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Liver cirrhosis is a leading cause of death worldwide, with 1-year mortality rates of up to 57% in decompensated patients. Hepatocellular carcinoma (HCC) is the most common primary tumor in cirrhotic livers and the second leading cause of cancer-related mortality worldwide. Annually, up to 8% of patients with cirrhosis develop HCC. The diagnosis of HCC rarely requires histological confirmation: in fact, according to the most recent guidelines, the imaging features of HCC are almost always sufficient for a certain diagnosis. Thus, the role of the radiologist is pivotal because the accurate detection and characterization of focal liver lesions in patients with cirrhosis are essential in improving clinical outcomes. Despite recent technical innovations in liver imaging, several issues remain for radiologists regarding the differentiation of HCC from other hepatic lesions, particularly benign lesions and pseudolesions. It is important to avoid misdiagnosis of benign liver lesions as HCC (false-positive cases) because this diagnostic misinterpretation may lead to ineligibility of a patient for potentially curative treatments or inappropriate assignment of high priority scores to patients on waiting lists for liver transplantation. This review presents a pocket guide that could be useful for the radiologist in the diagnosis of benign lesions and pseudolesions in cirrhotic livers, highlighting the imaging features that help in making the correct diagnosis of macroregenerative nodules; siderotic nodules; arterioportal shunts; hemangiomas, including fast-filling hemangiomas, hemangiomas with pseudowashout, and sclerosed hemangiomas; confluent fibrosis; pseudomasses in chronic portal vein thrombosis; and focal fatty changes.

This is an illustrated case about CT ventilation and perfusion in Covid patient.

Resume Objectif Evaluer le succes technique, les complications et l’influence de la courbe d’apprentissage sur les resultats de stenting de l’artere carotide (SAC) realises chez des patients ne pouvant etre traites par chirurgie. Patients et methodes Cent neuf mises en place d’un stent carotidien sous protection cerebrale ont ete effectuees chez 103 patients a haut risque. Tous les patients presentaient au moins un facteur qui pouvait accroitre le risque chirurgical lie a une endarteriectomie carotidienne (EAC) selon les criteres SAPPHIRE. Les complications neurologiques ont ete quantifiees au moyen de l’echelle d’accident vasculaire cerebral des National Institutes of Health (National Institutes of Health Stroke Scale ; NIHSS) et le retablissement a ete evalue au moyen de l’echelle de Rankin modifiee (mRS). Dans le but d’evaluer l’influence de l’experience de l’operateur en matiere de realisation de SAC, nous avons realise une analyse retrospective des complications periprocedurales et neurologiques des 50 premieres interventions comparativement aux 59 interventions suivantes. Resultats Le taux de succes technique a ete de 98 %. Des complications neurologiques periprocedurales ont ete decelees chez 4,5 % des patients. Les taux de complications neurologiques en milieu hospitalier et a 30 jours ont ete respectivement de 7,6 % et 2,6 %. Le taux de complications neurologiques a ete plus faible a la suite des 59 dernieres interventions realisees, en accord avec une confiance plus elevee des operateurs. Conclusion Un SAC peut etre effectue a titre d’alternative a une EAC pour le traitement de lesions carotidiennes obstructives severes chez les patients ne pouvant etre traites par chirurgie. La courbe d’apprentissage influence positivement le taux de complications.

Purpose of the study To report our experience in treating complicated biliary calculi by percutaneous transhepatic endoscopic biliary holmium laser lithotripsy (PTBL). Patients and Methods Ten symptomatic patients with intrahepatic or common bile duct calculi underwent PTBL. Six of these patients had previously undergone unsuccessful endoscopic treatment; four patients were declared not suitable for endoscopic procedure. PTBL was performed with a flexible choledochoscopy inserted by way of the percutaneous access sheath. A holmium laser was used to fragment the biliary stones. Sphincteroplasty was performed when considered necessary and an occlusion balloon for the clearance of common bile duct (CBD) calculi was used when continuous warm saline irrigation at high pressure was not sufficient. Clinical follow up was performed by the referring physician. Technical success, clinical success and complications were evaluated. Main findings Technical success rate was 100%. The overall clinical success rate was 100%. No patients underwent additional procedures for retained stones or developed de novo strictures or other complications related to the procedure. Hospital stay was no more than 4 days after the procedure. Duration of follow-up was 6–25 months (mean 12.6). One patient died from unrelated causes. During this period, no recurrence and/or complications related to procedure were observed. No major complications were registered. Minor complications like temporary abdominal pain were considered not significant by the patients. Conclusions Complicated or large biliary calculi can be treated successfully using PTBL. In selected patients, this approach should become the first choice of treatment after other treatments are rejected.

Purpose of the study The aim of the study was to assess the efficacy, safety and effectiveness of percutaneous image-guided microwave ablation (MWA) in Bosniak category III or IV cystic renal lesions after 24 months follow-up duration. Methods Between May 2008 and December 2012, computed tomography (CT)- or ultrasound (US)-guided MWA was performed in 6 patients with 7 cystic renal lesions (range 13.8–27 mm, mean 17.02 mm, SD 8.5 mm) Bosniak catgegory III or IV. The number of treatment sessions, treatment results, lesion size changes and complications were evaluated. Technical success (TS), technical effectiveness (TE), local tumor progression rate (LTPR), cancer-specific survival rate (CSSR) and overall survival rate (OSR) were computed. Main findings TS was 100% (7/7) and TE was 100%; LTPR was 0%; CSSR and OSR were 100%. No major complications were observed. Conclusion Our preliminary experience with MWA shows a potential role for US/CT-guided percutaneous MWA in treating Bosniak category III or IV cystic renal lesions, as a safe approach to treat selected patients not suitable for surgery.