Faculty Bibliography

Purpose: To determine the safety and effectiveness of genicular artery embolization (GAE) in reducing knee pain in patients with mild to moderate knee osteoarthritis (OA), as measured by validated patient reported outcome measures, and to characterize pre/post-procedural trends in multiple OA-associated serum biomarkers
Material(s) and Method(s): In an ongoing, prospective, single-arm clinical trial, patients with mild to moderate (Kellgren-Lawrence grade 2-3) symptomatic knee OA, without prior surgery and who failed conservative therapy, were included. Pre-intervention imaging (plain radiographs and MRI), patient-reported outcome measures (KOOS, WOMAC, VAS), and serum biomarkers (IL-1Ra, CRP, Hyaluronan, COMP, VEGF, CCL2-MCP-1) were obtained. Each patient underwent transcatheter arterial embolization of one or more genicular arteries in the affected knee using 250-mum microspheres (Embozene, Varian). One- and three-month post-intervention patient-reported outcome measures and serum biomarkers were obtained. Baseline and follow-up outcomes were compared using paired Wilcoxon signed-rank tests.
Result(s): The first 7 patients (4 male, mean age 68 +/- 6y, mean BMI 30 +/- 2) recruited into this trial were included in this preliminary analysis. Technical success was 100%. There were no adverse events. By 3 months, VAS pain scores decreased from 56 to 21 (63% decrease); WOMAC pain scores decreased from 8 to 4 (50% decrease); and KOOS pain scores (for which higher scores indicate less pain) increased from 57 to 81 (42% increase), all P >0.05. Baseline and 3-month mean biomarker values were: IL-1Ra (471 +/- 276 vs 590 +/- 320 pg/mL), CRP (1.81 +/- 1.78 vs 3.24 +/- 4.25 mg/L), Hyaluronan (92 +/- 66 vs 166 +/- 102 ng/mL), COMP (942 +/- 336 vs 1057 +/- 462 ng/mL), VEGF (372 +/- 283 vs 303 +/- 101 pg/mL), and CCL2-MCP-1 (335 +/- 90 vs 323 +/- 69 pg/mL), all P >0.05.
Conclusion(s): Patient-reported pain scores demonstrated a trend in improvement 3 months after GAE at our interim analysis. There were no significant changes between baseline and 3-month follow-up in serum OA biomarkers in this small sample size. Full study analysis will further delineate trends in serum biomarkers after GAE.
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Purpose: To evaluate the cryoablation zones generated in human subjects during the treatment of pulmonary tumors using 14-gauge cryoablation probes; current understanding of in vivo pulmonary cryoablation zone volumes stems predominantly from study of 17-gauge probes
Material(s) and Method(s): A single-center database of all adult patients who underwent CT-guided cryoablation of pulmonary tumors between August 2017 and June 2020 was compiled. All patients were treated using one or more 14-gauge cryoablation probes. Intraprocedural and 1- to 2-month post-procedural chest CTs were evaluated to characterize pulmonary lesions, procedural ice balls, and follow-up ablation zones. Comparison of single-probe ablation zone volumes to manufacturer reference values, and to previously published data on 17-gauge probes was performed using the Wilcoxon rank-sum test. Comparison of ablation zone volume to the number of probes used, distance of the pulmonary lesion to the pleura, and distance of the pulmonary lesion to the nearest >=3 mm vessel, were performed using Kruskal-Wallis and Pearson correlation tests.
Result(s): Pulmonary cryoablation was performed on 47 pulmonary lesions (64% primary adenocarcinoma) across 45 unique procedures on 42 patients (Female: 50%; Mean age: 75.2 +/- 11.5 years). Mean intraprocedural ice ball volume when 1, 2, or 3 probes were used was 5.4 +/- 3.8, 8.0 +/- 4.8, and 22.9 +/- 10.8 cm³, respectively. Mean cryoablation zone volume at 1-2 months when 1, 2, or 3 probes were used was 5.0 +/- 2.3, 37.5 +/- 20.5, and 28.4 cm³, respectively (n = 1 for 3 probes). Mean single-probe ablation zone volume (5.0 +/- 2.3 cm³) was significantly larger than that previously reported for 17-gauge probes (3.0 +/- 0.3 cm³) (P = 0.014)¹, but significantly smaller than manufacturer-reported in vitro 0degreeC, -20degreeC, and -40degreeC isotherms (all P < 0.0001). The number of probes was significantly associated with ablation zone volume (P = 0.0033). Mean cryoablation zone volume was not significantly associated with lesion distance to pleura (P=0.40) or lesion distance to the nearest >=3 mm vessel (P = 0.60).
Conclusion(s): Single-probe pulmonary cryoablation with 14-gauge probes generates significantly larger ablation zone volumes than with 17-gauge probes. In vivo pulmonary cryoablation generates significantly smaller ablation zone volumes than manufacturer-reported in vitro isotherms. Use of multiple probes significantly increased ablation zone volume compared with use of a single probe.
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PURPOSE/OBJECTIVE:Y radioembolization. MATERIALS AND METHODS/METHODS:for women. Survival at 90 days, 180 days, 1 year, and 3 years following initial treatment was assessed using medical and public obituary records. RESULTS:Sarcopenia was identified in 30% (25/82) of patients. Death was reported for 49% (32/65) of males and 71% (8/17) of females (mean follow-up 19.6 months, range 21 days-58 months). Patients with sarcopenia were found to have increased mortality at 180 days (31.8% vs. 8.9%) and 1 year (68.2% vs. 21.2%). Sarcopenia was an independent predictor of mortality adjusted for BCLC stage and sub-analysis demonstrated that sarcopenia independently predicted increased mortality for patients with BCLC stage B disease. CONCLUSION/CONCLUSIONS:Y radioembolization. Sarcopenia was an independent predictor of survival adjusted for BCLC stage with significant deviation in the survival curves of BCLC stage B patients with and without sarcopenia.

BACKGROUND:There is a lack of consensus in optimal management of portal vein thrombosis (PVT) in patients with cirrhosis. The purpose of this study is to compare the safety and thrombosis burden change for cirrhotic patients with non-tumoral PVT managed by transjugular intrahepatic portosystemic shunt (TIPS) only, anticoagulation only, or no treatment. METHODS:This single-center retrospective study evaluated 52 patients with cirrhosis and non-tumoral PVT managed by TIPS only (14), anticoagulation only (11), or no treatment (27). The demographic, clinical, and imaging data for patients were collected. The portomesenteric thrombosis burden and liver function tests at early follow-up (6-9 months) and late follow-up (9-16 months) were compared to the baseline. Adverse events including bleeding and encephalopathy were recorded. RESULTS:= 0.007). No bleeding complications attributable to anticoagulation were observed. CONCLUSION/CONCLUSIONS:TIPS decreased portomesenteric thrombus burden compared to anticoagulation or no treatment for cirrhotic patients with PVT. Both TIPS and anticoagulation were safe therapies.

Insulinomas are the most common functional pancreatic neuroendocrine tumor. Most insulinomas can be localized non-invasively with cross-sectional and nuclear imaging. Selective arterial calcium stimulation and hepatic venous sampling is an effective and safe minimally-invasive procedure for insulinoma localization that may be utilized when non-invasive techniques are inconclusive. The procedure's technical success and proper interpretation of its results is dependent on the interventional radiologist's knowledge of normal and variant pancreatic arterial perfusion. Accurate pre-operative localization aids in successful surgical resection. Technical and anatomic considerations of insulinoma localization with selective arterial calcium stimulation and hepatic venous sampling are reviewed.

PURPOSE/OBJECTIVE:To assess the safety and effectiveness of yttrium-90 radioembolization and checkpoint inhibitor immunotherapy within a short interval for the treatment of unresectable hepatic metastases. MATERIALS AND METHODS/METHODS:This single-institution retrospective study included 22 patients (12 men; median age, 65 y ± 11) with unresectable hepatic metastases and preserved functional status (Eastern Cooperative Oncology Group performance status 0/1) who received immunotherapy and radioembolization within a 15-month period (median, 63.5 d; interquartile range, 19.7-178.2 d) from February 2013 to March 2018. Primary malignancies were uveal melanoma (12 of 22; 54.5%), soft tissue sarcoma (3; 13.6%), cutaneous melanoma (3; 14%), and others (4; 18.2%). Studies were reviewed to March 2019 to assess Common Terminology Criteria for Adverse Events grade 3/4 toxicities, disease progression, and death. RESULTS:There were no grade 4 toxicities within 6 mo of radioembolization. Grade 3 hepatobiliary toxicities occurred in 3 patients (13.6%) within 6 months, 2 from rapid disease progression and 1 from a biliary stricture. Two patients (9.1%) experienced clinical toxicities, including grade 4 colitis at 6 months and hepatic abscess at 3 months. Median overall survival (OS) from first radioembolization was 20 mo (95% confidence interval [CI], 12.5-27.5 mo), and median OS from first immunotherapy was 23 months (95% CI, 15.9-30.1 mo). Within the uveal melanoma subgroup, the median OS from first radioembolization was 17.0 months (95% CI, 14.2-19.8 mo). Median time to progression was 7.8 months (95% CI, 3.3-12.2 mo), and median progression-free survival was 7.8 mo (95% CI, 3.1-12.4 mo). CONCLUSIONS:Checkpoint immunotherapy around the time of radioembolization is safe, with a low incidence of toxicity independent of primary malignancy.

Purpose: To compare the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) to anticoagulation and no treatment in cirrhotic patients with portal vein thrombosis (PVT). Materials: This single-center retrospective study evaluated 64 consecutive cirrhotic patients with imaging diagnosis of PVT between November 2005 and July 2019. 15 patients were excluded due to lack of adequate follow-up imaging. Of the remaining 49 patients, 11 (22%) were female. The median age was 61.5 (range, 24-80) years. 9 (18%) patients were treated with TIPS, 12 (24%) with anticoagulation, and 28 (57%) received no treatment. Demographic and clinical data were collected by reviewing the electronic medical record. PVT was evaluated using contrast-enhanced CT or MRI. Thrombus burden in the main portal (MPV), superior mesenteric (SMV), and splenic (SV) vein was graded as follows: grade 1, < 25%; grade 2, 26-50%; grade 3, 51-75%; and grade 4, > 75% of the luminal diameter. Yerdel scoring system was also used to evaluate the extent of portomesenteric thrombus. Thrombus burden at 6 and 12 months was compared to baseline imaging. Patient survival was estimated using Kaplan-Meier analysis. The extent of baseline thrombus was compared using Kruskal-Wallis test. Treatment response was analyzed by chi square test.
Result(s): There was no statistically significant difference in baseline thrombus burden between the 3 groups (MPV, P = 0.345; SMV, P = 0.244; SV, P = 0.541; Yerdel grade, P = 0.230). At 6 months, 87.5%, 58.3%, and 4.8% patients demonstrated complete or partial recanalization in the TIPS, anticoagulation, and no treatment groups respectively (TIPS/no treatment, P <0.0001; TIPS/anticoagulation, P = 0.163). At 12 months, 100%, 57.1%, 11.1% patients demonstrated complete or partial recanalization in the TIPS, anticoagulation, and no treatment groups respectively (TIPS/no treatment, P <0.0001; TIPS/ anticoagulation, P = 0.051). The overall survival between the 3 groups was not significantly different (P = 0.788) Conclusion(s): TIPS has significantly higher recanalization rate compared to no treatment and has a trend towards higher recanalization rate than that of anticoagulation at 6 and 12 months in cirrhotic patients with PVT.