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Hu EY, Bhagavatula SK, Shi A, Merriam P, Levesque VM, Shyn PB. Image-guided percutaneous ablation of hepatic epithelioid hemangioendothelioma. Abdom Radiol (NY) 2024; 49:1241-1247. [PMID: 38240859 DOI: 10.1007/s00261-023-04154-y] [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: 10/16/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 03/22/2024]
Abstract
PURPOSE Disease control and survival following percutaneous ablation of hepatic epithelioid hemangioendothelioma (EHE) was studied retrospectively. METHODS Six patients underwent 16 image-guided ablation procedures to treat 35 liver tumors from 2015 to 2022 (17 microwave ablation, 9 irreversible electroporation, 8 cryoablation, and 1 radiofrequency ablation). Technical success, local progression, intrahepatic progression, distant progression, overall survival, and adverse events were assessed. RESULTS Four of six (67%) patients were treatment naïve prior to ablation. The mean length of imaging follow-up from first ablation procedure was 43.0 ± 31.2 months. Thirty-three of 35 (94.3%) ablated tumors did not progress locally. Three of 6 patients (50%) had new intrahepatic progression and underwent repeat ablation or systemic treatment. No extrahepatic progression was observed. One patient died from EHE 2.7 years after initial diagnosis. No severe adverse events occurred. CONCLUSION Percutaneous ablation is feasible, often in a staged fashion, and may provide favorable intermediate to long-term disease control for patients with hepatic EHE.
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Affiliation(s)
- Emmy Y Hu
- Division of Abdominal Imaging and Intervention, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Sharath K Bhagavatula
- Division of Abdominal Imaging and Intervention, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Andy Shi
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Priscilla Merriam
- Sarcoma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Vincent M Levesque
- Division of Abdominal Imaging and Intervention, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Paul B Shyn
- Division of Abdominal Imaging and Intervention, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
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2
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Shyn PB, Bhagavatula SK. PET/CT-Guided Tumor Ablation, From the AJR "How We Do It" Special Series. AJR Am J Roentgenol 2024. [PMID: 38447025 DOI: 10.2214/ajr.24.30952] [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: 03/08/2024]
Abstract
PET/CT guidance during percutaneous tumor ablation procedures combines metabolic and anatomic imaging, providing a powerful approach that can improve intraprocedural tumor visibility and ablation margin evaluation for a variety of cancers. This article reviews key advantages of the use of PET/CT as guidance for tumor ablation and describes the authors' technique for performing such procedures, highlighting the application of PET/CT for each procedural stage, including planning, targeting, monitoring, and assessment of results. Practical considerations in establishing and operating an interventional PET/CT practice are discussed. Suggestions for overcoming logistical challenges that have historically limited procedural PET/CT adoption are proposed. Several emerging procedural approaches relating to PET/CT and other molecular or anatomic imaging technologies are briefly explored.
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Affiliation(s)
- Paul B Shyn
- Harvard Medical School, Brigham and Women's Hospital, Department of Radiology, Abdominal Imaging and Intervention, 75 Francis St., Boston, MA 02115
| | - Sharath K Bhagavatula
- Harvard Medical School, Brigham and Women's Hospital, Department of Radiology, Abdominal Imaging and Intervention, 75 Francis St., Boston, MA 02115
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Shyn PB, Seyal AR, Gottumukkala RV, Silverman SG, Bhagavatula SK, Alencar RO, Dabiri BE, Souza DAT, Cosman ER, Kapur T. Feasibility and safety of bipolar radiofrequency track cautery during percutaneous image-guided abdominal biopsy procedures. Abdom Radiol (NY) 2024; 49:586-596. [PMID: 37816800 DOI: 10.1007/s00261-023-04054-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE The purpose of this study was to assess the feasibility and safety of using a bipolar radiofrequency track cautery device during percutaneous image-guided abdominal biopsy procedures in at-risk patients. METHODS Forty-two patients (26-79 years old; female 44%) with at least one bleeding risk factor who underwent an abdominal image-guided (CT or US) biopsy and intended bipolar radiofrequency track cautery (BRTC) were retrospectively studied. An 18G radiofrequency electrode was inserted through a 17G biopsy introducer needle immediately following coaxial 18G core biopsy, to cauterize the biopsy track using temperature control. Bleeding risk factors, technical success, and adverse events were recorded. RESULTS BRTC was technically successful in 41/42 (98%) of procedures; in one patient, the introducer needle retracted from the liver due to respiratory motion prior to BRTC. BRTC following percutaneous biopsy was applied during 41 abdominal biopsy procedures (renal mass = 12, renal parenchyma = 10, liver mass = 9, liver parenchyma = 5, splenic mass or parenchyma = 4, gastrohepatic mass = 1). All patients had one or more of the following risk factors: high-risk organ (spleen or renal parenchyma), hypervascular mass, elevated prothrombin time, renal insufficiency, thrombocytopenia, recent anticoagulation or anticoagulation not withheld for recommended interval, cirrhosis, intraprocedural hypertension, brisk back bleeding observed from the introducer needle, or subcapsular tumor location. No severe adverse events (grade 3 or higher) occurred. Two (2/41, 5%) mild (grade 1) bleeding events did not cause symptoms or require intervention. CONCLUSION Bipolar radiofrequency track cautery was feasible and safe during percutaneous image-guided abdominal biopsy procedures. IRB approval: MBG 2022P002277.
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Affiliation(s)
- Paul B Shyn
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
| | - Adeel R Seyal
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Ravi V Gottumukkala
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Stuart G Silverman
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Sharath K Bhagavatula
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Raquel O Alencar
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Borna E Dabiri
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Daniel A T Souza
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Eric R Cosman
- Cambridge Interventional, LLC, 78 Cambridge St., Burlington, MA, 01803, USA
| | - Tina Kapur
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
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Lucassen RT, Jafari MH, Duggan NM, Jowkar N, Mehrtash A, Fischetti C, Bernier D, Prentice K, Duhaime EP, Jin M, Abolmaesumi P, Heslinga FG, Veta M, Duran-Mendicuti MA, Frisken S, Shyn PB, Golby AJ, Boyer E, Wells WM, Goldsmith AJ, Kapur T. Deep Learning for Detection and Localization of B-Lines in Lung Ultrasound. IEEE J Biomed Health Inform 2023; 27:4352-4361. [PMID: 37276107 PMCID: PMC10540221 DOI: 10.1109/jbhi.2023.3282596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Lung ultrasound (LUS) is an important imaging modality used by emergency physicians to assess pulmonary congestion at the patient bedside. B-line artifacts in LUS videos are key findings associated with pulmonary congestion. Not only can the interpretation of LUS be challenging for novice operators, but visual quantification of B-lines remains subject to observer variability. In this work, we investigate the strengths and weaknesses of multiple deep learning approaches for automated B-line detection and localization in LUS videos. We curate and publish, BEDLUS, a new ultrasound dataset comprising 1,419 videos from 113 patients with a total of 15,755 expert-annotated B-lines. Based on this dataset, we present a benchmark of established deep learning methods applied to the task of B-line detection. To pave the way for interpretable quantification of B-lines, we propose a novel "single-point" approach to B-line localization using only the point of origin. Our results show that (a) the area under the receiver operating characteristic curve ranges from 0.864 to 0.955 for the benchmarked detection methods, (b) within this range, the best performance is achieved by models that leverage multiple successive frames as input, and (c) the proposed single-point approach for B-line localization reaches an F 1-score of 0.65, performing on par with the inter-observer agreement. The dataset and developed methods can facilitate further biomedical research on automated interpretation of lung ultrasound with the potential to expand the clinical utility.
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Jiang L, Jowkar N, King F, Plishker W, Bhagavatula SK, Levesque VM, Kapur T, Shyn PB. PET/CT Fluoroscopy during PET/CT-Guided Interventions: Initial Experience. J Vasc Interv Radiol 2023; 34:1319-1323. [PMID: 37142215 PMCID: PMC10512656 DOI: 10.1016/j.jvir.2023.04.020] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/03/2023] [Accepted: 04/23/2023] [Indexed: 05/06/2023] Open
Abstract
This study assessed the feasibility and functionality of the use of a high-speed image fusion technology to generate and display positron emission tomography (PET)/computed tomography (CT) fluoroscopic images during PET/CT-guided tumor ablation procedures. Thirteen patients underwent 14 PET/CT-guided ablations for the treatment of 20 tumors. A Food and Drug Administration-cleared multimodal image fusion platform received images pushed from a scanner, followed by near-real-time, nonrigid image registration. The most recent intraprocedural PET dataset was fused to each single-rotation CT fluoroscopy dataset as it arrived, and the fused images were displayed on an in-room monitor. PET/CT fluoroscopic images were generated and displayed in all procedures and enabled more confident targeting in 3 procedures. The mean lag time from CT fluoroscopic image acquisition to the in-room display of the fused PET/CT fluoroscopic image was 21 seconds ± 8. The registration accuracy was visually satisfactory in 13 of 14 procedures. In conclusion, PET/CT fluoroscopy was feasible and may have the potential to facilitate PET/CT-guided procedures.
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Affiliation(s)
- Liwei Jiang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nick Jowkar
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Franklin King
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Sharath K Bhagavatula
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Vincent M Levesque
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tina Kapur
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul B Shyn
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
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Burch EA, Bhagavatula SK, Malone FE, Reichert RR, Tuncali K, Levesque VM, Lan Z, Sticka WT, Shyn PB. Tumor and Ablation Margin Visibility during Cryoablation of Musculoskeletal Tumors: Comparing Intraprocedural PET/CT Images with CT-Only Images. J Vasc Interv Radiol 2023; 34:1311-1318. [PMID: 37028704 PMCID: PMC10506080 DOI: 10.1016/j.jvir.2023.03.034] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/25/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023] Open
Abstract
PURPOSE To compare tumor and ice-ball margin visibility on intraprocedural positron emission tomography (PET)/computed tomography (CT) and CT-only images and report technical success, local tumor progression, and adverse event rates for PET/CT-guided cryoablation procedures for musculoskeletal tumors. MATERIALS AND METHODS This Health Insurance Portability and Accountability Act (HIPAA)-compliant and institutional review board-approved retrospective study evaluated 20 PET/CT-guided cryoablation procedures performed with palliative and/or curative intent to treat 15 musculoskeletal tumors in 15 patients from 2012 to 2021. Cryoablation was performed using general anesthesia and PET/CT guidance. Procedural images were reviewed to determine the following: (a) whether the tumor borders could be fully assessed on PET/CT or CT-only images; and (b) whether tumor ice-ball margins could be fully assessed on PET/CT or CT-only images. The ability to visualize tumor borders and ice-ball margins on PET/CT images was compared with that on CT-only images. RESULTS Tumor borders were fully assessable for 100% (20 of 20; 95% CI, 0.83-1) of procedures on PET/CT versus 20% (4 of 20; 95 CI, 0.057-0.44) of procedures on CT only (P < .001). The tumor ice-ball margin was fully assessable in 80% (16 of 20; 95% CI, 0.56-0.94) of procedures using PET/CT versus 5% (1 of 20; 95% CI, 0.0013-0.25) of procedures using CT only (P < .001). Primary technical success was achieved in 75% (15 of 20; 95% CI, 0.51-0.91) of procedures. There was local tumor progression in 23% (3/13; 95% CI, 0.050-0.54) of the treated tumors with at least 6 months of follow-up. There were 3 adverse events (1 Grade 3, 1 Grade 2, and 1 Grade 1). CONCLUSIONS PET/CT-guided cryoablation of musculoskeletal tumors can provide superior intraprocedural visualization of the tumor and ice-ball margins compared with that provided by CT alone. Further studies are warranted to confirm the long-term efficacy and safety of this approach.
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Affiliation(s)
- Ezra A Burch
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sharath K Bhagavatula
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Fiona E Malone
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ryan R Reichert
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vincent M Levesque
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Zhou Lan
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William T Sticka
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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7
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Abrishami Kashani M, Murphy MC, Saenger JA, Wrobel MM, Tahir I, Mrah S, Ringer S, Bunck AC, Silverman SG, Shyn PB, Pachamanova DA, Fintelmann FJ. Risk of persistent air leaks following percutaneous cryoablation and microwave ablation of peripheral lung tumors. Eur Radiol 2023; 33:5740-5751. [PMID: 36892641 DOI: 10.1007/s00330-023-09499-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 01/13/2023] [Accepted: 02/08/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVES To compare the incidence of persistent air leak (PAL) following cryoablation vs MWA of lung tumors when the ablation zone includes the pleura. METHODS This bi-institutional retrospective cohort study evaluated consecutive peripheral lung tumors treated with cryoablation or MWA from 2006 to 2021. PAL was defined as an air leak for more than 24 h after chest tube placement or an enlarging postprocedural pneumothorax requiring chest tube placement. The pleural area included by the ablation zone was quantified on CT using semi-automated segmentation. PAL incidence was compared between ablation modalities and a parsimonious multivariable model was developed to assess the odds of PAL using generalized estimating equations and purposeful selection of predefined covariates. Time-to-local tumor progression (LTP) was compared between ablation modalities using Fine-Gray models, with death as a competing risk. RESULTS In total, 260 tumors (mean diameter, 13.1 mm ± 7.4; mean distance to pleura, 3.6 mm ± 5.2) in 116 patients (mean age, 61.1 years ± 15.3; 60 women) and 173 sessions (112 cryoablations, 61 MWA) were included. PAL occurred after 25/173 (15%) sessions. The incidence was significantly lower following cryoablation compared to MWA (10 [9%] vs 15 [25%]; p = .006). The odds of PAL adjusted for the number of treated tumors per session were 67% lower following cryoablation (odds ratio = 0.33 [95% CI, 0.14-0.82]; p = .02) vs MWA. There was no significant difference in time-to-LTP between ablation modalities (p = .36). CONCLUSIONS Cryoablation of peripheral lung tumors bears a lower risk of PAL compared to MWA when the ablation zone includes the pleura, without adversely affecting time-to-LTP. KEY POINTS • The incidence of persistent air leaks after percutaneous ablation of peripheral lung tumors was lower following cryoablation compared to microwave ablation (9% vs 25%; p = .006). • The mean chest tube dwell time was 54% shorter following cryoablation compared to MWA (p = .04). • Local tumor progression did not differ between lung tumors treated with percutaneous cryoablation compared to microwave ablation (p = .36).
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Affiliation(s)
- Maya Abrishami Kashani
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- University of Heidelberg, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Mark C Murphy
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan A Saenger
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Maria M Wrobel
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ismail Tahir
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sofiane Mrah
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Stefan Ringer
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Alexander C Bunck
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Dessislava A Pachamanova
- Division of Mathematics and Science, Babson College, Wellesley, MA, USA
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
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Chaurasia A, Singh S, Homayounieh F, Gopal N, Jones EC, Linehan WM, Shyn PB, Ball MW, Malayeri AA. Complications after Nephron-sparing Interventions for Renal Tumors: Imaging Findings and Management. Radiographics 2023; 43:e220196. [PMID: 37384546 PMCID: PMC10323228 DOI: 10.1148/rg.220196] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/20/2022] [Accepted: 01/10/2023] [Indexed: 07/01/2023]
Abstract
The two primary nephron-sparing interventions for treating renal masses such as renal cell carcinoma are surgical partial nephrectomy (PN) and image-guided percutaneous thermal ablation. Nephron-sparing surgery, such as PN, has been the standard of care for treating many localized renal masses. Although uncommon, complications resulting from PN can range from asymptomatic and mild to symptomatic and life-threatening. These complications include vascular injuries such as hematoma, pseudoaneurysm, arteriovenous fistula, and/or renal ischemia; injury to the collecting system causing urinary leak; infection; and tumor recurrence. The incidence of complications after any nephron-sparing surgery depends on many factors, such as the proximity of the tumor to blood vessels or the collecting system, the skill or experience of the surgeon, and patient-specific factors. More recently, image-guided percutaneous renal ablation has emerged as a safe and effective treatment option for small renal tumors, with comparable oncologic outcomes to those of PN and a low incidence of major complications. Radiologists must be familiar with the imaging findings encountered after these surgical and image-guided procedures, especially those indicative of complications. The authors review cross-sectional imaging characteristics of complications after PN and image-guided thermal ablation of kidney tumors and highlight the respective management strategies, ranging from clinical observation to interventions such as angioembolization or repeat surgery. Work of the U.S. Government published under an exclusive license with the RSNA. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Quiz questions for this article are available in the Online Learning Center. See the invited commentary by Chung and Raman in this issue.
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Affiliation(s)
- Aditi Chaurasia
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Shiva Singh
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Fatemeh Homayounieh
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Nikhil Gopal
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Elizabeth C. Jones
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - W. Marston Linehan
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Paul B. Shyn
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Mark W. Ball
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Ashkan A. Malayeri
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
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Tahir I, Cahalane AM, Saenger JA, Leppelmann KS, Abrishami Kashani M, Marquardt JP, Silverman SG, Shyn PB, Mercaldo ND, Fintelmann FJ. Factors Associated with Hospital Length of Stay and Adverse Events following Percutaneous Ablation of Lung Tumors. J Vasc Interv Radiol 2023; 34:759-767.e2. [PMID: 36521793 DOI: 10.1016/j.jvir.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/12/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To explore the association between risk factors established in the surgical literature and hospital length of stay (HLOS), adverse events, and hospital readmission within 30 days after percutaneous image-guided thermal ablation of lung tumors. MATERIALS AND METHODS This bi-institutional retrospective cohort study included 131 consecutive adult patients (67 men [51%]; median age, 65 years) with 180 primary or metastatic lung tumors treated in 131 sessions (74 cryoablation and 57 microwave ablation) from 2006 to 2019. Age-adjusted Charlson Comorbidity Index, sex, performance status, smoking status, chronic obstructive pulmonary disease (COPD), primary lung cancer versus pulmonary metastases, number of tumors treated per session, maximum axial tumor diameter, ablation modality, number of pleural punctures, anesthesia type, pulmonary artery-to-aorta ratio, lung densitometry, sarcopenia, and adipopenia were evaluated. Associations between risk factors and outcomes were assessed using univariable and multivariable generalized linear models. RESULTS In univariable analysis, HLOS was associated with current smoking (incidence rate ratio [IRR], 4.54 [1.23-16.8]; P = .02), COPD (IRR, 3.56 [1.40-9.04]; P = .01), cryoablations with ≥3 pleural punctures (IRR, 3.13 [1.07-9.14]; P = .04), general anesthesia (IRR, 10.8 [4.18-27.8]; P < .001), and sarcopenia (IRR, 2.66 [1.10-6.44]; P = .03). After multivariable adjustment, COPD (IRR, 3.56 [1.57-8.11]; P = .003) and general anesthesia (IRR, 12.1 [4.39-33.5]; P < .001) were the only risk factors associated with longer HLOS. No associations were observed between risk factors and adverse events in multivariable analysis. Tumors treated per session were associated with risk of hospital readmission (P = .03). CONCLUSIONS Identified preprocedural risk factors from the surgical literature may aid in risk stratification for HLOS after percutaneous ablation of lung tumors, but were not associated with adverse events.
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Affiliation(s)
- Ismail Tahir
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexis M Cahalane
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan A Saenger
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Medical School, Sigmund Freud University, Vienna, Austria
| | - Konstantin S Leppelmann
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Maya Abrishami Kashani
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - J Peter Marquardt
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Florian J Fintelmann
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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10
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Murphy MC, Tahir I, Saenger JA, Abrishami Kashani M, Muniappan A, Levesque VM, Shyn PB, Silverman SG, Fintelmann FJ. Safety and Effectiveness of Percutaneous Image-Guided Thermal Ablation of Juxtacardiac Lung Tumors. J Vasc Interv Radiol 2023; 34:750-758. [PMID: 36707028 DOI: 10.1016/j.jvir.2023.01.020] [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: 09/27/2022] [Revised: 01/10/2023] [Accepted: 01/15/2023] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of percutaneous image-guided thermal ablation (IGTA) for juxtacardiac lung tumors. MATERIALS AND METHODS This bi-institutional retrospective cohort study included 23 consecutive patients (13 [57%] male; mean age, 55 years ± 18) with 30 juxtacardiac lung tumors located ≤10 mm from the pericardium treated in 28 IGTA sessions (25 sessions of cryoablation and 3 sessions of microwave ablation) between April 2008 and August 2022. The primary outcome was any adverse cardiac event within 90 days after ablation. Secondary outcomes included noncardiac adverse events, local tumor progression-free survival (LT-PFS), and the cumulative incidence of local tumor progression with death as a competing risk. Two tumors treated without curative intent or follow-up imaging were considered in the safety analysis but not in the progression analysis. RESULTS The median imaging follow-up duration was 22 months (interquartile range [IQR], 10-53 months). Primary technical success was achieved in 25 (89%) ablations. No adverse cardiac events attributable to IGTA occurred. One patient experienced a phrenic nerve injury. The median LT-PFS duration was 59 months (IQR, 32-73 months). At 1, 3, and 5 years, LT-PFS was 90% (95% CI, 78%-100%), 74% (CI, 53%-100%), and 45% (CI, 20%-97%), respectively, and the cumulative incidence of local tumor progression was 4.3% (CI, 0.29%-19%), 11% (CI, 1.6%-30%), and 26% (CI, 3.3%-58%), respectively. CONCLUSIONS IGTA is safe and effective for lung tumors located ≤10 mm from the pericardium. No adverse cardiac events were not observed within 90 days after ablation.
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Affiliation(s)
- Mark C Murphy
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ismail Tahir
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan A Saenger
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Maya Abrishami Kashani
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ashok Muniappan
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Vincent M Levesque
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Florian J Fintelmann
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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11
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Jiang L, Jowkar N, Bhagavatula SK, Levesque VM, Walsh MF, Kapur T, Shyn PB. PET and CT Contributions to Patient Dose and Personnel Exposure from Radiation During PET/CT-Guided Tumor Ablations. J Vasc Interv Radiol 2022; 33:1234-1239. [PMID: 35817359 DOI: 10.1016/j.jvir.2022.07.001] [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: 11/17/2021] [Revised: 05/14/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022] Open
Abstract
This study sought to quantify positron emission tomography (PET) and computed tomography (CT) components of patient dose and personnel radiation exposure during PET/CT-guided tumor ablations, and to assess the utility of a rolling lead shield for operator protection. Two operators performed 21 PET/CT-guided ablations behind a custom 25 mm lead shield with mid-chest to mid-thigh coverage. Mean patient dose per procedure was 3.90 ± 1.13 mSv (11.3%) from PET and 30.51 ± 19.05 mSv (88.7%) from CT. Mean primary and secondary operator exposures outside neck-level thyroid shields were 0.05 mSv and 0.02 mSv per procedure, respectively. Radiation exposure behind the rolling lead shield, inside primary operator's thyroid shield, and on other personnel were below measurable threshold cumulatively over 21 procedures. Mean PET exposure at continuous close proximity to patient was 0.02 mSv per procedure. PET doses to patient and personnel were small; the rolling lead shield provided limited benefit.
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Affiliation(s)
- Liwei Jiang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Nick Jowkar
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
| | - Sharath K Bhagavatula
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Vincent M Levesque
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
| | - Mark F Walsh
- Department of Health Physics, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
| | - Tina Kapur
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Paul B Shyn
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115.
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12
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Leppelmann KS, Levesque VM, Bunck AC, Cahalane AM, Lanuti M, Silverman SG, Shyn PB, Fintelmann FJ. Correction to: Outcomes Following Percutaneous Microwave and Cryoablation of Lung Metastases from Adenoid Cystic Carcinoma of the Head and Neck: A Bi-Institutional Retrospective Cohort Study. Ann Surg Oncol 2022; 29:7009. [PMID: 35175457 DOI: 10.1245/s10434-022-11465-9] [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: 11/18/2022]
Affiliation(s)
- Konstantin S Leppelmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Alexander C Bunck
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Alexis M Cahalane
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael Lanuti
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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13
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Daye D, Hu EY, Glazer DI, Tuncali K, Levesque V, Shyn PB. Periprocedural factors associated with overall patient survival following percutaneous image-guided liver tumor cryoablation. Int J Hyperthermia 2021; 39:34-39. [PMID: 34937523 DOI: 10.1080/02656736.2021.2013552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To assess the impact of periprocedural factors, including adverse events, on overall patient survival following image-guided liver tumor cryoablation procedures. METHODS In this retrospective single-institution study, 143 patients (73 male, 70 female, ages 29-88) underwent 169 image-guided liver tumor cryoablation procedures between October 1998 and August 2014. Patient, tumor and procedural variables were recorded. The primary outcome was overall survival post-procedure (Kaplan-Meier analysis). Secondary outcomes were the impact of 15 variables on patient survival, which were assessed with multivariate cox regression and log-rank tests. RESULTS Mean tumor diameter was 2.5 ± 1.2 cm. 26 of 143 (18.2%) patients had primary hepatic malignancies; 117 of 143 (81.8%) had liver metastases. Survival analysis revealed survivor functions at 3, 5, 7, 10 and 12 years post-ablation of 0.54, 0.37, 0.30, 0.17 and 0.06, with mean survival time of 40.8 ± 4.9 months. Tumor size ≥4 cm (p = .018), pre-procedural platelet count <100 × 103/μL (p = .023), and prior local radiation therapy (p = .014) were associated with worse overall patient survival. Grade 3 or higher adverse events were not associated with reduced survival (p = .49). CONCLUSIONS All variables associated with overall survival were patient-related and none were associated with the cryoablation procedure. Pre-procedural thrombocytopenia, larger tumor size and history of prior local radiation therapy were independent risk factors for reduced overall survival in patients undergoing hepatic cryoablation. Adverse events related to hepatic cryoablation were not associated with decreased survival.
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Affiliation(s)
- Dania Daye
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Boston, MA, USA
| | - Emmy Y Hu
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel I Glazer
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kemal Tuncali
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Vincent Levesque
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Boston, MA, USA
| | - Paul B Shyn
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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14
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Lee EJ, Plishker W, Hata N, Shyn PB, Silverman SG, Bhattacharyya SS, Shekhar R. Rapid Quality Assessment of Nonrigid Image Registration Based on Supervised Learning. J Digit Imaging 2021; 34:1376-1386. [PMID: 34647199 PMCID: PMC8669090 DOI: 10.1007/s10278-021-00523-5] [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: 10/21/2020] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 11/25/2022] Open
Abstract
When preprocedural images are overlaid on intraprocedural images, interventional procedures benefit in that more structures are revealed in intraprocedural imaging. However, image artifacts, respiratory motion, and challenging scenarios could limit the accuracy of multimodality image registration necessary before image overlay. Ensuring the accuracy of registration during interventional procedures is therefore critically important. The goal of this study was to develop a novel framework that has the ability to assess the quality (i.e., accuracy) of nonrigid multimodality image registration accurately in near real time. We constructed a solution using registration quality metrics that can be computed rapidly and combined to form a single binary assessment of image registration quality as either successful or poor. Based on expert-generated quality metrics as ground truth, we used a supervised learning method to train and test this system on existing clinical data. Using the trained quality classifier, the proposed framework identified successful image registration cases with an accuracy of 81.5%. The current implementation produced the classification result in 5.5 s, fast enough for typical interventional radiology procedures. Using supervised learning, we have shown that the described framework could enable a clinician to obtain confirmation or caution of registration results during clinical procedures.
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Affiliation(s)
- Eung-Joo Lee
- Department of Electrical and Computer Engineering, University of Maryland, College Park, MD USA
| | - William Plishker
- Institute for Advanced Computer Studies, University of Maryland, College Park, MD USA
| | | | | | | | - Shuvra S. Bhattacharyya
- Department of Electrical and Computer Engineering, University of Maryland, College Park, MD USA
- Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
| | - Raj Shekhar
- Institute for Advanced Computer Studies, University of Maryland, College Park, MD USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC USA
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15
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Wen KW, Joseph NM, Srivastava A, Saunders TA, Jain D, Rank J, Feely M, Zarrinpar A, Al Diffalha S, Shyn PB, Graham RP, Drage MG, Kakar S. Inhibin-positive hepatic carcinoma: proposal for a solid-tubulocystic variant of intrahepatic cholangiocarcinoma. Hum Pathol 2021; 116:82-93. [PMID: 34298064 DOI: 10.1016/j.humpath.2021.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/02/2021] [Accepted: 07/10/2021] [Indexed: 01/13/2023]
Abstract
Inhibin-positive hepatic carcinoma is a rare primary liver neoplasm that resembles sex cord-stromal tumor and thyroid follicular tumors. The term "cholangioblastic variant of intrahepatic cholangiocarcinoma" has been proposed. This study describes the clinicopathologic, immunophenotypic, and molecular features of a small series (n = 6) of this rare tumor. Albumin in situ hybridization (ISH) and capture-based next-generation sequencing (NGS) were also performed. All tumors occurred in young women (mean age 32.5 years, range 19-44 years) as a solitary large mass (mean 15.8 cm, range 6.9-23.5 cm). All tumors showed a highly distinctive morphology with sheets and large nests of tumor cells alternating with tubular and cystic areas imparting a sex cord-like or thyroid follicle-like morphology. Cytologic atypia was mild, and mitotic activity was low. All cases were positive for inhibin, as well as pancytokeratin, CK7, CK19, and albumin ISH. Synaptophysin and chromogranin showed focal or patchy staining, whereas INSM1 was negative. Markers for hepatocellular differentiation, thyroid origin, and sex cord-stromal tumor were negative. There were no recurrent genomic changes based on capture-based NGS of ∼500 cancer genes. Recurrence and/or metastasis was seen in three (50%) cases (follow-up time range for all cases: 5 months to 2 years). In conclusion, this series describes the distinctive morphology, immunophenotypic features, and diffuse albumin staining in six cases of a rare inhibin-positive primary liver carcinoma that runs an aggressive course similar to intrahepatic cholangiocarcinoma. Genomic changes typical of cholangiocarcinoma or hepatocellular carcinoma were not identified, and there were no recurrent genetic abnormalities. We propose the term "solid-tubulocystic variant of intrahepatic cholangiocarcinoma" to reflect the spectrum of morphologic patterns observed in this tumor.
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Affiliation(s)
- Kwun Wah Wen
- Department of Pathology, University of California, San Francisco, San Francisco, CA 91343, United States
| | - Nancy M Joseph
- Department of Pathology, University of California, San Francisco, San Francisco, CA 91343, United States
| | - Amitabh Srivastava
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Tara A Saunders
- Department of Pathology, University of California, San Francisco, San Francisco, CA 91343, United States
| | - Dhanpat Jain
- Department of Pathology, Yale University, New Haven, CT 06520, United States
| | - Joseph Rank
- Cellnetix Pathology & Laboratories, Seattle, WA 98104, United States
| | - Michael Feely
- Department of Pathology, University of Florida, Gainesville, FL 32610, United States
| | - Ali Zarrinpar
- Department of Surgery, University of Florida, Gainesville, FL 32610, United States
| | - Sameer Al Diffalha
- Department of Pathology, University of Alabama, Birmingham, AL 35294, United States
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Rondell P Graham
- Department of Pathology, Mayo Medical Laboratories, Rochester, MN 55901, United States
| | - Michael G Drage
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY 14642, United States
| | - Sanjay Kakar
- Department of Pathology, University of California, San Francisco, San Francisco, CA 91343, United States.
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16
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Bogoni M, Cerci JJ, Cornelis FH, Nanni C, Tabacchi E, SchÖder H, Shyn PB, Sofocleous CT, Solomon SB, Kirov AS. Practice and prospects for PET/CT guided interventions. Q J Nucl Med Mol Imaging 2021; 65:20-31. [PMID: 33494585 PMCID: PMC10446123 DOI: 10.23736/s1824-4785.21.03291-x] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
During the past 10 years, performing real-time molecular imaging with positron emission tomography (PET) in combination with computed tomography (CT) during interventional procedures has undergone rapid development. Keeping in mind the interest of the nuclear medicine readers, an update is provided of the current workflows using real-time PET/CT in percutaneous biopsies and tumor ablations. The clinical utility of PET/CT guided biopsies in cancer patients with lung, liver, lymphoma, and bone tumors are reviewed. Several technological developments, including the introduction of new PET tracers and robotic arms as well as opportunities provided through acquiring radioactive biopsy specimens are briefly reviewed.
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Affiliation(s)
| | | | | | - Cristina Nanni
- Unit of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Elena Tabacchi
- Unit of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Heiko SchÖder
- Unit of Nuclear Medicine, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Constantinos T Sofocleous
- Unit of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B Solomon
- Unit of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Assen S Kirov
- Unit of Molecular Imaging and Therapy Physics, Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA -
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17
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Leppelmann KS, Levesque VM, Bunck AC, Cahalane AM, Lanuti M, Silverman SG, Shyn PB, Fintelmann FJ. Outcomes Following Percutaneous Microwave and Cryoablation of Lung Metastases from Adenoid Cystic Carcinoma of the Head and Neck: A Bi-Institutional Retrospective Cohort Study. Ann Surg Oncol 2021; 28:5829-5839. [PMID: 33620616 DOI: 10.1245/s10434-021-09714-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/23/2020] [Accepted: 01/27/2021] [Indexed: 02/06/2023]
Abstract
OBECTIVE The aim of this study was to report outcomes following percutaneous microwave and cryoablation of lung metastases from adenoid cystic carcinoma (ACC) of the head and neck. MATERIAL AND METHODS This bi-institutional retrospective cohort study included 10 patients (6 females, median age 59 years [range 28-81]) who underwent 32 percutaneous ablation sessions (21 cryoablation, 11 microwave) of 60 lung metastases (median 3.5 tumors per patient [range 1-16]) from 2007 to 2019. Median tumor diameter was 16 mm [range 7-40], significantly larger for cryoablation (22 mm, p = 0.002). A median of two tumors were treated per session [range 1-7]. Technical success, local control, complications, and overall survival were assessed. RESULTS Primary technical success was achieved for 55/60 tumors (91.7%). Median follow-up was 40.6 months (clinical) and 32.5 months (imaging, per tumor). Local control at 1, 2, and 3 years was 94.7%, 80.8%, and 76.4%, respectively, and did not differ between ablation modalities. Five of fifteen recurrent tumors underwent repeat ablation, and secondary technical success was achieved in four (80%). Assisted local tumor control at 1, 2, and 3 years was 96.2%, 89.8%, and 84.9%, respectively. Complications occurred following 24/32 sessions (75.0%) and 57.2% Common Terminology Criteria for Adverse Events (CTCAE) lower than grade 3. Of 13 pneumothoraces, 7 required chest tube placements. Hemoptysis occurred after 7/21 cryoablation sessions, and bronchopleural fistula developed more frequently with microwave (p = 0.037). Median length of hospital stay was 1 day [range 0-10], and median overall survival was 81.5 months (IQR 40.4-93.1). CONCLUSION Percutaneous computed tomography-guided microwave and cryoablation can treat lung metastases from ACC of the head and neck. Complications are common but manageable, with full recovery expected.
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Affiliation(s)
- Konstantin S Leppelmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Alexander C Bunck
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Alexis M Cahalane
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael Lanuti
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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18
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Sheth RA, Baerlocher MO, Connolly BL, Dariushnia SR, Shyn PB, Vatsky S, Tam AL, Gupta S. Society of Interventional Radiology Quality Improvement Standards on Percutaneous Needle Biopsy in Adult and Pediatric Patients. J Vasc Interv Radiol 2020; 31:1840-1848. [DOI: 10.1016/j.jvir.2020.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022] Open
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19
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Bhagavatula SK, Tuncali K, Shyn PB, Levesque VM, Chang SL, Silverman SG. Percutaneous CT- and MRI-guided Cryoablation of cT1 Renal Cell Carcinoma: Intermediate- to Long-term Outcomes in 307 Patients. Radiology 2020; 296:687-695. [PMID: 32633677 DOI: 10.1148/radiol.2020200149] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Percutaneous ablation for cT1 renal cell carcinoma (RCC) remains underused, partially because of heterogeneous and limited long-term outcomes data assessing recent cryoablation methods. Purpose To report intermediate- to long-term outcomes of image-guided percutaneous cryoablation of cT1 RCC and to compare outcomes for CT versus MRI guidance. Materials and Methods This HIPAA-compliant retrospective single-institution study assessed patients who underwent percutaneous cryoablation for solitary pathology-proven cT1 RCC between August 2000 and July 2017. Tumors (cT1a, n = 282; cT1b, n = 25; size range, 0.6-6.5 cm; median size, 2.5 cm) underwent cryoablation with CT (n = 155) or MRI (n = 152) guidance. Primary end points of overall survival (OS), disease-specific survival (DSS), imaging-confirmed disease-free survival (DFS), and local progression-free survival (LPFS) were calculated by using Kaplan-Meier analysis. Secondary end points of technique efficacy and adverse event rate were also calculated. Primary and secondary end points for CT and MRI guidance were compared by using univariable regression analysis. Results A total of 307 patients (mean age, 68 years ± 11 [standard deviation]; 192 men) were evaluated. Median clinical follow-up lasted 95 months (range, 8-219 months), and median imaging follow-up lasted 41 months (range, 0-189 months). Survival metrics at 3, 5, 10, and 15 years, respectively, included OS of 91% (95% confidence interval [CI]: 88%, 94%), 86% (95% CI: 82%, 90%), 78% (95% CI: 73%, 84%), and 76% (95% CI: 69%, 83%); DSS of 99.6% (95% CI: 99%, 100%), 99% (95% CI: 98%, 100%), 99% (95% CI: 98%, 100%), and 99% (95% CI: 98%, 100%); DFS of 94% (95% CI: 92%, 97%), 91% (95% CI: 88%, 96%), 88% (95% CI: 83%, 93%), and 88% (95% CI: 83%, 93%); and LPFS of 97% (95% CI: 94%, 99%), 95% (95% CI: 93%, 98%), 95% (95% CI: 93%, 98%), and 95% (95% CI: 93%, 98%). Survival did not significantly differ between CT and MRI guidance, with univariable Cox regression analysis hazard ratios of 0.97 (95% CI: 0.57, 1.67; P = .92) for OS, 0.63 (95% CI: 0.26, 1.52; P = .30) for DFS, and 0.83 (95% CI: 0.26, 2.74; P = .77) for LPFS. Primary and secondary technique efficacy were 96% and 99%, respectively. Overall adverse event rate was 14% (43 of 307), including 11 grade 3 events and three grade 4 events according to the Common Terminology Criteria for Adverse Events. Conclusion Percutaneous CT- and MRI-guided cryoablation of cT1 renal cell carcinoma had similar excellent intermediate- and long-term outcomes. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Georgiades in this issue.
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Affiliation(s)
- Sharath K Bhagavatula
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (S.K.B., K.T., P.B.S., V.M.L., S.G.S.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, Harvard Medical School; 75 Francis Street, Boston, MA 02115
| | - Kemal Tuncali
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (S.K.B., K.T., P.B.S., V.M.L., S.G.S.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, Harvard Medical School; 75 Francis Street, Boston, MA 02115
| | - Paul B Shyn
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (S.K.B., K.T., P.B.S., V.M.L., S.G.S.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, Harvard Medical School; 75 Francis Street, Boston, MA 02115
| | - Vincent M Levesque
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (S.K.B., K.T., P.B.S., V.M.L., S.G.S.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, Harvard Medical School; 75 Francis Street, Boston, MA 02115
| | - Steven L Chang
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (S.K.B., K.T., P.B.S., V.M.L., S.G.S.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, Harvard Medical School; 75 Francis Street, Boston, MA 02115
| | - Stuart G Silverman
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (S.K.B., K.T., P.B.S., V.M.L., S.G.S.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, Harvard Medical School; 75 Francis Street, Boston, MA 02115
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Hu EY, Levesque VM, Bay CP, Seol JG, Shyn PB. Liver Tumor Ablation Procedure Duration and Estimated Patient Radiation Dose: Comparing Positron Emission Tomography/CT and CT Guidance. J Vasc Interv Radiol 2020; 31:1052-1059. [PMID: 32534979 DOI: 10.1016/j.jvir.2019.11.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/25/2019] [Revised: 11/12/2019] [Accepted: 11/28/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To compare procedure duration and patient radiation dose in positron emission tomography/computed tomography (PET/CT) and CT-guided liver tumor ablation procedures. MATERIALS AND METHODS In this retrospective, case-control study, 275 patients underwent 368 image-guided ablation procedures to treat 537 tumors. Radiologists used PET/CT guidance for 117 procedures and CT guidance for 251 procedures. PET/CT-guided procedures were performed by one radiologist (C: P.B.S.). All 3 radiologists (A: J.G.S., B: a radiologist who is not an author on this article, and C: P.B.S.) performed CT-guided procedures. Potential confounders included patient demographics, clinical and tumor characteristics, and procedural variables. RESULTS The mean duration and estimated patient radiation dose of PET/CT-guided procedures performed by radiologist C were 21.5 ± 4.9 minutes longer and 0.7 ± 2.8 mSv higher than CT-guided procedures performed by all radiologists in an unadjusted comparison. Adjusting for confounding, mean duration and estimated dose of PET/CT-guided procedures performed by radiologist C were 28.3 ± 3.8 minutes longer (P < .0001) and 6.2 ± 2.9 mSv higher (P = .03) than CT-guided procedures performed by the same radiologist. Comparing CT-guided procedures performed by all 3 radiologists, adjusted mean durations and estimated patient doses of procedures by the least experienced radiologist, radiologist A, and the second most experienced radiologist, radiologist B, were 24.2 ± 5.1 (P < .0001) and 18.1 ± 8.9 (P = .04) minutes longer and 13.1 ± 3.7 (P < .001) and 14.5 ± 6.4 (P = .02) mSv higher, respectively, than procedures performed by the most experienced radiologist, radiologist C. CONCLUSIONS PET/CT-guided liver ablations had a slightly longer duration with slightly higher estimated patient radiation dose than similar CT-guided liver ablations. Procedure duration and patient dose do not appear to be major impediments to the emerging field of PET/CT-guided tumor ablation.
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Affiliation(s)
- Emmy Y Hu
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Vincent M Levesque
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Camden P Bay
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Julia G Seol
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Paul B Shyn
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115.
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Affiliation(s)
- Paul B Shyn
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
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22
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Abstract
Image-guided renal biopsies have an increasing role in clinical practice. Renal mass and renal parenchymal biopsy indications, techniques, and other clinical considerations are reviewed in this article. Image-guided renal mass ablation shows significant promise and increasing clinical usefulness as more studies demonstrate its safety and efficacy. Renal mass ablation indications, techniques, and other considerations are also reviewed.
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Affiliation(s)
- Sharath K Bhagavatula
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Paul B Shyn
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Shyn PB, Casadaban LC, Sainani NI, Sadow CA, Bunch PM, Levesque VM, Kim CK, Gerbaudo VH, Silverman SG. Intraprocedural Ablation Margin Assessment by Using Ammonia Perfusion PET during FDG PET/CT–guided Liver Tumor Ablation: A Pilot Study. Radiology 2018; 288:138-145. [DOI: 10.1148/radiol.2018172108] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Paul B. Shyn
- From the Department of Radiology, Division of Abdominal Imaging and Intervention (P.B.S., L.C.C., N.I.S., C.A.S., P.M.B., V.M.L., S.G.S.) and Division of Nuclear Medicine (C.K.K., V.H.G.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Leigh C. Casadaban
- From the Department of Radiology, Division of Abdominal Imaging and Intervention (P.B.S., L.C.C., N.I.S., C.A.S., P.M.B., V.M.L., S.G.S.) and Division of Nuclear Medicine (C.K.K., V.H.G.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Nisha I. Sainani
- From the Department of Radiology, Division of Abdominal Imaging and Intervention (P.B.S., L.C.C., N.I.S., C.A.S., P.M.B., V.M.L., S.G.S.) and Division of Nuclear Medicine (C.K.K., V.H.G.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Cheryl A. Sadow
- From the Department of Radiology, Division of Abdominal Imaging and Intervention (P.B.S., L.C.C., N.I.S., C.A.S., P.M.B., V.M.L., S.G.S.) and Division of Nuclear Medicine (C.K.K., V.H.G.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Paul M. Bunch
- From the Department of Radiology, Division of Abdominal Imaging and Intervention (P.B.S., L.C.C., N.I.S., C.A.S., P.M.B., V.M.L., S.G.S.) and Division of Nuclear Medicine (C.K.K., V.H.G.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Vincent M. Levesque
- From the Department of Radiology, Division of Abdominal Imaging and Intervention (P.B.S., L.C.C., N.I.S., C.A.S., P.M.B., V.M.L., S.G.S.) and Division of Nuclear Medicine (C.K.K., V.H.G.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Chun K. Kim
- From the Department of Radiology, Division of Abdominal Imaging and Intervention (P.B.S., L.C.C., N.I.S., C.A.S., P.M.B., V.M.L., S.G.S.) and Division of Nuclear Medicine (C.K.K., V.H.G.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Victor H. Gerbaudo
- From the Department of Radiology, Division of Abdominal Imaging and Intervention (P.B.S., L.C.C., N.I.S., C.A.S., P.M.B., V.M.L., S.G.S.) and Division of Nuclear Medicine (C.K.K., V.H.G.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Stuart G. Silverman
- From the Department of Radiology, Division of Abdominal Imaging and Intervention (P.B.S., L.C.C., N.I.S., C.A.S., P.M.B., V.M.L., S.G.S.) and Division of Nuclear Medicine (C.K.K., V.H.G.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
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Aguirre AJ, Nowak JA, Camarda ND, Moffitt RA, Ghazani AA, Hazar-Rethinam M, Raghavan S, Kim J, Brais LK, Ragon D, Welch MW, Reilly E, McCabe D, Marini L, Anderka K, Helvie K, Oliver N, Babic A, Da Silva A, Nadres B, Van Seventer EE, Shahzade HA, St Pierre JP, Burke KP, Clancy T, Cleary JM, Doyle LA, Jajoo K, McCleary NJ, Meyerhardt JA, Murphy JE, Ng K, Patel AK, Perez K, Rosenthal MH, Rubinson DA, Ryou M, Shapiro GI, Sicinska E, Silverman SG, Nagy RJ, Lanman RB, Knoerzer D, Welsch DJ, Yurgelun MB, Fuchs CS, Garraway LA, Getz G, Hornick JL, Johnson BE, Kulke MH, Mayer RJ, Miller JW, Shyn PB, Tuveson DA, Wagle N, Yeh JJ, Hahn WC, Corcoran RB, Carter SL, Wolpin BM. Real-time Genomic Characterization of Advanced Pancreatic Cancer to Enable Precision Medicine. Cancer Discov 2018; 8:1096-1111. [PMID: 29903880 DOI: 10.1158/2159-8290.cd-18-0275] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/17/2018] [Accepted: 06/13/2018] [Indexed: 12/28/2022]
Abstract
Clinically relevant subtypes exist for pancreatic ductal adenocarcinoma (PDAC), but molecular characterization is not yet standard in clinical care. We implemented a biopsy protocol to perform time-sensitive whole-exome sequencing and RNA sequencing for patients with advanced PDAC. Therapeutically relevant genomic alterations were identified in 48% (34/71) and pathogenic/likely pathogenic germline alterations in 18% (13/71) of patients. Overall, 30% (21/71) of enrolled patients experienced a change in clinical management as a result of genomic data. Twenty-six patients had germline and/or somatic alterations in DNA-damage repair genes, and 5 additional patients had mutational signatures of homologous recombination deficiency but no identified causal genomic alteration. Two patients had oncogenic in-frame BRAF deletions, and we report the first clinical evidence that this alteration confers sensitivity to MAPK pathway inhibition. Moreover, we identified tumor/stroma gene expression signatures with clinical relevance. Collectively, these data demonstrate the feasibility and value of real-time genomic characterization of advanced PDAC.Significance: Molecular analyses of metastatic PDAC tumors are challenging due to the heterogeneous cellular composition of biopsy specimens and rapid progression of the disease. Using an integrated multidisciplinary biopsy program, we demonstrate that real-time genomic characterization of advanced PDAC can identify clinically relevant alterations that inform management of this difficult disease. Cancer Discov; 8(9); 1096-111. ©2018 AACR.See related commentary by Collisson, p. 1062This article is highlighted in the In This Issue feature, p. 1047.
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Affiliation(s)
- Andrew J Aguirre
- Dana-Farber Cancer Institute, Boston, Massachusetts. .,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jonathan A Nowak
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nicholas D Camarda
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Joint Center for Cancer Precision Medicine, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Richard A Moffitt
- Department of Biomedical Informatics, Department of Pathology, Stony Brook University, Stony Brook, New York
| | - Arezou A Ghazani
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Joint Center for Cancer Precision Medicine, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Srivatsan Raghavan
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jaegil Kim
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | | | | | | | - Emma Reilly
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Devin McCabe
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Joint Center for Cancer Precision Medicine, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lori Marini
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.,Joint Center for Cancer Precision Medicine, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | - Kristin Anderka
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | - Karla Helvie
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Joint Center for Cancer Precision Medicine, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | - Nelly Oliver
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Joint Center for Cancer Precision Medicine, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | - Ana Babic
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Annacarolina Da Silva
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brandon Nadres
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | | | | | | | - Kelly P Burke
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Thomas Clancy
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - James M Cleary
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Leona A Doyle
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kunal Jajoo
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nadine J McCleary
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jeffrey A Meyerhardt
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Janet E Murphy
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Kimmie Ng
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Anuj K Patel
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Kimberly Perez
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Michael H Rosenthal
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Douglas A Rubinson
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Marvin Ryou
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Geoffrey I Shapiro
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Ewa Sicinska
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Stuart G Silverman
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rebecca J Nagy
- Department of Medical Affairs, Guardant Health, Inc., Redwood City, California
| | - Richard B Lanman
- Department of Medical Affairs, Guardant Health, Inc., Redwood City, California
| | | | | | - Matthew B Yurgelun
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Charles S Fuchs
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Joint Center for Cancer Precision Medicine, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Levi A Garraway
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Joint Center for Cancer Precision Medicine, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | - Gad Getz
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Jason L Hornick
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Bruce E Johnson
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Joint Center for Cancer Precision Medicine, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew H Kulke
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Robert J Mayer
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jeffrey W Miller
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Paul B Shyn
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - David A Tuveson
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York; Lustgarten Foundation Pancreatic Cancer Research Laboratory, Cold Spring Harbor, New York
| | - Nikhil Wagle
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Joint Center for Cancer Precision Medicine, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | - Jen Jen Yeh
- Departments of Surgery and Pharmacology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - William C Hahn
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Ryan B Corcoran
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Scott L Carter
- Dana-Farber Cancer Institute, Boston, Massachusetts. .,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Joint Center for Cancer Precision Medicine, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Brian M Wolpin
- Dana-Farber Cancer Institute, Boston, Massachusetts. .,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Kis B, El-Haddad G, Sheth RA, Parikh NS, Ganguli S, Shyn PB, Choi J, Brown KT. Liver-Directed Therapies for Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma. Cancer Control 2018; 24:1073274817729244. [PMID: 28975829 PMCID: PMC5937250 DOI: 10.1177/1073274817729244] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC) are primary liver cancers where all or most of the tumor burden is usually confined to the liver. Therefore, locoregional liver-directed therapies can provide an opportunity to control intrahepatic disease with minimal systemic side effects. The English medical literature and clinical trials were reviewed to provide a synopsis on the available liver-directed percutaneous therapies for HCC and IHC. Locoregional liver-directed therapies provide survival benefit for patients with HCC and IHC compared to best medical treatment and have lower comorbid risks compared to surgical resection. These treatment options should be considered, especially in patients with unresectable disease.
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Affiliation(s)
- Bela Kis
- 1 Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ghassan El-Haddad
- 1 Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Rahul A Sheth
- 2 Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Nainesh S Parikh
- 1 Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Suvranu Ganguli
- 3 Center for Image Guided Cancer Therapy, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul B Shyn
- 4 Department of Radiology, Abdominal Imaging and Intervention, Brigham and Women's, Boston, MA, USA
| | - Junsung Choi
- 1 Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Karen T Brown
- 5 Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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26
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Frenk NE, Daye D, Tuncali K, Arellano RS, Shyn PB, Silverman SG, Fintelmann FJ, Uppot RN. Local Control and Survival after Image-Guided Percutaneous Ablation of Adrenal Metastases. J Vasc Interv Radiol 2018; 29:276-284. [DOI: 10.1016/j.jvir.2017.07.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/21/2017] [Accepted: 07/23/2017] [Indexed: 12/11/2022] Open
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Khalilzadeh O, Baerlocher MO, Shyn PB, Connolly BL, Devane AM, Morris CS, Cohen AM, Midia M, Thornton RH, Gross K, Caplin DM, Aeron G, Misra S, Patel NH, Walker TG, Martinez-Salazar G, Silberzweig JE, Nikolic B. Proposal of a New Adverse Event Classification by the Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol 2017; 28:1432-1437.e3. [DOI: 10.1016/j.jvir.2017.06.019] [Citation(s) in RCA: 326] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/04/2017] [Accepted: 06/12/2017] [Indexed: 01/19/2023] Open
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Young AS, Shyn PB, Johnson OW, Sainani NI, Nawfel RD, Silverman SG. Bending percutaneous drainage catheters to facilitate CT-guided insertion using curved trocar technique. Abdom Radiol (NY) 2017; 42:2160-2167. [PMID: 28361226 DOI: 10.1007/s00261-017-1108-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/30/2022]
Abstract
PURPOSE To assess the safety and efficacy of placing thoraco-abdominal drainage catheters under CT-guidance using a curved trocar technique. METHODS A retrospective study of 182 CT/CT-fluoroscopy-guided thoraco-abdominal catheter drainages was conducted; half were performed by residents or fellows under the supervision of one radiologist (Group 1) and the other half under the supervision of 10 other radiologists (Group 2). Group 1 procedures employed a curved catheter assembly placed using trocar technique (n = 44) or straight catheters placed with Seldinger technique (n = 47). Group 2 procedures employed a straight catheter placed using trocar technique (n = 16) or straight catheters placed with Seldinger technique (n = 75). Technical success, procedure time, radiation dose (CT Dose Index CTDIvol), and adverse events (Common Terminology Criteria for Adverse Events, 4.0) were compared between techniques and groups using Student's t test, Fisher's exact test or Chi-square analysis. RESULTS All procedures in groups 1 and 2 were technically successful. Mean procedure time for Group 1 curved trocar technique (28 ± 8 min) was shorter than groups 1 and 2 Seldinger technique (37 ± 11 min, p = .00002). Mean CTDIvol for Group 1 curved trocar technique (107.8 ± 54.2 mGy) was lower than groups 1 and 2 Seldinger technique (136.1 ± 99.7 mGy, p = 0.032). Adverse event rates for curved trocar, straight trocar, and Seldinger techniques were 2.3% (1/44), 0% (0/16), and 3.3% (4/122), respectively (p = 1); all were grade 1 or 2, and no catheter malfunctions occurred. CONCLUSIONS The curved catheter trocar technique is a safe and effective modification of the standard trocar technique that may facilitate CT-guided procedures impeded by CT gantry size limitations.
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Affiliation(s)
- Adam S Young
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
| | - Oren W Johnson
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Nisha I Sainani
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Richard D Nawfel
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
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Burch EA, Shyn PB. Developing an Interventional Radiology Online Quality Assurance Database. J Am Coll Radiol 2016; 14:383-385. [PMID: 28029584 DOI: 10.1016/j.jacr.2016.07.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Ezra A Burch
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
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Shyn PB, Bird JR, Koch RM, Tatli S, Levesque VM, Catalano PJ, Silverman SG. Hepatic Microwave Ablation Zone Size: Correlation with Total Energy, Net Energy, and Manufacturer-Provided Chart Predictions. J Vasc Interv Radiol 2016; 27:1389-1396. [DOI: 10.1016/j.jvir.2016.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/30/2016] [Accepted: 05/09/2016] [Indexed: 02/08/2023] Open
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Sainani NI, Silverman SG, Tuna IS, Aghayev A, Shyn PB, Tuncali K, Kadiyala V, Tatli S. Incidence and clinical sequelae of portal and hepatic venous thrombosis following percutaneous cryoablation of liver tumors. Abdom Radiol (NY) 2016; 41:970-7. [PMID: 27193794 DOI: 10.1007/s00261-015-0626-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/29/2022]
Abstract
PURPOSE To assess the incidence and sequelae of portal and hepatic venous thrombosis after percutaneous cryoablation of hepatic tumors. METHODS From November 1998 through December 2010, 223 hepatic tumors were cryoablated during 170 ablation procedures in 135 patients. 24-h post-procedure MR images were reviewed retrospectively by two abdominal radiologists in consensus to identify tumor ablations that developed one or more new portal or hepatic venous thromboses in or outside the ablation zone. On follow-up MRI and CT examinations the outcomes of thromboses were classified as resolved, partially recanalized, persistent, or propagated. RESULTS Venous thrombosis developed in association with 54 (24%) of 223 tumor ablations treated during 53 (31%) ablation procedures in 39 (28.8%) patients (15 women, 24 men; age range 40-82 years, mean 59 years). Of these 54 thromboses, 49 (91%) were located in portal vein branches, four (7%) in both portal and hepatic vein branches, and one (2%) in a hepatic vein branch. Thrombosed veins were outside but abutted the ablation zone in 36 (66.7%), and within it in 18 (33.3%). On follow-up imaging (n = 49), thrombi resolved in 29 (59%), partially recanalized in two (4%), persisted in 18 (37%) and propagated from sub-segmental or segmental branches to the left or right portal branches in five (10%). No thrombus propagated to the main portal vein or inferior vena cava. CONCLUSION Portal and hepatic vein branch thromboses are common in small branches following percutaneous cryoablation of hepatic tumors and most resolve spontaneously without sequelae.
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Affiliation(s)
- Nisha I Sainani
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Stuart G Silverman
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Ibrahim S Tuna
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Ayaz Aghayev
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Paul B Shyn
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Kemal Tuncali
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Vivek Kadiyala
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Servet Tatli
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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King F, Jayender J, Bhagavatula SK, Shyn PB, Pieper S, Kapur T, Lasso A, Fichtinger G. An Immersive Virtual Reality Environment for Diagnostic Imaging. ACTA ACUST UNITED AC 2016. [DOI: 10.1142/s2424905x16400031] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose: Advancements in and adoption of consumer virtual reality (VR) are currently being propelled by numerous upcoming devices such as the Oculus Rift. Although applications are currently growing around the entertainment field, wide-spread adoption of VR devices opens up the potential for other applications that may have been unfeasible with past implementations of VR. A VR environment may provide an equal or larger screen area than what is provided with the use of multiple conventional displays while remaining comparatively cheaper and more portable making it an attractive option for diagnostic radiology applications. Methods A VR application for the viewing of multiple image slices was designed using: the Oculus Rift head-mounted display (HMD), Unity, and 3D Slicer. Volumes loaded within 3D Slicer are sent to a Unity application that proceeds to render a scene for the Oculus Rift HMD. Users may interact with the images adjusting windowing and leveling using a handheld gamepad controller. Multiple images may be brought closer to the user for detailed inspection. Results Application usage was demonstrated with the simultaneous visualization of longitudinal slices of a serial CT scan of a patient with a lung nodule. Pilot studies for validating usage of the VR system for differential diagnosis and remote collaboration were performed. Initial results suggest that using the VR system increased both task load and time taken to complete tasks, however, the resulting accuracy in assessing nodule growth of nodules was not significantly different than that achieved using a DICOM viewer application on a traditional display.
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Affiliation(s)
- Franklin King
- Laboratory for Percutaneous Surgery, School of Computing, Queen’s University, Kingston, ON, Canada
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, USA
| | - Jagadeesan Jayender
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, USA
| | | | - Paul B. Shyn
- Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, USA
| | - Steve Pieper
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, USA
- Isomics Inc., 55 Kirkland Street, Cambridge, MA, USA
| | - Tina Kapur
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, USA
| | - Andras Lasso
- Laboratory for Percutaneous Surgery, School of Computing, Queen’s University, Kingston, ON, Canada
| | - Gabor Fichtinger
- Laboratory for Percutaneous Surgery, School of Computing, Queen’s University, Kingston, ON, Canada
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Levesque VM, Shyn PB, Tuncali K, Tatli S, Nawfel RD, Olubiyi O, Silverman SG. Radiation dose during CT-guided percutaneous cryoablation of renal tumors: Effect of a dose reduction protocol. Eur J Radiol 2015. [DOI: 10.1016/j.ejrad.2015.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abstract
PURPOSE Cryoablation has been successfully used to treat lung tumors. However, the safety and effectiveness of treating tumors adjacent to critical structures has not been fully established. We describe our experience with computed tomography (CT)-guided percutaneous cryoablation of central lung tumors and the role of ice ball monitoring. MATERIALS AND METHODS Eight patients with 11 malignant central lung tumors (nine metastatic, two primary; mean, 2.6 cm; range, 1.0-4.5 cm) located adjacent to mediastinal or hilar structures were treated using CT-guided cryoablation in 10 procedures. Technical success and effectiveness rates were calculated, complications were tabulated and intraprocedural imaging features of ice balls were described. RESULTS All procedures were technically successful; imaging after 24 hours demonstrated no residual tumor. Five tumors recurred, three of which were re-ablated successfully. A hypodense ice ball with well-defined margin was visible during the first (n=6, 55%) or second (n=11, 100%) freeze, encompassing the entire tumor in all patients, and abutting (n=7) or minimally involving (n=4) adjacent mediastinal and hilar structures. Pneumothorax developed following six procedures (60%); percutaneous treatment was applied in three of them. All patients developed pleural effusions, with one patient requiring percutaneous drainage. Transient hemoptysis occurred after six procedures (60%), but all cases improved within a week. No injury occurred to mediastinal or hilar structures. CONCLUSION CT-guided percutaneous cryoablation can be used to treat central lung tumors successfully. Although complications were common, they were self-limited, treatable, and not related to tumor location. Ice ball monitoring helped maximize the amount of tumor treated, while avoiding critical mediastinal and hilar structures.
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Affiliation(s)
- Errol Colak
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Lemay A, Shyn PB, Foley R, Beutler SS, Silverman SG, Urman RD. A procedural sedation quality improvement audit form tool for interventional radiology. J Med Pract Manage 2015; 30:44-47. [PMID: 26062317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
As the number of interventional radiology (IR) procedures performed in the United States increases, so does the need for procedural sedation (PS) performed outside the operating room. PS is not without risk, and without the use of proper guidelines and adequate training, adverse outcomes can occur. Improved oversight and evaluation of PS practice are necessary. This concept paper presents a method to incorporate a quality improvement tool in the IR suite that can be implemented at any healthcare center. This tool was created by radiologists, anesthesiologists, and nurses performing PS and evaluates preprocedural, intraprocedural, and postprocedural steps related to effectiveness of sedation, safety practices, and communication. It was implemented in the IR suite at a large tertiary care hospital. The goal of this study is to show that the tool is practical and easily implementable in any tertiary center and can be used as a quality measure to assess outcomes of PS.
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Fairchild AH, Tatli S, Dunne RM, Shyn PB, Tuncali K, Silverman SG. Percutaneous cryoablation of hepatic tumors adjacent to the gallbladder: assessment of safety and effectiveness. J Vasc Interv Radiol 2014; 25:1449-55. [PMID: 24906627 DOI: 10.1016/j.jvir.2014.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/25/2014] [Accepted: 04/27/2014] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To assess safety and effectiveness of percutaneous image-guided cryoablation of hepatic tumors adjacent to the gallbladder. MATERIALS AND METHODS Twenty-one cryoablation procedures were performed to treat 19 hepatic tumors (mean size, 2.7 cm; range, 1.0-5.0 cm) adjacent to the gallbladder in 17 patients (11 male; mean age, 59.2 y; range, 40-82 y) under computed tomography (n = 15) or magnetic resonance imaging (n = 6) guidance in a retrospective study. All tumors (mean size, 2.67 cm; range, 1.0-5.0 cm) were within 1 cm (mean, 0.4 cm) of the gallbladder; seven (33%) were contiguous with the gallbladder. Primary outcomes included complication rate and severity and postprocedure gallbladder imaging findings. Secondary outcomes included technical success and technique effectiveness at 6 months. RESULTS Complications occurred in six of 21 procedures (29%); one (5%) was severe. Ice balls extended into the gallbladder lumen in 20 of 21 procedures (95%); no gallbladder-related complications occurred. The most common gallbladder imaging finding was mild, asymptomatic focal wall thickening after nine of 21 procedures (42%), which resolved on follow-up. Technical success was achieved in 19 of 21 sessions (90%). Six-month follow-up was available for 16 tumors; of these, all but two (87%) had no imaging evidence of local tumor progression. CONCLUSIONS Percutaneous cryoablation of hepatic tumors adjacent to the gallbladder can be performed safely and successfully. Although postprocedural gallbladder changes are common, they are self-limited and clinically inconsequential, even when the ice ball extends into the gallbladder lumen.
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Affiliation(s)
- Alexandra H Fairchild
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115.
| | - Servet Tatli
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115
| | - Ruth M Dunne
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115
| | - Paul B Shyn
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115
| | - Kemal Tuncali
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115
| | - Stuart G Silverman
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115
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Sainani NI, Tatli S, Anthony SG, Shyn PB, Tuncali K, Silverman SG. Successful percutaneous radiologic management of renal cell carcinoma tumor seeding caused by percutaneous biopsy performed before ablation. J Vasc Interv Radiol 2014; 24:1404-8. [PMID: 23973027 DOI: 10.1016/j.jvir.2013.04.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 02/14/2013] [Revised: 04/26/2013] [Accepted: 04/26/2013] [Indexed: 12/28/2022] Open
Abstract
A case is reported of the successful image-based detection, diagnosis, and percutaneous ablation of tumor seeding in a 61-year-old man that was caused by percutaneous biopsy of a renal cell carcinoma performed before cryoablation and was not detected until 4 years after the biopsy procedure. Although tumor seeding is a rare complication after percutaneous biopsy or ablation, this case emphasizes the importance of imaging surveillance of the needle tract used during both biopsy and ablation procedures, provides guidance on measures that can be used to minimize the occurrence of tumor seeding, and demonstrates that entirely radiologic management can be successful.
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Affiliation(s)
- Nisha I Sainani
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. nsainani@ partners.org
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Shyn PB, Tatli S, Sahni VA, Sadow CA, Forgione K, Mauri G, Morrison PR, Catalano PJ, Silverman SG. PET/CT-guided percutaneous liver mass biopsies and ablations: targeting accuracy of a single 20 s breath-hold PET acquisition. Clin Radiol 2014; 69:410-5. [PMID: 24411824 DOI: 10.1016/j.crad.2013.11.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 11/10/2013] [Accepted: 11/14/2013] [Indexed: 01/02/2023]
Abstract
AIM To determine whether a single 20 s breath-hold positron-emission tomography (PET) acquisition obtained during combined PET/computed tomography (CT)-guided percutaneous liver biopsy or ablation procedures has the potential to target 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG)-avid liver masses as accurately as up to 180 s breath-hold PET acquisitions. MATERIALS AND METHODS This retrospective study included 10 adult patients with 13 liver masses who underwent FDG PET/CT-guided percutaneous biopsies (n = 5) or ablations (n = 5). PET was acquired as nine sequential 20 s, monitored, same-level breath-hold frames and CT was acquired in one monitored breath-hold. Twenty, 40, 60, and 180 s PET datasets were reconstructed. Two blinded readers marked tumour centres on randomized PET and CT datasets. Three-dimensional spatial localization differences between PET datasets and either 180 s PET or CT were analysed using multiple regression analyses. Statistical tests were two-sided and p < 0.05 was considered significant. RESULTS Targeting differences between 20 s PET and 180 s PET ranged from 0.7-20.3 mm (mean 5.3 ± 4.4 mm; median 4.3) and were not statistically different from 40 or 60 s PET (p = 0.74 and 0.91, respectively). Targeting differences between 20 s PET and CT ranged from 1.4-36 mm (mean 9.6 ± 7.1 mm; median 8.2 mm) and were not statistically different from 40, 60, or 180 s PET (p = 0.84, 0.77, and 0.35, respectively). CONCLUSION Single 20 s breath-hold PET acquisitions from PET/CT-guided percutaneous liver procedures have the potential to target FDG-avid liver masses with equivalent accuracy to 180 s summed, breath-hold PET acquisitions and may facilitate strategies that improve image registration and shorten procedure times.
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Affiliation(s)
- P B Shyn
- Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - S Tatli
- Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - V A Sahni
- Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - C A Sadow
- Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - K Forgione
- Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - G Mauri
- Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - P R Morrison
- Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - P J Catalano
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - S G Silverman
- Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
Computed Tomography Enterography (CTE) and Magnetic Resonance Enterography (MRE) are currently the dominant imaging tests used in the assessment of patients with Crohn's disease. More recently, the possibility of utilizing F-18 fluorodeoxyglucose (18F-FDG) Positron Emission Tomography (PET) or PET/CT has been explored in several preliminary studies. 18F-FDG PET appears to enable reliable detection of moderate to severe inflammation in bowel segments involved by Crohn's disease. Perhaps more importantly, 18F-FDG PET has the potential to provide a noninvasive, quantitative measure of inflammation that dynamically reflects changes in Crohn's disease activity. If 18F-FDG PET proves useful in monitoring responses to medical therapy within a few days of therapy initiation, an important new role for imaging in the management of patients with Crohn's disease could emerge.
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Affiliation(s)
- Paul B Shyn
- Department of Radiology, Abdominal Imaging and Intervention, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Wasser EJ, Shyn PB, Riveros-Angel M, Sadow CA, Steele GS, Silverman SG. Renal cell carcinoma containing abundant non-calcified fat. ACTA ACUST UNITED AC 2012; 38:598-602. [DOI: 10.1007/s00261-012-9921-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Park BK, Morrison PR, Tatli S, Govindarajulu U, Tuncali K, Judy P, Shyn PB, Silverman SG. Estimated effective dose of CT-guided percutaneous cryoablation of liver tumors. Eur J Radiol 2011; 81:1702-6. [PMID: 21645981 DOI: 10.1016/j.ejrad.2011.04.067] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 04/19/2011] [Accepted: 04/20/2011] [Indexed: 02/05/2023]
Abstract
PURPOSE To estimate effective dose during CT-guided cryoablation of liver tumors, and to assess which procedural factors contribute most to dose. MATERIALS AND METHODS Our institutional review board approved this retrospective, HIPAA-compliant study. A total of 20 CT-guided percutaneous liver tumor cryoablation procedures were performed in 18 patients. Effective dose was determined by multiplying the dose length product for each CT scan obtained during the procedure by a conversion factor (0.015mSv/mGy-cm), and calculating the sum for each phase of the procedure: planning, targeting, monitoring, and post-ablation survey. Effective dose of each phase was compared using a repeated measures analysis. Using Spearman correlation coefficients, effective doses were correlated with procedural factors including number of scans, ratio of targeting distance to tumor size, anesthesia type, number of applicators, performance of ancillary procedures (hydrodissection and biopsy), and use of CT fluoroscopy. RESULTS Effective dose per procedure was 72±18mSv. The effective dose of targeting (37.5±12.5mSv) was the largest component compared to the effective dose of the planning phase (4.8±2.2mSv), the monitoring phase (25.5±6.8mSv), and the post-ablation survey (4.1±1.9mSv) phase (p<0.05). Effective dose correlated positively only with the number of scans (p<0.01). CONCLUSIONS The effective dose of CT-guided percutaneous cryoablation of liver tumors can be substantial. Reducing the number of scans during the procedure is likely to have the greatest effect on lowering dose.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Tatli S, Gerbaudo VH, Feeley CM, Shyn PB, Tuncali K, Silverman SG. PET/CT-guided Percutaneous Biopsy of Abdominal Masses: Initial Experience. J Vasc Interv Radiol 2011; 22:507-14. [DOI: 10.1016/j.jvir.2010.12.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 11/24/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022] Open
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Sainani NI, Shyn PB, Tatli S, Morrison PR, Tuncali K, Silverman SG. PET/CT-guided Radiofrequency and Cryoablation: Is Tumor Fluorine-18 Fluorodeoxyglucose Activity Dissipated by Thermal Ablation? J Vasc Interv Radiol 2011; 22:354-60. [DOI: 10.1016/j.jvir.2010.11.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Revised: 09/06/2010] [Accepted: 11/15/2010] [Indexed: 11/15/2022] Open
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Affiliation(s)
- V Anik Sahni
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Shyn PB, Mortele KJ, Britz-Cunningham SH, Friedman S, Odze RD, Burakoff R, Goldberg JE, Erturk M, Silverman SG. Low-dose 18F-FDG PET/CT enterography: improving on CT enterography assessment of patients with Crohn disease. J Nucl Med 2010; 51:1841-8. [PMID: 21078803 DOI: 10.2967/jnumed.110.080796] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
UNLABELLED The purpose of this study was to evaluate the diagnostic efficacy of low-dose, combined (18)F-FDG PET/CT enterography (PET/CTE), compared with CT enterography (CTE) alone, in the assessment of patients with Crohn disease. METHODS Thirteen patients with Crohn disease were prospectively enrolled in this pilot study and underwent abdominal-pelvic (18)F-FDG PET/CTE using neutral oral and intravenous contrast medium. The effective dose from PET/CTE was 17.7 mSv for the first 4 patients and 8.31 mSv for the last 9 patients. Six patients underwent surgical resection of the bowel, and 7 patients underwent colonoscopy with biopsies within 27 d (mean, 12 d) of PET/CTE. PET/CTE and CTE images were each visually assessed for Crohn disease involvement in 54 bowel segments with pathology correlation. Extraintestinal findings were recorded. A CTE severity score, maximum standardized uptake value (SUVmax), SUVmax ratio, simplified endoscopic score, and clinical parameters were correlated with pathology inflammation grade, on a per-patient basis and on a per-bowel-segment basis, using Spearman correlation. RESULTS In 3 (23.1%) of 13 patients, (18)F-FDG uptake using PET/CTE revealed active inflammation in a bowel segment not evident using CTE (n = 2) or revealed an enterocolic fistula missed with CTE (n = 1). Visual interpretation of both PET/CTE and CTE images detected the presence of disease in all bowel segments with more than mild inflammation (sensitivity, 100%; specificity, 89.7%; positive predictive value, 78.9%; and negative predictive value, 100%). Correlation to inflammation grade per patient was the strongest for the SUVmax ratio (0.735, P = 0.004) and SUVmax (0.67, P = 0.013), as compared with the CTE score (0.62, P = 0.024). Correlation with inflammation per bowel segment was higher for the CTE score (0.79, P < 0.0001) than the SUVmax ratio (0.62, P < 0.0001) or SUVmax (0.48, P < 0.0001). SUVmax correlated strongly with serum C-reactive protein (0.82, P = 0.023), but CTE score did not. CONCLUSION Low-dose (18)F-FDG PET/CTE, compared with CTE, may improve the detection and grading of active inflammation in patients with Crohn disease. PET/CTE also may reveal clinically significant findings, such as enterocolic fistula, not evident on PET or CTE alone.
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Affiliation(s)
- Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Elhawary H, Oguro S, Tuncali K, Morrison PR, Tatli S, Shyn PB, Silverman SG, Hata N. Multimodality non-rigid image registration for planning, targeting and monitoring during CT-guided percutaneous liver tumor cryoablation. Acad Radiol 2010; 17:1334-44. [PMID: 20817574 DOI: 10.1016/j.acra.2010.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 06/06/2010] [Accepted: 06/08/2010] [Indexed: 10/19/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to develop non-rigid image registration between preprocedure contrast-enhanced magnetic resonance (MR) images and intraprocedure unenhanced computed tomographic (CT) images, to enhance tumor visualization and localization during CT imaging-guided liver tumor cryoablation procedures. MATERIALS AND METHODS A non-rigid registration technique was evaluated with different preprocessing steps and algorithm parameters and compared to a standard rigid registration approach. The Dice similarity coefficient, target registration error, 95th-percentile Hausdorff distance, and total registration time (minutes) were compared using a two-sided Student's t test. The entire registration method was then applied during five CT imaging-guided liver cryoablation cases with the intraprocedural CT data transmitted directly from the CT scanner, with both accuracy and registration time evaluated. RESULTS Selected optimal parameters for registration were a section thickness of 5 mm, cropping the field of view to 66% of its original size, manual segmentation of the liver, B-spline control grid of 5 × 5 × 5, and spatial sampling of 50,000 pixels. A mean 95th-percentile Hausdorff distance of 3.3 mm (a 2.5 times improvement compared to rigid registration, P < .05), a mean Dice similarity coefficient of 0.97 (a 13% increase), and a mean target registration error of 4.1 mm (a 2.7 times reduction) were measured. During the cryoablation procedure, registration between the preprocedure MR and the planning intraprocedure CT imaging took a mean time of 10.6 minutes, MR to targeting CT image took 4 minutes, and MR to monitoring CT imaging took 4.3 minutes. Mean registration accuracy was <3.4 mm. CONCLUSIONS Non-rigid registration allowed improved visualization of the tumor during interventional planning, targeting, and evaluation of tumor coverage by the ice ball. Future work is focused on reducing segmentation time to make the method more clinically acceptable.
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Tatli S, Gerbaudo VH, Mamede M, Tuncali K, Shyn PB, Silverman SG. Abdominal masses sampled at PET/CT-guided percutaneous biopsy: initial experience with registration of prior PET/CT images. Radiology 2010; 256:305-11. [PMID: 20574103 DOI: 10.1148/radiol.10090931] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To establish the feasibility of performing combined positron emission tomography (PET)/computed tomography (CT)-guided biopsy of abdominal masses by using previously acquired PET/CT images registered with intraprocedural CT images. MATERIALS AND METHODS In this HIPAA-compliant institutional review board-approved study, 14 patients underwent clinically indicated percutaneous biopsy of abdominal masses (mean size, 3.3 cm; range, 1.2-5.0 cm) in the liver (n = 6), presacral soft tissue (n = 3), retroperitoneal lymph nodes (n = 2), spleen (n = 2), and pancreas (n = 1). PET/CT images obtained no more than 62 days (mean, 18.3 days) before the biopsy procedure were registered with intraprocedural CT images by using image registration software. The registered images were used to plan the procedure and help target the masses. RESULTS The image registrations were technically successful in all but one patient, who had severe scoliosis. The remaining 13 biopsy procedures yielded diagnostic results, which were positive for malignancy in 10 cases and negative in three cases. CONCLUSION PET/CT-guided abdominal biopsy with use of prior PET/CT images registered with intraprocedural CT scans is feasible and may be helpful when fluorine 18 fluorodeoxyglucose-avid masses that are not seen sufficiently with nonenhanced CT are sampled at biopsy.
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Affiliation(s)
- Servet Tatli
- Department of Radiology, Divisions of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Oei TN, Shyn PB, Govindarajulu U, Flint R. Diagnostic medical radiation dose in patients after laparoscopic bariatric surgery. Obes Surg 2009; 20:569-73. [PMID: 19779760 DOI: 10.1007/s11695-009-9966-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 08/19/2009] [Indexed: 12/17/2022]
Abstract
BACKGROUND The purpose of this study was to estimate the cumulative radiation dose from computed tomography (CT) scans and upper gastrointestinal fluoroscopic exams in the post-bariatric-surgery population and correlate these values with current concepts of potential radiation-induced cancer risk. METHODS A retrospective study of 100 roux-en-y gastric bypass (RYGB) patients and 100 gastric band patients was performed. The cumulative estimated radiation doses from CT scans and fluoroscopic studies received by these patients over a 2.5-year postoperative interval were calculated. The rate of positive radiological studies was determined. Nonlinear regression analyses were used to identify potential independent predictors of higher radiation dose. RESULTS Mean cumulative dose was 20 +/- 20 mSv for RYGB patients and 11 +/- 11 mSv for gastric band patients. The RYGB procedure and a higher preoperative body mass index were each significant predictors of higher cumulative radiation doses. Dose in the RYGB group ranged from 4 to 156 mSv. Dose in the gastric banding group ranged from 4 to 46 mSv. In the RYGB cohort, positive findings were present in 35% and 16% of CT and fluoroscopic studies, respectively, and 24% and 22% in the gastric band group. None of the fluoroscopic exams performed after the routine 24-h postoperative studies were positive. CONCLUSIONS Allowing for uncertainties of cancer risk at doses less than 50 mSv, patients undergoing laparoscopic bariatric surgery may receive radiation doses from postoperative diagnostic imaging tests that increase their lifetime cancer risk.
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Affiliation(s)
- Tamara N Oei
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, 02115 MA, USA
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