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MRI-Derived Sarcopenia Associated with Increased Mortality Following Yttrium-90 Radioembolization of Hepatocellular Carcinoma

Guichet, Phillip L; Taslakian, Bedros; Zhan, Chenyang; Aaltonen, Eric; Farquharson, Sean; Hickey, Ryan; Horn, Cash J; Gross, Jonathan S
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.
PMID: 34089074
ISSN: 1432-086x
CID: 4899312

The environmental impact of interventional radiology: An evaluation of greenhouse gas emissions from an academic interventional radiology practice

Chua, Anthony; Amin, Ruhana; Zhang, Jinchun; Thiel, Cassandra L; Gross, Jonathan S
PURPOSE/OBJECTIVE:To calculate the volume of greenhouse gases (GHG) generated by a hospital-based interventional radiology department. MATERIALS AND METHODS/METHODS:Life cycle assessment (LCA) was used to calculate GHG emitted by an IR department at a tertiary care academic medical center during a single workweek. The volume of waste generated, the amount of disposable supplies and linens used, and the operating time of electrical equipment were recorded for each procedure performed between 7:00AM-7:00PM on five consecutive weekdays. LCA was then performed using purchasing data, plug loads for electrical hardware, data from temperature control units, and estimates of emissions related to travel in the area surrounding the medical center. RESULTS:e). CONCLUSION/CONCLUSIONS:The practice of interventional radiology generates substantial volumes of greenhouse gases, a majority of which come from energy used to power climate control followed by emissions related to the production and transportation of single use supplies. Efforts to reduce energy consumption and the use of disposable supplies may decrease GHG emissions and IR's contribution to climate change.
PMID: 33794372
ISSN: 1535-7732
CID: 4862672

Intragastric Balloon Improves Steatohepatitis and Fibrosis [Case Report]

Lin, Elissa; Huang, Xiaoyan; Pei, Zhiheng; Gross, Jonathan; Popov, Violeta
Obesity is a major risk factor for nonalcoholic steatohepatitis (NASH). Although weight loss has been shown to reverse histologic features of NASH, lifestyle intervention alone is often challenging and unfeasible. In this case report, we discuss the effects of intragastric balloon (IGB) therapy on steatosis, fibrosis, and portal pressures. We also demonstrate that improvement in histologic features persist at least 6 months after IGB removal. Although there are little data thus far to support IGB therapy in the treatment of NASH, our case provides evidence of the potential benefit of IGB on improving metabolic parameters and markers of liver fibrosis.
PMCID:7810505
PMID: 33490302
ISSN: 2326-3253
CID: 4766842

Essentials of Insulinoma Localization with Selective Arterial Calcium Stimulation and Hepatic Venous Sampling

Zhao, Ken; Patel, Nihal; Kulkarni, Kopal; Gross, Jonathan S; Taslakian, Bedros
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.
PMID: 32992761
ISSN: 2077-0383
CID: 4616802

Yttrium-90 Radioembolization in the Office-Based Lab

Hickey, Ryan M; Maslowski, John M; Aaltonen, Eric T; Horn, Jeremy Cash; Patel, Amish; Sista, Akhilesh K; Gross, Jonathan S
PURPOSE/OBJECTIVE:To evaluate the feasibility and benefits of performing yttrium-90 radioembolization in an office-based lab (OBL) compared to a hospital setting. MATERIALS AND METHODS/METHODS:A radioembolization program was established in March 2019 in an OBL that is managed by the radiology department of a tertiary care center. Mapping and treatment angiograms performed in the OBL from March 2019 through January 2020 were compared to mapping and treatment angiograms performed in the hospital during the same time period. RESULTS:One hundred seventy-six mapping and treatment angiograms were evaluated. There was no difference in the proportion of mapping versus treatment angiograms performed at each site, the proportion of lobar versus selective dose vial administrations, or the mean number of dose vials administered per treatment procedure. Procedure start delays were longer in the hospital than in the OBL (28.6 minutes vs 0.8 minutes; P < .0001), particularly for procedures that were not scheduled as the first case of the day (hospital later case delay, 38.8 minutes vs OBL later case delay, 0.5 minutes; P < .0001). Procedures performed in the hospital took longer on average than procedures performed in the OBL (2 hours, 1.8 minutes vs 1 hour, 44.4 minutes; P = .0004), particularly for procedures that were not scheduled as the first case of the day (hospital later case duration, 2 hours, 7.4 minutes vs OBL later case duration, 1 hour, 43 minutes; P = .0006). CONCLUSIONS:Establishing a radioembolization program within an OBL is feasible and might provide more efficient procedure scheduling than the hospital setting.
PMID: 32800662
ISSN: 1535-7732
CID: 4572972

Burnout among Interventional Radiologists

Bundy, Jacob J; Hage, Anthony N; Srinivasa, Ravi N; Gemmete, Joseph J; Lee, Eunjee; Gross, Jonathan S; Healey, Travis L; Solberg, Agnieszka O; Monroe, Eric J; Chick, Jeffrey Forris Beecham
PURPOSE/OBJECTIVE:To characterize burnout, as defined by high emotional exhaustion (EE) or depersonalization (DP), among interventional radiologists using a validated assessment tool. MATERIALS AND METHODS/METHODS:An anonymous 34-question survey was distributed to interventional radiologists. The survey consisted of demographic and practice environment questions and the 22-item Maslach Burnout Inventory-Human Services Survey (MBI). Interventional radiologists with high scores on EE (≥ 27) or DP (≥ 10) MBI subscales were considered to have a manifestation of career burnout. RESULTS:Beginning on January 7, 2019, 339 surveys were completed over 31 days. Of respondents, 263 (77.6%) identified as male, 75 (22.1%) identified as female, and 1 (0.3%) identified as trans-male. The respondents were interventional radiology attending physicians (298; 87.9%), fellows (20; 5.9%), and residents (21; 6.2%) practicing at academic (136; 40.1%), private (145; 42.8%), and hybrid (58; 17.1%) centers. Respondents worked < 40 hours (15; 4.4%), 40-60 hours (225; 66.4%), 60-80 hours (81; 23.9%), and > 80 hours (18; 5.3%) per week. Mean MBI scores for EE, DP, and personal achievement were 30.0 ± 13.0, 10.6 ± 6.9, and 39.6 ± 6.6. Burnout was present in 244 (71.9%) participants. Identifying as female (odds ratio 2.4; P = .009) and working > 80 hours per week (odds ratio 7.0; P = .030) were significantly associated with burnout. CONCLUSIONS:Burnout is prevalent among interventional radiologists. Identifying as female and working > 80 hours per week were strongly associated with burnout.
PMID: 31345730
ISSN: 1535-7732
CID: 3988192

Muscle mass on magnetic resonance imaging predicts hepatocellular carcinoma survival following Yttrium-90 radioembolization [Meeting Abstract]

Guichet, P; Taslakian, B; Aaltonen, E; Farquharson, S; Hickey, R; Horn, C; Gross, J
Purpose: To assess the impact of muscle mass on survival in patients with hepatocellular carcinoma undergoing yttrium-90 radioembolization. Materials: The medical records of 186 patients undergoing Yttrium-90 radioembolization for hepatocellular carcinoma between April 2014 and May 2017 were retrospectively reviewed. Fifty patients with an abdominal MRI performed within 90 days prior to treatment were identified. All patients underwent standardized abdominal and liver MRI sequence protocols. Axial T2-weighted fat-suppressed sequences were used for image analysis. The paraspinal musculature was manually segmented at the level of the origin of the superior mesenteric artery using syngo.via (Siemens Healthineers, USA) and used to calculate skeletal muscle area (cm2) and skeletal muscle index (cm2/m2). Sarcopenia was defined as skeletal muscle area < 35.23 cm2 for men and < 31.53 cm2 for women. Medical records were reviewed to determine patient survival following treatment. Descriptive statistics, including Mann-Whitney tests and receiver operating characteristic curves, were performed.
Result(s): Fifty patients (86% male) with mean age 64 years (range, 31-83 years) met inclusion criteria. Death was reported for 49% (21/43) of male and 57% (4/7) of female patients, with average follow-up of 21 months (range, 0.7-56 months). Sarcopenia was identified in 16% (7/43) of male and 29% (2/7) of female patients. There were statistically significant differences in skeletal muscle area (48.72 +/- 12.01 cm2 vs. 42.18 +/- 15.13 cm2) (P = 0.047) and skeletal muscle index (16.26 +/- 2.69 cm2/m2 vs. 14.56 +/- 5.83 cm2/m2) (P = 0.024) between men who survived and died. Differences for the seven female patients included in the study did not achieve statistical significance, likely due to small sample size. Median survival was estimated as 1403 days for nonsarcopenic men (36/43) and 243 days for sarcopenic men (7/43) (P = 0.272).
Conclusion(s): Muscle mass on pre procedure MRI predicts survival in patients with hepatocellular carcinoma undergoing Yttrium-90 radioembolization. Sarcopenia may be associated with shorter survival and ongoing analysis of additional patients will improve study power to detect significant differences.
Copyright
EMBASE:2004990344
ISSN: 1535-7732
CID: 4326232

Utility or futility: Is the routine preoperative evaluation of patient coagulation status essential prior to tunneled subcutaneous port placement? [Meeting Abstract]

Braun, R; Aaltonen, E; Gross, J; Horn, J
Purpose: To determine whether routine preoperative evaluation of patient coagulation status, as reflected by the calculated International Normalized Ratio (INR), is necessary prior to placement of a tunneled subcutaneous port. Materials: We conducted a retrospective analysis of tunneled subcutaneous port placements performed by interventional radiology in the ambulatory setting at a single institution over a 6-month period from March to September 2017. The INR values at time of initial outpatient referral, as well as any subsequent preoperative coagulation testing, were compiled from the electronic medical record. Any INR abnormalities, defined as a value greater than 1.5, were then cross-referenced with specific patient past medical history. Results: A total of 263 patients had subcutaneous ports placed during the 6-month study period (29.7% male, mean age 59). INR testing was performed within 30 days of port placement for every patient, as per departmental protocol based on the Society of Interventional Radiology (SIR) guidelines for management of patient coagulation status. Of the 263 port placements, only 4 patients (1.5%) demonstrated INR values above the threshold limit: Two patients were on Coumadin therapy for chronic thromboembolic disease and atrial fibrillation respectively, one patient was on Apixaban (Eliquis) for atrial fibrillation and one patient had known non-Alcoholic steatohepatitis (NASH) cirrhosis. Conclusions: The incidence of an abnormal INR in patients is very low. Within the study period, only 1.5% of patients undergoing tunneled subcutaneous port placement demonstrated a coagulation abnormality on routine preoperative testing. All noted abnormalities were explained by a review of the individual patient medical history; specifically, these patients were either on anticoagulation or had known hepatic dysfunction. These findings suggest that the majority of patients do not require routine preoperative testing of coagulation status and that a preprocedural INR can be obtained on a case-by-case basis as predicted by relevant patient medical history
EMBASE:621353060
ISSN: 1535-7732
CID: 3028662

Abstract No. 549 - The prognostic utility of MELD-Na for early mortality following TIPS

Yuhasz, M; Morris, E; Merola, J; Chaudhary, N; Sigal, S; Gross, J; Aaltonen, E
CINAHL:121066603
ISSN: 1051-0443
CID: 2463952

Percutaneous radiologically guided gastrostomy tube placement: comparison of antegrade transoral and retrograde transabdominal approaches

Haber, Zachary M; Charles, Hearns W; Gross, Jonathan S; Pflager, Daniel; Deipolyi, Amy R
PURPOSE: We aimed to compare the antegrade transoral and the retrograde transabdominal approaches for fluoroscopy-guided percutaneous gastrostomy tube (G-tube) placement. METHODS: Following institutional review board approval, all G-tubes at two academic hospitals (January 2014 to May 2015) were reviewed retrospectively. Retrograde approach was used at Hospital 1 and both antegrade and retrograde approaches were used at Hospital 2. Chart review determined type of anesthesia used during placement, dose of radiation used, fluoroscopy time, procedure time, medical history, and complications. RESULTS: A total of 149 patients (64 women, 85 men; mean age, 64.4+/-1.3 years) underwent G-tube placement, including 93 (62%) placed via the retrograde transabdominal approach and 56 (38%) placed via the antegrade transoral approach. Retrograde placement entailed fewer anesthesiology consultations (P < 0.001), less overall procedure time (P = 0.023), and less fluoroscopy time (P < 0.001). A comparison of approaches for placement within the same hospital demonstrated that the retrograde approach led to significantly reduced radiation dose (P = 0.022). There were no differences in minor complication rates (13%-19%; P = 0.430), or major complication rates (6-7%; P = 0.871) between the two techniques. CONCLUSION: G-tube placement using the retrograde transabdominal approach is associated with less fluoroscopy time, procedure time, radiation exposure, and need for anesthesiology consultation with similar safety profile compared with the antegrade transoral approach. Additionally, it is hypothesized that decreased procedure time and anesthesiology consultation using the transoral approach are likely associated with reduced cost.
PMCID:5214078
PMID: 27911264
ISSN: 1305-3612
CID: 2329572