1
|
Narayanan G, Koethe Y, Gentile N. Irreversible Electroporation of the Hepatobiliary System: Current Utilization and Future Avenues. Medicina (Kaunas) 2024; 60:251. [PMID: 38399539 PMCID: PMC10890312 DOI: 10.3390/medicina60020251] [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] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/25/2024]
Abstract
Liver cancer remains a leading cause of cancer-related deaths worldwide despite numerous advances in treatment. While surgical resection remains the gold standard for curative treatment, it is only possible for a minority of patients. Thermal ablation is an effective option for the treatment of smaller tumors; however, its use is limited to tumors that are not located in proximity to sensitive structures due to the heat sink effect and the potential of thermal damage. Irreversible electroporation (IRE) is a non-thermal ablative modality that can deliver targeted treatment and the effective destruction of tumors that are in close proximity to or even surrounding vascular or biliary ducts with minimal damage to these structures. IRE produces short pulses of high-frequency energy which opens pores in the lipid bilayer of cells leading to apoptosis and cell death. IRE has been utilized clinically for over a decade in the treatment of liver cancers with multiple studies documenting an acceptable safety profile and high efficacy rates.
Collapse
Affiliation(s)
- Govindarajan Narayanan
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA;
- Miami Cardiac and Vascular, Baptist Health South Florida, 8900 North Kendall Drive, Miami, FL 33176, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | | | - Nicole Gentile
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA;
| |
Collapse
|
2
|
Ohaegbulam KC, Koethe Y, Fung A, Mayo SC, Grossberg AJ, Chen EY, Sharzehi K, Kardosh A, Farsad K, Rocha FG, Thomas CR, Nabavizadeh N. The multidisciplinary management of cholangiocarcinoma. Cancer 2023; 129:184-214. [PMID: 36382577 DOI: 10.1002/cncr.34541] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/14/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022]
Abstract
Cholangiocarcinoma is a lethal malignancy of the biliary epithelium that can arise anywhere along the biliary tract. Surgical resection confers the greatest likelihood of long-term survivability. However, its insidious onset, difficult diagnostics, and resultant advanced presentation render the majority of patients unresectable, highlighting the importance of early detection with novel biomarkers. Developing liver-directed therapies and emerging targeted therapeutics may offer improved survivability for patients with unresectable or advanced disease. In this article, the authors review the current multidisciplinary standards of care in resectable and unresectable cholangiocarcinoma, with an emphasis on novel biomarkers for early detection and nonsurgical locoregional therapy options.
Collapse
Affiliation(s)
- Kim C Ohaegbulam
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Yilun Koethe
- Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Alice Fung
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Skye C Mayo
- Department of Surgical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Aaron J Grossberg
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Emerson Y Chen
- Division of Hematology/Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kaveh Sharzehi
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Adel Kardosh
- Division of Hematology/Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Khashayar Farsad
- Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Flavio G Rocha
- Department of Surgical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA.,Department of Radiation Oncology, Dartmouth School of Medicine, Hanover, New Hampshire, USA
| | - Nima Nabavizadeh
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
3
|
Karandikar A, Solberg A, Fung A, Lee AY, Farooq A, Taylor AC, Oliveira A, Narayan A, Senter A, Majid A, Tong A, McGrath AL, Malik A, Brown AL, Roberts A, Fleischer A, Vettiyil B, Zigmund B, Park B, Curran B, Henry C, Jaimes C, Connolly C, Robson C, Meltzer CC, Phillips CH, Dove C, Glastonbury C, Pomeranz C, Kirsch CFE, Burgan CM, Scher C, Tomblinson C, Fuss C, Santillan C, Daye D, Brown DB, Young DJ, Kopans D, Vargas D, Martin D, Thompson D, Jordan DW, Shatzkes D, Sun D, Mastrodicasa D, Smith E, Korngold E, Dibble EH, Arleo EK, Hecht EM, Morris E, Maltin EP, Cooke EA, Schwartz ES, Lehrman E, Sodagari F, Shah F, Doo FX, Rigiroli F, Vilanilam GK, Landinez G, Kim GGY, Rahbar H, Choi H, Bandesha H, Ojeda-Fournier H, Ikuta I, Dragojevic I, Schroeder JLT, Ivanidze J, Katzen JT, Chiang J, Nguyen J, Robinson JD, Broder JC, Kemp J, Weaver JS, Conyers JM, Robbins JB, Leschied JR, Wen J, Park J, Mongan J, Perchik J, Barbero JPM, Jacob J, Ledbetter K, Macura KJ, Maturen KE, Frederick-Dyer K, Dodelzon K, Cort K, Kisling K, Babagbemi K, McGill KC, Chang KJ, Feigin K, Winsor KS, Seifert K, Patel K, Porter KK, Foley KM, Patel-Lippmann K, McIntosh LJ, Padilla L, Groner L, Harry LM, Ladd LM, Wang L, Spalluto LB, Mahesh M, Marx MV, Sugi MD, Sammer MBK, Sun M, Barkovich MJ, Miller MJ, Vella M, Davis MA, Englander MJ, Durst M, Oumano M, Wood MJ, McBee MP, Fischbein NJ, Kovalchuk N, Lall N, Eclov N, Madhuripan N, Ariaratnam NS, Vincoff NS, Kothary N, Yahyavi-Firouz-Abadi N, Brook OR, Glenn OA, Woodard PK, Mazaheri P, Rhyner P, Eby PR, Raghu P, Gerson RF, Patel R, Gutierrez RL, Gebhard R, Andreotti RF, Masum R, Woods R, Mandava S, Harrington SG, Parikh S, Chu S, Arora SS, Meyers SM, Prabhu S, Shams S, Pittman S, Patel SN, Payne S, Hetts SW, Hijaz TA, Chapman T, Loehfelm TW, Juang T, Clark TJ, Potigailo V, Shah V, Planz V, Kalia V, DeMartini W, Dillon WP, Gupta Y, Koethe Y, Hartley-Blossom Z, Wang ZJ, McGinty G, Haramati A, Allen LM, Germaine P. Radiologists staunchly support patient safety and autonomy, in opposition to the SCOTUS decision to overturn Roe v Wade. Clin Imaging 2023; 93:117-121. [PMID: 36064645 DOI: 10.1016/j.clinimag.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Alice Fung
- Oregon Health & Science University (OHSU), United States of America
| | - Amie Y Lee
- University of California, San Francisco, United States of America
| | | | - Amy C Taylor
- University of Virginia, Charlottesville, VA, United States of America
| | | | - Anand Narayan
- University of Wisconsin Hospitals and Clinics, Madison, WI, United States of America
| | | | | | | | | | | | | | - Anne Roberts
- University of California San Diego, United States of America
| | | | | | - Beth Zigmund
- Larner College of Medicine at University of Vermont, United States of America
| | - Brian Park
- Oregon Health & Science University (OHSU), United States of America
| | - Bruce Curran
- Virginia Commonwealth University Health System, United States of America
| | - Cameron Henry
- Vanderbilt University Medical Center, United States of America
| | - Camilo Jaimes
- Boston Children's Hospital and Harvard Medical School, United States of America
| | - Cara Connolly
- Vanderbilt University Medical Center, United States of America
| | - Caroline Robson
- Boston Children's Hospital and Harvard Medical School, United States of America
| | - Carolyn C Meltzer
- Keck School of Medicine of the University of Southern California, United States of America
| | | | - Christine Dove
- Vanderbilt University Medical Center, United States of America
| | | | | | | | | | - Courtney Scher
- Henry Ford Health, Detroit, MI, United States of America
| | | | - Cristina Fuss
- Oregon Health & Science University (OHSU), United States of America
| | | | - Dania Daye
- Massachusetts General Hospital/Harvard Medical School, United States of America
| | - Daniel B Brown
- Vanderbilt University Medical Center, United States of America
| | - Daniel J Young
- Oregon Health & Science University (OHSU), United States of America
| | | | | | - Dann Martin
- Vanderbilt University Medical Center, United States of America
| | | | - David W Jordan
- University Hospitals Cleveland Medical Center & Case Western Reserve University, United States of America
| | | | - Derek Sun
- University of California, San Francisco, United States of America
| | | | | | - Elena Korngold
- Oregon Health & Science University (OHSU), United States of America
| | - Elizabeth H Dibble
- The Warren Alpert Medical School of Brown University, United States of America
| | | | | | | | | | - Erin A Cooke
- Vanderbilt University Medical Center, United States of America
| | - Erin Simon Schwartz
- Perelman School of Medicine, University of Pennsylvania, United States of America
| | | | - Faezeh Sodagari
- Massachusetts General Hospital, Harvard Medical School, United States of America
| | - Faisal Shah
- Radiology Partners, United States of America
| | | | | | - George K Vilanilam
- Dept of Radiology, University of Arkansas for Medical Sciences, United States of America
| | - Gina Landinez
- University of California, San Francisco, United States of America
| | | | - Habib Rahbar
- University of Washington, United States of America
| | - Hailey Choi
- University of California, San Francisco, United States of America
| | | | | | - Ichiro Ikuta
- Yale University School of Medicine, Department of Radiology & Biomedical Imaging, United States of America
| | | | | | | | | | - Jason Chiang
- Ronald Reagan UCLA Medical Center, United States of America
| | - Jeffers Nguyen
- Yale University School of Medicine, Department of Radiology & Biomedical Imaging, United States of America
| | | | - Jennifer C Broder
- Lahey Hospital and Medical Center, Burlington, MA, United States of America
| | - Jennifer Kemp
- University of Colorado School of Medicine, United States of America
| | | | | | - Jessica B Robbins
- University of Wisconsin School of Medicine and Public Health, United States of America
| | | | - Jessica Wen
- Stanford University, United States of America
| | - Jocelyn Park
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | | | - Jordan Perchik
- University of Alabama at Birmingham, United States of America
| | | | - Jubin Jacob
- St Lawrence Radiology, United States of America
| | | | | | | | | | | | | | - Kelly Kisling
- University of California San Diego, United States of America
| | | | | | | | | | | | - Kimberly Seifert
- Stanford University School of Medicine, United States of America
| | - Kirang Patel
- University of Texas Southwestern Medical Center, United States of America
| | - Kristin K Porter
- University of Alabama at Birmingham Hospital, United States of America
| | | | | | | | - Laura Padilla
- University of California San Diego, United States of America
| | | | - Lauren M Harry
- Indiana University School of Medicine, United States of America
| | - Lauren M Ladd
- Indiana University School of Medicine, United States of America
| | - Lisa Wang
- Oregon Health & Science University (OHSU), United States of America
| | - Lucy B Spalluto
- Vanderbilt University Medical Center, United States of America
| | - M Mahesh
- Johns Hopkins University School of Medicine, United States of America
| | | | - Mark D Sugi
- University of California, San Francisco, United States of America
| | | | - Maryellen Sun
- Mount Auburn Hospital/Harvard Medical School, Cambridge, MA, United States of America
| | | | | | - Maya Vella
- University of California, San Francisco, United States of America
| | | | | | | | - Michael Oumano
- Rhode Island Hospital (Brown University), Providence, RI, United States of America
| | - Monica J Wood
- Mount Auburn Hospital/Harvard Medical School, Cambridge, MA, United States of America
| | - Morgan P McBee
- Medical University of South Carolina, United States of America
| | | | | | - Neil Lall
- Emory University, Atlanta, GA, United States of America
| | - Neville Eclov
- Duke University, Durham, NC, United States of America
| | | | | | - Nina S Vincoff
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Nishita Kothary
- Stanford University School of Medicine, United States of America
| | | | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Orit A Glenn
- University of California, San Francisco, United States of America
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Parisa Mazaheri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, United States of America
| | | | - Peter R Eby
- Virginia Mason Franciscan Health, United States of America
| | - Preethi Raghu
- University of California, San Francisco, United States of America
| | - Rachel F Gerson
- Northwest Radiologists, Inc, PS, Bellingham, WA, United States of America
| | - Rina Patel
- University of California, San Francisco, United States of America
| | | | - Robyn Gebhard
- The Ohio State University, Columbus, OH, United States of America
| | | | - Rukya Masum
- The Ohio State University, Columbus, OH, United States of America
| | - Ryan Woods
- University of Wisconsin School of Medicine and Public Health, United States of America
| | - Sabala Mandava
- Henry Ford Health, Detroit, MI, United States of America
| | | | - Samir Parikh
- Henry Ford Health, Jackson, MI, United States of America
| | - Sammy Chu
- University of Washington (Seattle, WA), United States of America
| | | | - Sandra M Meyers
- University of California San Diego, United States of America
| | - Sanjay Prabhu
- Boston Children's Hospital, United States of America
| | | | - Sarah Pittman
- Stanford University School of Medicine, United States of America
| | | | | | - Steven W Hetts
- University of California, San Francisco, United States of America
| | - Tarek A Hijaz
- Northwestern Memorial Hospital/Feinberg School of Medicine of Northwestern University, Chicago, IL, United States of America
| | - Teresa Chapman
- University of Washington (Seattle, WA), United States of America
| | - Thomas W Loehfelm
- University of California, Davis, Sacramento, CA, United States of America
| | | | | | | | - Vinil Shah
- University of California, San Francisco, United States of America
| | - Virginia Planz
- Vanderbilt University Medical Center, United States of America
| | - Vivek Kalia
- Texas Scottish Rite for Children Hospital, United States of America
| | - Wendy DeMartini
- Stanford University School of Medicine, United States of America
| | - William P Dillon
- University of California, San Francisco, United States of America
| | - Yasha Gupta
- Memorial Sloan Kettering Cancer Center, United States of America
| | - Yilun Koethe
- Oregon Health & Science University (OHSU), United States of America
| | | | - Zhen Jane Wang
- University of California, San Francisco, United States of America
| | | | - Adina Haramati
- Massachusetts General Hospital, Boston, MA, United States of America
| | - Laveil M Allen
- Vanderbilt University Medical Center, United States of America
| | | |
Collapse
|
4
|
Koethe Y, Bochnakova T, Kaufman CS. Upper Extremity Deep Venous Thrombosis: Etiologies, Diagnosis, and Updates in Therapeutic Strategies. Semin Intervent Radiol 2022; 39:475-482. [PMID: 36561939 PMCID: PMC9767760 DOI: 10.1055/s-0042-1757937] [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
Upper extremity deep vein thrombosis (UEDVT) is responsible for 4 to 10% of all deep vein thrombosis (DVT). Untreated UEDVT can lead to significant disability secondary to the postthrombotic syndrome. To date, there are no randomized trials specifically comparing different therapeutic strategies. Ultimately, optimal management of UEDVT depends on the underlying etiology, patient symptoms, and degree of thrombosis, with supporting evidence primarily extrapolated from lower extremity DVT data. This article will review the classification, presentation, and diagnosis of both primary and secondary UEDVT. In addition, it will discuss updates in clinical guidelines, anticoagulation, endovascular and surgical treatment strategies.
Collapse
Affiliation(s)
- Yilun Koethe
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
| | - Teodora Bochnakova
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
| | - Claire S. Kaufman
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
| |
Collapse
|
5
|
McClellan K, Chen EY, Kardosh A, Lopez CD, Del Rivero J, Mallak N, Rocha FG, Koethe Y, Pommier R, Mittra E, Pegna GJ. Therapy Resistant Gastroenteropancreatic Neuroendocrine Tumors. Cancers (Basel) 2022; 14:4769. [PMID: 36230691 PMCID: PMC9563314 DOI: 10.3390/cancers14194769] [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] [Received: 08/31/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a heterogenous group of malignancies originating from neuroendocrine cells of the gastrointestinal tract, the incidence of which has been increasing for several decades. While there has been significant progress in the development of therapeutic options for patients with advanced or metastatic disease, these remain limited both in quantity and durability of benefit. This review examines the latest research elucidating the mechanisms of both up-front resistance and the eventual development of resistance to the primary systemic therapeutic options including somatostatin analogues, peptide receptor radionuclide therapy with lutetium Lu 177 dotatate, everolimus, sunitinib, and temozolomide-based chemotherapy. Further, potential strategies for overcoming these mechanisms of resistance are reviewed in addition to a comprehensive review of ongoing and planned clinical trials addressing this important challenge.
Collapse
Affiliation(s)
- Kristen McClellan
- School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Emerson Y. Chen
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Adel Kardosh
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Charles D. Lopez
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jaydira Del Rivero
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nadine Mallak
- Division of Molecular Imaging and Therapy, Oregon Health & Science University, Portland, OR 97239, USA
| | - Flavio G. Rocha
- Division of Surgical Oncology, Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Yilun Koethe
- Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Rodney Pommier
- Division of Surgical Oncology, Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Erik Mittra
- Division of Molecular Imaging and Therapy, Oregon Health & Science University, Portland, OR 97239, USA
| | - Guillaume J. Pegna
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| |
Collapse
|
6
|
Le M, Russell L, Kim Y, Koethe Y. Abstract No. 325 Assessment of central line infections based on patient location: retrospective chart review. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.406] [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
|
7
|
Koethe Y, Wilson N, Narayanan G. Irreversible electroporation for colorectal cancer liver metastasis: a review. Int J Hyperthermia 2022; 39:682-687. [PMID: 35469520 DOI: 10.1080/02656736.2021.2008025] [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: 10/18/2022] Open
Abstract
Irreversible electroporation (IRE) ablation is gaining popularity over the last decade as a nonthermal alternative to thermal ablation technologies such as radiofrequency ablation (RFA) and Microwave ablation (MWA). This review serves as a practical guide for applying IRE to colorectal cancer liver metastases (CRLM) for interventional radiologists, oncologists, surgeons, and anesthesiologists. It covers patient selection, procedural technique, anesthesia, imaging, and outcomes.
Collapse
Affiliation(s)
- Yilun Koethe
- Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Nicole Wilson
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Govindarajan Narayanan
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.,Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.,Miami Cardiac and Vascular, Baptist Health South Florida, Miami, FL, USA
| |
Collapse
|
8
|
Tyagi R, Ahmed SS, Koethe Y, Raskind A, Ahmed O. Genicular Artery Embolization for Primary Knee Osteoarthritis. Semin Intervent Radiol 2022; 39:125-129. [PMID: 35782001 DOI: 10.1055/s-0042-1745798] [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: 10/17/2022]
Abstract
Genicular artery embolization (GAE) is a novel treatment for knee osteoarthritis (OA) with increasing interest and utilization worldwide. The genicular arteries are selectively embolized using microspheres with subsequent cessation of abnormal synovial hyperemia, a process believed to arrest the inflammatory changes and pain associated with OA. Current data indicate that GAE offers sustained, 6-month improvement in Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and visual analog scale scores in 80 to 85% of patients with mild to moderate OA. As GAE gains traction, future studies are needed to establish its safety and efficacy relative to placebo and other standard-of-care therapies while also characterizing populations for which it is most effective.
Collapse
Affiliation(s)
- Ravi Tyagi
- University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - S Samaduddin Ahmed
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, Illinois
| | - Yilun Koethe
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon
| | - Aleksandr Raskind
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, Illinois
| | - Osman Ahmed
- Section of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, Illinois
| |
Collapse
|
9
|
Huber TC, Bochnakova T, Koethe Y, Park B, Farsad K. Percutaneous Therapies for Hepatocellular Carcinoma: Evolution of Liver Directed Therapies. J Hepatocell Carcinoma 2021; 8:1181-1193. [PMID: 34589446 PMCID: PMC8476177 DOI: 10.2147/jhc.s268300] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Received: 06/15/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022] Open
Abstract
Percutaneous ablation is a mainstay of treatment for early stage, unresectable hepatocellular carcinoma (HCC). Recent advances in technology have created multiple ablative modalities for treatment of this common malignancy. The purpose of this review is to familiarize readers with the technical and clinical aspects of both existing and emerging percutaneous treatment options for HCC.
Collapse
Affiliation(s)
- Timothy C Huber
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Teodora Bochnakova
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Yilun Koethe
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Brian Park
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Khashayar Farsad
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
10
|
Abstract
Incidental adrenal masses are common and are found in 4% of the CT scans.1 While clinical history, laboratory results, and imaging characteristics are typically sufficient for diagnosis of an adrenal lesion, a biopsy is sometimes warranted. In some cases, adrenal mass ablation is subsequently indicated. This article serves as a brief but comprehensive review of preprocedural work-up and planning before an adrenal mass ablation, as well as a discussion on ablation techniques, associated challenges and solutions, and management of expected and unexpected outcomes.
Collapse
Affiliation(s)
- Barbara Manchec
- Department of Radiology, Advent Health Medical Group/Central Florida Division, Orlando, FL
| | - Yilun Koethe
- Miami Cardiac and Vascular Institute, Miami Cancer Institute, Miami, FL
| | - Brian Schiro
- Miami Cardiac and Vascular Institute, Miami Cancer Institute, Miami, FL
| | - Constantino Peña
- Miami Cardiac and Vascular Institute, Miami Cancer Institute, Miami, FL
| | - Ripal Gandhi
- Miami Cardiac and Vascular Institute, Miami Cancer Institute, Miami, FL.
| |
Collapse
|
11
|
Koethe Y, Lokken RP, Lehrman ED, Kerlan RK, Roberts JP, Rhee SJ, Kohi MP, Kolli KP. Overdilation of a 6-mm Self-Expanding Stent with a 10-mm Balloon-Expandable Stent Graft Preserves Failing Meso-Rex Bypass. J Vasc Interv Radiol 2020; 31:521-523. [PMID: 32007411 DOI: 10.1016/j.jvir.2019.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/20/2019] [Accepted: 09/25/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yilun Koethe
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143
| | - R Peter Lokken
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143
| | - Evan D Lehrman
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143
| | - Robert K Kerlan
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143
| | - John P Roberts
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143
| | - Sue J Rhee
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143
| | - K Pallav Kolli
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143
| |
Collapse
|
12
|
Koethe Y, Boone C, Lehrman ED, Kolli KP, Kumar V, Kohi MP. Uterine Artery Embolization as a Uterine-Sparing Solution for Postpartum Pseudoaneurysms. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Yilun Koethe
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Christine Boone
- Department of Medicine, Santa Clara Valley Medical Centers, San Jose, CA
| | - Evan D. Lehrman
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Kanti Pallav Kolli
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Vishal Kumar
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Maureen P. Kohi
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| |
Collapse
|
13
|
Boone C, Koethe Y, Kohi M, Lehrman E. Collateral Uterine Arterial Supply in the Setting of Various Uterine Pathologies. J Clin Interv Radiol ISVIR 2018. [DOI: 10.1055/s-0038-1676166] [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: 10/27/2022] Open
Abstract
AbstractIn most patients, bilateral uterine arteries supply the uterus exclusively. However, collateral arterial supply to the uterus has been described, predominantly in the context of uterine artery embolization (UAE) for fibroid treatment. This may lead to incomplete embolization, which can impact clinical outcomes. Therefore, identification of potential collateral supply to the uterus is essential for achieving optimal clinical results. The authors report three cases of collateral uterine arterial supply from the ovarian and round ligament arteries in the setting of uterine arteriovenous fistula (uAVF), postpartum hemorrhage (PPH), and symptomatic fibroids. Aortography from the level of the renal arteries was performed for initial evaluation of uterine arterial supply in all patients and identified hypertrophied, tortuous ovarian artery collaterals. Selective angiography of the external iliac artery was required to identify round ligament collateral uterine supply. Three-dimensional cone beam computed tomography (CT) was also used to visualize vascular distribution of bilateral uterine arteries and an ovarian collateral feeding a uAVF. In regard to outcomes, identification of collateral uterine arterial supply allowed for single-session complete embolization in fibroid patients with collateralized round ligament or ovarian arteries and in the PPH patient in disseminated intravascular coagulation with predominantly ovarian artery supply to the uterus. Identification of collateral uterine arterial supply facilitated technical success in all patients. In the setting of various uterine pathologies, identification of collateral uterine arterial supply is essential to optimize clinical success of UAE.
Collapse
Affiliation(s)
- Christine Boone
- Department of Medicine, Santa Clara Valley Medical Center, San Jose, California, United States
| | - Yilun Koethe
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, United States
| | - Maureen Kohi
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, United States
| | - Evan Lehrman
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, United States
| |
Collapse
|
14
|
Koethe Y, Kumar V, Kothary N, Hwang G, Kohi M. Abstract No. 462 Perception of interventional radiology and its influence among women trainees. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.507] [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: 11/25/2022] Open
|
15
|
Koethe Y, Xu S, Velusamy G, Wood BJ, Venkatesan AM. Accuracy and efficacy of percutaneous biopsy and ablation using robotic assistance under computed tomography guidance: a phantom study. Eur Radiol 2014; 24:723-30. [PMID: 24220755 PMCID: PMC3945277 DOI: 10.1007/s00330-013-3056-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/24/2013] [Accepted: 10/10/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare the accuracy of a robotic interventional radiologist (IR) assistance platform with a standard freehand technique for computed-tomography (CT)-guided biopsy and simulated radiofrequency ablation (RFA). METHODS The accuracy of freehand single-pass needle insertions into abdominal phantoms was compared with insertions facilitated with the use of a robotic assistance platform (n = 20 each). Post-procedural CTs were analysed for needle placement error. Percutaneous RFA was simulated by sequentially placing five 17-gauge needle introducers into 5-cm diameter masses (n = 5) embedded within an abdominal phantom. Simulated ablations were planned based on pre-procedural CT, before multi-probe placement was executed freehand. Multi-probe placement was then performed on the same 5-cm mass using the ablation planning software and robotic assistance. Post-procedural CTs were analysed to determine the percentage of untreated residual target. RESULTS Mean needle tip-to-target errors were reduced with use of the IR assistance platform (both P < 0.0001). Reduced percentage residual tumour was observed with treatment planning (P = 0.02). CONCLUSION Improved needle accuracy and optimised probe geometry are observed during simulated CT-guided biopsy and percutaneous ablation with use of a robotic IR assistance platform. This technology may be useful for clinical CT-guided biopsy and RFA, when accuracy may have an impact on outcome. KEY POINTS • A recently developed robotic intervention radiology assistance platform facilitates CT-guided interventions. • Improved accuracy of complex needle insertions is achievable. • IR assistance platform use can improve target ablation coverage.
Collapse
Affiliation(s)
- Yilun Koethe
- Center for Interventional Oncology, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | |
Collapse
|
16
|
Koethe Y, Widemann BC, Hajjar F, Wood BJ, Venkatesan AM. PET-guided biopsy with needle navigation facilitates diagnosis of angiosarcoma in neurofibromatosis type 1. Pediatr Blood Cancer 2013; 60:E166-9. [PMID: 23922330 PMCID: PMC3798049 DOI: 10.1002/pbc.24668] [Citation(s) in RCA: 6] [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: 05/02/2013] [Accepted: 06/03/2013] [Indexed: 01/30/2023]
Abstract
Malignant degeneration frequently arises from preexisting plexiform neurofibroma in patients with neurofibromatosis type 1 (NF1). Image guided biopsy for diagnostic purposes, such as with CT guidance, can be technically challenging in these patients, as CT cannot distinguish malignant from benign areas within the same tumor. Navigation with multi-modality (PET, CT, and ultrasound) image fusion facilitated the successful biopsy and diagnosis of angiosarcoma arising from a pelvic neurofibroma in a patient with NF1. Successful targeting assisted treatment selection in this case. This novel navigation technique may facilitate the otherwise difficult diagnosis of malignancy in patients with NF1.
Collapse
Affiliation(s)
- Yilun Koethe
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland,Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland,Duke University School of Medicine, Durham, North Carolina
| | | | - Fouad Hajjar
- Children’s Center for Cancer and Blood Diseases, Florida Hospital, Orlando, Florida
| | - Bradford J. Wood
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland,Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland
| | - Aradhana M. Venkatesan
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland,Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland,Correspondence to: Aradhana M. Venkatesan, Center for Interventional Oncology, Radiology and Imaging Sciences, National Institutes of Health, 10 Center Drive, Building 10 CRC, Room 1C369, MSC 1182, Bethesda, MD 20892.
| |
Collapse
|