealand Peripheral neuropathies are very common in the general population. The diagnosis and management is frequently challenging, partly because of limitations of established diagnostic methods, especially in terms of anatomical detail and examination flexibility. This frequently leaves patients with significant diagnostic delay, associated morbidity and unnecessary or excessive surgical intervention. High-Resolution ultrasound (HRUS) is an evolving technique that has been shown to provide excellent information about anatomy and pathology of peripheral nerves, is highly flexible, bedside and therefore an ideal addition to the diagnostic toolkit in peripheral neuropathy patients. It gives the examiner the possibility for direct patient interaction and dynamic examination technique, two techniques especially crucial for examining extremity nerves. At the same time it is easy to learn and highly rewarding. This presentation is meant as an introduction to upper limb nerve ultrasound, giving you an overview of upper limb nerve anatomy from an ultrasound perspective, basic examination technique and common pathology of upper limb nerves, using instructive cases and illustrations.