Diagnostic Accuracy of CEUS LI-RADS for the Characterization of Liver Nodules 20 mm or Smaller in Patients at Risk for Hepatocellular Carcinoma.

Background: American College of Radiology contrast agent–enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) was developed to improve the accuracy of hepatocellular carcinoma (HCC) diagnosis at contrast agent2enhanced US. However, to the knowledge of the authors, the diagnostic accuracy of the system in characterization of liver nodules 20 mm or smaller has not been fully evaluated. Purpose: To evaluate the diagnostic accuracy of CEUS LI-RADS in diagnosing HCC in liver nodules 20 mm or smaller in patients at risk for HCC. Materials and Methods: Between January 2015 and February 2018, consecutive patients at risk for HCC presenting with untreated liver nodules 20 mm or less were enrolled in this retrospective double-reader study. Each nodule was categorized according to the CEUS LI-RADS and World Federation for Ultrasound in Medicine and Biology (WFUMB)–European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) criteria. Diagnostic performance of CEUS LI-RADS and WFUMB-EFSUMB characterization was evaluated by using tissue histologic analysis, multiphase contrast-enhanced CT and MRI, and imaging follow-up as reference standard and compared by using McNemar test. Results: The study included 175 nodules (mean diameter, 16.1 mm 6 3.4) in 172 patients (mean age, 51.8 years 6 10.6; 136 men). The sensitivity of CEUS LR-5 versus WFUMB-EFSUMB criteria in diagnosing HCC was 73.3% (95% confidence inter-val [CI]: 63.8%, 81.5%) versus 88.6% (95% CI: 80.9%, 94%), respectively (P, .001). The specificity of CEUS LR-5 versus WFUMB-EFSUMB criteria was 97.1% (95% CI: 90.1%, 99.7%) versus 87.1% (95% CI: 77%, 94%), respectively (P = .02). No malignant lesions were found in CEUS LR-1 and LR-2 categories. Only two nodules (of 41; 5%, both HCC) were malignant in CEUS LR-3 category. The incidences of HCC in CEUS LR-4, LR-5, and LR-M were 48% (11 of 23), 98% (77 of 79), and 75% (15 of 20), respectively. Two of 175 (1.1%) histologic analysis2confirmed intrahepatic cholangiocarcinomas were categorized as CEUS LR-M by CEUS LI-RADS and misdiagnosed as HCC by WFUMB-EFSUMB criteria. Conclusion: The contrast-enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) algorithm was an effective tool for characterization of small (≤20 mm) liver nodules in patients at risk for hepatocellular carcinoma (HCC). Compared with World Federation for Ultrasound in Medicine and Biology2European Federation of Societies for Ultrasound in Medicine and Biology criteria, CEUS LR-5 demonstrated higher specificity for diagnosing small HCCs with lower sensitivity

N′-Diphenyl­methyl­ene-2-hydroxy­benzohydrazide

The title compound, C20H16N2O2, was synthesized by the reaction of 2-hydroxy­benzohydrazide with diphenyl­methanone. The dihedral angle between the phenyl rings is 76.28 (11)°. The amino H atom is involved in an intra­molecular N—H⋯O hydrogen bond. In the crystal structure, the hydr­oxy groups and carbonyl O atoms form inter­molecular O—H⋯O hydrogen bonds, which link the mol­ecules into chains running along the b axis

2-(1H-1,2,3-Benzotriazol-1-yl)-N′-(2-chloro­benzyl­idene)acetohydrazide

In the title compound, C15H12ClN5O, the mean planes of the benzotriazole and chloro­phenyl fragments form a dihedral angle of 70.8 (1)°. In the crystal, mol­ecules are linked into infinite chains along the a axis by N—H⋯O hydrogen bonds. Weak inter­molecular C—H⋯N hydrogen bonds further link these chains into layers parallel to the ab plane. The crystal studied was a racemic twin

2-(1H-Benzotriazol-1-yl)acetohydrazide

The title compound, C8H9N5O, was synthesized by the reaction of ethyl 2-(benzotriazol-1-yl)acetate with hydrazine hydrate in ethanol. In the amide group, the C—N bond is relatively short [1.3283 (16) Å], suggesting some degree of electronic delocalization in the mol­ecule. In the crystal structure, mol­ecules are linked into infinite chains along the a axis by inter­molecular O—H⋯N hydrogen bonding

2-Hydr­oxy-N′-[(1E,2E)-3-phenyl­prop-2-enyl­idene]benzohydrazide

In mol­ecule of the title compound, C16H14N2O2, the two aromatic rings form a dihedral angle of 6.93 (3)° and an intramolecular N—H⋯O hydrogen bond occurs. In the crystal structure, inter­molecular O—H⋯O hydrogen bonds link the mol­ecules into zigzag chains running in the [10] direction

1-(2-Chloro­benzyl­idene)-2-(2,4-dinitro­phen­yl)hydrazine

In the title compound, C13H9ClN4O4, there are two crystallographically independent mol­ecules in the asymmetric unit, which have very similar conformations. The C=N—N angles in each independent mol­ecule are 115.0 (2) and 116.6 (2)°, which are significantly smaller than the ideal value of 120° expected for sp 2-hybridized N atoms. This is probably a consequence of repulsion between the nitro­gen lone pairs and the adjacent N—N bonds. Two bifurcated intra­molecular N—H⋯O hydrogen bonds help to establish the mol­ecular conformation and consolidate the crystal packing

Dirac-boson stars

In this paper, we construct \textit{Dirac-boson stars} (DBSs) model composed of a scalar field and two Dirac fields. The scalar field and both Dirac fields are in the ground state. We consider the solution families of the DBSs for the synchronized frequency $\tilde{\omega}$ and the nonsynchronized frequency $\tilde{\omega}_D$ cases, respectively. We find several different solutions when the Dirac mass $\tilde{\mu}_D$ and scalar field frequency $\tilde{\omega}_S$ are taken in some particular ranges. In contrast, no similar case has been found in previous studies of multistate boson stars. Moreover, we discuss the characteristics of each type of solution family of the DBSs and present the relationship between the ADM mass $M$ of the DBSs and the synchronized frequency $\tilde{\omega}$ or the nonsynchronized frequency $\tilde{\omega}_D$. Finally, we calculate the binding energy $E_B$ of the DBSs and investigate the relationship of $E_B$ with the synchronized frequency $\tilde{\omega}$ or the nonsynchronized frequency $\tilde{\omega}_D$.Comment: 26 pages, 12 figure