1
|
Young S, Sanghvi T, Ragulojan R, Torkian P, Todatry S, D'Souza D, Flanagan S, Golzarian J. Local recurrence following a complete radiologic response in hepatocellular carcinoma patients: comparison of transarterial chemoembolisation and transarterial radioembolisation. Clin Radiol 2024; 79:371-377. [PMID: 38341344 DOI: 10.1016/j.crad.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 02/12/2024]
Abstract
AIM To evaluate and compare the rates of local recurrence in hepatocellular carcinoma (HCC) patients who undergo selective transarterial radioembolisation (TARE) or transarterial chemoembolisation (TACE) and achieve a complete response (CR) radiologically. MATERIALS AND METHODS All patients undergoing treatment with TARE or TACE at a single academic institution were reviewed retrospectively. Those who had been treated previously, presented with multifocal disease, had non-selective TARE or TACE, or did not achieve a complete response (CR) radiologically were excluded. RESULTS In total 110 patients were included (TACE n=60 [54.5%]; TARE n=50 [45.5%]). TARE patients were older (66.4 ± 9.4 versus 61.2 ± 5.6 years, p<0.001) and had larger tumours (4.4 ± 2.2 versus 3 ± 1.4 cm, p=0.002). TACE patients were significantly more likely to suffer a local recurrence (31/60, 51.7% versus 9/50, 18%, p<0.001) and had a significantly shorter time to recurrence (median 8.3 {interquartile range [IQR]}: 12 versus median 17.9 [IQR: 23.5] months, p=0.001). A local time to progression (TTP) Kaplan-Meier curve demonstrated TACE patients had a significantly shorter local TTP (hazard ratio [HR]: 7.2; 95% confidence interval [CI]: 3.64-14.24; p<0.001) and treatment modality (TACE or TARE; HR: 0.05; 95% CI: 0.005-0.5; p=0.01) was found to be associated with local recurrences on multivariate Cox proportional HR analysis. When overall TTP was evaluated, again TACE patients were found to have a significantly shorter TTP (HR: 2.13 [1.28-3.53], p=0.004). CONCLUSION In HCC patients undergoing selective treatment who achieve a CR radiologically, those treated with TARE may be less likely to suffer recurrence, either local or general, than those treated with TACE.
Collapse
Affiliation(s)
- S Young
- Department of Radiology, University of Arizona, Division of Interventional Radiology, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724, USA.
| | - T Sanghvi
- Minneapolis VA Hospital, 1 Veterans Dr, Minneapolis, MN 55417, USA
| | - R Ragulojan
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - P Torkian
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - S Todatry
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - D D'Souza
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - S Flanagan
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - J Golzarian
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| |
Collapse
|
2
|
Chehrehgosha H, Chegini H, Heydari I, Ebrahiminik H, Salouti R, Golzarian J. Radiofrequency Ablation of Parathyroid Adenoma: Results of a Retrospective Analysis of 60 Patients. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03725-w. [PMID: 38641669 DOI: 10.1007/s00270-024-03725-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/30/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE To present the effectiveness and safety of radiofrequency ablation (RFA) in parathyroid adenoma (PTA). MATERIALS AND METHODS In this retrospective study, 60 patients with a single PTA were evaluated for changes in biochemical and ultrasonographic features up to 6 months after RFA of the lesion. Adenomas were ablated with an alternative technique so called "Nik jet dissection" which incorporates full hydrodissection and polar artery coagulation. Complications as well as the variations in biochemical data and nodule volumes were analyzed between baseline measurements and at each follow-up interval data (first day, 1, 3, and 6 months after ablation) were analyzed. RESULTS A significant reduction in serum intact parathyroid hormone and calcium levels was observed 6 months after ablation, with a mean difference of - 83.4 ± 104.1 pg/mL, p < 0.001, and - 0.29 ± 0.22 mmol/L, p < 0.001, respectively. Serum phosphorus levels increased significantly with a mean difference of 0.09 ± 0.19 mmol/L, p = 0.040 at the end of the follow up. We observed a significant volume reduction rate of parathyroid adenomas with 89 ± 20.8 percent, p < 0.001. Also, 51% of adenomas disappeared at the end of the follow up. In this study, two cases of hematoma and one case of transient hoarseness (grade 1 of the CIRSE classification) were encountered. CONCLUSION Our study showed that RFA with the alternative technique, called "Nik jet dissection" is a safe and effective modality in management of PTA. Therefore, we suggest expanding the indications for RFA in PTA management, especially when surgery is not feasible. LEVEL OF EVIDENCE Level 3, Local non-random sample.
Collapse
Affiliation(s)
- Haleh Chehrehgosha
- Hazrat Rasool Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | | | - Iraj Heydari
- Endocrinology Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Hojat Ebrahiminik
- Department of Interventional Radiology and Radiation, Sciences Research Center, AJA University of Medical Sciences, Etemadzadeh St, West Fatemi St, Tehran, Tehran Province, 11366, Islamic Republic of Iran.
| | | | - Jafar Golzarian
- Radiology and Vascular Imaging, Amplatz Chair in Interventional Radiology, University of Minnesota, Minneapolis, USA
| |
Collapse
|
3
|
Liu S, Swilling D, Morris EM, Macaulay W, Golzarian J, Hickey R, Taslakian B. Genicular Artery Embolization: A Review of Essential Anatomic Considerations. J Vasc Interv Radiol 2024; 35:487-496.e6. [PMID: 38128722 DOI: 10.1016/j.jvir.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/28/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
Genicular artery embolization is increasingly recognized as a safe and effective treatment option for symptomatic knee osteoarthritis and recurrent hemarthrosis after total knee arthroplasty. Genicular arteries are an essential contributor to vascular supply for the knee joint and demonstrate considerable variability. Familiarity with the anatomy and common variations is critical for preprocedural planning, accurate target selection, and minimizing adverse events in transarterial embolization procedures. This review aimed to provide a detailed discussion of the genicular artery anatomy that is relevant to interventional radiologists performing genicular artery embolization.
Collapse
Affiliation(s)
- Shu Liu
- Department of Radiology, NYU Langone Health, New York, New York
| | - David Swilling
- Department of Radiology, NYU Langone Health, New York, New York
| | | | - William Macaulay
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Jafar Golzarian
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota; Northstar Vascular and Interventional Center, Golden Valley, Minnesota
| | - Ryan Hickey
- Department of Radiology, NYU Langone Health, New York, New York
| | - Bedros Taslakian
- Department of Radiology, NYU Langone Health, New York, New York.
| |
Collapse
|
4
|
Torkian P, Wallace S, Lim N, Flanagan S, Golzarian J, Young SJ. Pre-existing Hepatic Encephalopathy: Really a Contraindication to Elective TIPS? Cardiovasc Intervent Radiol 2024; 47:69-77. [PMID: 37798432 DOI: 10.1007/s00270-023-03566-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/07/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To evaluate the impact of pre-transjugular intrahepatic portosystemic shunt (TIPS) hepatic encephalopathy (HE) on developing post-TIPS HE. MATERIALS AND METHODS In this retrospective, single center observational study, all patients who underwent successful TIPS placement between January 2005 and May 2020 with data pertaining to HE in their chart were included. Patient demographics and procedural details were recorded. Clinical outcomes post-TIPS, were collected and compared across patients with and without pre-TIPS HE. RESULTS Of 326 included patients, 159 (159/326, 48.8%) had a history of pre-TIPS HE. In total those without a history of HE were more likely to develop HE during follow up (136 (136/167, 81.4%) vs 107 (107/159, 67.3%), p = 0.001). When evaluating for predictors of developing HE within 3 months of TIPS placement, no significant variables were found on logistic regression, including prior history of HE (HR 1.16 (95% CI 0.73-1.84), p = 0.529). Univariate and multivariate regression analysis, however, showed that a history of HE was predictive of developing HE at any point in the follow-up period (p = 0.002 and p = 0.008, respectively). However, on Kaplan-Meier analysis no significant difference in the development of HE (p = 0.574) or hospital admission for HE (p = 0.554) post-TIPS was seen between patients with and without pre-TIPS HE. Additionally, there was no difference in 3-month survival (p = 0.412) or overall survival post-TIPS survival (p = 0.798). CONCLUSION Pre-TIPS HE did not predict the development of HE within 3 months of TIPS. Outcomes such as hospital admission and survivability were not different between patients with and without prior HE.
Collapse
Affiliation(s)
- Pooya Torkian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA.
| | - Stephanie Wallace
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA
| | - Nicholas Lim
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Siobhan Flanagan
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA
| | - Jafar Golzarian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA
| | - Shamar J Young
- Department of Medical Imaging, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, USA
| |
Collapse
|
5
|
Ahmadzade M, Rouientan H, Golzarian J, Akhlaghpoor S. An Evaluation of Ultrasound-Guided Percutaneous Microwave Ablation for the Treatment of Symptomatic Uterine Fibroids. J Vasc Interv Radiol 2024; 35:45-50. [PMID: 37748576 DOI: 10.1016/j.jvir.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/12/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE To evaluate the feasibility and effectiveness of ultrasound-guided percutaneous microwave ablation (MWA) for the treatment of symptomatic uterine fibroids. MATERIALS AND METHODS A single-center retrospective study was conducted on 17 patients, mean age 37.5 years (SD ± 7.3; range 19-47 years) with symptomatic uterine fibroid who underwent MWA between September 2018 and December 2022. Outcomes included volume reduction of uterine fibroids, hemoglobin levels, uterine fibroid symptoms, and health-related quality-of-life questionnaire scores before and 12 months after ablation. RESULTS Preoperative fibroid diameter was a mean of 6.7 cm (SD ± 1.1; range 5-9 cm), and volume was a mean of 101.9 cm3 (SD ± 63.3; range 16.9-264.1 cm3). The mean ablation time was 12.2 minutes (SD ± 3.1; range, 8-20 minutes). The mean reduction of volume at 12 months after treatment was 70.9% (SD ± 23.8). The hemoglobin level increased significantly from 9.96 g/dL ± 2.33 before treatment to 12.14 g/dL ± 1.34 at 12 months after treatment (P = .002). The symptom severity score and health-related quality-of-life scores were significantly improved at follow-up (P < .001). CONCLUSIONS The application of MWA as a standalone treatment method might provide an effective, minimally invasive option for Federation of Gynecology and Obstetrics Types 1-6 symptomatic uterine fibroids with the potential to enhance patients' quality of life.
Collapse
Affiliation(s)
- Mohadese Ahmadzade
- Department of Interventional Radiology, Pardis Noor Medical Imaging Center, Tehran, Iran
| | - Hamidreza Rouientan
- Department of Interventional Radiology, Pardis Noor Medical Imaging Center, Tehran, Iran
| | - Jafar Golzarian
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Shahram Akhlaghpoor
- Department of Interventional Radiology, Pardis Noor Medical Imaging Center, Tehran, Iran.
| |
Collapse
|
6
|
İnce O, Önder H, Gençtürk M, Cebeci H, Golzarian J, Young S. Machine Learning Models in Prediction of Treatment Response After Chemoembolization with MRI Clinicoradiomics Features. Cardiovasc Intervent Radiol 2023; 46:1732-1742. [PMID: 37884802 DOI: 10.1007/s00270-023-03574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE To evaluate machine learning models, created with radiomics and clinicoradiomics features, ability to predict local response after TACE. MATERIALS AND METHODS 188 treatment-naïve patients (150 responders, 38 non-responders) with HCC who underwent TACE were included in this retrospective study. Laboratory, clinical and procedural information were recorded. Local response was evaluated by European Association for the Study of the Liver criteria at 3-months. Radiomics features were extracted from pretreatment pre-contrast enhanced T1 (T1WI) and late arterial-phase contrast-enhanced T1 (CE-T1) MRI images. After data augmentation, data were split into training and test sets (70/30). Intra-class correlations, Pearson's correlation coefficients were analyzed and followed by a sequential-feature-selection (SFS) algorithm for feature selection. Support-vector-machine (SVM) models were trained with radiomics and clinicoradiomics features of T1WI, CE-T1 and the combination of both datasets, respectively. Performance metrics were calculated with the test sets. Models' performances were compared with Delong's test. RESULTS 1128 features were extracted. In feature selection, SFS algorithm selected 18, 12, 24 and 8 features in T1WI, CE-T1, combined datasets and clinical features, respectively. The SVM models area-under-curve was 0.86 and 0.88 in T1WI; 0.76, 0.71 in CE-T1 and 0.82, 0.91 in the combined dataset, with and without clinical features, respectively. The only significant change was observed after inclusion of clinical features in the combined dataset (p = 0.001). Higher WBC and neutrophil levels were significantly associated with lower treatment response in univariant analysis (p = 0.02, for both). CONCLUSION Machine learning models created with clinical and MRI radiomics features, may have promise in predicting local response after TACE. LEVEL OF EVIDENCE Level 4, Case-control study.
Collapse
Affiliation(s)
- Okan İnce
- Department of Radiology, Medical School, University of Minnesota, 420 Delaware Street S.E, Minneapolis, MN, 55455, USA.
| | - Hakan Önder
- Department of Radiology, Health Sciences University, Prof. Dr. Cemil TASCIOGLU City Hospital, Istanbul, Turkey
| | - Mehmet Gençtürk
- Department of Radiology, Medical School, University of Minnesota, 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Hakan Cebeci
- Department of Radiology, Medical School, University of Minnesota, 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Jafar Golzarian
- Department of Radiology, Medical School, University of Minnesota, 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Shamar Young
- Department of Radiology, College of Medicine, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA
| |
Collapse
|
7
|
Hund HC, Du L, Matsuoka L, Sze DY, Kennedy AS, Golzarian J, Gandhi RT, Collins ZS, Brown DB. Effect of Previous Transarterial Chemoembolization on Survival and Toxicity after Yttrium-90 Transarterial Radioembolization of Hepatocellular Carcinoma in the Radiation-Emitting SIR-Spheres in Nonresectable Liver Tumor Registry. J Vasc Interv Radiol 2023; 34:2147-2154.e2. [PMID: 37657500 DOI: 10.1016/j.jvir.2023.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/28/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023] Open
Abstract
PURPOSE To determine overall survival (OS), best response, and toxicities in patients with hepatocellular carcinoma (HCC) previously treated with chemoembolization (TACE+) or yttrium-90 resin transarterial radioembolization (TARE) compared with those of TACE-naïve (T-N) participants. MATERIALS AND METHODS In this prospective, observational study, 262 adult participants with HCC were divided into TACE+ (n = 93, 35%) or T-N (n = 169, 65%) groups, included from 36 centers in the United States. Overall survival (OS) was assessed using Kaplan-Meier analysis from the date of TARE. Best response at 6 months was evaluated using modified Response Evaluation Criteria in Solid Tumors. Six-month toxicities were reported using Common Terminology Criteria for Adverse Events, version 5. RESULTS Median OS for patients in the TACE+ and T-N groups was 22.3 months (95% CI: 17.2 to not reachable) and 21.5 months (95% confidence interval [CI]: 14.9-29.9), respectively (P = .6). Imaging at 6 months ± 2 weeks was available in 156 of 262 (60%) participants. Partial or complete response was seen in 27 of 55 patients (49%) in the TACE+ group and 65 of 101 patients (64%) in the T-N group (P = .2). Six-month toxicities were available in 69 of 93 patients (74%) in the TACE+ group and 135 of 167 patients (81%) in the T-N group. Attributable Grade 3 or greater liver function toxicities were similar between the study groups (all P > .05). CONCLUSIONS OS and imaging response at 6 months in the TACE+ group was similar to that in the T-N group with similar toxicities. Radioembolization is an acceptable treatment option for patients with HCC previously treated with TACE.
Collapse
Affiliation(s)
- Hannah C Hund
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Liping Du
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lea Matsuoka
- Transplant Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel Y Sze
- Interventional Radiology, Stanford University, Palo Alto, California
| | - Andrew S Kennedy
- Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tennessee
| | - Jafar Golzarian
- Interventional Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Ripal T Gandhi
- Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Florida
| | | | - Daniel B Brown
- Interventional Radiology, Vanderbilt University Medical Center, Nashville, Tennessee.
| |
Collapse
|
8
|
İnce O, Önder H, Gençtürk M, Golzarian J, Young S. Machine Learning Insights: Predicting Hepatic Encephalopathy After TIPS Placement. Cardiovasc Intervent Radiol 2023; 46:1715-1725. [PMID: 37978062 DOI: 10.1007/s00270-023-03593-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To develop and assess machine learning (ML) models' ability to predict post-procedural hepatic encephalopathy (HE) following transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS In this retrospective study, 327 patients who underwent TIPS for hepatic cirrhosis between 2005 and 2019 were analyzed. Thirty features (8 clinical, 10 laboratory, 12 procedural) were collected, and HE development regardless of severity was recorded one month follow-up. Univariate statistical analysis was performed with numeric and categoric data, as appropriate. Feature selection is used with a sequential feature selection model with fivefold cross-validation (CV). Three ML models were developed using support vector machine (SVM), logistic regression (LR) and CatBoost, algorithms. Performances were evaluated with nested fivefold-CV technique. RESULTS Post-procedural HE was observed in 105 (32%) patients. Patients with variceal bleeding (p = 0.008) and high post-porto-systemic pressure gradient (p = 0.004) had a significantly increased likelihood of developing HE. Also, patients having only one indication of bleeding or ascites were significantly unlikely to develop HE as well as Budd-Chiari disease (p = 0.03). The feature selection algorithm selected 7 features. Accuracy ratios for the SVM, LR and CatBoost, models were 74%, 75%, and 73%, with area under the curve (AUC) values of 0.82, 0.83, and 0.83, respectively. CONCLUSION ML models can aid identifying patients at risk of developing HE after TIPS placement, providing an additional tool for patient selection and management.
Collapse
Affiliation(s)
- Okan İnce
- Department of Radiology, Medical School, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA.
| | - Hakan Önder
- Department of Radiology, Prof. Dr. Cemil TASCIOGLU City Hospital, Health Sciences University, Kaptanpaşa Mah, Daruleceze Cad. No: 25 Prof. Dr. Cemil Taşçıoğlu Şehir Hastanesi, Radyoloji Kliniği, 34384, Şişli, Istanbul, Turkey
| | - Mehmet Gençtürk
- Department of Radiology, Medical School, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA
| | - Jafar Golzarian
- Department of Radiology, Medical School, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA
| | - Shamar Young
- Department of Radiology, College of Medicine, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA
| |
Collapse
|
9
|
Young S, Torkian P, Flanagan S, D’Souza D, Sanghvi T, Golzarian J. Intrahepatic cholangiocarcinoma: a dose threshold evaluation in those undergoing transarterial radioembolization. J Gastrointest Oncol 2023; 14:2202-2211. [PMID: 37969824 PMCID: PMC10643573 DOI: 10.21037/jgo-23-210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/07/2023] [Indexed: 11/17/2023] Open
Abstract
Background Intrahepatic cholangiocarcinoma (ICC) is a rare primary hepatic malignancy. One of the treatment strategies which has shown some promise is transarterial radioembolization (TARE). However, data on dose thresholds, arguably the most important aspect of the procedure itself, is still limited. The study aims to evaluate the relationship between dose to tumor and radiologic response in intrahepatic cholangiocarcinoma patients undergoing transarterial radioembolization. Methods Twenty-patients who underwent treatment for 26 tumors were retrospectively reviewed. Radiologic response at 3-month was evaluated and post yttrium-90 bremsstrahlung single photon emission computerized tomography computed tomography was evaluated to determine tumor dose. Other factors such as particle load and activity per particle were evaluated. Results The mean tumor dose for those with progressive disease or stable disease, partial response, and complete response (CR) by European Association for the Study of Liver (EASL) criteria for the glass cohort was 294±0, 465.4±292.4 and 951.8±666.5 Gy respectively (P=0.039). A receiver operating characteristic (ROC) curve analysis of tumor dose demonstrated an area under the curve (AUC) of 0.738 (P=0.038) with Youden-index analysis demonstrated a cutoff point of >541.7 Gy (sensitivity: 55.56%; specificity: 92.86%) for the glass cohort. Significantly longer survival was noted in those who achieved a CR [HR: 4.79 (95% CI: 1.41-16.25)] and those treated with glass as compared to resin [HR: 5.02 (95% CI: 1.23-20.55), P=0.025]. Of the 17 treatments in 13 patients which were done concomitantly with chemotherapy 7/17 (41.2%) required a delay in chemotherapy, however all patients reinitiated chemotherapy after a delay. Conclusions There appears to be a relationship between tumor dose and radiologic response, with this study suggesting a target of ≥541.7 Gy being warranted in patients receiving treatment with glass microspheres.
Collapse
Affiliation(s)
- Shamar Young
- Division of Interventional Radiology, Department of Medical Imaging, University of Arizona, Tucson, AZ, USA
| | - Pooya Torkian
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis MN, USA
| | - Siobhan Flanagan
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis MN, USA
| | - Donna D’Souza
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis MN, USA
| | - Tina Sanghvi
- Department of Radiology, Arizona Veterans Administration Hospital, Tucson, AZ, USA
| | - Jafar Golzarian
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis MN, USA
| |
Collapse
|
10
|
Khanmohammadi S, Golzarian J, Akhlaghpoor S. CT-guided Transgluteal Prostate Fiducial Marker Insertion for Localized Radiation Therapy. Cardiovasc Intervent Radiol 2023; 46:1409-1413. [PMID: 37640950 DOI: 10.1007/s00270-023-03539-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To Evaluate the safety and technical success of transgluteal CT-guided fiducial marker implantation into the prostate as an alternative method to transperineal and transrectal approaches. MATERIAL AND METHODS We retrospectively identified all patients who had undergone CT-guided transgluteal fiducial marker insertion between 2020 and 2022. Four patients with confirmed prostate cancer were identified. One radiologist performed all procedures via a bilateral transgluteal approach under the guidance of real-time CT-fluoroscopy. Twenty cm long pre-waxed 18G guiding needles, preloaded with smooth gold fiducial markers, were used to implant markers. Technical success was defined as the successful placement of the fiducial markers into the planned positions. RESULTS The mean age of patients was 70 years. The mean procedure time was 19.25 (SD: 6.75) min, and the mean total dose length product (DLP) was 801.75 (SD: 291.17) mGycm, which is compatible with the 12 mSv estimated effective dose. All procedures were technically successful (100%). All patients tolerated the procedure and did not require any analgesia for pain, and there were no requests to stop or pause the procedure. Only one patient reported hematuria one day after the procedure, which required no treatment. CONCLUSION Transgluteal CT-guided fiducial marker implantation into the prostate is an alternative method to transperineal and transrectal approaches. In this technique, the risk of septic complications is minor, and general anesthesia is not required. Thus, transgluteal CT-guided marker insertion is a feasible and well-tolerated method for image-guided radiation therapy (IGRT) in patients with prostate cancer.
Collapse
Affiliation(s)
- Shaghayegh Khanmohammadi
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Jafar Golzarian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Shahram Akhlaghpoor
- Department of Radiology, Pardis Noor Medical Imaging Center, No 5, 25th Street, Sa'adat abad street, Tehran, Iran.
| |
Collapse
|
11
|
Torkian P, Jalaeian H, Wallace S, Shrestha P, Talaie R, Golzarian J. Post-Embolization Hemoglobin Changes: When to Consider Re-intervention. Cardiovasc Intervent Radiol 2023; 46:617-625. [PMID: 36869220 DOI: 10.1007/s00270-023-03386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/05/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Decline in hemoglobin (Hgb) levels is common post-embolization, but there is no consensus on the classification of patients based on risk for re-bleeding or re-intervention. The current study evaluated post-embolization Hgb level trends with the goal of understanding the factors predictive of re-bleeding and re-intervention. MATERIALS AND METHODS All patients who underwent embolization for gastrointestinal (GI), genitourinary, peripheral, or thoracic arterial hemorrhage from 01/2017 to 01/2022 were reviewed. Data included demographics, periprocedural pRBC transfusion (TF) or pressor requirements, and outcome. Lab data consisted of Hgb values pre-embolization, immediately post-embolization, and daily values on days 1-10 after embolization. Hgb trends were compared between patients across TF and re-bleeding outcomes. Regression model was used to examine factors predictive of re-bleeding and magnitude of Hgb reduction post-embolization. RESULTS A total of 199 patients were embolized for active arterial hemorrhage. Perioperative Hgb level trends were similar for all sites and between TF + and TF- patients, showing a decline reaching a nadir within 6 days post-embolization followed by an upward trend. Maximum Hgb drift was predicted by GI embolization (p = 0.018), TF before embolization (p = 0.001), and use of vasopressor (p = 0.000). Patients with Hgb drop > 15% within the first two days post-embolization had a higher chance of having a re-bleeding episode (p = 0.04). CONCLUSION Perioperative Hgb trends showed a consistent downward drift followed by an upward shift, irrespective of TF requirement status or site of embolization. Using a cut-off value of 15% Hgb reduction within the first two days post-embolization may be helpful to assess re-bleeding risk.
Collapse
Affiliation(s)
- Pooya Torkian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA.
| | - Hamed Jalaeian
- Department of Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Stephanie Wallace
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA
| | - Prashant Shrestha
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA
| | - Reza Talaie
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA
| | - Jafar Golzarian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA
| |
Collapse
|
12
|
Hund H, Du L, Matsuoka L, Sze D, Kennedy A, Vaheesan K, Petroziello M, Golzarian J, Wang E, Ghandi R, Collins Z, Brower J, Lee J, Brown D. Abstract No. 79 Comparison of 90Y Radioembolization Outcomes for Hepatocellular Carcinoma (HCC) in TACE-Refractory (T-REF) vs Treatment Naïve (TN) Patients in the RESiN Registry (NCT: 02685631). J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
|
13
|
Talaie R, Torkian P, Golzarian J. Knee and Shoulder Vascular Anatomy. Tech Vasc Interv Radiol 2023; 26:100877. [PMID: 36889840 DOI: 10.1016/j.tvir.2022.100877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the past decade, angiographic studies have demonstrated neovessels in or in the vicinity of affected joints in many musculoskeletal conditions that used to be considered wear and tear joint disease, such as knee osteoarthritis, frozen shoulder, and overuse injuries. The novelty of this finding is showing the presence of neovascularity at an angiographically detectable level, as compared to histologically evident neovessels that had been discovered years ago. These neovessels have now become the target of interventions in a growing field called muscoskeletal embolotherapy. An in-depth and all-encompassing understanding of the vascular anatomy that could specifically assist performing of these procedures is paramount. Such an understanding will help ensure success in clinical outcomes and avoid much dreaded complications. This review discusses the vascular anatomy relevant to the 2 most commonly performed musculoskeletal embolotherapies, genicular artery embolization and transarterial embolization for frozen shoulder.
Collapse
Affiliation(s)
- Reza Talaie
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN.
| | - Pooya Torkian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN.
| | - Jafar Golzarian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN.
| |
Collapse
|
14
|
İnce O, Önder H, Gençtürk M, Cebeci H, Golzarian J, Young S. Prediction of Response of Hepatocellular Carcinoma to Radioembolization: Machine Learning Using Preprocedural Clinical Factors and MR Imaging Radiomics. J Vasc Interv Radiol 2023; 34:235-243.e3. [PMID: 36384224 DOI: 10.1016/j.jvir.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/22/2022] [Accepted: 11/06/2022] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To create and evaluate the ability of machine learning-based models with clinicoradiomic features to predict radiologic response after transarterial radioembolization (TARE). MATERIALS AND METHODS 82 treatment-naïve patients (65 responders and 17 nonresponders; median age: 65 years; interquartile range: 11) who underwent selective TARE were included. Treatment responses were evaluated using the European Association for the Study of the Liver criteria at 3-month follow-up. Laboratory, clinical, and procedural information were collected. Radiomic features were extracted from pretreatment contrast-enhanced T1-weighted magnetic resonance images obtained within 3 months before TARE. Feature selection consisted of intraclass correlation, followed by Pearson correlation analysis and finally, sequential feature selection algorithm. Support vector machine, logistic regression, random forest, and LightGBM models were created with both clinicoradiomic features and clinical features alone. Performance metrics were calculated with a nested 5-fold cross-validation technique. The performances of the models were compared by Wilcoxon signed-rank and Friedman tests. RESULTS In total, 1,128 features were extracted. The feature selection process resulted in 12 features (8 radiomic and 4 clinical features) being included in the final analysis. The area under the receiver operating characteristic curve values from the support vector machine, logistic regression, random forest, and LightGBM models were 0.94, 0.94, 0.88, and 0.92 with clinicoradiomic features and 0.82, 0.83, 0.82, and 0.83 with clinical features alone, respectively. All models exhibited significantly higher performances when radiomic features were included (P = .028, .028, .043, and .028, respectively). CONCLUSIONS Based on clinical and imaging-based information before treatment, machine learning-based clinicoradiomic models demonstrated potential to predict response to TARE.
Collapse
Affiliation(s)
- Okan İnce
- Department of Radiology, Medical School, University of Minnesota, Minneapolis, Minnesota.
| | - Hakan Önder
- Department of Radiology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Health Sciences University, Istanbul, Turkey
| | - Mehmet Gençtürk
- Department of Radiology, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Hakan Cebeci
- Department of Radiology, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Jafar Golzarian
- Department of Radiology, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Shamar Young
- Department of Radiology, College of Medicine, University of Arizona, Tucson, Arizona
| |
Collapse
|
15
|
Young S, Flanagan S, D'Souza D, Todatry S, Ragulojan R, Sanghvi T, Golzarian J. Lung shunt fraction calculations before Y-90 transarterial radioembolization: Comparison of accuracy and clinical significance of planar scintigraphy and SPECT/CT. Diagn Interv Imaging 2023; 104:185-191. [PMID: 36604211 DOI: 10.1016/j.diii.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/02/2022] [Accepted: 12/16/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To determine the accuracy and clinical significance of planar scintigraphy lung shunt fraction (PLSF) and single-photon emission computerized tomography (SPECT) computed tomography (CT) lung shunt fraction (SLSF) before Y-90 transarterial radioembolization. MATERIALS AND METHODS Seventy patients (46 men, 24 women; mean age, 64 ± 9.5 [SD] years) who underwent 83 treatments with Y-90 transarterial radioembolization for primary or secondary malignancies of the liver with a PLSF ≥ 7.5% were retrospectively evaluated. The patients mapping technetium 99 m (Tc-99 m) macroaggregated albumin (MAA) PLSF and SLSF were calculated and compared to the post Y-90 delivery SLSF. A model using modern dose thresholds was created to identify patients who would require dose reduction due to a lung dose ≥ 30 Gy, with patients who required >50% dose reduction considered to be delivery cancelations. RESULTS A significant difference was found between mean PLSF (14.7 ± 11.6 [SD]%; range: 7.5-84.1%) and mean SLSF (8.7 ± 8.5 [SD]%; range: 1.7-73.5) (P < 0.001). The mean realized LSF (7.1 ± 3 [SD]%; range:1.5-17.6) was significantly less than the PLSF (P <0.001) but not the SLSF (P = 0.07). PLSF significantly overestimated the realized LSF by more than the SLSF (8.5 ± 5.3 [SD] % [range: -0.1-21.7] vs. 0.8 ± 3.6 [SD] % [range: -5-13.2], respectively) (P < 0.001). Based on the clinical significance model, 20 patients (20/83, 24.1%) would have required dose reduction or cancelation when using PLSF but would not require even a dose reduction when using the SLSF. Significantly more deliveries would have been be canceled if PLSF was used as compared to SLSF (22/83 [26.5%] vs. 6/83 [7.2%], respectively) (P < 0.001). CONCLUSION SLSF is significantly more accurate at predicting realized LSF than PLSF and this difference is of clinical significance in a number of patients with a PLSF ≥ 7.5%.
Collapse
Affiliation(s)
- Shamar Young
- Department of Medical Imaging, Division of Interventional Radiology, University of Arizona, Tucson, AZ 85724, USA
| | - Siobhan Flanagan
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Donna D'Souza
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Soorya Todatry
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Ranjan Ragulojan
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Tina Sanghvi
- Department of Radiology, Arizona Veterans Administration Hospital, Minneapolis, MN 55417, USA
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| |
Collapse
|
16
|
Jung JH, McCutcheon KA, Borofsky M, Young S, Golzarian J, Kim MH, Narayan V, Dahm P. Prostatic arterial embolisation for men with benign prostatic hyperplasia: a Cochrane review. BJU Int 2023; 131:32-45. [PMID: 35696302 DOI: 10.1111/bju.15823] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the effects of prostatic arterial embolisation (PAE) compared to other procedures for treatment of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). METHODS We included randomised controlled trials (RCTs), as well as non-randomised studies (NRSs) enrolling men with BPH undergoing PAE vs other surgical interventions via a comprehensive search up until 8 November 2021. Two independent reviewers screened the literature, extracted data, assessed risk of bias, performed statistical analyses by using a random-effects model, and rated the certainty of evidence (CoE) of RCTs and NRSs. RESULTS We found data to inform two comparisons: PAE vs transurethral resection of prostate (TURP; six RCTs and two NRSs), and PAE vs sham (one RCT). This abstract focuses on the primary outcomes in a comparison of PAE vs TURP. Short-term follow-up: based on RCT evidence, there may be little to no difference in urological symptom score improvement (mean difference [MD] 1.72, 95% confidence interval [CI] -0.37 to 3.81; low CoE) and quality of life (QoL; MD 0.28, 95% CI -0.28 to 0.84; low CoE) measured by International Prostatic Symptom Score. We are very uncertain about the effects of PAE on major adverse events (risk ratio [RR] 0.75, 95% CI 0.19-2.97; very low CoE). Long-term follow-up: based on RCT evidence, PAE may result in little to no difference in urological symptom scores (MD 2.58, 95% CI -1.54 to 6.71; low CoE) and QoL (MD 0.50, 95% CI -0.03 to 1.04; low CoE). We are very uncertain about major adverse events (RR 0.91, 95% CI 0.20-4.05; very low CoE). CONCLUSION Compared to TURP, the impact on urological symptoms and QoL improvement as perceived by patients appears to be similar. This review did reveal major uncertainty as to how major adverse events compare.
Collapse
Affiliation(s)
- Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, South Korea.,Center of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | | | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Shamar Young
- Division of Interventional Radiology and Vascular Imaging, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Jafar Golzarian
- Division of Interventional Radiology and Vascular Imaging, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Vikram Narayan
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, MN, USA.,Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA
| |
Collapse
|
17
|
Adeniran OR, Nguyen CN, Perez TH, Frantz SK, Matsuoka L, Du L, Gandhi RT, Collins ZS, Matrana MR, Petroziello M, Brower JS, Sze DY, Kennedy AS, Golzarian J, Wang EA, Brown DB. Overall survival and toxicity of hepatocellular carcinoma Barcelona Clinic Liver Cancer B patients receiving Y90 radioembolization: analysis of the radiation-emitting SIR-spheres in non-resectable liver tumor (RESiN) registry. J Gastrointest Oncol 2023; 14:874-885. [DOI: 10.21037/jgo-22-972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
|
18
|
Young S, Chen T, Golzarian J, Sanghvi T. Ablation of Cervical Lymph Nodes in Patients with Thyroid Cancer: A Comparison between Cryoablation and Percutaneous Ethanol Injection. J Vasc Interv Radiol 2022; 34:777-781.e1. [PMID: 36521788 DOI: 10.1016/j.jvir.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/29/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022] Open
Abstract
The purpose of this brief report was to retrospectively evaluate the safety and efficacy of cryoablation and compare the outcomes with those of percutaneous ethanol injection (PEI) for the treatment of metastatic cervical lymph nodes (CLNs) in patients with thyroid cancer at a single center. The study included 24 patients with 47 CLNs treated with PEI and 7 patients with 11 CLNs treated with cryoablation. Three of 7 (42.9%) patients did not respond to PEI and progressed to cryoablation. There were more local recurrences in CLNs treated with PEI (7/47, 14.9%) compared with cryoablation (0/11, 0%), but this did not reach significance (P = .33). There was no difference in mild/moderate (3/24, 12.5% vs 2/7, 28.6%; P = .31) or severe (1/24, 4.2% vs 0/7, 0%; P = 1) adverse events in the PEI and cryoablation cohorts. The number of treatments required for CLNs treated with PEI (2 ± 1.1) was significantly greater than those for CLNs treated with cryoablation (1 ± 0) (P = .002). These limited data suggest that the treatment of metastatic CLNs with cryoablation or PEI may be safe and effective; however, further data are needed.
Collapse
Affiliation(s)
- Shamar Young
- Department of Medical Imaging, Division of Interventional Radiology, University of Arizona, Tucson, Arizona.
| | - Ting Chen
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, Minnesota
| | | |
Collapse
|
19
|
Torkian P, Rosenberg M, Talaie R, Golzarian J. Varicocele Embolization: Interventional Radiologist's Perspective. Semin Intervent Radiol 2022; 39:581-586. [PMID: 36561796 PMCID: PMC9767774 DOI: 10.1055/s-0042-1759734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The goal of this article is to review the patient selection criteria, technical pearls, and outcomes of percutaneous varicocele embolization. This article will provide a brief overview of the history of the procedure, angiographic approach, and materials used in contemporary embolization. The success rates and complications of the varicocele embolization will also be discussed.
Collapse
Affiliation(s)
- Pooya Torkian
- Department of Radiology, Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Michael Rosenberg
- Department of Radiology, Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Reza Talaie
- Department of Radiology, Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Jafar Golzarian
- Department of Radiology, Vascular and Interventional Radiology, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
20
|
Rostambeigi N, Golzarian J, Little MW. Updates on Preprocedural Evaluation and Patient Selection for Prostatic Artery Embolization. Semin Intervent Radiol 2022; 39:547-554. [PMID: 36561799 PMCID: PMC9767769 DOI: 10.1055/s-0042-1760274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Prostatic artery embolization (PAE) is a safe and effective treatment for benign prostatic hyperplasia. Patient evaluation is a critical and important part of this growing practice. History taking should include symptoms score evaluations for lower urinary tract symptoms, erectile function, and prostatitis symptoms score. The objective evaluations commonly include measurement of prostate specific antigen, postvoid residual volume, and uroflowmetry as well as urodynamic studies in selective patients. Imaging evaluation may include computed tomography angiography or magnetic resonance angiography, elucidating prostate volume, prostate gland morphology, vasculature, and prostate cancer. With evolving knowledge on PAE, we aim to discuss patient evaluation and selection based on updated evidence and discuss specific scenarios.
Collapse
Affiliation(s)
- Nassir Rostambeigi
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Jafar Golzarian
- University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Mark W. Little
- Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| |
Collapse
|
21
|
Goswami P, Adeniran OR, K. Frantz S, Matsuoka L, Du L, Gandhi RT, Collins ZS, Matrana MR, Petroziello M, Brower JS, Sze DY, Kennedy AS, Golzarian J, Wang EA, Brown DB. Overall survival and toxicity of Y90 radioembolization for hepatocellular carcinoma patients in Barcelona Clinic Liver Cancer stage C (BCLC-C). BMC Gastroenterol 2022; 22:467. [PMCID: PMC9670475 DOI: 10.1186/s12876-022-02528-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 10/04/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction National Comprehensive Cancer Network HCC guidelines recommend Y90 to treat BCLC-C patients only in select cases given the development of systemic regimens. We sought to identify ideal candidates for Y90 by assessing survival and toxicities in this patient group.
Materials and methods The Radiation-Emitting Selective Internal radiation spheres in Non-resectable tumor registry is a prospective observational study (NCT: 02,685,631). Patients with advanced HCC were stratified into 3 groups based on tumor location, Eastern Cooperative Oncology Group (ECOG) performance status, and liver function. Group 1: liver isolated HCC, ECOG 0 and Child Pugh (CP) A (n = 12, 16%), Group 2: liver isolated HCC, ECOG ≥ 1 or CP B/C (n = 37, 49%), and Group 3: extrahepatic HCC with any ECOG or CP score (n = 26, 35%). Patients in any group could have macrovascular invasion. Overall survival (OS) and progression-free survival (PFS) with 95% confidence intervals (95% CI) were calculated. Grade 3 + toxicities were tracked using Common Terminology Criteria for Adverse Events v5. Cox proportional hazard model was performed to determine factors affecting OS.
Results Seventy-five BCLC-C patients treated between 2015 and 2019 were reviewed. The groups were similar in age, sex, race, and ethnicity (all p > 0.05). Bilobar disease was least common in Group 1 (p < 0.001). Median OS of the entire cohort was 13.6 (95% CI 7.5–16.1) months. Median OS of Groups 1–3 were 21.8, 13.1 and 11.5 months respectively (p = 0.6). Median PFS for the cohort was 6.3 (4.8–14.7) months. Median PFS for group 1 was not reached. Mean PFS for Group 1 was 17.3 ± 4.8 months. Median PFS for Groups 2 and 3 was 6.8 and 5.9 months (X2 = 1.5, p = 0.5). Twenty-four Grade 3 or greater toxicities developed, most commonly hyperbilirubinemia (8/75, 11%) and thrombocytopenia (2/75, 3%). The incidence of toxicities between groups was similar (all p > 0.05). Cox Proportional Hazard analysis predicted shorter OS with CP class B/C (X2 = 6.7, p = 0.01), while macrovascular invasion (X2 = 0.5, p = 0.5) and ECOG score of ≥ 1 (X2 = 2.1, p = 0.3) was not associated with OS. Conclusions OS of CPA patients with advanced HCC and performance status of 0 was 21.8 months following Y90. CP A cirrhosis is the best predictor of prolonged OS in advanced (BCLC-C) HCC.
Collapse
Affiliation(s)
- Pulak Goswami
- grid.152326.10000 0001 2264 7217Vanderbilt University School of Medicine, Nashville, TN USA
| | - Oladapo R. Adeniran
- grid.412807.80000 0004 1936 9916Division of Interventional Radiology, Vanderbilt University Medical Center, CCC-1118 Medical Center North, 1161 21st Ave S, Nashville, TN 37232 USA
| | - Shelby K. Frantz
- grid.412807.80000 0004 1936 9916Division of Interventional Radiology, Vanderbilt University Medical Center, CCC-1118 Medical Center North, 1161 21st Ave S, Nashville, TN 37232 USA
| | - Lea Matsuoka
- grid.412807.80000 0004 1936 9916Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN USA
| | - Liping Du
- grid.412807.80000 0004 1936 9916Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Ripal T. Gandhi
- grid.418212.c0000 0004 0465 0852Miami Cardiac and Vascular Institute/Miami Cancer Institute, Miami, FL USA
| | - Zachary S. Collins
- grid.266515.30000 0001 2106 0692Division of Interventional Radiology, University of Kansas, Kansas City, KS USA
| | - Marc R. Matrana
- grid.240416.50000 0004 0608 1972Division of Hematology/Oncology, Ochsner Medical Center, New Orleans, LA USA
| | - Michael Petroziello
- Division of Interventional Radiology, Roswell Park Medical Institute, Buffalo, NY USA
| | - Jayson S. Brower
- grid.416441.20000 0004 0457 8213Department of Radiology, Sacred Heart Medical Center, Spokane, WA USA
| | - Daniel Y. Sze
- grid.168010.e0000000419368956Division of Interventional Radiology, Stanford University, Palo Alto, CA USA
| | - Andrew S. Kennedy
- grid.419513.b0000 0004 0459 5478Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, TN USA
| | - Jafar Golzarian
- grid.17635.360000000419368657Division of Interventional Radiology, University of Minnesota, Minneapolis, MN USA
| | - Eric A. Wang
- grid.239494.10000 0000 9553 6721Department of Radiology, Carolinas Medical Center, Charlotte, NC USA
| | - Daniel B. Brown
- grid.412807.80000 0004 1936 9916Division of Interventional Radiology, Vanderbilt University Medical Center, CCC-1118 Medical Center North, 1161 21st Ave S, Nashville, TN 37232 USA
| |
Collapse
|
22
|
Torkian P, Ragulojan R, J. Woodhead G, D'Souza D, Flanagan S, Golzarian J, Young S. Lung shunt fraction quantification methods in radioembolization: What you need to know. Br J Radiol 2022; 95:20220470. [DOI: 10.1259/bjr.20220470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In some patients undergoing radioembolization, lung toxicity is a limiting factor when calculating their dose. At the same time, it is known that the lung shunt fraction (LSF) is overestimated by the mapping exam. Furthermore, there are multiple methods to measure LSF. Planar measurement is both the most commonly utilized and easiest to perform, however new dosimetry software provides the ability to use more advanced 3D techniques. This paper reviews the different LSF calculation methods and elucidates the available data comparing the techniques, clinical relevance, and dose calculation.
Collapse
Affiliation(s)
- Pooya Torkian
- Department of Radiology, Vascular and Interventional Radiology, University of Minnesota, Minneapolis, United States
| | - Ranjan Ragulojan
- Department of Radiology, Vascular and Interventional Radiology, University of Minnesota, Minneapolis, United States
| | - Gregory J. Woodhead
- Department of Medical Imaging, University of Arizona, 1501 North Campbell Avenue, Tucson, United States
| | - Donna D'Souza
- Department of Radiology, Vascular and Interventional Radiology, University of Minnesota, Minneapolis, United States
| | - Siobhan Flanagan
- Department of Radiology, Vascular and Interventional Radiology, University of Minnesota, Minneapolis, United States
| | - Jafar Golzarian
- Department of Radiology, Vascular and Interventional Radiology, University of Minnesota, Minneapolis, United States
| | - Shamar Young
- Department of Medical Imaging, University of Arizona, 1501 North Campbell Avenue, Tucson, United States
| |
Collapse
|
23
|
Emmons EC, Bishay S, Du L, Krebs H, Gandhi RT, Collins ZS, O'Hara R, Akhter NM, Wang EA, Grilli C, Brower JS, Peck SR, Petroziello M, Abdel Aal AK, Golzarian J, Kennedy AS, Matsuoka L, Sze DY, Brown DB. Survival and Toxicities after 90Y Transarterial Radioembolization of Metastatic Colorectal Cancer in the RESIN Registry. Radiology 2022; 305:228-236. [PMID: 35762890 DOI: 10.1148/radiol.220387] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Patients with unresectable, chemorefractory hepatic metastases from colorectal cancer have considerable mortality. The role of transarterial radioembolization (TARE) with yttrium 90 (90Y) microspheres is not defined because most reports are from a single center with limited patient numbers. Purpose To report outcomes in participants with colorectal cancer metastases treated with resin 90Y microspheres from a prospective multicenter observational registry. Materials and Methods This study treated enrolled adult participants with TARE using resin microspheres for liver-dominant metastatic colorectal cancer at 42 centers, with enrollment from July 2015 through August 2020. TARE was used as the first-, second-, or third-line therapy or beyond. Overall survival (OS), progression-free survival (PFS), and toxicity outcomes were assessed by line of therapy by using Kaplan-Meier analysis for OS and PFS and Common Terminology Criteria for Adverse Events, version 5, for toxicities. Results A total of 498 participants (median age, 60 years [IQR, 52-69 years]; 298 men [60%]) were treated. TARE was used in first-line therapy in 74 of 442 participants (17%), second-line therapy in 180 participants (41%), and third-line therapy or beyond in 188 participants (43%). The median OS of the entire cohort was 15.0 months (95% CI: 13.3, 16.9). The median OS by line of therapy was 13.9 months for first-line therapy, 17.4 months for second-line therapy, and 12.5 months for third-line therapy (χ2 = 9.7; P = .002). Whole-group PFS was 7.4 months (95% CI: 6.4, 9.5). The median PFS by line of therapy was 7.9 months for first-line therapy, 10.0 months for second-line therapy, and 5.9 months for third-line therapy (χ2 = 8.3; P = .004). TARE-attributable grade 3 or 4 hepatic toxicities were 8.4% for bilirubin (29 of 347 participants) and 3.7% for albumin (13 of 347). Grade 3 and higher toxicities were greater with third-line therapy for bilirubin (P = .01) and albumin (P = .008). Conclusion Median overall survival (OS) after transarterial radioembolization (TARE) with yttrium 90 microspheres for liver-dominant metastatic colorectal cancer was 15.0 months. The longest OS was achieved when TARE was part of second-line therapy. Grade 3 or greater hepatic function toxicity rates were less than 10%. Clinical trial registration no. NCT02685631 Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Liddell in this issue.
Collapse
Affiliation(s)
- Erica C Emmons
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Steven Bishay
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Liping Du
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Henry Krebs
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Ripal T Gandhi
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Zachary S Collins
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Ryan O'Hara
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Nabeel M Akhter
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Eric A Wang
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Christopher Grilli
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Jayson S Brower
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Shannon R Peck
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Michael Petroziello
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Ahmed K Abdel Aal
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Jafar Golzarian
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Andrew S Kennedy
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Lea Matsuoka
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Daniel Y Sze
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Daniel B Brown
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| |
Collapse
|
24
|
Ince O, Önder H, Gencturk M, Cebeci H, Golzarian J, Young S. Abstract No. 27 Radiomics with machine learning in selective internal radiation therapy: prediction of radiologic response. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
25
|
Torkian P, Talaie R, Shrestha P, Spano A, Rosenberg M, D’Souza D, Golzarian J. Abstract No. 75 Endovascular treatment of visceral artery aneurysms and pseudoaneurysms: comparing outcomes of self-expandable vs balloon-expandable stent grafts. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
26
|
Emmons E, Krebs H, Gandhi R, Collins Z, O’Hara R, Akhter N, Wang E, Grilli C, Brower J, Peck S, Petroziello M, Aal AA, Golzarian J, Kennedy A, Matsuoka L, Sze D, Brown D. Abstract No. 1 ▪ ABSTRACT OF THE YEAR Survival outcomes and toxicities following Y-90 radioembolization of colorectal cancer metastatic to the liver: 498-patient analysis from the RESiN registry (NCT: 02685631). J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
27
|
Rohr A, Collins Z, Hodson A, Zhang K, Krebs H, Ghandi R, O’Hara R, Akhter N, Wang E, Grilli C, Brower J, Peck S, Petroziello M, Aal AA, Golzarian J, Brown D. Abstract No. 32 Multi-institutional review of patients receiving Y-90 transarterial radioembolization (TARE) with hepatic tumors status post partial hepatectomy. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
28
|
Young S, Sanghvi T, Ragulojan R, Torkian P, Todarty S, D’Souza D, Flanagan S, Golzarian J. Abstract No. 30 Local recurrence following complete radiologic response: a comparison of transarterial radioembolization and transarterial chemoembolization. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
29
|
Ince O, Önder H, Gencturk M, Golzarian J, Young S. Abstract No. 220 Machine learning and refractory ascites: ability to predict those who will respond to TIPS placement. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
30
|
Goswami P, Adeniran O, Frantz S, Matsuoka L, Du L, Gandhi R, Collins Z, Matrana M, Petroziello M, Brower J, Sze D, Kennedy A, Golzarian J, Wang E, Brown D. Abstract No. 196 Overall survival and toxicities of advanced hepatocellular carcinoma (HCC) Barcelona clinic liver cancer C (BCLC-C) patients following Y-90 radioembolization: assessment from the RESiN Registry (NCT: 02685631). J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
31
|
Torkian P, Young S, Jahangiri Y, Rosenberg M, Shrestha P, Golzarian J, Talaie R. Abstract No. 534 Effects of lumbar spine construct and movements in May-Thurner syndrome using a detailed Finite Element Model (FEM). J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
32
|
Torkian P, Talaie R, Golzarian J, Akhlaghpoor S. Abstract No. 182 Transarterial bleomycin–Lipiodol embolization (B/LE) for symptomatic giant hepatic hemangioma: interim analysis. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
33
|
White S, Aal AA, Gandhi R, Kalva S, Golzarian J, Collins Z, Haste P, Foteh M, Lynch F, Cornejo S, Rilling W. Abstract No. 297 Interim results of a prospective, multi-center, single-arm, real-world study assessing the clinical use of the Caterpillar Arterial Embolization Device for arterial embolization in the peripheral vasculature (MONARCH). J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
34
|
Young S, Ragulojan R, Torkian P, Todarty S, Sanghvi T, D’Souza D, Golzarian J, Flanagan S. Abstract No. 559 Planar vs 3D: comparison of two lung shunt fraction calculation methods utilized for radioembolization. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
35
|
Talaie R, Torkian P, Amili O, Aboufirass Y, Rostambeigi N, Jalaeian H, Golzarian J. Particle Distribution in Embolotherapy, How Do They Get There? A Critical Review of the Factors Affecting Arterial Distribution of Embolic Particles. Ann Biomed Eng 2022; 50:885-897. [PMID: 35524027 DOI: 10.1007/s10439-022-02965-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/05/2022] [Indexed: 11/26/2022]
Abstract
Embolization has tremendously evolved in recent years and has expanded to treatment of a variety of pathologic processes. There has been emerging evidence that the level of arterial occlusion and the distribution of embolic particles may play an important role in the clinical outcome. This is a comprehensive literature review to identify variables that play important role in determination of level of occlusion of blood vessels and distribution of embolic particles. The literature searches between 1996 to 2020 through PubMed and Ovid-MEDLINE yielded over 1030 articles of which 30 studies providing details on the level of occlusion are reviewed here. We divided the playing factors into characteristics of the particles, solution/injection and vascular bed. Accordingly, particle size, type and aggregation, compressibility/deformability, and biodegradability are categorized as the factors involving particles' behavioral nature. Infusion rate and concentration/dilution of the medium are related to the carrying solution. Hemodynamics and the arterial resistance are characteristics of the vascular bed that also play an important role in the distribution of embolic particles. Understanding and predicting the level of embolization is a complex multi-factor problem that requires more evidence, warranting further randomized controlled trials, and powered human and animal studies.
Collapse
Affiliation(s)
- Reza Talaie
- Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Pooya Torkian
- Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, MN, USA.
| | - Omid Amili
- Department of Mechanical, Industrial and Manufacturing Engineering (MIME), University of Toledo, Toledo, OH, USA
| | | | - Nassir Rostambeigi
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Hamed Jalaeian
- Department of Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jafar Golzarian
- Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
36
|
Jung JH, McCutcheon KA, Borofsky M, Young S, Golzarian J, Kim MH, Narayan VM, Dahm P. Prostatic arterial embolization for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev 2022; 3:CD012867. [PMID: 35349161 PMCID: PMC8962961 DOI: 10.1002/14651858.cd012867.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND A variety of minimally invasive surgical approaches are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Prostatic arterial embolization (PAE) is a relatively new, minimally invasive treatment approach. OBJECTIVES To assess the effects of PAE compared to other procedures for treatment of LUTS in men with BPH. SEARCH METHODS We performed a comprehensive search the Cochrane Library, MEDLINE, Embase, three other databases, trials registries, other sources of grey literature, and conference proceedings with no restrictions on language of publication or publication status, up to 8 November 2021. SELECTION CRITERIA We included parallel-group randomized controlled trials (RCTs), as well as non-randomized studies (NRS, limited to prospective cohort studies with concurrent comparison groups) enrolling men over the age of 40 years with LUTS attributed to BPH undergoing PAE versus TURP or other surgical interventions. DATA COLLECTION AND ANALYSIS: Two review authors independently classified studies for inclusion or exclusion and abstracted data from the included studies. We performed statistical analyses by using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We used GRADE guidance to rate the certainty of evidence of RCTs and NRSs. MAIN RESULTS: We found data to inform two comparisons: PAE versus TURP (six RCTs and two NRSs), and PAE versus sham (one RCT). Mean age was 66 years, International Prostate Symptom Score (IPSS) was 22.8, and prostate volume of participants was 72.8 mL. This abstract focuses on the comparison of PAE versus TURP as the primary topic of interest. Prostatic arterial embolization versus transurethral resection of the prostate We included six RCTs and two NRSs with short-term (up to 12 months) follow-up, and two RCTs and one NRS with long-term follow-up (13 to 24 months). Short-term follow-up: based on RCT evidence, there may be little to no difference in urologic symptom score improvement measured by the International Prostatic Symptom Score (IPSS) on a scale from 0 to 35, with higher scores indicating worse symptoms (mean difference [MD] 1.72, 95% confidence interval [CI] -0.37 to 3.81; 6 RCTs, 360 participants; I² = 78%; low-certainty evidence). There may be little to no difference in quality of life as measured by the IPSS-quality of life question on a scale from 0 to 6, with higher scores indicating worse quality of life between PAE and TURP, respectively (MD 0.28, 95% CI -0.28 to 0.84; 5 RCTs, 300 participants; I² = 63%; low-certainty evidence). While we are very uncertain about the effects of PAE on major adverse events (risk ratio [RR] 0.75, 95% CI 0.19 to 2.97; 4 RCTs, 250 participants; I² = 24%; very low-certainty evidence), PAE likely increases retreatments (RR 3.20, 95% CI 1.41 to 7.27; 4 RCTs, 303 participants; I² = 0%; moderate-certainty evidence). PAE may make little to no difference in erectile function measured by the International Index of Erectile Function-5 on a scale from 1 to 25, with higher scores indicating better function (MD -0.50 points, 95% CI -5.88 to 4.88; 2 RCTs, 120 participants; I² = 68%; low-certainty evidence). Based on NRS evidence, PAE may reduce the occurrence of ejaculatory disorders (RR 0.51, 95% CI 0.35 to 0.73; 1 NRS, 260 participants; low-certainty evidence). Long-term follow-up: based on RCT evidence, PAE may result in little to no difference in urologic symptom scores (MD 2.58 points, 95% CI -1.54 to 6.71; 2 RCTs, 176 participants; I² = 73%; low-certainty evidence) and quality of life (MD 0.50 points, 95% CI -0.03 to 1.04; 2 RCTs, 176 participants; I² = 29%; low-certainty evidence). We are very uncertain about major adverse events (RR 0.91, 95% CI 0.20 to 4.05; 2 RCTs, 206 participants; I² = 72%; very low-certainty evidence). PAE likely increases retreatments (RR 3.80, 95% CI 1.32 to 10.93; 1 RCT, 81 participants; moderate-certainty evidence). While PAE may result in little to no difference in erectile function (MD 3.09 points, 95% CI -0.76 to 6.94; 1 RCT, 81 participants; low-certainty evidence), PAE may reduce the occurrence of ejaculatory disorders (RR 0.67, 95% CI 0.45 to 0.98; 1 RCT, 50 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Compared to TURP, PAE may provide similar improvement in urologic symptom scores and quality of life. While we are very uncertain about major adverse events, PAE likely increases retreatment rates. While erectile function may be similar, PAE may reduce ejaculatory disorders. Certainty of evidence for the outcomes of this review was low or very low except for retreatment (moderate-certainty evidence), signaling that our confidence in the reported effect size is limited or very limited, and that this topic should be better informed by future research.
Collapse
Affiliation(s)
- Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
- Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
| | | | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shamar Young
- Department of Radiology, Division of Interventional Radiology & Vascular Imaging, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology & Vascular Imaging, University of Minnesota, Minneapolis, Minnesota, USA
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Vikram M Narayan
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| |
Collapse
|
37
|
Gerberding S, Golzarian J. Prostate Artery Embolization for Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia- Radiology In Training. Radiology 2022; 304:31-37. [PMID: 35348376 DOI: 10.1148/radiol.212419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 71-year-old man was evaluated and treated with prostate artery embolization (PAE) for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Appropriate patient selection, workup, and expected treatment outcomes for PAE are discussed.
Collapse
Affiliation(s)
- Shannon Gerberding
- From the Department of Radiology, University of Minnesota, 420 Delaware St SE, MMC 292, Minneapolis, MN 55455
| | - Jafar Golzarian
- From the Department of Radiology, University of Minnesota, 420 Delaware St SE, MMC 292, Minneapolis, MN 55455
| |
Collapse
|
38
|
Young S, Rubin N, D'Souza D, Sharma P, Pontolillo J, Flanagan S, Golzarian J, Sanghvi T. Inflammatory Scores: Correlation with Clinical Outcomes in Hepatocellular Carcinoma Patients Undergoing Transarterial Radioembolization. Cardiovasc Intervent Radiol 2022; 45:461-475. [PMID: 35178599 DOI: 10.1007/s00270-022-03080-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/26/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the ability of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), aspartate aminotransferase-to-lymphocyte ratio (ALRI) and systemic-inflammation index (SII) to predict clinical outcomes in hepatocellular carcinoma (HCC) patients undergoing transarterial radioembolization (TARE). MATERIALS AND METHODS One hundred forty-five patients who underwent treatment of 167 HCCs had their pretreatment and 1 month post treatment laboratory values evaluated. Overall survival (OS), progression-free survival (PFS) and local PFS models were performed with patients separated by median inflammatory scores. RESULTS The median pretreatment NLR, PLR, ALRI and SII were 3.0 (range: 0.5-176), 104.4 (range: 25-830), 55.7 (range: 7.5-2090) and 360.2 (range: 51.1-7207.8), respectively. While the median post treatment NLR, PLR, ALRI and SII were 6.2 (range: 0.4-176), 180 (range: 35-2100), 125 (range: 15.9-5710) and 596.8 (range: 28.9-19,320), respectively. OS models showed significant differences when separating the groups by median post treatment NLR (p = 0.003) and SII (p = 0.003). Multivariate Cox regression models for OS with all pre and post treatment inflammatory markers (log-scale) as well as tumor size, AFP and Child-Pugh score showed significant pretreatment NLR [HR: 0.22 (95% CI:0.06-0.75), p = 0.016] and SII [3.52 (95% CI: 1.01-12.3), p = 0.048], as well as post treatment NLR [6.54 (95% CI: 1.57-27.2), p = 0.010] and SII [0.20 (95% CI: 0.05-0.82), p = 0.025] association. The post treatment ALRI (p = 0.010) correlated with PFS while, post treatment NLR (p < 0.001), ALRI (p = 0.024) and SII (p = 0.005) correlated with local PFS. CONCLUSION Pretreatment and post treatment NLR and SII may be associated with OS and post treatment ALRI may be associated with both PFS and local PFS in HCC patients undergoing TARE.
Collapse
Affiliation(s)
- Shamar Young
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delware St. SE, MMC 292, Minneapolis, MN, 55455, USA.
| | - Nathan Rubin
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delware St. SE, MMC 292, Minneapolis, MN, 55455, USA
| | - Donna D'Souza
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delware St. SE, MMC 292, Minneapolis, MN, 55455, USA
| | - Pranav Sharma
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delware St. SE, MMC 292, Minneapolis, MN, 55455, USA
| | - John Pontolillo
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delware St. SE, MMC 292, Minneapolis, MN, 55455, USA
| | - Siobhan Flanagan
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delware St. SE, MMC 292, Minneapolis, MN, 55455, USA
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delware St. SE, MMC 292, Minneapolis, MN, 55455, USA
| | - Tina Sanghvi
- Department of Radiology, Minneapolis VA Medical Center, Minneapolis, MN, USA
| |
Collapse
|
39
|
Torkian P, Golzarian J, Talaie R. Osteoarthritis-Related Knee Pain Treated With Genicular Artery Embolization: Letter to the Editor. Orthop J Sports Med 2022; 10:23259671211065422. [PMID: 35155700 PMCID: PMC8832583 DOI: 10.1177/23259671211065422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
40
|
Young S, Ragulojan R, Chen T, Owen J, D’souza D, Sanghvi T, Golzarian J, Flanagan S. Dynamic Lymphocyte Changes Following Transarterial Radioembolization: Association with Normal Liver Dose and Effect on Overall Survival. J Hepatocell Carcinoma 2022; 9:29-39. [PMID: 35155299 PMCID: PMC8824436 DOI: 10.2147/jhc.s350219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the dynamic changes of lymphocytes following transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC) and their relationship to normal liver dose (NLD). Materials and Methods A total of 93 patients who underwent 102 treatments were retrospectively reviewed. Absolute lymphocyte counts pretreatment and at 1, 3, 6, and 12 months were evaluated. Kaplan–Meier, Spearman correlation, receiver operating characteristic (ROC) curve, and area under the curve (AUC) analyses were performed. Results The mean absolute lymphocyte count at baseline was 1.25 ± 0.79 103/µL which was significantly greater than 1 (0.71 ± 0.47 103/µL, p<0.0001), 3 (0.79 ± 0.77 103/µL, p=0.0003), and 6 (0.81 ± 0.44 103/µL, p=0.0001) months, but not significantly different than 12 (0.92 ± 0.8 103/µL, p=0.12) months post treatment. There was a modest negative correlation between NLD and lymphocyte count at 1 month (rho= −0.216, p=0.03), which strengthened at 3 months post treatment (rho= −0.342, p=0.008). AUC of ROC analysis between absolute lymphocyte count ≤1 103/µL or >1 103/µL at 1, 3, 6, and 12 months post treatment was 0.625, 0.676, 0.560, and 0.794, respectively. Univariate analysis of overall survival when separating patients by a lymphocyte count of ≤1 103/µL and >1 103/µL demonstrated a significant difference at 1 (HR: 0.56, 95% CI: 0.33–0.95, p=0.03), 3 (HR: 0.41, 95% CI: 0.18–0.94, p=0.035) and 6 (HR: 0.36, 95% CI: 0.17–0.77, p=0.008) months post treatment, but not pretreatment or at 12 months. Conclusion NLD may correlate with lymphocyte depression at 1 and 3 months and lymphopenia may portend a worse overall survival in the post treatment setting.
Collapse
Affiliation(s)
- Shamar Young
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
- Correspondence: Shamar Young, Tel +1 612-624-6189, Email
| | - Ranjan Ragulojan
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Ting Chen
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Joshua Owen
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Donna D’souza
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Tina Sanghvi
- Minneapolis VA Medical Center, Department of Radiology, Minneapolis, MN, 55455, USA
| | - Jafar Golzarian
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Siobhan Flanagan
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| |
Collapse
|
41
|
Young S, Moran P, Golzarian J. Ejaculatory dysfunction following prostate artery embolization: A retrospective study utilizing the male sexual health questionnaire-ejaculation dysfunction questionnaire. Diagn Interv Imaging 2022; 103:310-315. [DOI: 10.1016/j.diii.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/28/2022]
|
42
|
Young S, Larson AS, Torkian P, Golzarian J. Embolic Materials: Understanding the Ocean of Choices. The Arab Journal of Interventional Radiology 2022. [DOI: 10.1055/s-0042-1746412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractEmbolization is a fundamental procedure that interventional radiologists perform on a daily basis to treat a variety of diseases. The disease processes for which embolization is considered a safe and effective treatment are continuously expanding, as are the embolization materials available for use. To achieve optimal clinical outcomes and minimize complications, it is imperative that the interventional radiologist understands the properties, strengths, and weaknesses of each class of embolic and specific embolic products. This is a continuous process as new materials are always becoming available. This article reviews the different classes of embolic materials, discusses strengths and weaknesses, and reviews areas of innovation.
Collapse
Affiliation(s)
- Shamar Young
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Anthony S. Larson
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Pooya Torkian
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Jafar Golzarian
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States
| |
Collapse
|
43
|
Young S, Cam I, Gencturk M, Rubin N, D’souza D, Flanagan S, Golzarian J, Sanghvi T. Inflammatory Scores: Comparison and Utility in HCC Patients Undergoing Transarterial Chemoembolization in a North American Cohort. J Hepatocell Carcinoma 2021; 8:1513-1524. [PMID: 34881208 PMCID: PMC8646226 DOI: 10.2147/jhc.s335183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/17/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The purpose of this study is to determine and compare the ability of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), aspartate-aminotransferase-to-lymphocyte ratio (ALRI), systemic-inflammation index (SII) and lymphocyte count to predict oncologic outcomes in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE). MATERIALS AND METHODS A single-center retrospective review of 296 patients who were treated for 457 HCCs was performed. Pre- and post-treatment laboratory and treatment outcome variables were collected. Objective radiologic response (ORR), progression-free survival (PFS), and overall survival (OS) were evaluated. Patients were categorized into above and below median scores and compared. RESULTS The median pretreatment NLR, PLR, ALRI, SII, and lymphocyte count were 2.7 (range: 0.4-55), 88.3 (range: 0.1-840), 71.8 (range: 0.1-910), 238.1 (range: 0.1-5150.8), and 1 (range: 0.1-5.2) 103/µL, respectively. Patients with above median ALRI scores were less likely to achieve an ORR as compared to those with below median ALRI values (132 (132/163, 81%) vs 150 (150/163, 92%), p = 0.004). On univariate analysis, patients with above median pretreatment NLR (HR 1.41, 95% CI: 1.09-1.83, p = 0.01) and below median lymphocyte count (HR 0.69, 95% CI: 0.53-0.92, p = 0.01) had significantly worse PFS. The relationship between PFS and NLR (p = 0.08) as well as lymphocytes (p = 0.20) no longer remained on multivariate analysis. On univariate analysis, below median pretreatment NLR (HR 1.72, 95% CI: 1.2-2.45, p = 0.003) and ALRI (HR 1.52, 95% CI: 1.05-2.2); p = 0.03) as well as above median lymphocyte count (HR 0.48, 95% CI: 0.34-0.7, p < 0.0001) were associated with improved OS. The significant relationship between lymphocytes and OS remained on multivariate analysis (HR 0.50, 95% CI: 0.28-0.9, p = 0.02), but the relationship with NLR (p = 0.94) did not persist. CONCLUSION NLR is predictive of PFS and OS in patients with HCC undergoing TACE and may be superior to other inflammatory scores (PLR, ALRI, and SII) in this setting. However, lymphocyte count may be most predictive of OS.
Collapse
Affiliation(s)
- Shamar Young
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Isa Cam
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Mehmet Gencturk
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Nathan Rubin
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Donna D’souza
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Siobhan Flanagan
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Jafar Golzarian
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Tina Sanghvi
- Minneapolis VA Medical Center, Department of Radiology, Minneapolis, MN, USA
| |
Collapse
|
44
|
Young S, Rostambeigi N, Golzarian J. The Common but Complicated Tool: Review of Embolic Materials for the Interventional Radiologist. Semin Intervent Radiol 2021; 38:535-541. [PMID: 34853499 PMCID: PMC8612830 DOI: 10.1055/s-0041-1736658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Embolization is an important and widely utilized technique in interventional radiology. There are a variety of different categories and individual products which can be utilized to perform embolization. Understanding the different classes of embolic agents, the important features of each of these classes including strengths and limitations, and the variation in individual products within the classes is critical for interventional radiologist to practice safely and effectively. This article reviews the different kinds of embolics and relays some of the pertinent physical and chemical properties of individual products which should be considered when determining which embolic to select for a given purpose.
Collapse
Affiliation(s)
- Shamar Young
- Department of Radiology, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Nassir Rostambeigi
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Jafar Golzarian
- Department of Radiology, University of Minnesota Medical Center, Minneapolis, Minnesota
| |
Collapse
|
45
|
Franco JVA, Jung JH, Imamura M, Borofsky M, Omar MI, Escobar Liquitay CM, Young S, Golzarian J, Veroniki AA, Garegnani L, Dahm P. Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta-analysis. BJU Int 2021; 130:142-156. [PMID: 34820997 DOI: 10.1111/bju.15653] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the comparative effectiveness and ranking of minimally invasive treatments (MITs) for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS We searched multiple databases up to 24 February 2021. We included randomized controlled trials assessing the following treatments: convective radiofrequency water vapour thermal therapy (WVTT; or Rezūm); prostatic arterial embolization (PAE); prostatic urethral lift (PUL; or Urolift); temporary implantable nitinol device (TIND); and transurethral microwave thermotherapy (TUMT) compared to transurethral resection of the prostate (TURP) or sham surgery. We performed a frequentist network meta-analysis. RESULTS We included 27 trials involving 3017 men. The overall certainty of the evidence of most outcomes according to GRADE was low to very low. Compared to TURP, we found that PUL and PAE may result in little to no difference in urological symptoms, while WVTT, TUMT and TIND may result in worse urological symptoms. MITs may result in little to no difference in quality of life, compared to TURP. MITs may result in a large reduction in major adverse events compared to TURP. We were uncertain about the effects of PAE and PUL on retreatment compared to TURP, however, TUMT may result in higher retreatment rates. We were very uncertain of the effects of MITs on erectile function and ejaculatory function. Among MITs, PUL and PAE had the highest likelihood of being the most efficacious for urinary symptoms and quality of life, TUMT for major adverse events, WVTT and TIND for erectile function and PUL for ejaculatory function. Excluding WVTT and TIND, for which there were only studies with short-term (3-month) follow-up, PUL had the highest likelihood of being the most efficacious for retreatment. CONCLUSIONS Minimally invasive treatments may result in similar or worse effects concerning urinary symptoms and quality of life compared to TURP at short-term follow-up.
Collapse
Affiliation(s)
- Juan Victor Ariel Franco
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, South Korea.,Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, South Korea
| | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Muhammad Imran Omar
- Guidelines Office, European Association of Urology, Arnhem, The Netherlands.,Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | | | - Shamar Young
- Department of Radiology, Division of Interventional Radiology & Vascular Imaging, University of Minnesota, Minneapolis, MN, USA
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology & Vascular Imaging, University of Minnesota, Minneapolis, MN, USA
| | - Areti Angeliki Veroniki
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Luis Garegnani
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA
| |
Collapse
|
46
|
Wongjarupong N, Said HS, Huynh RK, Golzarian J, Lim N. Hemoperitoneum From Bleeding Intra-Abdominal Varices: A Rare, Life-Threatening Cause of Abdominal Pain in a Patient With Cirrhosis. Cureus 2021; 13:e18955. [PMID: 34815901 PMCID: PMC8605961 DOI: 10.7759/cureus.18955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/05/2022] Open
Abstract
We report the case of a 54-year-old male with alcoholic cirrhosis who presented several times to the emergency department (ED) with right upper quadrant abdominal pain. Ten days after his initial presentation, the patient represented with hypotension and anemia. An abdominal CT angiogram identified hemorrhage from an ectopic varix successfully treated with emergent glue embolization of mesenteric, omental, and periumbilical varices. Intraperitoneal bleeding from ectopic varices in cirrhosis patients is a rare, life-threatening condition. Consideration and recognition of ectopic variceal hemorrhage in patients with cirrhosis can facilitate prompt life-saving treatment in a population susceptible to significant morbidity and mortality.
Collapse
Affiliation(s)
- Nicha Wongjarupong
- Internal Medicine, University of Minnesota, Minneapolis, USA.,Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, USA
| | - Hamdi S Said
- Gastroenterology and Hepatology, University of Minnesota, Minneapolis, USA
| | - Richie K Huynh
- Medicine, M Health Fairview Woodwinds Hospital, Woodbury, USA
| | - Jafar Golzarian
- Interventional Radiology, University of Minnesota, Minneapolis, USA
| | - Nicholas Lim
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, USA
| |
Collapse
|
47
|
Talaie R, Torkian P, Moghadam AD, Tradi F, Vidal V, Sapoval M, Golzarian J. Hemorrhoid embolization: A review of current evidences. Diagn Interv Imaging 2021; 103:3-11. [PMID: 34456172 DOI: 10.1016/j.diii.2021.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 12/21/2022]
Abstract
Hemorrhoids are local vascular structure dilations in the lower rectum, associated with morbidity and reduced quality of life. Endovascular coil or particle embolization of the superior rectal arteries, known as Emborrhoid technique, is a minimally invasive, image-guided therapy that targets the hemorrhoidal plexus and reduces hemorrhage. The purpose of this review was to analyze the results of published studies to determine the efficacy, clinical outcomes, and morbidities associated with the endovascular occlusion of hemorrhoidal arteries for the treatment of internal hemorrhoids. Current evidences suggest that hemorrhoids treated by Emborrhoid technique using microcoils, embolic particles or a combination is safe with no reported serious complications. Hemorrhoid embolization can preserve the anal tone without direct anorectal trauma and maintain the hemorrhoidal tissue in place requiring minimal local wound care on an outpatient basis. However, due to the paucity of high-quality trials, further research is warranted to evaluate its long-term outcomes, compare its efficacy with other treatment modalities, and fully assess its role in the treatment of hemorrhoid.
Collapse
Affiliation(s)
- Reza Talaie
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, 55455 Minneapolis, USA.
| | - Pooya Torkian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, 55455 Minneapolis, USA
| | - Arash Dooghaie Moghadam
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Farouk Tradi
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, 13005 Marseille, France
| | - Vincent Vidal
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, 13005 Marseille, France
| | - Marc Sapoval
- Vascular and Oncological Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France; Université de Paris, Faculté de Médecine, 75006 Paris, France
| | - Jafar Golzarian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, 55455 Minneapolis, USA
| |
Collapse
|
48
|
Franco JV, Jung JH, Imamura M, Borofsky M, Omar MI, Escobar Liquitay CM, Young S, Golzarian J, Veroniki AA, Garegnani L, Dahm P. Minimally invasive treatments for lower urinary tract symptoms in men with benign prostatic hyperplasia: a network meta-analysis. Cochrane Database Syst Rev 2021; 7:CD013656. [PMID: 34693990 PMCID: PMC8543673 DOI: 10.1002/14651858.cd013656.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A variety of minimally invasive treatments are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). However, it is unclear which treatments provide better results. OBJECTIVES Our primary objective was to assess the comparative effectiveness of minimally invasive treatments for lower urinary tract symptoms in men with BPH through a network meta-analysis. Our secondary objective was to obtain an estimate of relative ranking of these minimally invasive treatments, according to their effects. SEARCH METHODS We performed a comprehensive search of multiple databases (CENTRAL, MEDLINE, Embase, Scopus, Web of Science and LILACS), trials registries, other sources of grey literature, and conference proceedings, up to 24 February 2021. We had no restrictions on language of publication or publication status. SELECTION CRITERIA We included parallel-group randomized controlled trials assessing the effects of the following minimally invasive treatments, compared to TURP or sham treatment, on men with moderate to severe LUTS due to BPH: convective radiofrequency water vapor therapy (CRFWVT); prostatic arterial embolization (PAE); prostatic urethral lift (PUL); temporary implantable nitinol device (TIND); and transurethral microwave thermotherapy (TUMT). DATA COLLECTION AND ANALYSIS Two review authors independently screened the literature, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model for pair-wise comparisons and a frequentist network meta-analysis for combined estimates. We interpreted them according to Cochrane methods. We planned subgroup analyses by age, prostate volume, and severity of baseline symptoms. We used risk ratios (RRs) with 95% confidence intervals (CIs) to express dichotomous data and mean differences (MDs) with 95% CIs to express continuous data. We used the GRADE approach to rate the certainty of evidence. MAIN RESULTS We included 27 trials involving 3017 men, mostly over age 50, with severe LUTS due to BPH. The overall certainty of evidence was low to very low due to concerns regarding bias, imprecision, inconsistency (heterogeneity), and incoherence. Based on the network meta-analysis, results for our main outcomes were as follows. Urologic symptoms (19 studies, 1847 participants): PUL and PAE may result in little to no difference in urologic symptoms scores (MD of International Prostate Symptoms Score [IPSS]) compared to TURP (3 to 12 months; MD range 0 to 35; higher scores indicate worse symptoms; PUL: 1.47, 95% CI -4.00 to 6.93; PAE: 1.55, 95% CI -1.23 to 4.33; low-certainty evidence). CRFWVT, TUMT, and TIND may result in worse urologic symptoms scores compared to TURP at short-term follow-up, but the CIs include little to no difference (CRFWVT: 3.6, 95% CI -4.25 to 11.46; TUMT: 3.98, 95% CI 0.85 to 7.10; TIND: 7.5, 95% CI -0.68 to 15.69; low-certainty evidence). Quality of life (QoL) (13 studies, 1459 participants): All interventions may result in little to no difference in the QoL scores, compared to TURP (3 to 12 months; MD of IPSS-QoL score; MD range 0 to 6; higher scores indicate worse symptoms; PUL: 0.06, 95% CI -1.17 to 1.30; PAE: 0.09, 95% CI -0.57 to 0.75; CRFWVT: 0.37, 95% CI -1.45 to 2.20; TUMT: 0.65, 95% CI -0.48 to 1.78; TIND: 0.87, 95% CI -1.04 to 2.79; low-certainty evidence). Major adverse events (15 studies, 1573 participants): TUMT probably results in a large reduction of major adverse events compared to TURP (RR 0.20, 95% CI 0.09 to 0.43; moderate-certainty evidence). PUL, CRFWVT, TIND and PAE may also result in a large reduction in major adverse events, but CIs include substantial benefits and harms at three months to 36 months; PUL: RR 0.30, 95% CI 0.04 to 2.22; CRFWVT: RR 0.37, 95% CI 0.01 to 18.62; TIND: RR 0.52, 95% CI 0.01 to 24.46; PAE: RR 0.65, 95% CI 0.25 to 1.68; low-certainty evidence). Retreatment (10 studies, 799 participants): We are uncertain about the effects of PAE and PUL on retreatment compared to TURP (12 to 60 months; PUL: RR 2.39, 95% CI 0.51 to 11.1; PAE: RR 4.39, 95% CI 1.25 to 15.44; very low-certainty evidence). TUMT may result in higher retreatment rates (RR 9.71, 95% CI 2.35 to 40.13; low-certainty evidence). Erectile function (six studies, 640 participants): We are very uncertain of the effects of minimally invasive treatments on erectile function (MD of International Index of Erectile Function [IIEF-5]; range 5 to 25; higher scores indicates better function; CRFWVT: 6.49, 95% CI -8.13 to 21.12; TIND: 5.19, 95% CI -9.36 to 19.74; PUL: 3.00, 95% CI -5.45 to 11.44; PAE: -0.03, 95% CI -6.38, 6.32; very low-certainty evidence). Ejaculatory dysfunction (eight studies, 461 participants): We are uncertain of the effects of PUL, PAE and TUMT on ejaculatory dysfunction compared to TURP (3 to 12 months; PUL: RR 0.05, 95 % CI 0.00 to 1.06; PAE: RR 0.35, 95% CI 0.13 to 0.92; TUMT: RR 0.34, 95% CI 0.17 to 0.68; low-certainty evidence). TURP is the reference treatment with the highest likelihood of being the most efficacious for urinary symptoms, QoL and retreatment, but the least favorable in terms of major adverse events, erectile function and ejaculatory function. Among minimally invasive procedures, PUL and PAE have the highest likelihood of being the most efficacious for urinary symptoms and QoL, TUMT for major adverse events, PUL for retreatment, CRFWVT and TIND for erectile function and PUL for ejaculatory function. AUTHORS' CONCLUSIONS Minimally invasive treatments may result in similar or worse effects concerning urinary symptoms and QoL compared to TURP at short-term follow-up. They may result in fewer major adverse events, especially in the case of PUL and PAE; resulting in better rankings for symptoms scores. PUL may result in fewer retreatments compared to other interventions, especially TUMT, which had the highest retreatment rates at long-term follow-up. We are very uncertain about the effects of these interventions on erectile function. There was limited long-term data, especially for CRFWVT and TIND. Future high-quality studies with more extended follow-up, comparing different, active treatment modalities, and adequately reporting critical outcomes relevant to patients, including those related to sexual function, could provide more information on the relative effectiveness of these interventions.
Collapse
Affiliation(s)
- Juan Va Franco
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
- Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
| | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Muhammad Imran Omar
- Guidelines Office, European Association of Urology, Arnhem, Netherlands
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | | | - Shamar Young
- Department of Radiology, Division of Interventional Radiology & Vascular Imaging, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology & Vascular Imaging, University of Minnesota, Minneapolis, Minnesota, USA
| | - Areti Angeliki Veroniki
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Luis Garegnani
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| |
Collapse
|
49
|
Torkian P, Golzarian J, Chalian M, Clayton A, Rahimi-Dehgolan S, Tabibian E, Talaie R. Osteoarthritis-Related Knee Pain Treated With Genicular Artery Embolization: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:23259671211021356. [PMID: 34350303 PMCID: PMC8287378 DOI: 10.1177/23259671211021356] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Genicular artery embolization (GAE) is an innovative technique that has been investigated as a supplementary treatment method for chronic pain secondary to knee osteoarthritis (OA). PURPOSE To evaluate the current evidence on the effectiveness and safety of GAE for OA-related knee pain. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic literature search was conducted in the PubMed, Web of Science, EMBASE, and Scopus databases to identify studies related to knee OA treated with GAE. Treatment agents were categorized as Embozene, imipenem/cilastatin, resorbable microspheres, and polyvinyl alcohol. The main outcomes were the mean difference (MD) in pre- and postembolization pain based on the visual analog scale (VAS) or the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores as well as changes in the need for pain medication. Random- and fixed-effects models were applied for data analysis. RESULTS Of 379 initially inspected publications, 11 (N = 225 patients; 268 knees) were included in the final review. The quality of the studies was fair in 8 and poor in 3-categorized according to the National Institutes of Health quality assessment tool. Overall, 119, 72, 13, and 21 patients were treated with imipenem/cilastatin, Embozene, resorbable microspheres, and polyvinyl alcohol, respectively. Symptomatic improvement was reported in all studies. The pooled effect size, characterized by MD, showed a significant improvement in the VAS and WOMAC pain scores, with better functional status after GAE. Pre- versus postembolization MDs in VAS scores ranged from 32 within the first week to 58 after a 2-year follow-up (equivalent to 54% and 80% improvement, respectively). There was a similar trend in the overall WOMAC scores, with MDs ranging from 28.4 to 36.8 (about 58% and 85% improvement, respectively). GAE resulted in a decreased need for pain medication for knee OA, with a 27%, 65%, and 73% decline in the number of patients who used opioids, nonsteroidal anti-inflammatory drugs, and intra-articular hyaluronic acid injection, respectively (P < .00001 for all). No significant difference between embolic agents was seen with regard to post-GAE pain reduction. No severe or life-threatening complications were reported. CONCLUSION OA treated by GAE using different embolic particles can be considered generally safe, with good efficacy and no reported serious complications.
Collapse
Affiliation(s)
- Pooya Torkian
- Department of Radiology, Division of Vascular and Interventional
Radiology, University of Minnesota, Minneapolis, USA
| | - Jafar Golzarian
- Department of Radiology, Division of Vascular and Interventional
Radiology, University of Minnesota, Minneapolis, USA
| | - Majid Chalian
- Division of Musculoskeletal Imaging and Intervention, Department of
Radiology, University of Washington, Seattle, Washington, USA
| | - Alexander Clayton
- Department of Radiology, Division of Vascular and Interventional
Radiology, University of Minnesota, Minneapolis, USA
| | | | - Elnaz Tabibian
- Radiology Department, Tehran University of Medical Sciences, Tehran,
Iran
| | - Reza Talaie
- Department of Radiology, Division of Vascular and Interventional
Radiology, University of Minnesota, Minneapolis, USA
| |
Collapse
|
50
|
Gasparetto A, Hunter D, Sapoval M, Sharma S, Golzarian J. Splenic embolization in trauma: results of a survey from an international cohort. Emerg Radiol 2021; 28:955-963. [PMID: 34115235 DOI: 10.1007/s10140-021-01929-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE A questionnaire regarding splenic embolization in trauma was submitted to an international sample of IR faculty members, to compare their practice to the available recommendations. METHODS A 21 multiple-choice questionnaire was sent to an international cohort of 96 IR faculty. Questions included the initial patient evaluation, embolization materials and techniques, post-procedure management, availability of an institutional protocol, and use of guidelines. RESULTS For each question, there were from a minimum of 45 to a maximum of 52 responders: 94% require a CT with contrast prior to embolization, and 87% use the American Association for the Surgery of Trauma (AAST) scale to grade the splenic injuries. Embolization is performed across all values of the AAST scale. Of the patients with injuries of grade III or greater, embolization is primarily done for those patients who are hemodynamically stable. Unstable patients are embolized less frequently and primarily in cases in which the injuries are of a lower grade. Coils are the preferred material for proximal embolization (69%). Particles/Gelfoam is the preferred material for distal embolization (38%). In total, 63% administer intravenous antibiotics before the procedure and 15% administer intra-arterial antibiotics during the procedure. After embolization, follow-up imaging is recommended by 87%, antibiotics are administered regularly by 33%, clinical follow-up is recommended by 73%, and vaccination against encapsulated organisms is routinely recommended by 39%. CONCLUSIONS There is significant variability among a heterogeneous cohort of respondents. Available recommendations may not be sufficiently addressing the practice of splenic embolization.
Collapse
Affiliation(s)
| | - David Hunter
- University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Marc Sapoval
- Hopital Europeen Georges-Pompidou (Hopitaux Universitaires Paris-Ouest), 20 Rue Leblanc 75015, Paris, France
| | - Sandeep Sharma
- University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Jafar Golzarian
- University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| |
Collapse
|