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Stratchko LM, Rossebo AE, Kisting MA, Hinshaw JL, Mao L, Meyer CA, Robbins JB, Tuite MJ, Grist TM, Lee FT. Unreimbursed Costs of Multidisciplinary Conferences to a Radiology Department: A Prospective Analysis at an Academic Medical Center. J Am Coll Radiol 2024; 21:668-675. [PMID: 37922969 DOI: 10.1016/j.jacr.2023.10.015] [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: 07/31/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Multidisciplinary conferences (MDCs) are important for clinical care but are unreimbursed and can be time-consuming for radiologists to prepare for and present. The purpose of this single-center, prospective, survey-based study is to measure the per-conference time and total time radiologists devote to MDCs at a single academic medical center. Secondary objectives are to determine the source of radiologist preparation time, and calculate the per conference and overall radiology departmental costs of MDC participation. METHODS A prospective survey was performed to capture all radiology preparation and presentation time for MDCs in a 3-month period, which was then annualized. Total cost was calculated on the basis of Association of Administrators in Academic Radiology survey data for nonchair academic radiologist compensation plus a 30% fringe-benefit rate. RESULTS The survey response rate was 86.9%. A total of 3,358 hours were devoted annually to MDCs, which represents time equivalent to 1.9 full-time equivalents or $1,155,152 in unreimbursed radiology departmental costs. Per-MDC total preparation and presentation time was 2.7 hours, at an annual cost of $46,440 for each weekly MDC. Radiologists used a combination of personal time (49.7%), academic time (42%), and/or clinical time (35.4%) to prepare for MDCs. Radiologists devoted a mean of 47.9 hours (1.2 weeks) of time per annum to MDCs. CONCLUSIONS Radiologist time devoted to MDCs at the survey institution was substantial, and preparation time was drawn disproportionately from personal and academic time, which may have negative implications for burnout, recruitment and retention, and academic productivity unless it is effectively mitigated.
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Affiliation(s)
- Lindsay M Stratchko
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Annika E Rossebo
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Meridith A Kisting
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Cristopher A Meyer
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jessica B Robbins
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael J Tuite
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Thomas M Grist
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Fred T Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin.
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2
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Rossebo AE, Zlevor AM, Knott EA, Mao L, Couillard AB, Ziemlewicz TJ, Hinshaw JL, Abel EJ, Lubner MG, Knavel Koepsel EM, Wells SA, Stratchko LM, Laeseke PF, Lee FT. Percutaneous Microwave Ablation for Treatment of Retroperitoneal Tumors. Radiol Imaging Cancer 2024; 6:e230080. [PMID: 38334471 PMCID: PMC10988338 DOI: 10.1148/rycan.230080] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/05/2023] [Accepted: 12/15/2023] [Indexed: 02/10/2024]
Abstract
Purpose To determine if microwave ablation (MWA) of retroperitoneal tumors can safely provide high rates of local tumor control. Materials and Methods This retrospective study included 19 patients (median age, 65 years [range = 46-78 years]; 13 [68.4%] men and six [31.6%] women) with 29 retroperitoneal tumors treated over 22 MWA procedures. Hydrodissection (0.9% saline with 2% iohexol) was injected in 17 of 22 (77.3%) procedures to protect nontarget anatomy. The primary outcomes evaluated were local tumor progression (LTP) and complication rates. Oncologic outcomes, including overall survival (OS), progression-free survival (PFS), and treatment-free interval (TFI), were examined as secondary outcome measures. Results Median follow-up was 18 months (range = 0.5-113). Hydrodissection was successful in displacing nontarget anatomy in 16 of 17 (94.1%) procedures. The LTP rate was 3.4% (one of 29; 95% CI: 0.1, 17.8) per tumor and 5.3% (one of 19; 95% CI: 0.1, 26.0) per patient. The overall complication rate per patient was 15.8% (three of 19), including two minor complications and one major complication. The OS rate at 1, 2, and 3 years was 81.8%, 81.8%, and 72.7%, respectively, with a median OS estimated at greater than 7 years. There was no evidence of a difference in OS (P = .34) and PFS (P = .56) between patients with renal cell carcinoma (six of 19 [31.6%]) versus other tumors (13 of 19 [68.4%]) and patients treated with no evidence of disease (15 of 22 [68.2%]) versus patients with residual tumors (seven of 22 [31.8%]). Median TFI was 18 months (range = 0.5-108). Conclusion Treatment of retroperitoneal tumors with MWA combined with hydrodissection provided high rates of local control, prolonged systemic therapy-free intervals, and few serious complications. Keywords: Ablation Techniques (ie, Radiofrequency, Thermal, Chemical), Retroperitoneum, Microwave Ablation, Hydrodissection © RSNA, 2024.
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Affiliation(s)
- Annika E. Rossebo
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Annie M. Zlevor
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Emily A. Knott
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Lu Mao
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Allison B. Couillard
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Timothy J. Ziemlewicz
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - J. Louis Hinshaw
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - E. Jason Abel
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Meghan G. Lubner
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Erica M. Knavel Koepsel
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Shane A. Wells
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Lindsay M. Stratchko
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Paul F. Laeseke
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Fred T. Lee
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
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3
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Kavandi H, Itani M, Strnad B, Martin S, Ebrahimzadeh SA, Lubner MG, Noe-Kim V, Hinshaw JL, Bansal M, Karam AR, Khanna K, Hadied MO, Planz V, Glazer DI, Burgan CM, Galgano S, Brook A, Brook OR. A Multicenter Study of Needle Size and Safety for Splenic Biopsy. Radiology 2024; 310:e230453. [PMID: 38259204 DOI: 10.1148/radiol.230453] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Splenic biopsy is rarely performed because of the perceived risk of hemorrhagic complications. Purpose To evaluate the safety of large bore (≥18 gauge) image-guided splenic biopsy. Materials and Methods This retrospective study included consecutive adult patients who underwent US- or CT-guided splenic biopsy between March 2001 and March 2022 at eight academic institutions in the United States. Biopsies were performed with needles that were 18 gauge or larger, with a comparison group of biopsies with needles smaller than 18 gauge. The primary outcome was significant bleeding after the procedure, defined by the presence of bleeding at CT performed within 30 days or angiography and/or surgery performed to manage the bleeding. Categorical variables were compared using the χ2 test and medians were compared using the Mann-Whitney test. Results A total of 239 patients (median age, 63 years; IQR, 50-71 years; 116 of 239 [48.5%] female patients) underwent splenic biopsy with an 18-gauge or smaller needle and 139 patients (median age, 58 years [IQR, 49-69 years]; 66 of 139 [47.5%] female patients) underwent biopsy with a needle larger than 18 gauge. Bleeding was detected in 20 of 239 (8.4%) patients in the 18-gauge or smaller group and 11 of 139 (7.9%) in the larger than 18-gauge group. Bleeding was treated in five of 239 (2.1%) patients in the 18-gauge or smaller group and one of 139 (1%) in the larger than 18-gauge group. No deaths related to the biopsy procedure were recorded during the study period. Patients with bleeding after biopsy had smaller lesions compared with patients without bleeding (median, 2.1 cm [IQR, 1.6-5.4 cm] vs 3.5 cm [IQR, 2-6.8 cm], respectively; P = .03). Patients with a history of lymphoma or leukemia showed a lower incidence of bleeding than patients without this history (three of 90 [3%] vs 28 of 288 [9.7%], respectively; P = .05). Conclusion Bleeding after splenic biopsy with a needle 18 gauge or larger was similar to biopsy with a needle smaller than 18 gauge and seen in 8% of procedures overall, with 2% overall requiring treatment. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Grant in this issue.
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Affiliation(s)
- Hadiseh Kavandi
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Malak Itani
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Benjamin Strnad
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Sooyoung Martin
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Seyed Amir Ebrahimzadeh
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Meghan G Lubner
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Victoria Noe-Kim
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - J Louis Hinshaw
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Mohit Bansal
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Adib R Karam
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Kanika Khanna
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Mohamad Omar Hadied
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Virginia Planz
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Daniel I Glazer
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Constantine M Burgan
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Samuel Galgano
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Alexander Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Olga R Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
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4
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Kisting MA, Hinshaw JL, Toia GV, Ziemlewicz TJ, Kisting AL, Lee FT, Wagner MG. Artificial Intelligence-Aided Selection of Needle Pathways: Proof-of-Concept in Percutaneous Lung Biopsies. J Vasc Interv Radiol 2023:S1051-0443(23)00830-8. [PMID: 38008378 DOI: 10.1016/j.jvir.2023.11.016] [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: 08/03/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 11/28/2023] Open
Abstract
PURPOSE To evaluate the concordance between lung biopsy puncture pathways determined by artificial intelligence (AI) and those determined by expert physicians. MATERIALS AND METHODS An AI algorithm was created to choose optimal lung biopsy pathways based on segmented thoracic anatomy and emphysema in volumetric lung computed tomography (CT) scans combined with rules derived from the medical literature. The algorithm was validated using pathways generated from CT scans of randomly selected patients (n = 48) who had received percutaneous lung biopsies and had noncontrast CT scans of 1.25-mm thickness available in picture archiving and communication system (PACS) (n = 28, mean age, 68.4 years ± 9.2; 12 women, 16 men). The algorithm generated 5 potential pathways per scan, including the computer-selected best pathway and 4 random pathways (n = 140). Four experienced physicians rated each pathway on a 1-5 scale, where scores of 1-3 were considered safe and 4-5 were considered unsafe. Concordance between computer and physician ratings was assessed using Cohen's κ. RESULTS The algorithm ratings were statistically equivalent to the physician ratings (safe vs unsafe: κ¯=0.73; ordinal scale: κ¯=0.62). The computer and physician ratings were identical in 57.9% (81/140) of cases and differed by a median of 0 points. All least-cost "best" pathways generated by the algorithm were considered safe by both computer and physicians (28/28) and were judged by physicians to be ideal or near ideal. CONCLUSIONS AI-generated lung biopsy puncture paths were concordant with expert physician reviewers and considered safe. A prospective comparison between computer- and physician-selected puncture paths appears indicated in addition to expansion to other anatomic locations and procedures.
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Affiliation(s)
- Meridith A Kisting
- Departments of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - J Louis Hinshaw
- Departments of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Giuseppe V Toia
- Departments of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Adrienne L Kisting
- Departments of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Fred T Lee
- Departments of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Urology, University of Wisconsin-Madison, Madison, Wisconsin; Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Martin G Wagner
- Departments of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.
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5
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Couillard AB, Zlevor AM, Ziemlewicz TJ, Kisting MA, Knott E, Rossebo AE, White J, Lubner MG, Gettle LM, Hinshaw JL, Mao L, Stoffregen W, Swietlik JF, Knavel-Koepsel E, Stratchko L, Abel EJ, Xu Z, Lee FT, Laeseke PF. A Comparison of Histotripsy and Percutaneous Cryoablation in a Chronic Healthy Swine Kidney Model. J Vasc Interv Radiol 2023; 34:1986-1996. [PMID: 37481064 DOI: 10.1016/j.jvir.2023.07.014] [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: 02/01/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023] Open
Abstract
PURPOSE To compare the safety and efficacy of histotripsy with cryoablation in a chronic human-scale normal porcine kidney model. MATERIALS AND METHODS Eighteen female domestic swine were divided evenly into histotripsy and cryoablation treatment arms. A planned 2-3 cm diameter treatment was performed under ultrasound (histotripsy) or ultrasound and computed tomography (CT) guidance (cryoablation). Contrast-enhanced CT and serum blood analysis were performed immediately postprocedure and on day 7, with either immediate killing (n = 3) or continued survival to day 30 (n = 6), at which time contrast-enhanced CT, serum blood analysis, and necropsy were performed. Animal welfare, treatment zone appearance, procedure-related adverse events, and histopathology of the treatment zones and surrounding tissues were assessed. RESULTS Histotripsy treatment zones (mean ±standard deviation diameters, 2.7 ± 0.12 × 2.4 ± 0.19 × 2.4 ± 0.26 cm; volume, 8.3 ± 1.9 cm3) were larger than cryoablation zones (mean diameters, 2.2 ± 0.19 × 1.9 ± 0.13 × 1.7 ± 0.19 cm; volume, 3.9 ± 0.8 cm3; P < .001). At 30 days, histotripsy and cryoablation treatment zone volumes decreased by 96% and 83% on CT, respectively (P < .001). Perirenal hematomas were present after 8 of 9 (89%) cryoablation (mean volume, 22.2 cm3) and 1 of 9 (11%, P < .001) histotripsy (volume, 0.4 cm3) procedures, with active arterial extravasation in 4 of 9 (44%) cryoablation and no histotripsy animals (P = .206). All 9 histotripsy animals and 5 of 9 (56%) cryoablation animals had collecting system debris (P = .042). Changes in serum creatinine were similar between the groups (P = .321). CONCLUSIONS Other than a higher rate of bleeding after cryoablation, the safety and early efficacy of histotripsy and cryoablation were comparable for creating treatment zones in a chronic normal porcine kidney model.
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Affiliation(s)
| | - Annie M Zlevor
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Meridith A Kisting
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Emily Knott
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Annika E Rossebo
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jim White
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lu Mao
- Department of Biostatistics, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - John F Swietlik
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Lindsay Stratchko
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - E Jason Abel
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Fred T Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Paul F Laeseke
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin.
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6
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Eckelmann BJ, Blitzer GC, Smilowitz JB, Trask D, Weiss M, Weber S, Abbott D, Varley P, Neuman H, Maloney JD, Hinshaw JL, Morris BA, Merfeld E, Howard SP, Bradley KA, Baschnagel AM, Bassetti MF, Hennessey DW, Morris Z. Initial Results of a Phase II Trial of Hypofractionated Radiation Therapy for Inoperable Soft Tissue Sarcoma. Int J Radiat Oncol Biol Phys 2023; 117:S147-S148. [PMID: 37784374 DOI: 10.1016/j.ijrobp.2023.06.564] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) For patients with soft tissue sarcoma (STS) who cannot or choose not to have surgery, radiation can provide local tumor control in both palliative and definitive settings. Conventionally fractionated radiation provides modest (< 50%) rates of local control (LC) for STS at 2 years. To our knowledge, no prospective studies to date have evaluated the safety and efficacy of dose-escalated hypofractionated radiation therapy as treatment of inoperable STS. We hypothesized that dose-escalated, hypofractionated radiation therapy (RT) for inoperable STS could achieve higher rates of LC than reported in trials of conventionally fractionated RT. MATERIALS/METHODS An IRB-approved single institution prospective phase II clinical trial of dose-escalated, hypofractionated RT as local control for STS was designed and completed planned accrual. Exclusion criteria included anti-cancer systemic therapy within the preceding two weeks. Patients underwent hypofractionated RT utilizing either CT-guided radiation (24, 50%) or MRI-guided radiation treatments (24, 50%). Data on patient characteristics, RT dose and fractionation, LC, toxicity, and overall survival (OS) was collected. The primary endpoint was local tumor control (stable, partial, or complete response according to RECIST) at 2-years after completion of radiation. Secondary endpoints were acute and late toxicity, rates of complete response, 5-year local tumor control, and progression-free and overall survival. Acute toxicity was graded on the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 scale during treatment and at 3 months following RT. RESULTS Forty-eight patients were enrolled, 17 with non-metastatic localized disease and 31 with metastatic disease. Median patient age was 64. Twenty-five men and 23 women were treated. Ninety-six total lesions were treated (36 lung, 7 extremity, 37 abdominopelvic, 16 other). Radiation dose per fraction ranged from 6-12 Gy for a total of 1-12 fractions (median dose was 52.5 Gy in 6 fractions. Median patient follow-up is 8.6 months (range 1 - 36 months). Six patients (13%) did not complete initial 3-month follow-up imaging. Of the 40 patients who have undergone 3-month follow up imaging, 32 (80%) had stable disease, 5 (12.5%) had partial response, 0 had complete response, and 3 (7.5%) had disease progression. Median PFS was 17.2 months at time of last follow up. Median OS was 12.9 months at time of last follow up. Twenty-five patients (52%) experienced an acute toxicity likely or possibly related to radiation. Three (6%) patients experienced CTACE grade 3 or greater treatment-related toxicity (pain, weakness, decreased range of motion, dermatitis). CONCLUSION In this initial report of a prospective, single-institution clinical trial of hypofractionated RT for STS not undergoing resection, we report low rates of acute grade 3 or greater toxicity and high rates of tumor response. We will continue to follow these patients to assess late toxicity and durability of tumor control.
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Affiliation(s)
- B J Eckelmann
- Department of Human Oncology, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - G C Blitzer
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - J B Smilowitz
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - D Trask
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - M Weiss
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - S Weber
- Department of Surgical Oncology, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - D Abbott
- Department of Surgical Oncology, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - P Varley
- Department of Surgical Oncology, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - H Neuman
- Department of Surgical Oncology, University of Wisconsin, Madison, WI
| | - J D Maloney
- University of Wisconsin, Department of Cardiothoracic Surgery, Madison, WI
| | - J L Hinshaw
- Department of Radiology, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - B A Morris
- Department of Human Oncology, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - E Merfeld
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - S P Howard
- Department of Human Oncology, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - K A Bradley
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - A M Baschnagel
- Department of Human Oncology, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - M F Bassetti
- Department of Human Oncology, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - D W Hennessey
- Department of Orthopedic and Rehabilitation, University of Wisconsin, Madison, WI
| | - Z Morris
- University of Wisconsin - Madison, Madison, WI
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7
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Sorensen AM, Zlevor AM, Kisting MA, Couillard AB, Ziemlewicz TJ, Toia GV, Hinshaw JL, Woods M, Stratchko LM, Pickhardt PJ, Foltz ML, Peppler WW, Lee FT, Knavel Koepsel EM. CT Navigation for Percutaneous Needle Placement: How I Do It. Tech Vasc Interv Radiol 2023; 26:100911. [PMID: 38071032 DOI: 10.1016/j.tvir.2023.100911] [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: 12/18/2023]
Abstract
CT navigation (CTN) has recently been developed to combine many of the advantages of conventional CT and CT-fluoroscopic guidance for needle placement. CTN systems display real-time needle position superimposed on a CT dataset. This is accomplished by placing electromagnetic (EM) or optical transmitters/sensors on the patient and needle, combined with fiducials placed within the scan field to superimpose a known needle location onto a CT dataset. Advantages of CTN include real-time needle tracking using a contemporaneous CT dataset with the patient in the treatment position, reduced radiation to the physician, facilitation of procedures outside the gantry plane, fewer helical scans during needle placement, and needle guidance based on diagnostic-quality CT datasets. Limitations include the display of a virtual (vs actual) needle position, which can be inaccurate if the needle bends, the fiducial moves, or patient movement occurs between scans, and limitations in anatomical regions with a high degree of motion such as the lung bases. This review summarizes recently introduced CTN technologies in comparison to historical methods of CT needle guidance. A "How I do it" section follows, which describes how CT navigation has been integrated into the study center for both routine and challenging procedures, and includes step-by-step explanations, technical tips, and pitfalls.
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Affiliation(s)
- Anna M Sorensen
- Departments of Radiology, University of Wisconsin, Madison, WI
| | - Annie M Zlevor
- Departments of Radiology, University of Wisconsin, Madison, WI
| | | | | | | | - Giuseppe V Toia
- Departments of Radiology, University of Wisconsin, Madison, WI; Medical Physics, University of Wisconsin, Madison, WI
| | - J Louis Hinshaw
- Departments of Radiology, University of Wisconsin, Madison, WI; Departments of Urology, University of Wisconsin, Madison, WI
| | - Michael Woods
- Departments of Radiology, University of Wisconsin, Madison, WI
| | | | | | - Marcia L Foltz
- Departments of Radiology, University of Wisconsin, Madison, WI
| | | | - Fred T Lee
- Departments of Radiology, University of Wisconsin, Madison, WI; Departments of Urology, University of Wisconsin, Madison, WI; Biomedical Engineering, University of Wisconsin, Madison, WI
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8
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Zlevor AM, Kisting MA, Couillard AB, Rossebo AE, Szczykutowicz TP, Mao L, White JK, Hartung MP, Gettle LM, Hinshaw JL, Pickhardt PJ, Ziemlewicz TJ, Foltz ML, Lee FT. Percutaneous CT-Guided Abdominal and Pelvic Biopsies: Comparison of an Electromagnetic Navigation System and CT Fluoroscopy. J Vasc Interv Radiol 2023; 34:910-918. [PMID: 36736821 DOI: 10.1016/j.jvir.2023.01.024] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/09/2023] [Accepted: 01/22/2023] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To compare electromagnetic navigation (EMN) with computed tomography (CT) fluoroscopy for guiding percutaneous biopsies in the abdomen and pelvis. MATERIALS AND METHODS A retrospective matched-cohort design was used to compare biopsies in the abdomen and pelvis performed with EMN (consecutive cases, n = 50; CT-Navigation; Imactis, Saint-Martin-d'Hères, France) with those performed with CT fluoroscopy (n = 100). Cases were matched 1:2 (EMN:CT fluoroscopy) for target organ and lesion size (±10 mm). RESULTS The population was well-matched (age, 65 vs 65 years; target size, 2.0 vs 2.1 cm; skin-to-target distance, 11.4 vs 10.7 cm; P > .05, EMN vs CT fluoroscopy, respectively). Technical success (98% vs 100%), diagnostic yield (98% vs 95%), adverse events (2% vs 5%), and procedure time (33 minutes vs 31 minutes) were not statistically different (P > .05). Operator radiation dose was less with EMN than with CT fluoroscopy (0.04 vs 1.2 μGy; P < .001), but patient dose was greater (30.1 vs 9.6 mSv; P < .001) owing to more helical scans during EMN guidance (3.9 vs 2.1; P < .001). CT fluoroscopy was performed with a mean of 29.7 tap scans per case. In 3 (3%) cases, CT fluoroscopy was performed with gantry tilt, and the mean angle out of plane for EMN cases was 13.4°. CONCLUSIONS Percutaneous biopsies guided by EMN and CT fluoroscopy were closely matched for technical success, diagnostic yield, procedure time, and adverse events in a matched cohort of patients. EMN cases were more likely to be performed outside of the gantry plane. Radiation dose to the operator was higher with CT fluoroscopy, and patient radiation dose was higher with EMN. Further study with a wider array of procedures and anatomic locations is warranted.
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Affiliation(s)
- Annie M Zlevor
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Meridith A Kisting
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Annika E Rossebo
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Timothy P Szczykutowicz
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - James K White
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael P Hartung
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Marcia L Foltz
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Fred T Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin.
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9
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Knott EA, Zlevor AM, Hinshaw JL, Laeseke PF, Longhurst C, Frank J, Bradley CW, Couillard AB, Rossebo AE, Xu Z, Lee FT, Ziemlewicz TJ. A comparison study of microwave ablation vs. histotripsy for focal liver treatments in a swine model. Eur Radiol 2023; 33:1050-1062. [PMID: 36048208 DOI: 10.1007/s00330-022-09112-8] [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: 07/06/2022] [Revised: 07/06/2022] [Accepted: 08/11/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the acute and chronic safety and treatment effects of non-invasive hepatic histotripsy vs. percutaneous microwave (MW) ablation in a healthy porcine model. METHODS This was a dual-arm study in which each animal (n = 14) received either a single hepatic microwave (n = 6) or histotripsy (n = 6 single treatment; n = 2 double treatment) under ultrasound guidance. The goal was to create 2.5-3.0 cm short-axis treatments in similar locations across modalities. Animals were survived for 1 month with contrast-enhanced CT imaging on days 0, 2, 7, 14, and 28. On day 28, necropsy and histopathology were performed. RESULTS All procedures were well-tolerated. MW ablation zones were longer and more oblong, but equivalent in the short axes to histotripsy zones on immediate post-procedure CT (p < 0.001 and p = 0.45, respectively). Overall, MW volumes were larger (21.4 cm3 vs. 13.4 cm3; p = 0.001) and histotripsy treatment zones were more spherical (p = 0.007). Histotripsy zones were close to the prescribed size (p < 0.001). Over the study period, histotripsy treatment zones decreased in volume while microwave ablation zones slightly increased (-83% vs. +17%, p = 0.001). There were several imaging-only findings: Branch portal vein thrombus with both histotripsy (7/8) and MW (6/6), hematoma in 2/6 MW only, and a gallbladder injury in 1/6 MW animals. The ablation zones demonstrated complete cellular destruction for both modalities. CONCLUSION Histotripsy was associated with more spherical treatments, fewer biliary complications, and greater treatment zone involution. Hepatic MW and histotripsy treatment in a normal porcine model appear at least equally effective for creating treatment zones with a similar safety profile. KEY POINTS • Microwave ablation and histotripsy for liver treatment in a healthy porcine model yield equivalent procedural tolerance and cellular destruction. • Histotripsy was associated with more spherical treatments, fewer biliary complications, and greater treatment zone involution over the 28-day follow-up period. • These findings confirm the safety and efficacy of hepatic histotripsy and support the pursuit of clinical trials to further evaluate the translatability of these results.
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Affiliation(s)
- Emily A Knott
- The Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Annie M Zlevor
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
- Department of Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Paul F Laeseke
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Colin Longhurst
- Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Jenifer Frank
- College of Agriculture and Life Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Charles W Bradley
- Department of Pathobiology, University of Pennsylvania: School of Veterinary Medicine, Philadelphia, PA, USA
| | - Allison B Couillard
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Annika E Rossebo
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
- Department of Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- College of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA.
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10
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Lubner MG, Ziemlewicz TJ, Wells SA, Li K, Wu PH, Hinshaw JL, Lee FT, Brace CL. Advanced CT techniques for hepatic microwave ablation zone monitoring and follow-up. Abdom Radiol (NY) 2022; 47:2658-2668. [PMID: 34731282 DOI: 10.1007/s00261-021-03333-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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate utility of advanced CT techniques including HighlY constrained back-projection and dual-energy CT for intra- and post-procedure hepatic microwave ablation zone monitoring. METHODS 8 hepatic microwave ablations were performed in 4 adult swine (5 min/65 W). Low-dose routine CECT and dual-energy CT images were obtained every 1 min during ablation. Images were reconstructed ± HYPR. Image quality and dose metrics were collected. 21 MWA were performed in 4 adult swine. Immediate post-procedure CECT was performed in the arterial, portal venous, and delayed phases using both routine and DECT imaging with full-dose weight-based IV contrast dosing. An additional 16 MWA were subsequently performed in 2 adult swine. Immediate post-procedure CT was performed with half-dose IV contrast using routine and DECT. 12 patients (10 M/2F, mean age 62.4 yrs) with 14 hepatic tumors (4 HCC, 10 metastatic lesions) treated with MWA were prospectively imaged with DECT 1 month post-procedure. 120 kV equivalent images were compared to DECT [51 keV, iodine material density]. Image quality and dose metrics were collected. RESULTS Gas created during MWA led to high CNR in all intraprocedural CT datasets. Optimal CNRs were noted at 4 min with CNR 6.7, 15.5,15.9, and 21.5 on LD-CECT, LD-CECT + HYPR, DECT, and DECT + HYPR, respectively (p < 0.001). Image quality scores at 4 min were 1.8, 2.8, 2.4, and 3, respectively (p < 0.001). Mean radiation dose (CTDIvol) was eightfold higher for the DECT series. For swine, post-procedural DECT images (IMD/51 keV) showed improved CNR compared to routine CT at all time points with full and with reduced dose contrast (CNR 4.6, 3.2, and 1.5, respectively, at half-contrast dose, p < 0.001). For human subjects, the 51 keV and IMD images showed higher CNRs (5.8, 4.8 vs 4.0, p < 0.001) and SNRs (3.7, 5.9 vs 2.8). Ablation zone sharpness was improved with DECT (routine 3.0 ± 0.7, DECT 3.5 ± 0.5). Diagnostic confidence was higher with DECT (routine 2.3 ± 0.9, DECT 2.6 ± 0.8). Mean DLP for DECT was 905.7 ± 606 mGy-cm, CTDIvol 37.5 ± 21.2 mGy, and effective dose 13.6 ± 9.1 mSv, slightly higher than conventional CT series. CONCLUSION Advanced CT techniques can improve CT image quality in peri-procedural hepatic microwave ablation zone evaluation.
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Affiliation(s)
- Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA.
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Shane A Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Ke Li
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA.,Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Po-Hung Wu
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA.,Department of Biomedical and Electrical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Electrical and Computer Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Chris L Brace
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA.,Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Biomedical and Electrical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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11
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Couillard AB, Knott EA, Zlevor AM, Mezrich JD, Cristescu MM, Agarwal P, Ziemlewicz TJ, Longhurst C, Lubner MG, Hinshaw JL, Said A, Laeseke PF, Lucey MR, Rice JP, Foley D, Al-Adra D, Lee FT. Microwave ablation as bridging to liver transplant for patients with hepatocellular carcinoma: a single-center retrospective analysis. J Vasc Interv Radiol 2022; 33:1045-1053. [PMID: 35667580 DOI: 10.1016/j.jvir.2022.05.019] [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: 10/30/2021] [Revised: 05/03/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of microwave (MW) ablation as first-line locoregional therapy (LRT) for bridging patients with hepatocellular carcinoma (HCC) to liver transplant. MATERIALS AND METHODS This retrospective study evaluated 88 patients who received percutaneous MW ablation for 141 tumors as first-line LRT for HCC and listed for liver transplantation at a single medical center between 2011 and 2019. Overall survival rate status-post liver transplant, waitlist retention and disease progression were evaluated using Kaplan-Meier techniques. RESULTS Of 88 patients (72M, 16F, mean age 60 years, MELD=11.2) listed for transplant, median waitlist time was 9.4 months (IQR: 5.5 - 18.9). Seventy-one patients (80.7%) received transplant after median wait time of 8.5 months. Seventeen patients (19.3%) were removed from the waitlist, four (4.5%) due to tumors outside of the Milan criteria (HCC-specific dropout). No difference in tumor size or AFP was seen in transplanted vs. non-transplanted patients at time of ablation (2.1 vs. 2.1 cm and 34.4 vs. 34.7 ng/mL for transplanted vs. non-transplanted, respectively, p>0.05). Five of 88 patients (5.1%) experienced adverse events after ablation; however, all recovered. There were no cases of tract seeding. The local tumor progression (LTP) rate was 7.2%. The overall survival status-post liver transplant at 5-years was 76.7% and the disease-specific survival after LT was 89.6% with a median follow-up of 61 months for all patients. CONCLUSION MW ablation appears to be safe and effective for bridging patients with HCC to liver transplant without waitlist removal from seeding, adverse events, or local tumor progression.
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Affiliation(s)
| | - Emily A Knott
- University of Wisconsin-Madison: Department of Radiology
| | - Annie M Zlevor
- University of Wisconsin-Madison: Department of Radiology
| | | | | | | | | | - Colin Longhurst
- Department of Carbone Cancer Center; Department of Biostatistics and Medical Informatics
| | | | - J Louis Hinshaw
- University of Wisconsin-Madison: Department of Radiology; Department of Urology
| | | | - Paul F Laeseke
- University of Wisconsin-Madison: Department of Radiology
| | | | | | | | | | - Fred T Lee
- University of Wisconsin-Madison: Department of Radiology; Department of Urology; Department of Biomedical Engineering.
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12
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Hayenga HN, Cai C, Fetzer D, White S, Kuban J, Wardak Z, Benjamin RS, Pan E, Strauss J, Gao B, Minna J, Martin-Broto J, Hinshaw JL. Rare solid and cystic presentation of hemangiopericytoma/ solitary fibrous tumor: a case report. Current Problems in Cancer: Case Reports 2022. [DOI: 10.1016/j.cpccr.2022.100149] [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: 11/24/2022] Open
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13
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Knott EA, Ziemlewicz TJ, Lubner SJ, Swietlik JF, Weber SM, Zlevor AM, Longhurst C, Hinshaw JL, Lubner MG, Mulkerin DL, Abbott DE, Deming D, LoConte NK, Uboha N, Couillard AB, Wells SA, Laeseke PF, Alexander ML, Lee FT. Microwave ablation for colorectal cancer metastasis to the liver: a single-center retrospective analysis. J Gastrointest Oncol 2021; 12:1454-1469. [PMID: 34532102 DOI: 10.21037/jgo-21-159] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/11/2021] [Indexed: 12/24/2022] Open
Abstract
Background The purpose of this study is to evaluate the safety and intermediate-term efficacy of percutaneous microwave (MW) ablation for the treatment of colorectal liver metastases (CRLM) at a single institution. Methods A retrospective review was performed of all CRLM treated with MW ablation from 3/2011 to 7/2020 (102 tumors; 72 procedures; 57 patients). Mean age was 60 years (range, 36-88) and mean tumor size was 1.8 cm (range, 0.5-5.0 cm). The patient population included 19 patients with extra-hepatic disease. Chemotherapy (pre- and/or post-ablation) was given in 98% of patients. Forty-five sessions were preceded by other focal CRLM treatments including resection, ablation, radiation, and radioembolization. Kaplan-Meier curves were used to estimate local tumor progression-free survival (LTPFS), disease-free survival (DFS), and overall survival (OS) and multivariate analysis (Cox Proportional Hazards model) was used to test predictors of OS. Results Technical success (complete ablation) was 100% and median follow-up was 42 months (range, 1-112). There was a 4% major complication rate and an overall complication rate of 8%. Local tumor progression (LTP) rate during the entire study period was 4/98 (4%), in which 2 were retreated with MW ablation for a secondary LTP-rate of 2%. LTP-free survival at 1, 3, and 5 years was 93%, 58%, and 39% and median LTP-free survival was 48 months. OS at 1, 3, and 5 years was 96%, 66%, 47% and median OS was 52 months. There were no statistically significant predictors of OS. Conclusions MW ablation of hepatic colorectal liver metastases appears safe with excellent local tumor control and prolonged survival compared to historical controls in selected patients. Further comparative studies with other local treatment strategies appear indicated.
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Affiliation(s)
- Emily A Knott
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Sam J Lubner
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - John F Swietlik
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Sharon M Weber
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.,Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Annie M Zlevor
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Colin Longhurst
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.,Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,Department of Urology, University of Wisconsin-Madison, Madison, WI, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel L Mulkerin
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel E Abbott
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.,Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Dustin Deming
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Noelle K LoConte
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Nataliya Uboha
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Shane A Wells
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Paul F Laeseke
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Marci L Alexander
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.,Department of Urology, University of Wisconsin-Madison, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
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14
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Krieger JR, Lee FT, McCormick T, Ziemlewicz TJ, Hinshaw JL, Wells SA, Laeseke PE, Stratchko L, Alexander M, Hedican SP, Best SL, Borza T, Nakada SY, Abel EJ. Microwave Ablation of Renal Cell Carcinoma. J Endourol 2021; 35:S33-S37. [PMID: 34499558 DOI: 10.1089/end.2020.1078] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Management options for small renal masses include active surveillance, partial nephrectomy, radical nephrectomy, and thermal ablation. For tumors typically ≤3 cm in size, thermal ablation is a good option for those desiring an alternative to surgery or active surveillance, especially in patients who are considered high surgical risk. We favor microwave ablation because of the more rapid heating, higher temperatures that overcome the heat sink effect of vessels, reproducible cell kill, and a highly visible ablation zone formed by water vapor that corresponds well to the zone of necrosis. For central tumors, we favor cryoablation because of the slower formation of the ablation zone and less likelihood of damage to the collecting system. With microwaves, it is important to monitor the ablation zone in real time (ultrasound is the best modality for this purpose), avoid direct punctures of the collecting system, and to place probes tangential to the collecting system to avoid burning open a persistent tract between the urothelium and extrarenal spaces or causing strictures. The surgical steps described in this video cover our use of high-frequency jet ventilation with general anesthesia to minimize organ motion, initial imaging and targeting, probe insertion, hydrodissection (a technique that enables displacement of adjacent structures), the ablation itself, and finally our dressing. Postoperative cares typically consist of observation with a same-day discharge or an overnight stay. Follow-up includes a magnetic resonance imaging abdomen with and without contrast, chest X-ray, and laboratories (basic metabolic panel, complete blood count, and C-reactive protein) 6 months postablation. Overall, percutaneous microwave ablation is an effective and safe treatment option for renal cell carcinoma in both T1a and T1b tumors in selected patients with multiple studies showing excellent oncologic outcomes when compared with partial and radical nephrectomy.
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Affiliation(s)
- Jordan R Krieger
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Fred T Lee
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Timothy McCormick
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Timothy J Ziemlewicz
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - J Louis Hinshaw
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Shane A Wells
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Paul E Laeseke
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lindsay Stratchko
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Marci Alexander
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sean P Hedican
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sara L Best
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Tudor Borza
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Stephen Y Nakada
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - E Jason Abel
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
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15
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Zlevor AM, Mauch SC, Knott EA, Pickhardt PJ, Mankowski Gettle L, Mao L, Meyer CA, Hartung MP, Kim DH, Lubner MG, Hinshaw JL, Foltz ML, Ziemlewicz TJ, Lee FT. Percutaneous Lung Biopsy with Pleural and Parenchymal Blood Patching: Results and Complications from 1,112 Core Biopsies. J Vasc Interv Radiol 2021; 32:1319-1327. [PMID: 34229043 DOI: 10.1016/j.jvir.2021.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To evaluate the outcomes of computed tomography (CT) fluoroscopy-guided core lung biopsies with emphasis on diagnostic yield, complications, and efficacy of parenchymal and pleural blood patching to avoid chest tube placement. METHODS This is a single-center retrospective analysis of CT fluoroscopy-guided percutaneous core lung biopsies between 2006 and 2020. Parenchymal blood patching during introducer needle withdrawal was performed in 74% of cases as a preventive measure, and pleural blood patching was the primary salvage maneuver for symptomatic or growing pneumothorax in 60 of 83 (72.2%) applicable cases. RESULTS A total of 1,029 patients underwent 1,112 biopsies (532 men; mean age, 66 years; 38.6%, history of emphysema; lesion size, 16.7 mm). The diagnostic yield was 93.6% (1,032/1,103). Fewer complications requiring intervention were observed in patients who underwent parenchymal blood patching (5.7% vs 14.2%, P < .001). Further intervention was required in 83 of 182 pneumothorax cases, which included the following: (a) pleural blood patch (5.4%, 60/1,112), (b) chest tube placement without a pleural blood patch attempt (1.5%, 17/1,112), and (c) simple aspiration (0.5%, 6/1,112). Pleural blood patch as monotherapy was successful in 83.3% (50/60) of cases without need for further intervention. The overall chest tube rate was 2.6% (29/1,112). Emphysema was the only significant risk factor for complications requiring intervention (P ≤ .001). CONCLUSIONS Parenchymal blood patching during introducer needle withdrawal decreased complications requiring intervention. Salvage pleural blood patching reduced the frequency of chest tube placement for pneumothorax.
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Affiliation(s)
- Annie M Zlevor
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Scott C Mauch
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Emily A Knott
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | | | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | | | - Michael P Hartung
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - David H Kim
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin, Madison, Wisconsin; Department of Urology, University of Wisconsin, Madison, Wisconsin
| | - Marcia L Foltz
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | | | - Fred T Lee
- Department of Radiology, University of Wisconsin, Madison, Wisconsin; Department of Urology, University of Wisconsin, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin.
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16
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Blitzer GC, Wojcieszynski A, Abel EJ, Best S, Lee FT, Hinshaw JL, Wells S, Ziemlewicz TJ, Lubner MG, Alexander M, Yadav P, Bayouth JE, Floberg J, Cooley G, Harari PM, Bassetti MF. Combining Stereotactic Body Radiotherapy and Microwave Ablation Appears Safe and Feasible for Renal Cell Carcinoma in an Early Series. Clin Genitourin Cancer 2021; 19:e313-e318. [PMID: 34024743 DOI: 10.1016/j.clgc.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/03/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 01/20/2023]
Abstract
Microwave (MW) ablation and stereotactic body radiation therapy (SBRT) are both used in treating inoperable renal cell carcinoma (RCC). MW ablation and SBRT have potentially complementary advantages and limitations. Combining SBRT and MW ablation may optimize tumor control and toxicity for patients with larger (> 5 cm) RCCs or those with vascular involvement. Seven patients with RCC were treated at our institution with combination of SBRT and MW ablation, median tumor size of 6.4 cm. Local control was 100% with a median follow-up of 15 months. Four patients experienced grade 2 nausea during SBRT. Three patients experienced toxicities after MW ablation, 2 with grade 1 hematuria and 1 with grade 3 retroperitoneal bleed/collecting system injury. Median eGFR (estimated glomerular filtration rate) preceding and following SBRT and MW ablation was 69 mL/min/1.73 m2 and 68 mL/min/1.73 m2 (P = .19), respectively. In patients who are not surgical candidates, larger RCCs or those with vascular invasion are challenging to treat. Combination treatment with SBRT and MW ablation may balance the risks and benefits of both therapies and demonstrates high local control in our series. MW ablation and SBRT have potentially complementary advantages and limitations.
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Affiliation(s)
- Grace C Blitzer
- Department of Human Oncology, University of Wisconsin Hospitals & Clinics, Madison, WI.
| | | | - E Jason Abel
- Department of Urology, University of Wisconsin Hospitals & Clinics, Madison, WI
| | - Sara Best
- Department of Urology, University of Wisconsin Hospitals & Clinics, Madison, WI
| | - Fred T Lee
- Department of Radiology, University of Wisconsin Hospitals & Clinics, Madison, WI
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin Hospitals & Clinics, Madison, WI
| | - Shane Wells
- Department of Radiology, University of Wisconsin Hospitals & Clinics, Madison, WI
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin Hospitals & Clinics, Madison, WI
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin Hospitals & Clinics, Madison, WI
| | - Marci Alexander
- Department of Radiology, University of Wisconsin Hospitals & Clinics, Madison, WI
| | - Poonam Yadav
- Department of Human Oncology, University of Wisconsin Hospitals & Clinics, Madison, WI
| | - John E Bayouth
- Department of Human Oncology, University of Wisconsin Hospitals & Clinics, Madison, WI
| | - John Floberg
- Department of Human Oncology, University of Wisconsin Hospitals & Clinics, Madison, WI
| | - Greg Cooley
- Department of Human Oncology, University of Wisconsin Hospitals & Clinics, Madison, WI
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin Hospitals & Clinics, Madison, WI
| | - Michael F Bassetti
- Department of Human Oncology, University of Wisconsin Hospitals & Clinics, Madison, WI
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Knott EA, Rose SD, Wagner MG, Lee FT, Radtke J, Anderson DR, Zlevor AM, Lubner MG, Hinshaw JL, Szczykutowicz TP. CT Fluoroscopy for Image-Guided Procedures: Physician Radiation Dose During Full-Rotation and Partial-Angle CT Scanning. J Vasc Interv Radiol 2021; 32:439-446. [PMID: 33414069 DOI: 10.1016/j.jvir.2020.10.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/01/2020] [Revised: 09/29/2020] [Accepted: 10/18/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To determine physician radiation exposure when using partial-angle computed tomography (CT) fluoroscopy (PACT) vs conventional full-rotation CT and whether there is an optimal tube/detector position at which physician dose is minimized. MATERIALS AND METHODS Physician radiation dose (entrance air kerma) was measured for full-rotation CT (360°) and PACT (240°) at all tube/detector positions using a human-mimicking phantom placed in a 64-channel multidetector CT. Parameters included 120 kV, 20- and 40-mm collimation, and 100 mA. The mean, standard deviation, and increase/decrease in physician dose compared with a full-rotation scan were reported. RESULTS Physician radiation exposure during CT fluoroscopy with PACT was highly dependent on the position of the tube/detector during scanning. The lowest PACT physician dose was when the physician was on the detector side (center view angle 116°; -35% decreased dose vs full-angle CT). The highest PACT physician dose was with the physician on the tube side (center view angle 298°; +34% increased dose vs full-angle CT), all doses P <.05 vs full-rotation CT. CONCLUSIONS Partial-angle CT has the potential to both significantly increase or decrease physician radiation dose during CT fluoroscopy-guided procedures. The detector/tube position has a profound effect on physician dose. The lowest dose during PACT was achieved when the physician was located on the detector side (ie, distant from the tube). This data could be used to optimize CT fluoroscopy parameters to reduce physician radiation exposure for PACT-capable scanners.
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Affiliation(s)
- Emily A Knott
- Department of Radiology, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Sean D Rose
- Department of Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Martin G Wagner
- Department of Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Fred T Lee
- Department of Radiology, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Jeff Radtke
- Department of Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Daniel R Anderson
- Department of Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Annie M Zlevor
- Department of Radiology, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Timothy P Szczykutowicz
- Department of Radiology, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705; Department of Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705; Department of Biomedical Engineering, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705.
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18
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Kliewer MA, Brinkman MR, Hinshaw JL. The Back Alleys and Dark Corners of Abdomen and Pelvis Computed Tomography: The Most Frequent Sites of Missed Findings in the Multiplanar Era. J Clin Imaging Sci 2020; 10:70. [PMID: 33194312 PMCID: PMC7656035 DOI: 10.25259/jcis_184_2020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/18/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives Radiologists reading multiplanar abdominal/pelvic computed tomography (CT) are vulnerable to oversight of specific anatomic areas, leading to perceptual errors (misses). The aims of this study are to identify common sites of major perceptual error at our institution and then to put these in context with earlier studies to produce a comprehensive overview. Material and Methods We reviewed our quality assurance database over an 8-year period for cases of major perceptual error on CT examinations of the abdomen and pelvis. A major perceptual error was defined as a missed finding that had altered management in a way potentially detrimental to the patient. Record was made of patient age, gender, study indication, study priority (stat/routine), and use of IV and/or oral contrast. Anatomic locations were subdivided as lung bases, liver, pancreas, kidneys, spleen, mesentery, peritoneum, retroperitoneum, small bowel, colon, appendix, vasculature, body wall, and bones. Results A total of 216 missed findings were identified in 201 patients. The most common indication for the study was cancer follow-up (71%) followed by infection (11%) and abdominal pain (6%). The most common anatomic regions of error were the liver (15%), peritoneum (10%), body wall (9%), retroperitoneum (8%), and mesentery (6%). Data from other studies were reorganized into congruent categories for comparison. Conclusion This study demonstrates that the most common sites of significant missed findings on multiplanar abdominal/pelvic CT included the mesentery, peritoneum, body wall, bowel, vasculature, and the liver in the arterial phase. Data from other similar studies were reorganized into congruent categories to provide a comprehensive overview.
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Affiliation(s)
- Mark A Kliewer
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mikala R Brinkman
- Department of Radiology, Central Illinois Radiological Associates, Peoria, Illinois
| | - J Louis Hinshaw
- Department of Radiology and Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
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Hui TCH, Brace CL, Hinshaw JL, Quek LHH, Huang IKH, Kwan J, Lim GHT, Lee FT, Pua U. Microwave ablation of the liver in a live porcine model: the impact of power, time and total energy on ablation zone size and shape. Int J Hyperthermia 2020; 37:668-676. [DOI: 10.1080/02656736.2020.1774083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Christopher Lee Brace
- Department of Radiology and Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - J. Louis Hinshaw
- Department of Radiology and Urology, University of Wisconsin, Madison, WI, USA
| | | | | | - Justin Kwan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Gavin Hock Tai Lim
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Fred T. Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Radiology and Urology, University of Wisconsin, Madison, WI, USA
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
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Dreyfuss LD, Wells SA, Best SL, Hedican SP, Ziemlewicz TJ, Lubner MG, Hinshaw JL, Lee FT, Nakada SY, Abel EJ. Development of a Risk-stratified Approach for Follow-up Imaging After Percutaneous Thermal Ablation of Sporadic Stage One Renal Cell Carcinoma. Urology 2019; 134:148-153. [DOI: 10.1016/j.urology.2019.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/10/2019] [Accepted: 08/14/2019] [Indexed: 01/20/2023]
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21
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Knott EA, Swietlik JF, Longo KC, Watson RF, Green CM, Abel EJ, Lubner MG, Hinshaw JL, Smolock AR, Xu Z, Lee FT, Ziemlewicz TJ. Robotically-Assisted Sonic Therapy for Renal Ablation in a Live Porcine Model: Initial Preclinical Results. J Vasc Interv Radiol 2019; 30:1293-1302. [PMID: 31130365 PMCID: PMC6925588 DOI: 10.1016/j.jvir.2019.01.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To demonstrate the feasibility of Robotically Assisted Sonic Therapy (RAST)-a noninvasive and nonthermal focused ultrasound therapy based on histotripsy-for renal ablation in a live porcine model. MATERIALS AND METHODS RAST ablations (n = 11) were performed in 7 female swine: 3 evaluated at 1 week (acute) and 4 evaluated at 4 weeks (chronic). Treatment groups were acute bilateral (3 swine, 6 ablations with immediate computed tomography [CT] and sacrifice); chronic single kidney (3 swine, 3 ablations; CT at day 0, week 1, and week 4 after treatment, followed by sacrifice); and chronic bilateral (1 swine, 2 ablations). Treatments were performed using a prototype system (VortxRx; HistoSonics, Inc) and targeted a 2.5-cm-diameter sphere in the lower pole of each kidney, intentionally including the central collecting system. RESULTS Mean treatment time was 26.4 minutes. Ablations had a mean diameter of 2.4 ± 0.3 cm, volume of 8.5 ± 2.4 cm3, and sphericity index of 1.00. Median ablation volume decreased by 96.1% over 4 weeks. Histology demonstrated complete lysis with residual blood products inside the ablation zone. Temporary collecting system obstruction by thrombus was observed in 4/11 kidneys (2 acute and 2 chronic) and resolved by 1 week. There were no urinary leaks, main vessel thromboses, or adjacent organ injuries on imaging or necropsy. CONCLUSIONS In this normal porcine model, renal RAST demonstrated complete histologic destruction of the target renal tissue while sparing the urothelium.
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Affiliation(s)
- Emily A Knott
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024.
| | - John F Swietlik
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - Katherine C Longo
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - Rao F Watson
- Department of Pathology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - Chelsey M Green
- Department of Statistics, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - E Jason Abel
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024; Department of Urology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - Amanda R Smolock
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Fred T Lee
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024; Department of Urology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024; Department of Biomedical Engineering, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
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22
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Cherukuri AR, Lubner MG, Zea R, Hinshaw JL, Lubner SJ, Matkowskyj KA, Foltz ML, Pickhardt PJ. Tissue sampling in the era of precision medicine: comparison of percutaneous biopsies performed for clinical trials or tumor genomics versus routine clinical care. Abdom Radiol (NY) 2019; 44:2074-2080. [PMID: 30032384 DOI: 10.1007/s00261-018-1702-1] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of the study was to determine if patients undergoing percutaneous biopsy for genetic profiling are undergoing more biopsies (procedures, passes per procedure), or experiencing more procedure-related complications. METHODS 60 patients undergoing biopsy procedures for genetic profiling were retrospectively compared with 60 consecutive control patients undergoing routine biopsies. Procedural details and related complications were collected. Results were analyzed using t-tests and logistic regression. RESULTS Biopsied organs included mainly lung (n = 31), liver (n = 50), and lymph nodes (n = 18). The average number of core biopsy passes was 3.45 in the study group and 2.18 in the control group (0.73, 1.81; p = 0.0001). The average study patient underwent 1.44 biopsy procedures by radiology from 2016 to 2017, whereas the average control patient underwent 1.08 (0.1657, 0.5010, p = 0.0002). Results were similar when looking at the subset of patients undergoing liver biopsies. In our cohort of 120 patients total, only 6 complications were noted. There were 4 complications in the control patients and 2 complications in the study patients, all of which were pneumothoraces in patients undergoing lung biopsy; only 2 of these required treatment. The odds ratio for a complication occurring from an increase in one core biopsy is 1.07 (0.601, 1.573; p = 0.775), suggesting no significant relationship among the number of biopsies taken and the probability of complication in this cohort. CONCLUSIONS Patients being biopsied for genetic profiling or clinical study enrollment are undergoing more biopsy procedures and more biopsy passes per procedure, but are not experiencing a detectable increased rate of complications in this small cohort, single-center study.
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Affiliation(s)
- Anjuli R Cherukuri
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Meghan G Lubner
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA.
| | - Ryan Zea
- Biostatistics, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - J Louis Hinshaw
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Sam J Lubner
- Internal Medicine - Division of Human Oncology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Kristina A Matkowskyj
- Pathology and Lab Medicine, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Marcia L Foltz
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Perry J Pickhardt
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
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Maciolek KA, Abel EJ, Posielski NM, Hinshaw JL, Lubner MG, Lee FT, Ziemlewicz TJ, Wells SA. Tumor location does not impact oncologic outcomes for percutaneous microwave ablation of clinical T1a renal cell carcinoma. Eur Radiol 2019; 29:6319-6329. [PMID: 31016448 DOI: 10.1007/s00330-019-06121-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 12/31/2018] [Revised: 02/08/2019] [Accepted: 02/21/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the impact of anterior tumor location on oncologic efficacy, complication rates, and procedure duration for 151 consecutive biopsy-proven clinical T1a renal cell carcinoma (RCC) treated with percutaneous microwave (MW) ablation. METHODS This single-center retrospective study was performed under a waiver of informed consent. One hundred forty-eight consecutive patients (103 M/45 F; median age 67 years, IQR 61-73) with 151 cT1a biopsy-proven RCC (median diameter 2.4 cm, IQR 1.9-3.0) were treated with percutaneous MW ablation between March 2011 and August 2017. Patient and procedural data collected included Charlson comorbidity index (CCI), RENAL nephrometry score (NS), use of hydrodisplacement, MW antennas/generator output/time, and procedure time (PT). Data were stratified by anterior, posterior, and midline tumor location and compared with the Kruskal-Wallis or chi-squared tests. The Kaplan-Meier method was used for survival analyses. RESULTS Tumor size, NS, and use/volume of hydrodisplacement were similar for posterior and anterior tumors (p > 0.05). Patients with anterior tumors had a higher CCI (3 vs 4, p = 0.001). Median PT for posterior and anterior tumors was similar (100 vs 108 min, p = 0.26). Single session technical success and primary efficacy were achieved for all 151 tumors including 61 posterior and 67 anterior tumors. The 4 (3%) Clavien III-IV complications and 6 (4%) local recurrences were not associated with tumor location (p > 0.05). Three-year RFS, CSS, and OS were 95% (95% CI 0.87, 0.98), 100% (95% CI 1.0, 1.0), and 96% (95% CI 0.89, 0.98), respectively. CONCLUSIONS The safety and efficacy of percutaneous microwave ablation for anterior and posterior RCC are similar. KEY POINTS • The safety profile for percutaneous microwave ablation of anterior and posterior T1a renal cell carcinoma is equivalent. • Percutaneous microwave ablation of T1a renal cell carcinoma provides durable oncologic control regardless of tumor location. • Placement of additional microwave antennas and use of hydrodisplacement are associated with longer procedure times.
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Affiliation(s)
- Kim A Maciolek
- University of Wisconsin School of Medicine and Public Health, Health Sciences Learning Center, 750 Highland Avenue, Madison, WI, 53705, USA
| | - E Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Natasza M Posielski
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - J Louis Hinshaw
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/376 Clinical Science Center, Madison, WI, 53792, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/376 Clinical Science Center, Madison, WI, 53792, USA
| | - Fred T Lee
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/376 Clinical Science Center, Madison, WI, 53792, USA
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/376 Clinical Science Center, Madison, WI, 53792, USA
| | - Shane A Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/376 Clinical Science Center, Madison, WI, 53792, USA.
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Wagner MG, Hinshaw JL, Li Y, Szczykutowicz TP, Laeseke P, Mistretta CA, Lee FT. Ultra-Low Radiation Dose CT Fluoroscopy for Percutaneous Interventions: A Porcine Feasibility Study. Radiology 2019; 291:241-249. [PMID: 30644808 PMCID: PMC6438357 DOI: 10.1148/radiol.2019181362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/10/2018] [Accepted: 11/27/2018] [Indexed: 11/11/2022]
Abstract
Purpose To determine the feasibility of ultra-low-dose (ULD) CT fluoroscopy for performing percutaneous CT-guided interventions in an in vivo porcine model and to compare radiation dose, spatial accuracy, and metal artifact for conventional CT versus CT fluoroscopy. Materials and Methods An in vivo swine model was used (n = 4, ∼50 kg) for 20 procedures guided by 246 incremental conventional CT scans (mean, 12.5 scans per procedure). The procedures were approved by the Institutional Animal Care and Use Committee and performed by two experienced radiologists from September 7, 2017, to August 8, 2018. ULD CT fluoroscopic acquisitions were simulated by using only two of 984 conventional CT projections to locate and reconstruct the needle, which was superimposed on a previously acquired and motion-compensated CT scan. The authors (medical physicists) compared the ULD CT fluoroscopy results to those of conventional CT for needle location, radiation dose, and metal artifacts using Deming regression and generalized mixed models. Results The average distance between the needle tip reconstructed using conventional CT and ULD CT fluoroscopy was 1.06 mm. Compared with CT fluoroscopy, the estimated dose for a percutaneous procedure, including planning acquisitions, was 0.99 mSv (21% reduction) for patients (effective dose) and 0.015 µGy (97% reduction) for physicians (scattered dose in air). Metal artifacts were statistically significantly reduced (P < .001, bootstrapping), and the average registration error of the motion compensation was within 1-3 mm. Conclusion Ultra-low-dose CT fluoroscopy has the potential to reduce radiation exposure for intraprocedural scans to patients and staff by a factor of approximately 500 times compared with conventional CT acquisition, while maintaining image quality without metal artifacts. © RSNA, 2019.
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Affiliation(s)
- Martin G. Wagner
- From the Departments of Medical Physics (M.G.W., Y.L., T.P.S., C.A.M.), Radiology (J.L.H., T.P.S., P.L., C.A.M., F.T.L.), Urology (J.L.H., F.T.L.), and Biomedical Engineering (T.P.S., F.T.L.), University of Wisconsin–Madison, 1111 Highland Ave, Madison, WI 53705
| | - J. Louis Hinshaw
- From the Departments of Medical Physics (M.G.W., Y.L., T.P.S., C.A.M.), Radiology (J.L.H., T.P.S., P.L., C.A.M., F.T.L.), Urology (J.L.H., F.T.L.), and Biomedical Engineering (T.P.S., F.T.L.), University of Wisconsin–Madison, 1111 Highland Ave, Madison, WI 53705
| | - Yinsheng Li
- From the Departments of Medical Physics (M.G.W., Y.L., T.P.S., C.A.M.), Radiology (J.L.H., T.P.S., P.L., C.A.M., F.T.L.), Urology (J.L.H., F.T.L.), and Biomedical Engineering (T.P.S., F.T.L.), University of Wisconsin–Madison, 1111 Highland Ave, Madison, WI 53705
| | - Timothy P. Szczykutowicz
- From the Departments of Medical Physics (M.G.W., Y.L., T.P.S., C.A.M.), Radiology (J.L.H., T.P.S., P.L., C.A.M., F.T.L.), Urology (J.L.H., F.T.L.), and Biomedical Engineering (T.P.S., F.T.L.), University of Wisconsin–Madison, 1111 Highland Ave, Madison, WI 53705
| | - Paul Laeseke
- From the Departments of Medical Physics (M.G.W., Y.L., T.P.S., C.A.M.), Radiology (J.L.H., T.P.S., P.L., C.A.M., F.T.L.), Urology (J.L.H., F.T.L.), and Biomedical Engineering (T.P.S., F.T.L.), University of Wisconsin–Madison, 1111 Highland Ave, Madison, WI 53705
| | - Charles A. Mistretta
- From the Departments of Medical Physics (M.G.W., Y.L., T.P.S., C.A.M.), Radiology (J.L.H., T.P.S., P.L., C.A.M., F.T.L.), Urology (J.L.H., F.T.L.), and Biomedical Engineering (T.P.S., F.T.L.), University of Wisconsin–Madison, 1111 Highland Ave, Madison, WI 53705
| | - Fred T. Lee
- From the Departments of Medical Physics (M.G.W., Y.L., T.P.S., C.A.M.), Radiology (J.L.H., T.P.S., P.L., C.A.M., F.T.L.), Urology (J.L.H., F.T.L.), and Biomedical Engineering (T.P.S., F.T.L.), University of Wisconsin–Madison, 1111 Highland Ave, Madison, WI 53705
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Lubner S, Feng Y, Mulcahy M, O'Dwyer P, Giang GY, Hinshaw JL, Deming D, Klein L, Teitelbaum U, Payne J, Engstrom P, Stella P, Meropol N, Benson A. E4206: AMG 706 and Octreotide in Patients with Low-Grade Neuroendocrine Tumors. Oncologist 2018; 23:1006-e104. [PMID: 29853660 PMCID: PMC6192662 DOI: 10.1634/theoncologist.2018-0294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/08/2017] [Indexed: 12/23/2022] Open
Abstract
LESSONS LEARNED Rate of progression-free survival at a particular point in time, i.e., a landmark analysis, is a difficult endpoint for a heterogenous malignancy such as neuroendocrine cancer.Landmark analyses can also be complicated by evolution in the standard of care during the conduct of a clinical trial.Improvements in biomarker development would be useful in developing future clinical trials in NET to better tailor individualized therapies and assess for possible efficacy endpoints. BACKGROUND Neuroendocrine tumors (NETs) are rare malignancies of the gastrointestinal (GI) tract that are highly vascularized and overexpress vascular-endothelial growth factor (VEGF). Sunitinib has demonstrated efficacy in the pancreatic subset of NET. This study explored the activity of another oral VEGF inhibitor, AMG 706 or motesanib, a multikinase inhibitor that targets receptor tyrosine kinases, including VEGFR1, VEGFR2, VEGFR3, KIT, RET, and PDGFR (IC50s = 2, 3, 6, 8, 59, and 84 nM, respectively). METHODS This was a single-arm, first-line, phase II study run through the Eastern Cooperative Oncology Group. Patients with low-grade NET (as defined by central confirmation of Ki-67 of 0%-2%) were administered a flat dose of 125 mg per day orally combined with octreotide long acting-repeatable (LAR) for patients who had been on a stable dose. The primary objective was to determine the 4-month progression-free survival (PFS). RESULTS Forty-four patients were evaluated per protocol. The 4-month PFS was 78.5%. The partial response rate was 13.6% (6/44), stable disease was 54.5% (24/44), 9.1% (4/44) had progressive disease, and 10/44 were not evaluable for response. Common toxicities included fatigue, hypertension, nausea, and headache, and most were grade 1-2. Median PFS was 8.7 months, and overall survival was 27.5 months. CONCLUSION Motesanib (AMG 706) demonstrated a 4-month PFS that met the per-protocol definition of efficacy. Fatigue and hypertension were the most common toxicities, and few grade 3-4 toxicities were encountered. The progression-free survival of 8.7 months in all NETs merits further study.
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Affiliation(s)
- Sam Lubner
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Yang Feng
- Eastern Cooperative Oncology Group-American College of Radiology Imaging Network, Boston, Massachusetts, USA
| | - Mary Mulcahy
- Northwestern University, Evanston, Illinois, USA
| | - Peter O'Dwyer
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Dustin Deming
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | | | | | | | - Paul Engstrom
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | - Neal Meropol
- Flatiron Health, New York, New York, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA; Flatiron Health, New York, New York, USA
| | - Al Benson
- Northwestern University, Evanston, Illinois, USA
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Smolock AR, Cristescu MM, Hinshaw A, Woo KM, Wells SA, Ziemlewicz TJ, Lubner MG, Dalvie PS, Louis Hinshaw J, Brace CL, Ozkan OS, Lee FT, Laeseke P. Combination transarterial chemoembolization and microwave ablation improves local tumor control for 3- to 5-cm hepatocellular carcinoma when compared with transarterial chemoembolization alone. Abdom Radiol (NY) 2018; 43:2497-2504. [PMID: 29450606 DOI: 10.1007/s00261-018-1464-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare transarterial chemoembolization (TACE) monotherapy to combination TACE and microwave ablation (MWA) for local control of 3- to 5-cm hepatocellular carcinoma (HCC). METHODS Patients with HCC between 3 and 5 cm treated with TACE monotherapy or combination TACE + MWA at a single institution between 2007 and 2016 were retrospectively reviewed. Twenty-four HCCs (median diameter 3.8 cm) in 16 patients (13 males; median age 64 years) were treated using TACE monotherapy. Combination TACE + MWA was used to treat 23 HCCs (median diameter 4.2 cm) in 22 patients (18 males; median age 61 years). Microwave ablation was performed at a target time of two weeks following TACE. Individual tumors were followed by serial contrast-enhanced CT or MR. Response to treatment was evaluated on a tumor-by-tumor basis using mRECIST criteria with the primary outcome being local tumor progression (LTP). Data were analyzed using Fisher's exact test for categorical variables and Wilcoxon rank sum test for continuous variables. Time to LTP was estimated with the Kaplan-Meier method. RESULTS Relative to TACE monotherapy, TACE + MWA provided a trend toward both a lower rate of LTP (34.8% vs. 62.5%, p = 0.11) and a higher complete response rate (65.2% vs. 37.5%; p = 0.12). Time to LTP (22.3 months vs. 4.2 months; p = 0.001) was significantly longer in the TACE + MWA group compared to TACE monotherapy. CONCLUSIONS Combination therapy with TACE and microwave ablation improves local control and increases time to LTP for 3-5 cm HCC.
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Affiliation(s)
- Amanda R Smolock
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Mircea M Cristescu
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Audrey Hinshaw
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Kaitlin M Woo
- Departments of Biostatistics and Medical Informatics, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Shane A Wells
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Timothy J Ziemlewicz
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Meghan G Lubner
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Prasad S Dalvie
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - J Louis Hinshaw
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Christopher L Brace
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
- Departments of Biomedical Engineering, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
- Departments of Medical Physics, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Orhan S Ozkan
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Fred T Lee
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
- Departments of Biomedical Engineering, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Paul Laeseke
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA.
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Kitchin DR, del Rio AM, Woods M, Ludeman L, Hinshaw JL. Percutaneous liver biopsy and revised coagulation guidelines: a 9-year experience. Abdom Radiol (NY) 2018; 43:1494-1501. [PMID: 28929196 DOI: 10.1007/s00261-017-1319-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To retrospectively review revised pre-procedural coagulation guidelines for percutaneous liver biopsy to determine whether their implementation is associated with increased hemorrhagic complications on a departmental scale. Secondary endpoints were to determine the effect of this change on pre-procedural blood product (FFP and platelet) utilization, to evaluate the impact of administered blood products on hemorrhagic complications, and to determine whether bleeding complications were related to INR and platelet levels. MATERIALS AND METHODS This IRB-approved, HIPAA-compliant, retrospective study reviewed 1846 percutaneous liver biopsies in 1740 patients, comparing biopsies performed, while SIR consensus pre-procedural coagulation guidelines were in place (INR ≤ 1.5, platelets ≥50,000 µL) to those performed after departmental implementation of revised, less stringent guidelines (INR ≤ 2.0, platelets ≥25,000 µL). RESULTS On a departmental scale, there were significantly fewer hemorrhagic complications in the population of patients treated after adoption of less stringent guidelines as compared to those treated under the SIR guidelines (1.6% vs. 3.4%, p = 0.0192) despite a significant decrease in pre-procedural FFP (0.8% vs. 3.9%, p < 0.001) and platelet transfusions (0.3% vs. 1.2%, p = 0.021). Individual patient hemorrhagic complication rates significantly increased as INR increased (p = 0.006) and platelet counts decreased (p = 0.004), but pre-procedural FFP (p = 0.64) and/or platelet transfusion (p = 0.5) did not have a significant impact on hemorrhagic complication rates. CONCLUSION Implementation of less stringent pre-procedural coagulation parameter guidelines for percutaneous liver biopsy (INR ≤ 2.0, platelets ≥25,000 µL) did not result in an increase in departmental hemorrhagic complication rates but did significantly decrease pre-procedural FFP/platelet administration. An individual patient's bleeding risk does increase as INR increases and platelets decrease, but pre-procedural FFP and/or platelet transfusion did not mitigate that increased risk.
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Posielski N, Bui A, Wells SA, Best SL, Mankowski Gettle L, Ziemlewicz TJ, Lubner MG, Hinshaw JL, Lee FT, Nakada SY, Abel EJ. MP28-05 COMPLICATIONS FOLLOWING 1053 PERCUTANEOUS CORE RENAL MASS BIOPSIES: RISK FACTORS AND SAFETY ASSESSMENT. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.905] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shapiro DD, Wells SA, Ziemlewicz TJ, Lubner MG, Hinshaw JL, Lee FT, Jarrard DF, Richards KA, Best SL, Downs TM, Allen GO, Nakada SY, Abel EJ. PD61-07 COMPARATIVE ANALYSIS OF PERIOPERATIVE OUTCOMES FOR PATIENTS WITH 4-7CM RCC TREATED WITH EITHER MICROWAVE ABLATION, PARTIAL NEPHRECTOMY OR RADICAL NEPHRECTOMY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2831] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wells SA, Wong VK, Wittmann TA, Lubner MG, Best SL, Ziemlewicz TJ, Hinshaw JL, Lee FT, Abel EJ. Renal mass biopsy and thermal ablation: should biopsy be performed before or during the ablation procedure? Abdom Radiol (NY) 2017; 42:1773-1780. [PMID: 28184961 DOI: 10.1007/s00261-016-1037-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 12/23/2022]
Abstract
PURPOSE To determine if renal mass biopsy should be performed before or during the ablation procedure with emphasis on complications and rate of ablation for renal cell carcinomas (RCC), benign tumors, and small renal masses without a histologic diagnosis. METHODS This HIPAA-compliant, single-center retrospective study was performed under a waiver of informed consent from the institutional review board. Two hundred eighty-four consecutive patients with a small renal mass (≤4.0 cm) treated with percutaneous thermal ablation between January 2001 and January 2015 were included. Two cohorts were identified based upon the timing of renal mass biopsy: separate session two weeks prior to ablation and same session obtained immediately preceding ablation. Clinical and pathologic data were collected including risk factors for non-diagnostic biopsy. Two-sided t test, χ 2 test or Fischer's exact tests were used to evaluate differences between cohorts. Univariate and multivariate logistic regression models were constructed. RESULTS A histologic diagnostic was achieved more frequently in the separate session cohort [210/213 (98.6%) vs. 60/71 (84.3%), p < 0.0001]. The rate of ablation of RCC was higher in the separate session group [201/213 (94.4%) vs. 46/61 (64.7%), p = 0.001]. The rate of ablation for benign tumors [14/71 (19.7%) vs. 6/213 (2.8%), p < 0.0001] and small renal masses without a histologic diagnosis [3/213 (1.4%) vs. 11/71 (15.5%), p < 0.0001] was higher in the same session cohort. There were no high-grade complications in either cohort. CONCLUSION Performing renal mass biopsy prior to the day of ablation is safe, increases the rate of histologic diagnosis, and reduces the rate of ablation for benign tumors and small renal masses without a histologic diagnosis.
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Affiliation(s)
- Shane A Wells
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
| | - Vincenzo K Wong
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Tyler A Wittmann
- Health Sciences Learning Center, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI, 53705, USA
| | - Meghan G Lubner
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Sara L Best
- Department of Urology, University of Wisconsin Medical Foundation Centennial Building, Third Floor, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Timothy J Ziemlewicz
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - J Louis Hinshaw
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Urology, University of Wisconsin Medical Foundation Centennial Building, Third Floor, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Fred T Lee
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Urology, University of Wisconsin Medical Foundation Centennial Building, Third Floor, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - E Jason Abel
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Urology, University of Wisconsin Medical Foundation Centennial Building, Third Floor, 1685 Highland Avenue, Madison, WI, 53705, USA
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Johnson B, Wells S, Best S, Hartung M, Ziemlewicz T, Lubner M, Hinshaw JL, Lee F, Nakada SY, Abel EJ. MP100-04 PERCUTANEOUS MICROWAVE ABLATION FOR CLINICAL T1B RENAL CANCERS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3111] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Carberry GA, Smolock AR, Cristescu M, Wells SA, Ziemlewicz TJ, Lubner MG, Hinshaw JL, Brace CL, Lee FT. Safety and Efficacy of Percutaneous Microwave Hepatic Ablation Near the Heart. J Vasc Interv Radiol 2017; 28:490-497. [DOI: 10.1016/j.jvir.2016.12.1216] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/13/2016] [Accepted: 12/18/2016] [Indexed: 01/04/2023] Open
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Best S, Johnson B, Wells S, Lubner M, Ziemlewicz T, Hinshaw JL, Lee F, Nakada SY, Abel EJ. MP100-18 LONG-TERM OUTCOMES OF CRYOABLATION FOR BIOPSY-PROVEN RCC: SIZE MATTERS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3125] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Graffy P, Loomis SB, Pickhardt PJ, Lubner MG, Kitchin DR, Lee FT, Hinshaw JL. Pulmonary Intraparenchymal Blood Patching Decreases the Rate of Pneumothorax-Related Complications following Percutaneous CT-Guided Needle Biopsy. J Vasc Interv Radiol 2017; 28:608-613.e1. [PMID: 28185770 DOI: 10.1016/j.jvir.2016.12.1217] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 04/14/2016] [Revised: 12/16/2016] [Accepted: 12/18/2016] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate whether an autologous intraparenchymal blood patch (IPB) reduces the rate of pneumothorax-related complications associated with computed tomography (CT)-guided lung biopsies. MATERIALS AND METHODS This study included 834 patients: 482 who received an IPB and 352 who did not. Retrospective review was performed of all CT-guided lung biopsies performed at a single institution between August 2006 and September 2013. Patients were excluded if no aerated lung was crossed. The rate of pneumothorax, any associated intervention (eg, catheter placement, aspiration), chest tube placement, and chest tube replacement requiring hospital admission were compared by linear and multiple regression analysis. RESULTS Patients who received an IPB had a significantly lower rate of pneumothorax (145 of 482 [30%] vs 154 of 352 [44%]; P < .0001), pneumothorax-related intervention (eg, catheter aspiration, pleural blood patch, chest tube placement; 43 of 482 [8.9%] vs 85 of 352 [24.1%]; P < .0001), and chest tube placement along with other determinants requiring hospital admission (18 of 482 [3.7%] vs 27 of 352 [7.7%]; P < .0001). No complications related to the IPB were noted in the study group. CONCLUSIONS Autologous IPB placement is associated with a decreased rate of pneumothorax and associated interventions, including chest tube placement and hospital admission, after CT-guided lung biopsies, with no evidence of any adverse effects. These results suggest that an IPB is safe and effective and should be considered when aerated lung is traversed while performing a CT-guided lung biopsy.
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Affiliation(s)
- Peter Graffy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Mail Code 3252, Madison, WI 53792-3252.
| | - Scott B Loomis
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Mail Code 3252, Madison, WI 53792-3252
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Mail Code 3252, Madison, WI 53792-3252
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Mail Code 3252, Madison, WI 53792-3252
| | - Douglas R Kitchin
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Mail Code 3252, Madison, WI 53792-3252
| | - Fred T Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Mail Code 3252, Madison, WI 53792-3252
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Mail Code 3252, Madison, WI 53792-3252
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Klapperich ME, Abel EJ, Ziemlewicz TJ, Best S, Lubner MG, Nakada SY, Hinshaw JL, Brace CL, Lee FT, Wells SA. Effect of Tumor Complexity and Technique on Efficacy and Complications after Percutaneous Microwave Ablation of Stage T1a Renal Cell Carcinoma: A Single-Center, Retrospective Study. Radiology 2017; 284:272-280. [PMID: 28076721 DOI: 10.1148/radiol.2016160592] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose To evaluate the effects of tumor complexity and technique on early and midterm oncologic efficacy and rate of complications for 100 consecutive biopsy-proved stage T1a renal cell carcinomas (RCCs) treated with percutaneous microwave ablation. Materials and Methods This HIPAA-compliant, single-center retrospective study was approved by the institutional review board. The requirement to obtain informed consent was waived. Ninety-six consecutive patients (68 men, 28 women; mean age, 66 years ± 9.4) with 100 stage T1a N0M0 biopsy-proved RCCs (median diameter, 2.6 cm ± 0.8) underwent percutaneous microwave ablation between March 2011 and June 2015. Patient and procedural data were collected, including body mass index, comorbidities, tumor histologic characteristics and grade, RENAL nephrometry score, number of antennas, generator power, and duration of ablation. Technical success, local tumor progression, and presence of complications were assessed at immediate and follow-up imaging. The Kaplan-Meier method was used for survival analyses. Results Technical success was achieved for all 100 tumors (100%), including 47 moderately and five highly complex RCCs. Median clinical and imaging follow-up was 17 months (range, 0-48 months) and 15 months (range, 0-44 months), respectively. No change in estimated glomerular filtration rate was noted after the procedure (P = .49). There were three (3%) procedure-related complications and six (6%) delayed complications, all urinomas. One case of local tumor progression (1%) was identified 25 months after the procedure. Three-year local progression-free survival, cancer-specific survival, and overall survival were 88% (95% confidence interval: 0.52%, 0.97%), 100% (95% confidence interval: 1.0%, 1.0%), and 91% (95% confidence interval: 0.51%, 0.99%), respectively. Conclusion Percutaneous microwave ablation is an effective and safe treatment option for stage T1a RCC, regardless of tumor complexity. Long-term follow-up is needed to establish durable oncologic efficacy and survival relative to competing ablation modalities and surgery. © RSNA, 2017.
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Affiliation(s)
- Marki E Klapperich
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - E Jason Abel
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - Timothy J Ziemlewicz
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - Sara Best
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - Meghan G Lubner
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - Stephen Y Nakada
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - J Louis Hinshaw
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - Christopher L Brace
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - Fred T Lee
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - Shane A Wells
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
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Abstract
Tumor ablation is a safe and effective treatment available in the multidisciplinary care of the surgical oncology patient. The role of ablation is well established in the treatment of hepatocellular carcinoma and is becoming more accepted in the treatment of various malignancies metastatic to the liver, in particular colorectal cancer. Understanding the underlying technology, achieving appropriate applicator placement, using maximum energy delivery to create margins, and performing necessary adjunctive maneuvers are all required for successful tumor ablation.
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Affiliation(s)
- Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA.
| | - Shane A Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA
| | - Christopher L Brace
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA; Department of Biomedical Engineering, University of Wisconsin, 1415 Engineering Drive, Madison, WI 53706, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA; Department of Biomedical Engineering, University of Wisconsin, 1415 Engineering Drive, Madison, WI 53706, USA
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA
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Chiang J, Cristescu M, Lee MH, Moreland A, Hinshaw JL, Lee FT, Brace CL. Effects of Microwave Ablation on Arterial and Venous Vasculature after Treatment of Hepatocellular Carcinoma. Radiology 2016; 281:617-624. [PMID: 27257951 DOI: 10.1148/radiol.2016152508] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose To characterize vessel occlusion rates and their role in local tumor progression in patients with hepatocellular carcinoma (HCC) who underwent microwave tumor ablation. Materials and Methods This institutional review board approved, HIPAA-compliant retrospective review included 95 patients (75 men and 20 women) with 124 primary HCCs who were treated at a single center between January 2011 and March 2014. Complete occlusion of the portal veins, hepatic veins, and hepatic arteries within and directly abutting the ablation zone was identified with postprocedure contrast material-enhanced computed tomography. For each vessel identified in the ablation zone, its size and antenna spacing were recorded and correlated with vascular occlusion with logistic regression analysis. Local tumor progression rates were then compared between patent and occluded vessels for each vessel type with Fisher exact test. Results Occlusion was identified in 39.7% of portal veins (29 of 73), 15.0% of hepatic veins (six of 40), and 14.2% of hepatic arteries (10 of 70) encompassed within the ablation zone. Hepatic vein occlusion was significantly correlated with a smaller vessel size (P = .036) and vessel-antenna spacing (P = .006). Portal vein occlusion was only significantly correlated with a smaller vessel size (P = .001), particularly in vessels that were less than 3 mm in diameter. Local tumor progression rates were significantly correlated with patent hepatic arteries within the ablation zone (P = .02) but not with patent hepatic (P = .57) or portal (P = .14) veins. Conclusion During microwave ablation of HCC, hepatic veins and arteries were resistant to vessel occlusion compared with portal veins, and only arterial patency within an ablation zone was related to local tumor progression. © RSNA, 2016.
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Affiliation(s)
- Jason Chiang
- From the Departments of Radiology (J.C., M.C., M.H.L., A.M., J.L.H., F.T.L., C.L.B.) and Biomedical Engineering (J.C., F.T.L., C.L.B.), University of Wisconsin-Madison, 1111 Highland Ave, WIMR 1310-O, Madison, WI 53705
| | - Mircea Cristescu
- From the Departments of Radiology (J.C., M.C., M.H.L., A.M., J.L.H., F.T.L., C.L.B.) and Biomedical Engineering (J.C., F.T.L., C.L.B.), University of Wisconsin-Madison, 1111 Highland Ave, WIMR 1310-O, Madison, WI 53705
| | - Matthew H Lee
- From the Departments of Radiology (J.C., M.C., M.H.L., A.M., J.L.H., F.T.L., C.L.B.) and Biomedical Engineering (J.C., F.T.L., C.L.B.), University of Wisconsin-Madison, 1111 Highland Ave, WIMR 1310-O, Madison, WI 53705
| | - Anna Moreland
- From the Departments of Radiology (J.C., M.C., M.H.L., A.M., J.L.H., F.T.L., C.L.B.) and Biomedical Engineering (J.C., F.T.L., C.L.B.), University of Wisconsin-Madison, 1111 Highland Ave, WIMR 1310-O, Madison, WI 53705
| | - J Louis Hinshaw
- From the Departments of Radiology (J.C., M.C., M.H.L., A.M., J.L.H., F.T.L., C.L.B.) and Biomedical Engineering (J.C., F.T.L., C.L.B.), University of Wisconsin-Madison, 1111 Highland Ave, WIMR 1310-O, Madison, WI 53705
| | - Fred T Lee
- From the Departments of Radiology (J.C., M.C., M.H.L., A.M., J.L.H., F.T.L., C.L.B.) and Biomedical Engineering (J.C., F.T.L., C.L.B.), University of Wisconsin-Madison, 1111 Highland Ave, WIMR 1310-O, Madison, WI 53705
| | - Christopher L Brace
- From the Departments of Radiology (J.C., M.C., M.H.L., A.M., J.L.H., F.T.L., C.L.B.) and Biomedical Engineering (J.C., F.T.L., C.L.B.), University of Wisconsin-Madison, 1111 Highland Ave, WIMR 1310-O, Madison, WI 53705
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Lee MH, Hinshaw JL, Kim DH, Pickhardt PJ. Symptomatic Versus Asymptomatic Colorectal Cancer: Predictive Features at CT Colonography. Acad Radiol 2016; 23:712-7. [PMID: 26852246 DOI: 10.1016/j.acra.2015.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 10/06/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 01/05/2023]
Abstract
RATIONALE AND OBJECTIVES Computed tomographic colonography (CTC) is a robust tool for evaluating colorectal lesions in both screening and diagnostic settings. The purpose of this study was to assess the relationship between colorectal cancer (CRC) tumor characteristics and patient symptomatology. MATERIALS AND METHODS This is a retrospective analysis of all pathology-confirmed cases of CRC evaluated with CTC at our institution from October 2004 to October 2012. Cases were reviewed to determine tumor size, morphology, and degree of luminal narrowing. An electronic medical record review was performed to delineate specific patient symptomatology and determine depth of invasion. RESULTS A total of 55 patients (36 symptomatic and 19 asymptomatic) with a total of 63 CRCs were evaluated by CTC during the study time period. The most common symptoms were gastrointestinal (GI) bleeding/anemia (n = 26), followed by obstructive symptoms (n = 23), and constitutional symptoms (n = 5). Symptomatic cancers were more likely to have annular morphology (n = 30/43, 70% vs. n = 3/20, 15%; odds ratio [OR] = 13.1, P = 0.0003), whereas asymptomatic cancers were more likely to be polypoid (n = 11/20, 55% vs. n = 6/43, 14%, OR = 7.5, P = 0.001). Symptomatic cancers were also larger (46.1 ± 22.4 vs. 38.8 ± 18.4 mm, P = 0.005) and resulted in greater luminal narrowing (8.7 ± 8.5 mm vs. 35.8 ± 18.8 mm, P < 0.0001) with deeper invasion (n = 29/35 [invasion unknown for 8 cases], 83% vs. n = 6/20, 30%, OR = 11.3, P = 0.0003). Invasive cancers were more likely to have annular morphology (66%, 23/25, P = 0.002). CONCLUSIONS There is an intuitive and predictable relationship between tumor characteristics on CTC and patient symptoms. Annular morphology, tumor size, degree of luminal narrowing, and invasive disease all correlate with the presence of symptoms.
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Affiliation(s)
- Matthew H Lee
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53792-3252.
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53792-3252
| | - David H Kim
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53792-3252
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53792-3252
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Grimes MD, Wittmann TA, Best SL, Hinshaw JL, Lee FT, Lubner MG, Ziemlewicz TJ, Wells SA, Nakada SY, Abel EJ. PD46-04 COMPARING OUTCOMES FOR PERCUTANEOUS MICROWAVE ABLATION, CRYOABLATION AND SURGERY FOR TREATMENT OF SPORADIC RCC = 4CM. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2396] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Percutaneous abdominal biopsies provide referring physicians with valuable diagnostic and prognostic information that guides patient care. All biopsy procedures follow a similar process that begins with the preprocedure evaluation of the patient and ends with the postprocedure management of the patient. In this review, a step-by-step approach to both routine and challenging abdominal biopsies is covered with an emphasis on the differences in biopsy devices and imaging guidance modalities. Adjunctive techniques that may facilitate accessing a lesion in a difficult location or reduce procedure risk are described. An understanding of these concepts will help maintain the favorable safety profile and high diagnostic yield associated with percutaneous biopsies.
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Potretzke TA, Ziemlewicz TJ, Hinshaw JL, Lubner MG, Wells SA, Brace CL, Agarwal P, Lee FT. Microwave versus Radiofrequency Ablation Treatment for Hepatocellular Carcinoma: A Comparison of Efficacy at a Single Center. J Vasc Interv Radiol 2016; 27:631-8. [PMID: 27017124 DOI: 10.1016/j.jvir.2016.01.136] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To compare efficacy and major complication rates of radiofrequency (RF) and microwave (MW) ablation for treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS This retrospective single-center study included 69 tumors in 55 patients treated by RF ablation and 136 tumors in 99 patients treated by MW ablation between 2001 and 2013. RF and MW ablation devices included straight 17-gauge applicators. Overall survival and rates of local tumor progression (LTP) were evaluated using Kaplan-Meier techniques with Cox proportional hazard ratio (HR) models and competing risk regression of LTP. RESULTS RF and MW cohorts were similar in age (P = .22), Model for End-Stage Liver Disease score (P = .24), and tumor size (mean 2.4 cm [range, 0.6-4.5 cm] and 2.2 cm [0.5-4.2 cm], P = .09). Median length of follow-up was 31 months for RF and 24 months for MW. Rate of LTP was 17.7% with RF and 8.8% with MW. Corresponding HR from Cox and competing risk models was 2.17 (95% confidence interval [CI], 1.04-4.50; P = 0.04) and 2.01 (95% CI, 0.95-4.26; P = .07), respectively. There was improved survival for patients treated with MW ablation, although this was not statistically significant (Cox HR, 1.59 [95% CI, 0.91-2.77; P = .103]). There were few major (≥ grade C) complications (2 for RF, 1 for MW; P = .28). CONCLUSIONS Treating HCC percutaneously with RF or MW ablation was associated with high primary efficacy and durable response, with lower rates of LTP after MW ablation.
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Affiliation(s)
- Theodora A Potretzke
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366, Madison, WI 53792-3252
| | - Timothy J Ziemlewicz
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366, Madison, WI 53792-3252..
| | - J Louis Hinshaw
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366, Madison, WI 53792-3252
| | - Meghan G Lubner
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366, Madison, WI 53792-3252
| | - Shane A Wells
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366, Madison, WI 53792-3252
| | - Christopher L Brace
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366, Madison, WI 53792-3252.; Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366, Madison, WI 53792-3252; Medical Physics (C.L.B.), University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366, Madison, WI 53792-3252
| | - Parul Agarwal
- Medicine, Section of Hepatology, (P.A.), University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366, Madison, WI 53792-3252
| | - Fred T Lee
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366, Madison, WI 53792-3252.; Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366, Madison, WI 53792-3252
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Kim DH, Matkowskyj KA, Lubner MG, Hinshaw JL, Munoz Del Rio A, Pooler BD, Weiss JM, Pickhardt PJ. Serrated Polyps at CT Colonography: Prevalence and Characteristics of the Serrated Polyp Spectrum. Radiology 2016; 280:455-63. [PMID: 26878227 DOI: 10.1148/radiol.2016151608] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose To report the prevalence and characteristics of serrated polyps identified in a large, average-risk population undergoing screening computed tomographic (CT) colonography. Materials and Methods This HIPAA-compliant retrospective study was approved by the institutional review board of the University of Wisconsin School of Medicine and Public Health. The need for informed consent was waived. Nine thousand six hundred examinations from 8289 patients were enrolled in a single-institution CT colonography-based screening program (from 2004 to 2011) and were evaluated for the presence of nondiminutive serrated lesions and advanced adenomas. The prevalence and characteristics of these lesions were tabulated. Generalized estimating equation regressions of polyp characteristics that may contribute to visualization of serrated lesions were investigated, including polyp size, location, and morphologic appearance; histologic findings; and presence or absence of contrast material tagging. Results Nondiminutive serrated lesions (≥6 mm) were seen at CT colonography-based screening with a prevalence of 3.1% (254 of 8289 patients). Sessile serrated adenomas (SSAs) and traditional serrated adenomas (TSAs) constituted 36.8% (137 of 372) and 4.3% (16 of 372) of serrated lesions, respectively; hyperplastic polyps (HPs) accounted for 58.9% (219 of 372 lesions). SSA and TSA tended to be large (mean size, 10.6 mm and 14.1 mm, respectively), with size categories and polyp subgroups significantly associated (P < .0001). SSA tended to be proximal in location (91.2%, 125 of 137 lesions) and flat in morphologic appearance (39.4%, 54 of 137 lesions) compared with TSA and HP. The presence of high-grade dysplasia in serrated lesions was uncommon when compared with advanced adenomas (one of 372 lesions vs 22 of 395 lesions, respectively; P < .0001). Multivariate analysis showed that contrast material tagging markedly improved serrated polyp detection with an odds ratio of 40.4 (95% confidence interval: 10.1, 161.4). Conclusion Serrated lesions are seen at CT colonography-based screening with a nondiminutive prevalence of 3.1%. These lesions tend to be large, flat, and proximal in location. Adherent contrast material coating on these polyps aids in their detection, despite an often flat morphologic appearance. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- David H Kim
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - Kristina A Matkowskyj
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - Meghan G Lubner
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - J Louis Hinshaw
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - Alejandro Munoz Del Rio
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - B Dustin Pooler
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - Jennifer M Weiss
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - Perry J Pickhardt
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
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Abstract
Tumor ablation in the liver has evolved to become a well-accepted tool in the management of increasing complex oncologic patients. At present, percutaneous ablation is considered first-line therapy for very early and early hepatocellular carcinoma and second-line therapy for colorectal carcinoma liver metastasis. Because thermal ablation is a treatment option for other primary and secondary liver tumors, an understanding of the underlying tumor biology is important when weighing the potential benefits of ablation. This article reviews ablation modalities, indications, patient selection, and imaging surveillance, and emphasizes technique-specific considerations for the performance of percutaneous ablation.
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Affiliation(s)
- Shane A Wells
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA.
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Christopher L Brace
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA; Department of Biomedical Engineering, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA; Department of Biomedical Engineering, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
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Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why? Radiographics 2015; 10:47-57. [PMID: 25208284 DOI: 10.1053/j.tvir.2007.08.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Image-guided thermal ablation is an evolving and growing treatment option for patients with malignant disease of multiple organ systems. Treatment indications have been expanding to include benign tumors as well. Specifically, the most prevalent indications to date have been in the liver (primary and metastatic disease, as well as benign tumors such as hemangiomas and adenomas), kidney (primarily renal cell carcinoma, but also benign tumors such as angiomyolipomas and oncocytomas), lung (primary and metastatic disease), and soft tissue and/or bone (primarily metastatic disease and osteoid osteomas). Each organ system has different underlying tissue characteristics, which can have profound effects on the resulting thermal changes and ablation zone. Understanding these issues is important for optimizing clinical results. In addition, thermal ablation technology has evolved rapidly during the past several decades, with substantial technical and procedural improvements that can help improve clinical outcomes and safety profiles. Staying up to date on these developments is challenging but critical because the physical properties underlying the different ablation modalities and the appropriate use of adjuncts will have a tremendous effect on treatment results. Ultimately, combining an understanding of the physical properties of the ablation modalities with an understanding of the thermal kinetics in tissue and using the most appropriate ablation modality for each patient are key to optimizing clinical outcomes. Suggested algorithms are described that will help physicians choose among the various ablation modalities for individual patients.
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Affiliation(s)
- J Louis Hinshaw
- From the Departments of Radiology (J.L.H., M.G.L., T.J.Z., F.T.L., C.L.B.), Biomedical Engineering (C.L.B.), and Medical Physics (C.L.B.), University of Wisconsin, 600 Highland Ave, E3 366, Madison, WI 53792-3252
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Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why? Radiographics 2015; 34:1344-62. [PMID: 25208284 DOI: 10.1148/rg.345140054] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Image-guided thermal ablation is an evolving and growing treatment option for patients with malignant disease of multiple organ systems. Treatment indications have been expanding to include benign tumors as well. Specifically, the most prevalent indications to date have been in the liver (primary and metastatic disease, as well as benign tumors such as hemangiomas and adenomas), kidney (primarily renal cell carcinoma, but also benign tumors such as angiomyolipomas and oncocytomas), lung (primary and metastatic disease), and soft tissue and/or bone (primarily metastatic disease and osteoid osteomas). Each organ system has different underlying tissue characteristics, which can have profound effects on the resulting thermal changes and ablation zone. Understanding these issues is important for optimizing clinical results. In addition, thermal ablation technology has evolved rapidly during the past several decades, with substantial technical and procedural improvements that can help improve clinical outcomes and safety profiles. Staying up to date on these developments is challenging but critical because the physical properties underlying the different ablation modalities and the appropriate use of adjuncts will have a tremendous effect on treatment results. Ultimately, combining an understanding of the physical properties of the ablation modalities with an understanding of the thermal kinetics in tissue and using the most appropriate ablation modality for each patient are key to optimizing clinical outcomes. Suggested algorithms are described that will help physicians choose among the various ablation modalities for individual patients.
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Affiliation(s)
- J Louis Hinshaw
- From the Departments of Radiology (J.L.H., M.G.L., T.J.Z., F.T.L., C.L.B.), Biomedical Engineering (C.L.B.), and Medical Physics (C.L.B.), University of Wisconsin, 600 Highland Ave, E3 366, Madison, WI 53792-3252
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Cristescu M, Abel EJ, Wells S, Ziemlewicz TJ, Hedican SP, Lubner MG, Hinshaw JL, Brace CL, Lee FT. Percutaneous Microwave Ablation of Renal Angiomyolipomas. Cardiovasc Intervent Radiol 2015; 39:433-40. [PMID: 26390876 DOI: 10.1007/s00270-015-1201-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 03/11/2015] [Accepted: 07/18/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of US-guided percutaneous microwave (MW) ablation in the treatment of renal angiomyolipoma (AML). MATERIALS AND METHODS From January 2011 to April 2014, seven patients (5 females and 2 males; mean age 51.4) with 11 renal AMLs (9 sporadic type and 2 tuberous sclerosis associated) with a mean size of 3.4 ± 0.7 cm (range 2.4-4.9 cm) were treated with high-powered, gas-cooled percutaneous MW ablation under US guidance. Tumoral diameter, volume, and CT/MR enhancement were measured on pre-treatment, immediate post-ablation, and delayed post-ablation imaging. Clinical symptoms and creatinine were assessed on follow-up visits. RESULTS All ablations were technically successful and no major complications were encountered. Mean ablation parameters were ablation power of 65 W (range 60-70 W), using 456 mL of hydrodissection fluid per patient, over 4.7 min (range 3-8 min). Immediate post-ablation imaging demonstrated mean tumor diameter and volume decreases of 1.8% (3.4-3.3 cm) and 1.7% (27.5-26.3 cm(3)), respectively. Delayed imaging follow-up obtained at a mean interval of 23.1 months (median 17.6; range 9-47) demonstrated mean tumor diameter and volume decreases of 29% (3.4-2.4 cm) and 47% (27.5-12.1 cm(3)), respectively. Tumoral enhancement decreased on immediate post-procedure and delayed imaging by CT/MR parameters, indicating decreased tumor vascularity. No patients required additional intervention and no patients experienced spontaneous bleeding post-ablation. CONCLUSION Our early experience with high-powered, gas-cooled percutaneous MW ablation demonstrates it to be a safe and effective modality to devascularize and decrease the size of renal AMLs.
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Affiliation(s)
- Mircea Cristescu
- Department of Radiology, University of Wisconsin, E3/366 CSC, 600 Highland Avenue, Madison, WI, USA.
| | - E Jason Abel
- Department of Urology, University of Wisconsin, Madison, WI, USA.
| | - Shane Wells
- Department of Radiology, University of Wisconsin, E3/366 CSC, 600 Highland Avenue, Madison, WI, USA.
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin, E3/366 CSC, 600 Highland Avenue, Madison, WI, USA.
| | - Sean P Hedican
- Department of Urology, University of Wisconsin, Madison, WI, USA.
| | - Megan G Lubner
- Department of Radiology, University of Wisconsin, E3/366 CSC, 600 Highland Avenue, Madison, WI, USA.
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin, E3/366 CSC, 600 Highland Avenue, Madison, WI, USA.
| | - Christopher L Brace
- Department of Radiology, University of Wisconsin, E3/366 CSC, 600 Highland Avenue, Madison, WI, USA. .,Department of Medical Physics, University of Wisconsin, Madison, WI, USA. .,Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA.
| | - Fred T Lee
- Department of Radiology, University of Wisconsin, E3/366 CSC, 600 Highland Avenue, Madison, WI, USA. .,Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA.
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Harari CM, Magagna M, Bedoya M, Lee FT, Lubner MG, Hinshaw JL, Ziemlewicz T, Brace CL. Microwave Ablation: Comparison of Simultaneous and Sequential Activation of Multiple Antennas in Liver Model Systems. Radiology 2015; 278:95-103. [PMID: 26133361 DOI: 10.1148/radiol.2015142151] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare microwave ablation zones created by using sequential or simultaneous power delivery in ex vivo and in vivo liver tissue. MATERIALS AND METHODS All procedures were approved by the institutional animal care and use committee. Microwave ablations were performed in both ex vivo and in vivo liver models with a 2.45-GHz system capable of powering up to three antennas simultaneously. Two- and three-antenna arrays were evaluated in each model. Sequential and simultaneous ablations were created by delivering power (50 W ex vivo, 65 W in vivo) for 5 minutes per antenna (10 and 15 minutes total ablation time for sequential ablations, 5 minutes for simultaneous ablations). Thirty-two ablations were performed in ex vivo bovine livers (eight per group) and 28 in the livers of eight swine in vivo (seven per group). Ablation zone size and circularity metrics were determined from ablations excised postmortem. Mixed effects modeling was used to evaluate the influence of power delivery, number of antennas, and tissue type. RESULTS On average, ablations created by using the simultaneous power delivery technique were larger than those with the sequential technique (P < .05). Simultaneous ablations were also more circular than sequential ablations (P = .0001). Larger and more circular ablations were achieved with three antennas compared with two antennas (P < .05). Ablations were generally smaller in vivo compared with ex vivo. CONCLUSION The use of multiple antennas and simultaneous power delivery creates larger, more confluent ablations with greater temperatures than those created with sequential power delivery.
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Affiliation(s)
- Colin M Harari
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Michelle Magagna
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Mariajose Bedoya
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Fred T Lee
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Meghan G Lubner
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - J Louis Hinshaw
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Timothy Ziemlewicz
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Christopher L Brace
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
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Kitchin D, Lubner M, Ziemlewicz T, Hinshaw JL, Alexander M, Brace CL, Lee F. Microwave ablation of malignant hepatic tumours: intraperitoneal fluid instillation prevents collateral damage and allows more aggressive case selection. Int J Hyperthermia 2015; 30:299-305. [PMID: 25144819 DOI: 10.3109/02656736.2014.936050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Theaim of this peper was to retrospectively review our experience utilising protective fluid instillation techniques during percutaneous microwave ablation of liver tumours to determine if fluid instillation prevents non-target injuries and allows a more aggressive case selection. MATERIALS AND METHODS This institute review board-approved, U.S. Health Insurance Portability and Accountability Act-compliant, retrospective study reviewed percutaneous microwave ablation of 151 malignant hepatic tumours in 87 patients, comparing cases in which protective fluid instillation was performed with those where no fluid was utilised. In cases utilising hydrodisplacement for bowel protection, a consensus panel evaluated eligibility for potential ablation without hydrodisplacement. Patient age, tumour size, local tumour progression rate, length of follow-up, complications, displacement distance/artificial ascites thickness, and treatment power/time were compared. RESULTS Fluid administration was utilised during treatment in 29/151 of cases: 10/29 for protection of bowel (8/10 cases not possible without fluid displacement), and 19/29 for body wall/diaphragm protection. Local tumour progression was higher when hydrodisplacement was used to protect bowel tissue; this may be due to lower applied power due to operator caution. Local tumour progression was not increased for artificial ascites. There was no difference in complications between the fluid group and controls. CONCLUSION Intraperitoneal fluid administration is a safe and effective method of protecting non-target structures during percutaneous hepatic microwave ablation. While hydrodisplacement for bowel protection allows more aggressive case selection, these cases were associated with higher rates of local tumour progression.
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Affiliation(s)
- Douglas Kitchin
- Department of Radiology, University of Wisconsin , Madison, Wisconsin , USA
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Hasan HY, Hinshaw JL, Borman EJ, Gegios A, Leverson G, Winslow ER. Assessing normal growth of hepatic hemangiomas during long-term follow-up. JAMA Surg 2015; 149:1266-71. [PMID: 25321079 DOI: 10.1001/jamasurg.2014.477] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Few long-term data describe the natural history of hepatic hemangiomas. Because these lesions are frequently imaged repetitively on studies performed for other indications, health care professionals are commonly confronted with the problem of a growing hemangioma. Because the rate and magnitude of normal growth is not well characterized, it is difficult to recognize lesions growing at an abnormal rate, which may require further evaluation or intervention. OBJECTIVES To establish quantitatively the expected growth rate of hepatic hemangiomas and to define a measure of hemangioma growth that could be used clinically to help identify hemangiomas for which growth is more than expected. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study at an academic hospital tertiary referral center evaluating the growth rate of hepatic hemangiomas on cross-sectional imaging studies during a 10-year period (1997-2007). The mean (SD) follow-up time was 3.7 (1.9) years. The radiology information system was searched in a 10-year period for hemangioma. Patients with hepatic hemangiomas that were 1 cm or larger as seen on cross-sectional imaging (computed tomography or magnetic resonance imaging), and 1 year or more apart were selected. Images with the longest interval between studies were selected for further review. Each study was rereviewed for diagnostic confirmation and to ensure consistency in measurement technique. Lesions were remeasured in 3 dimensions, and volumes were calculated using 3-dimensional software. MAIN OUTCOMES AND MEASURES Primary outcomes include the fraction of hepatic hemangiomas that demonstrated growth during long-term follow-up and the annual growth rate of those lesions. RESULTS A total of 163 hemangiomas were identified in 123 patients. The mean (SD) initial size was 3.2 (3.1) cm. During follow-up, 39.3% of hemangiomas grew 5% or more in mean linear dimension. The mean (SD) annual linear growth rate was 0.03 (0.21) cm for all lesions and 0.19 (0.23) cm for those that grew 5% or more. By volume, 44.7% of lesions grew 5% or more. The mean (SD) annual volumetric growth rate was 2.8% (21.0%) for all lesions and 17.7% (22.8%) in those that grew 5% or more. The initial size predicted the growth in linear dimension and volume (P < .001). There was no significant change in growth rate over time, indicating uniform growth (R = 0.00843; P = .92). CONCLUSIONS AND RELEVANCE Nearly 40% of hepatic hemangiomas grow over time. Although the overall rate of growth is slow, hemangiomas that exhibit growth do so at a modest rate (2 mm/y in linear dimension and 17.4% per year in volume). Further research is needed to determine how patients with more rapidly growing hemangiomas should be treated.
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Affiliation(s)
- Hani Y Hasan
- Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - J Louis Hinshaw
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Milwaukee
| | - Edward J Borman
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Milwaukee
| | - Alison Gegios
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Milwaukee
| | - Glen Leverson
- Biostatistics Office, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Milwaukee
| | - Emily R Winslow
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Milwaukee
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50
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Hasan HY, Hinshaw JL, Winslow ER. Growth assessment of hepatic venous malformations—reply. JAMA Surg 2015; 150:371. [PMID: 25693046 DOI: 10.1001/jamasurg.2014.3933] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Hani Y Hasan
- Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - J Louis Hinshaw
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Milwaukee
| | - Emily R Winslow
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Milwaukee
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