Transarterial chemoembolization (TACE) is the current standard of therapy for patients with intermediate-stage hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer classification. The concept of conventional TACE (cTACE) is the selective obstruction of tumor-feeding artery by injection of chemotherapeutic agents, leading to ischemic necrosis of the target tumor via cytotoxic and ischemic effects. Drug-eluting beads (DEBs) have been imposed as novel drug-delivering agents for TACE, which allows for higher concentrations of drugs within the target tumor and lower systemic concentrations compared with cTACE. Despite the theoretical advantages of DEB-TACE, it is still controversial in clinical practice as to whether DEB-TACE is superior to cTACE in regard to overall survival and treatment response. In this review article, we summarize the clinical efficacy and safety of DEB-TACE for patients with intermediate or advanced stage HCC in comparison with cTACE.
Although we now think of the national and international development of organized interventional radiology, it is important to remember that some of the early beginnings were in local “angio clubs.” These clubs often had different formats such as case presentations, formal papers, and lectures, or combinations of these elements. There were also regional angio groups that eventually became part of the national society. The terminology interventional radiology was suggested by Dr Margulis.
The objective of this study was to investigate the combined efficacy of adrenal vein sampling (AVS) and imaging findings in predicting successful clinical outcomes following unilateral adrenalectomy for primary aldosteronism (PA). A retrospective chart review of 137 patients who underwent AVS between 2009 and 2014 at two hospitals in a single academic institution was performed. Preprocedure demographic, imaging, medication, and laboratory values were reviewed. In general, patients were considered for adrenalectomy when lateralization was suggested on AVS. Clinical outcomes such as improved blood pressure control and preserved renal function after adrenalectomy were correlated with preprocedure variables. AVS was technically successful in 120 out of 137 patients. Lateralization was seen in 64 patients and 48 out of 64 patients underwent adrenalectomy. Out of 48, 43 patients had an adrenal nodule on preoperative imaging, while 5 did not. 28 patients showed improvement in blood pressure after adrenalectomy, all of which had a nodule on imaging. Of the 28 patients, 22 also showed preservation of renal function. None of the remaining 5 (out of 48) patients who demonstrated lateralization on AVS and had no nodule on imaging showed clinical improvement following adrenalectomy. The presence of an adrenal nodule on preoperative imaging was also associated with improved blood pressure control (p=0.022) and preserved renal function (p=0.048) following adrenalectomy. Improved blood pressure control and preserved renal function in patients with PA who underwent adrenalectomy following lateralization on AVS are associated with the identification of an adrenal nodule on preoperative imaging.
Blood blister aneurysms are extremely rare, and its treatment continues to be controversial. Although surgery was the only available treatment a decade ago, today newer endovascular devices such as flow diverters (FDs) appears to have very low complication rates with good long-term results. We analyzed our data of seven patients who angiographically had features of a blister aneurysm. All these patients presented with subarachnoid hemorrhage (SAH). Six of these were in anterior circulation, all of which were in internal carotid artery (ICA) and one was in a P1 segment of posterior cerebral artery (PCA). All of the patients except one in PCA were treated with FDs. One of the patients died (14.3%) following the procedure secondary to thrombosis of FD. Rest of the patients did well postprocedure with the good clinical outcome (modified Rankin Scale [mRS] of less than or equal to 2 at 1-month follow-up) in 85.7% patients. Five of the patients showed complete obliteration of an aneurysm (83.3%) on 6-month follow-up angiography. The only patient with an aneurysm in PCA showed persistence of an aneurysm and this particular lesion was instead treated by a single stent. Blister aneurysms pose diagnostic and therapeutic challenges and demand prompt treatment. Considering that all patients who were treated with FD had complete obliteration, it can be inferred that FD can be the treatment of choice in patients with blister aneurysms presenting with SAH. Further, with the introduction of small vessel FD, thrombotic complications may reduce, lowering the morbidity and mortality. Isolated stenting may not be an optimal treatment of a blister aneurysm.
Noninvasive imaging modalities are being used for long-term follow-up of intracranial stented patients of nonatherosclerotic etiology. The aim of this study is to determine the utility of contrast-enhanced magnetic resonance angiography (CE-MRA) source images in delayed intracranial in-stent stenosis. A total of 18 stented patients for nonatherosclerotic etiology were reviewed; all had follow-up digital subtraction angiography (DSA) and CE- and time-of-flight (TOF)-MRA. Four sets of MR images (TOF-MRA reformatted images, TOF-MRA source images, CE-MRA reformatted images, and CE-MRA source images) were reviewed for detection of >=50% stenosis. Accuracy of each image set was calculated comparing to DSA. Overall delayed in-stent stenosis during follow-up DSA was 10%. The sensitivity of TOF reformatted image, TOF source image, CE-MRA reformatted image, CE-MRA source image are 33% (6/18), 55.6% (10/18), 77.8% (14/18), and 100% (18/18), respectively, while negative predictive value are 14.3% (2/14), 20% (2/10), 33% (2/6), and 100% (2/2), respectively. CE-MRA source images are equally efficacious as DSA to detect significant (>=50%) delayed in-stent stenosis.
The liver is a common site for primary or metastatic disease. In addition to primary liver tumors, such as hepatocellular carcinoma, cholangiocarcinoma, and gallbladder carcinoma, several cancers are known to present with isolated hepatic metastasis, including colorectal carcinoma, ocular melanoma, and neuroendocrine cancers. Moreover, in patients with additional sites of extrahepatic disease, it is the hepatic disease burden that is often the cause of morbidity and mortality.
Radiation dose from catheter-based interventional procedures performed in catheterization laboratories are of concern as an increase of radiation dose beyond threshold limits will be detrimental to the patient. It is important that radiation personnel understand the biological effects of radiation since patient and staff exposure may be significantly high when not adhered to radiation safety standards. Use of protective accessories, such as lead aprons and goggles, has been practiced worldwide for individual protection. Dose audit during interventional procedures is important for the benefit of the patient. Several factors including angiographic equipment, preset protocols, and tube angulations that influence radiation dose to patient and operators and hence modification on radiation safety work practices in the catheterization lab is warranted. Implementing periodic radiation safety training for occupational workers would be beneficial to practice a radiation safety culture.
Rejection is a common problem after orthotopic liver transplant. The tissue is required for the rapid diagnosis of rejection. Many of these patients have contraindications to percutaneous liver biopsies. Transjugular liver biopsies in patients with liver transplants can be very challenging due to the modified venous anatomy. This article will review the different types of surgical venous anastomosis in patients with whole liver transplants as well as the challenges and techniques to overcome these and successfully perform a transjugular liver biopsy.
While not primarily a chest disease, Osler Weber Rendu (OWR, otherwise known as hereditary hemorrhagic telangiectasia) is a rare genetic condition of the arteries that may manifest anywhere in the body. In this disorder, the switch that controls blood vessel growth cannot spontaneously turn off. Abnormal clusters and knots of vessels form. People with this condition often have small blood vessel malformations that cause red or purple spots on the lips or tongue. These are telangiectasia, sometimes known as birthmarks, and are commonly seen in other conditions.
Aneurysms involving the lenticulostriate arteries are rare and are described in the literature in small case series or single-case reports. In this report, we discuss a case of a young woman who presented with acute lateral ventricular bleed and was found to have an arteriovenous malformation within the corona radiata and an aneurysm involving the distal lenticulostriate artery. The aneurysm was treated successfully by endovascular embolization. In deep-seated arteriovenous malformations (AVMs) that are conventionally treated by stereotactic radiosurgery, a targeted approach for treatment of an associated aneurysm could be considered to reduce the risk of rebleed until the AVM is obliterated.
Purpose: To compare the outcomes of radiation segmentectomy (RS) and transarterial chemoembolization (TACE) combined with microwave ablation (MWA) in the treatment of unresectable solitary hepatocellular carcinoma (HCC) up to 3 cm.
Purpose: To (a) compare the diagnostic accuracy of breast magnetic resonance (MR) imaging with that of conventional imaging (digital mammography and breast ultrasonography) in the identification of ductal carcinoma in situ (DCIS) components of biopsy-proven invasive breast cancer before surgery and (b) investigate the surgical outcome (positive margin rates and mastectomy rates) of women with breast cancer who underwent preoperative MR imaging combined with MR-guided needle biopsy and/or MR-guided lesion localization or bracketing where appropriate.
Purpose: To assess the safety and efficacy of irreversible electroporation (IRE) in the treatment of patients with inoperable hepatocellular carcinoma (HCC) who are ineligible for thermal ablative techniques.
Purpose: To inform the management of fractured inferior vena cava filters on the basis of results from a tertiary referral center specializing in complex filter retrieval.
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