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No. 530 Hepatic vein imaging findings associated with elevated lung shunt fraction in patients being considered for yttrium-90 radioembolization O.G. Olorunsola, N. Fidelman, S. Behr, M. Kohi, K. Kolli, A.G. Taylor, R. Tong, J. LaBerge, R.K. Kerlan, Jr.; Radiology, University of California, San Francisco, San Francisco, CA Purpose: To identify hepatic vein (HV) morphologic and flow abnormalities associated with elevated lung shunt fraction (LSF) determined by Technetium-99m (Tc) macroaggregated albumin (MAA) imaging in patients being considered for yttrium-90 (Y) radioembolization. Materials and Methods: This single-center retrospective study included 152 consecutive patients who underwent mapping arteriography with Tc-MAA injection from 2009 to 2014 (50 with hepatocellular carcinoma [HCC], 102 with other tumors; 103 men, 49 women; median age 62). Each preprocedure imaging examination (CT or MRI) was assessed for HV tumor thrombus or HV occlusion from external compression by tumor. In addition, two readers separately evaluated the mapping arteriograms and the arterial phase from multiphase CTs (117 patients) for evidence of early HV opacification (relative to unaffected HVs), with consensus determined by a third reader. These factors were correlated with LSF categories (low [o10%], intermediate [10-20%], and high [420%]) determined by Tc-MAA imaging using uniand multivariate analysis. Results: Median LSF was 6.7% (range 0-71%; 74.3% low, 18.4% intermediate, 7.2% high). There was high interobserver agreement for determining early HV opacification (97%, kappa1⁄40.847). Early HV opacification at CT and angiography each were associated with higher LSF category (po.001 for both modalities). This finding at CT was 78% sensitive and 93% specific for predicting high (420%) LSF (64% sensitive and 95% specific at angiography). Of five cases of HV tumor thrombus (3 HCC, 2 other tumors), all had high (420%) LSF (po.001). HV occlusion due to external tumor compression was also associated with higher LSF category (p1⁄4.04). Multivariate analysis confirmed that early HV opacification at CT and either HV tumor thrombus or occlusion were associated with higher LSF category. Conclusion: Early HV opacification and HV tumor thrombus or occlusion on pre-procedure cross-sectional imaging are associated with elevated LSF, which may contraindicate or limit the dose delivered in Y radioembolization. This information could be helpful during patient counseling for anticipating the most appropriate mode of liver-directed therapy.

necrosis on explant evaluation (70%) compared to a negative CT/MRI after DEB-TACE (12.5%; p1⁄40.02). Conclusion: A negative CT/MRI on follow up imaging after interstitial ablation is significantly more often associated with a result of complete necrosis of tumor on explant evaluation compared to DEB-TACE. This warrants a larger study to confirm the findings, and to evaluate the unknown significance of microscopic residual disease.

Introduction: In order to select appropriate candidates for treatment of uterine fibroids using MR guided focused ultrasound (MRgFUS), a careful review of the patients' history and imaging is required. Not infrequently, patients with uterine fibroids seeking MRgFUS have previously undergone uterine artery embolization (UAE). The most common embolic agent used during UAE is Embosphere microspheres (Merit Medical Systems, INC, South Jordan, UT). Following UAE, the microspheres remain in the capillary beds of the fibroid vessels indefinitely. However, little is known regarding the nature of Embosphere microspheres in the setting of elevated temperatures (65–85degrees C) generated by high intensity focused ultrasound (HIFU). Embosphere microspheres are made of an acrylic co‐polymer (trisacryl), which is cross‐linked with gelatin. The aim of the present study was to evaluate for changes in Embosphere microspheres that underwent HIFU. Purpose: To evaluate for changes in shape and nature of Embosphere microspheres following MRgFUS.Materials and Methods: 10cc of 500–700micron Embosphere microspheres were injected into chicken breast. HIFU thermal ablation was performed, reaching high enough temperature to coagulate the chicken breast surrounding the microspheres. Additionally a vial containing microspheres was placed in a bath of heating water and temperature monitoring was performed until a maximum temperature of 100 degrees C. Gross and microscopic evaluation of the microspheres following HIFU and waterbath heating was performed. Results: The microspheres maintained their normal structure without evidence of denaturing or melting when targeted directly with HIFU (Figure 1). Additionally, the microspheres in boiling water did not alter their shape and structural integrity (Figure 2). Conclusion: HIFU of Embosphere microspheres does not change the structural integrity of the particles. As such, in the setting of prior UAE with Embosphere microspheres, MRgFUS may be safe without inducing particle denaturing or melting.

Purpose Determine outcomes associated with the percutaneous drainage of hematomas. Materials and Methods A retrospective analysis was performed of the last 50 drainages performed at this institution that had the appearance of bland blood products at drainage. 26 males and 24 females were included in the study with an age range of 14-90 and an average catheter placement time of 35 days. Evaluation of length of catheter drainage, need for reintervention, and outcomes were assessed. Results Of the 50 drainages in which fluid had the appearance of bland blood products expressed at drainage in the period between 8/2010- 2/2012, 41 had catheters placed. 9 were drained without catheter placement. Of the 9 in which a catheter was not placed, 0 had a positive culture. Of the 41 in which catheters were placed, 31 had positive cultures at analysis. 10 had negative cultures. Of the nine in which catheter placement was not performed 3 had minimal fluid aspirated, in 2 the clinician specifically requested no drain be placed, 1 was a liver lesion in which it was elected not to place a drain, and 3 were tiny collections in which the clinical services were requesting aspiration for culture only. All 50 were successfully drained by SIR criteria for diagnosis, with 46 patients resolving the clinical episode that precipitated drainage. Of these patients there were no serious complications associated with catheter placement, although 3 ultimately developed fistulas to bowel, pancreas, and biliary system, and the one death prior to catheter removal was related to multiorgan failure in a liver transplant patient perioperatively. Conclusion Hematoma drainage attempt may be warranted in most cases, given the very high association of bland appearing hematoma with positive culture (62%), and the frequency in which drainage was possible despite the collections appearing to contain only blood products(86%). In cases in which minimal fluid is returned from a collection that appears large enough to drain it may be appropriate to avoid catheter placement, as these collections may have a lower likelihood of infection.

Purpose To report the authors’ experience of breast seroma drainage following mastectomy with reconstruction. Materials and Methods Retrospective review of patients who underwent breast seroma drainage following mastectomy with reconstruction using breast expanders between January 2007 and September 2012 was performed. 879 mastectomies with breast expanders placement were performed during this period. 30 primary drainages in 28 patients were identified. Patient characteristics, clinical presentation, surgical technique, seroma size, seroma bacterial culture and outcomes of drainage were reviewed. Results All patients were women mean age of 51.5 years old who underwent breast seroma drainage following mastectomy with reconstruction. The median time between surgery and drainage was 35 days (range 4 to 235 days). Erythema (n=21, 67.7%) and swelling (n=16, 51.6%) were the most common presenting symptoms. 73% of the drainage procedures (n=22) had a formal breast ultrasound study prior to the drainage procedure. The median initial fluid drainage volume was 70 mL (range 5 to 900 mL). The median duration of drainage was 14 days (range 6 to 34 days). Eleven out of 30 cases (37%) were shown to have a positive fluid culture, with Staphylococcus aureus being the most common organism (n=7, 64%). The white blood cell count within seven days of the drainage procedure did not predict the presence or absence of abnormal fluid culture. In the majority of the cases (n=21, 70%), the seromas were successfully treated by the drainage and required no further intervention. Six cases (20%) required additional surgeries and three cases (10%) required additional drainage procedures. Conclusion To our knowledge, this is the first study to report the clinical outcome of IR drainage of breast seroma. At our institution, 70% of the cases were successfully treated by IR drainage. Only 37% of the cases were found to have a positive bacterial fluid culture. In conclusion, IR drainage resulted in symptom relief and salvage of the breast reconstruction for the majority of patients treated with this technique.