Section of Interventional Radiology

Upper Saint Clair, IL, United States

Section of Interventional Radiology

Upper Saint Clair, IL, United States

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Sotirchos V.S.,Section of Interventional Radiology | Petrovic L.M.,Section of Interventional Radiology | Petrovic L.M.,Sloan Kettering Cancer Center | Petrovic L.M.,University of Southern California | And 10 more authors.
Radiology | Year: 2016

Purpose: To establish the prognostic value of biopsy of the central and marginal ablation zones for time to local tumor progression (LTP) after radiofrequency (RF) ablation of colorectal cancer liver metastasis (CLM). Materials and Methods: A total of 47 patients with 67 CLMs were enrolled in this prospective institutional review board-approved and HIPAA-compliant study between November 2009 and August 2012. Mean tumor size was 2.1 cm (range, 0.6-4.3 cm). Biopsy of the center and margin of the ablation zone was performed immediately after RF ablation (mean number of biopsy samples per ablation zone, 1.9) and was evaluated for the presence of viable tumor cells. Samples containing tumor cells at morphologic evaluation were further interrogated with immunohistochemistry and were classified as either positive, viable tumor (V) or negative, necrotic (N). Minimal ablation margin size was evaluated in the first postablation CT study performed 4-8 weeks after ablation. Variables were evaluated as predictors of time to LTP with the competing-risks model (uni-and multivariate analyses). Results: Technical effectiveness was evident in 66 of 67 (98%) ablated lesions on the first contrast material-enhanced CT images at 4-8-week follow-up. The cumulative incidence of LTP at 12-month follow-up was 22% (95% confidence interval [CI]: 12, 32). Samples from 16 (24%) of 67 ablation zones were classified as viable tumor. At univariate analysis, tumor size, minimal margin size, and biopsy results were significant in predicting LTP. When these variables were subsequently entered in a multivariate model, margin size of less than 5 mm (P , .001; hazard ratio [HR], 6.7) and positive biopsy results (P = .008; HR, 3.4) were significant. LTP within 12 months after RF ablation was noted in 3% (95% CI: 0, 9) of necrotic CLMs with margins of at least 5 mm. Conclusion: Biopsy proof of complete tumor ablation and minimal ablation margins of at least 5 mm are independent predictors of LTP and yield the best oncologic outcomes. © RSNA, 2016.


Donahue L.A.,Section of Interventional Radiology | Baker T.,Northwestern Memorial Hospital | Gupta R.,Section of Interventional Radiology | Memon K.,Section of Interventional Radiology | And 3 more authors.
Journal of Vascular and Interventional Radiology | Year: 2013

Purpose: To evaluate the toxicity and response to radioembolization with yttrium-90 (90Y) glass microspheres in patients with hepatocellular carcinoma (HCC) and existing transjugular intrahepatic portosystemic shunts (TIPS). Materials and Methods: For treatment of unresectable HCC, 12 patients with a patent TIPS underwent a total of 21 infusions of 90Y. Toxicity within 90 days of treatment was assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE v4.0). Imaging response within the index lesion was assessed using the World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines. Survival was calculated using the Kaplan-Meier method. Results: All patients had a patent TIPS on imaging before treatment. Clinical toxicities included fatigue (83%), encephalopathy (33%), and abdominal pain (25%). Three patients (25%) experienced new grade 3 or 4 bilirubin toxicity. Imaging response was achieved in 50% and 67% of patients according to WHO and EASL criteria. Six patients (50%) went on to liver transplantation. Median survival censored for liver transplantation was 498 days (95% confidence interval [CI],100-800 d), and uncensored median survival was 827 days (95% CI, 250-2,400 d). Conclusions: 90Y radioembolization may be a safe and effective treatment for patients with unresectable HCC and existing TIPS. This minimally embolic therapy may be particularly useful as a bridge to curative liver transplantation. © 2013 SIR.


PubMed | Section of Interventional Radiology., Divison of Oncology., American University of Beirut and Sloan Kettering Cancer Center
Type: Journal Article | Journal: Gastrointestinal cancer research : GCR | Year: 2014

The combination of systemic antiangiogenic therapy and transarterial chemoembolization (TACE) for the treatment of unresectable hepatocellular carcinoma (HCC) is the subject of several ongoing clinical trials. We present a series of patients treated with sorafenib and TACE at our institution, highlighting the technical challenges of combining these two modalities of treatment.We retrospectively identified patients with HCC treated with TACE and sorafenib at our institution.Five patients were treated with the combination of TACE and sorafenib given off-protocol based on preliminary reports in the literature. The first four patients started sorafenib 7 days prior to TACE resulting in intratumoral vascular pruning and poor visualization of lesions on angiography. This was managed by either superselective angiography or lobar TACE. The fifth patient stopped sorafenib 7 days prior to TACE with full visualization of multiple hypervascular lesions on angiography prior to embolization.Our observations suggest that the biologically preferable strategy of continuous antiangiogenic therapy should be weighed against the possibility of suboptimal TACE due to poor visualization of lesions on angiography and safety.


Lewandowski R.J.,Section of Interventional Radiology | Mulcahy M.F.,Div. of Hematology and Oncology | Kulik L.M.,Div. of Hepatology | Riaz A.,Section of Interventional Radiology | And 18 more authors.
Radiology | Year: 2010

Purpose: To determine comprehensive imaging and long-term survival outcome following chemoembolization for hepatocellular carcinoma (HCC). Materials and Methods: One hundred seventy-two patients with HCC treated with chemoembolization were studied retrospectively in an institutional review board approved protocol; this study was HIPAA compliant. Baseline laboratory and imaging characteristics were obtained. Clinical and laboratory toxicities following treatment were assessed. Imaging characteristics following chemoembolization were evaluated to determine response rates (size and necrosis) and time to progression (TTP). Survival from the time of first chemoembolization treatment was calculated. Subanalyses were performed by stratifying the population according to Child-Pugh, United Network for Organ Sharing, and Barcelona Clinic for Liver Cancer (BCLC) staging systems. Results: Cirrhosis was present in 157 patients (91%); portal hypertension was present in 139 patients (81%). Eleven patients (6%) had metastases at baseline. Portal vein thrombosis was present in 11 patients (6%). Fifty-five percent of patients experienced some form of toxicity following treatment; 21% developed grade 3 or 4 bilirubin toxicity. Post-chemoembolization response was seen in 31% and 64% of patients according to size and necrosis criteria, respectively. Median TTP was 7.9 months (95% confidence interval: 7.1, 9.4) but varied widely by stage. Median survival was significantly different between patients with BCLC stages A, B, and C disease (stage A, 40.0 months; B, 17.4 months; C, 6.3 months; P < .0001). Conclusion: The determination of TTP and survival in patients with HCC is confounded by tumor biology and background cirrhosis; chemoembolization was shown to be a safe and effective therapy in patients with HCC. © RSNA, 2010.


Gaba R.C.,Section of Interventional Radiology | Mun S.J.,Section of Interventional Radiology | Ryu R.K.,Section of Interventional Radiology | Lewandowski R.J.,Section of Interventional Radiology | And 2 more authors.
Digestive Diseases and Sciences | Year: 2010

With the emergence of minimally invasive techniques, percutaneous drainage has been applied to the management of symptomatic pancreatic pseudocysts in lieu of conventional surgical or endoscopic therapy. Percutaneous insertion of internalized drainage catheters represents an attractive method for pseudocyst drainage, but has been limited by the usual need for cross-sectional imaging or endoscopic guidance. Herein, we describe the use of a simple fluoroscopically guided technique for percutaneous transgastric cystgastrostomy with internalized drainage catheter placement in two cases. © 2009 Springer Science+Business Media, LLC.


Cheng R.G.,University of Washington | Bhattacharya R.,University of Washington | Yeh M.M.,University of Washington | Padia S.A.,Section of Interventional Radiology
Journal of Vascular and Interventional Radiology | Year: 2015

Purpose To describe full explant pathology and radiographic correlation in patients with hepatocellular carcinoma (HCC) treated with irreversible electroporation (IRE) who subsequently underwent liver transplant. Materials and Methods In a retrospective study, 6 patients who had undergone IRE for HCC and subsequent orthotopic liver transplant during the period 2011-2013 were evaluated. Of the 6 patients, 4 had Child-Pugh class A cirrhosis, and 2 had class B cirrhosis. Irreversible electroporation was performed for a single focal HCC with median tumor diameter of 22 mm (range, 6-26 mm). After IRE, follow-up multiphasic cross-sectional imaging was performed at 1 month and every 3 months thereafter until liver transplant. Mean time between IRE and transplant was 10 months (range, 3-17 mo). Assessment of imaging response was based on modified Response Evaluation Criteria In Solid Tumors. Liver explants were evaluated for necrosis and viable carcinoma in IRE-treated tumors. Results After IRE, all tumors showed a complete response on follow-up imaging. Five tumors showed complete pathologic necrosis without any viable carcinoma, sharply demarcated from the surrounding hepatic parenchyma. Bile ducts within the treatment area were preserved. A single tumor treated with a bipolar IRE probe had < 5% viable carcinoma cells at the periphery. Conclusions This study demonstrates the efficacy of IRE for HCC based on pathologic evaluation and correlation to radiologic findings. © 2015 SIR.


PubMed | Section of Interventional Radiology
Type: Journal Article | Journal: Seminars in interventional radiology | Year: 2011

Transjugular intrahepatic portosystemic shunt (TIPS) creation using bare stents is a second-line treatment for complications of portal hypertension due in part to the relatively high number of reinterventions and the occurrence of new or worsened encephalopathy. Initially, custom-made stent-grafts were used for TIPS revision in cases of biliary fistulae. Subsequently, custom stent-grafts were used for de novo TIPS creation. With the introduction of the VIATORR() TIPS endoprosthesis a dedicated stent-graft became available for TIPS creation and revision. The VIATORR() demonstrated its efficacy and superiority to uncovered stents in retrospective analyses, case-matched analyses, and randomized studies. The improved patency of stent-grafts has led many to requestion the role of TIPS as a second-line therapy. Currently, randomized trials are warranted to redefine the role of TIPS in the treatment of complications of portal hypertension.


PubMed | Section of Interventional Radiology
Type: Case Reports | Journal: Digestive diseases and sciences | Year: 2010

With the emergence of minimally invasive techniques, percutaneous drainage has been applied to the management of symptomatic pancreatic pseudocysts in lieu of conventional surgical or endoscopic therapy. Percutaneous insertion of internalized drainage catheters represents an attractive method for pseudocyst drainage, but has been limited by the usual need for cross-sectional imaging or endoscopic guidance. Herein, we describe the use of a simple fluoroscopically guided technique for percutaneous transgastric cystgastrostomy with internalized drainage catheter placement in two cases.


PubMed | Section of Interventional Radiology.
Type: Comparative Study | Journal: Annals of hepatology | Year: 2013

To assess within-patient temporal variability in Model for End Stage Liver Disease (MELD) scores and impact on outcome prognostication after transjugular intrahepatic portosystemic shunt (TIPS) creation.In this single institution retrospective study, MELD score was calculated in 68 patients (M:F = 42:26, mean age 55 years) at 4 pre-procedure time points (1, 2-6, 7-14, and 15-35 days) before TIPS creation. Medical record review was used to identify 30- and 90-day clinical outcomes. Within-patient variability in pre-procedure MELD scores was assessed using repeated measures analysis of variance, and the ability of MELD scores at different time points to predict post-TIPS mortality was evaluated by comparing area under receiver operating characteristic (AUROC) curves.TIPS were successfully created for ascites (n = 30), variceal hemorrhage (n = 29), hepatic hydrothorax (n = 8), and portal vein thrombosis (n = 1). Pre-TIPS MELD scores showed significant (P = 0.032) within-subject variance that approached 18.5%. Higher MELD scores demonstrated greater variability in sequential scores as compared to lower MELD scores. Overall 30- and 90-day patient mortality was 22% (15/67) and 38% (24/64). AUROC curves showed that most recent MELD scores performed on the day of TIPS had superior predictive capacity for 30- (0.876, P = 0.037) and 90-day (0.805 P = 0.020) mortality compared to MELD scores performed 2-6 or 7-14 days prior.In conclusion, MELD scores show within-patient variability over time, and scores calculated on the day of TIPS most accurately predict risk and should be used for patient selection and counseling.

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