Computed Tomography Evaluation of In Vivo Pulmonary Cryoablation Zone Sizes
PURPOSE/OBJECTIVE:To evaluate ablation zone sizes in patients undergoing pulmonary tumor cryoablation with 14-gauge cryoablation probes. MATERIALS AND METHODS/METHODS:Single-center retrospective analysis of all consecutive patients who underwent cryoablation of pulmonary tumors with one or more 14-gauge probes (August 2017-June 2020) was performed. Intraprocedural and 1-2 month post-procedural chest CTs were evaluated to characterize pulmonary lesions, ice balls, and ablation zones. Single-probe 14-gauge ablation zone volumes were compared to manufacturer reference isotherms, and to single- and two-probe ablation zones from a prior investigation of 17-gauge probes. Overall and local recurrence-free survival were calculated to 3 years. RESULTS:) (all p<0.001). Three-year overall and local recurrence-free survival were 69% (95% CI: 53-89%) and 87% (95% CI: 74-100%), respectively. CONCLUSIONS:14-gauge probes generate larger ablation volumes than 17-gauge probes. Manufacturer-reported isotherms are significantly larger than actual cryoablation zones. Cryoablation can attain low rates of local recurrence.
Abstract No. 350 Genicular artery embolization for treatment of knee osteoarthritis: interim analysis of a prospective pilot trial including effect on serum osteoarthritis-associated biomarkers [Meeting Abstract]
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.
Abstract No. 271 Computed tomography evaluation of in vivo pulmonary cryoablation zone sizes [Meeting Abstract]
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.
MRI-Derived Sarcopenia Associated with Increased Mortality Following Yttrium-90 Radioembolization of Hepatocellular Carcinoma
PURPOSE/OBJECTIVE:Y radioembolization. MATERIALS AND METHODS/METHODS:for women. Survival at 90Â days, 180Â days, 1Â year, and 3Â 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 19.6Â months, range 21Â days-58Â months). Patients with sarcopenia were found to have increased mortality at 180Â days (31.8% vs. 8.9%) and 1Â 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.
Revenue Sources in Interventional Radiology: Revenue Analysis of an Interventional Oncology Service Line [Letter]
Comparison of Non-Tumoral Portal Vein Thrombosis Management in Cirrhotic Patients: TIPS Versus Anticoagulation Versus No Treatment
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.
Risk factors for bleeding complications after renal biopsy [Meeting Abstract]
Clinical predictors of need for endovascular intervention in hepatic trauma [Meeting Abstract]
Essentials of Insulinoma Localization with Selective Arterial Calcium Stimulation and Hepatic Venous Sampling
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.
Safety and Effectiveness of Yttrium-90 Radioembolization around the Time of Immune Checkpoint Inhibitors for Unresectable Hepatic Metastases
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 Â± 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.