Search

Prostatic artery embolization (PAE) is a safe and effective treatment for benign prostatic hyperplasia. Patient evaluation is a critical and important part of this growing practice. History taking should include symptoms score evaluations for lower urinary tract symptoms, erectile function, and prostatitis symptoms score. The objective evaluations commonly include measurement of prostate specific antigen, postvoid residual volume, and uroflowmetry as well as urodynamic studies in selective patients. Imaging evaluation may include computed tomography angiography or magnetic resonance angiography, elucidating prostate volume, prostate gland morphology, vasculature, and prostate cancer. With evolving knowledge on PAE, we aim to discuss patient evaluation and selection based on updated evidence and discuss specific scenarios.

The purpose of this study was to determine the rate of ejaculatory dysfunction that develops following prostate artery embolization (PAE) and identify predictive factors.Thirty-nine men (mean age, 67.9 ± 8.1 ([SD)] years; range: 52-84 years) who underwent PAE were retrospectively asked to complete the male sexual health questionnaire-ejaculation dysfunction (MSHQ-EjD) short form. Pre-treatment, procedural, and post-treatment variables were also collected.A total of four patients (4/39, 10.3%) developed ejaculatory dysfunction following PAE, with one (1/4, 25%) reporting improvement in his ejaculatory dysfunction over time. When evaluating the group as a whole there was no significant difference between the pre and post-treatment answers of patients when asked about how often they ejaculate when having sexual activity (P = 0.77), strength of ejaculation (P = 0.86), or volume of ejaculation (P = 0.67). Similarly, the total MHSQ-EjD score was not different when evaluating the group as a whole pre (11.4 ± 5.3 [SD]; range: 1-15) and post-treatment (10.7 ± 5.3 [SD]; range: 1-15) (P = 0.54), nor was the degree of bother from ejaculatory difficulties significantly different (0.82 ± 1.1 [SD]; range: 0-5 vs. 1 ± 1.1 [SD]; range: 0-5; P = 0.9). When comparing those who did to those who did not develop ejaculatory dysfunction, univariable analysis demonstrated that post void residual volume was significantly greater in those who did develop dysfunction (median, 202 mL; IQR: 274; range: 40-588) than in those who did not (median, 58 mL; IQR: 124; range: 0-408) (P = 0.04).We found that 10.3% of patients undergoing PAE develop ejaculatory dysfunction and those with greater post void residual volume may be at increased risk. However, the data should be interpreted with caution given the small sample size and more, preferably prospective, data are needed to determine the true rates of ejaculatory dysfunction following PAE.

A variety of minimally invasive surgical approaches are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Prostatic arterial embolization (PAE) is a relatively new, minimally invasive treatment approach.To assess the effects of PAE compared to other procedures for treatment of LUTS in men with BPH.We performed a comprehensive search using multiple databases (The Cochrane Library, MEDLINE, Embase, LILACS, Scopus, Web of Science, and Google Scholar), trials registries, other sources of grey literature, and conference proceedings with no restrictions on language of publication or publication status, up until 25 September 2020.We included parallel-group randomized controlled trials (RCTs), as well as non-randomized studies (NRS, limited to prospective cohort studies with concurrent comparison groups) enrolling men over the age of 40 with LUTS attributed to BPH undergoing PAE versus TURP or other surgical interventions. DATA COLLECTION AND ANALYSIS: Two review authors independently classified studies for inclusion or exclusion and abstracted data from the included studies. We performed statistical analyses by using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We used GRADE guidance to rate the certainty of evidence of RCTs and NRSs. MAIN RESULTS: We found data to inform two comparisons: PAE versus TURP (six RCTs and two NRSs), and PAE versus sham (one RCT). Mean age, IPSS, and prostate volume of participants were 66 years, 22.8, and 72.8 mL, respectively. This abstract focuses on the comparison of PAE versus TURP as the primary topic of interest. PAE versus TURP We included six RCTs and two NRSs with short-term (up to 12 months) follow-up and one RCT with long-term follow-up (13 to 24 months). Short-term follow-up: based on RCT evidence, there may be little to no difference in urologic symptom score improvement (mean difference [MD] 1.55, 95% confidence interval [CI] -0.40 to 3.50; 369 participants; 6 RCTs; I² = 75%; low-certainty evidence) measured by the International Prostatic Symptom Score (IPSS) on a scale from 0 to 35, with higher scores indicating worse symptoms. There may be little to no difference in quality of life (MD 0.16, 95% CI -0.37 to 0.68; 309 participants; 5 RCTs; I² = 56%; low-certainty evidence) as measured by the IPSS quality of life question on a scale from 0 to 6, with higher scores indicating worse quality of life between PAE and TURP, respectively. While we are very uncertain about the effects of PAE on major adverse events (risk ratio [RR] 0.71, 95% CI 0.16 to 3.10; 250 participants; 4 RCTs; I² = 26%; very low-certainty evidence), PAE may increase re-treatments (RR 3.64, 95% CI 1.02 to 12.98; 204 participants; 3 RCTs; I² = 0%; low-certainty evidence). Based on 18 re-treatments per 1000 men in the TURP group, this corresponds to 47 more (0 more to 214 more) per 1000 men undergoing PAE. We are very uncertain about the effects on erectile function (MD -0.03, 95% CI -6.35 to 6.29; 129 participants; 2 RCTs; I² = 78%; very low-certainty evidence) measured by the International Index of Erectile Function at 5 on a scale from 1 to 25, with higher scores indicating better function. NRS evidence when available yielded similar results. Based on evidence from NRS, PAE may reduce the occurrence of ejaculatory disorders (RR 0.51, 95% CI 0.35 to 0.73; 260 participants; 1 NRS; low-certainty evidence). Longer-term follow-up: based on RCT evidence, we are very uncertain about the effects of PAE on urologic symptom scores (MD 0.30, 95% CI -3.17 to 3.77; 95 participants; very low-certainty evidence) compared to TURP. Quality of life may be similar (MD 0.20, 95% CI -0.49 to 0.89; 95 participants; low-certainty evidence). We are also very uncertain about major adverse events (RR 1.96, 95% CI 0.63 to 6.13; 107 participants; very low-certainty evidence). We did not find evidence on erectile function and ejaculatory disorders. Based on evidence from NRS, PAE may increase re-treatment rates (RR 1.51, 95% CI 0.43 to 5.29; 305 participants; low-certainty evidence); based on 56 re-treatments per 1000 men in the TURP group. this corresponds to 143 more (25 more to 430 more) per 1000 men in the PAE group. AUTHORS' CONCLUSIONS: Compared to TURP up to 12 months (short-term follow-up), PAE may provide similar improvement in urologic symptom scores and quality of life. While we are very uncertain about major adverse events, PAE may increase re-treatment rates. We are uncertain about erectile function, but PAE may reduce ejaculatory disorders. Longer term (follow-up of 13 to 24 months), we are very uncertain as to how both procedures compare with regard to urologic symptom scores, but quality of life appears to be similar. We are very uncertain about major adverse events but PAE may increase re-treatments. We did not find longer term evidence on erectile function and ejaculatory disorders. Certainty of evidence for the main outcomes of this review was low or very low, signalling that our confidence in the reported effect size is limited or very limited, and that this topic should be better informed by future research.پیشینه: طیفی از رویکردهای جراحی کم‌تهاجمی‌تر به‌عنوان گزینه‌های درمانی جایگزین رزکسیون پروستات از طریق مجاری ادراری (transurethral resection of the prostate; TURP) در مدیریت نشانه‌های دستگاه ادراری تحتانی (lower urinary tract symptoms; LUTS) در مردان مبتلا به هیپرپلازی خوش‌خیم پروستات (benign prostatic hyperplasia; BPH) پیشنهاد شده‌اند. آمبولیزاسیون شریانی پروستات (prostatic arterial embolization; PAE) یک روش درمانی نسبتا جدید و کم تهاجمی است. اهداف: ارزیابی اثرات PAE در مقایسه با سایر روش‌های درمان LUTS در مردان مبتلا به BPH. روش‌های جست‌وجو: ما جست‌وجوی جامعی را در بانک‌های اطلاعاتی مختلف (کتابخانه کاکرین، MEDLINE؛ Embase؛ LILACS؛ Scopus؛ Web of Science؛ و Google Scholar)، پایگاه‌های ثبت کارآزمایی‌ها، سایر منابع علمی منتشر نشده، و مجموعه مقالات کنفرانس منتشر شده تا 25 سپتامبر 2020، بدون اعمال محدودیت در زبان یا وضعیت انتشار، انجام دادیم. معیارهای انتخاب: ما کارآزمایی‌های تصادفی‌سازی و کنترل شده (randomised controlled trials; RCTs)، همچنین مطالعات غیر‐تصادفی‌سازی شده (NRS، محدود به مطالعات کوهورت آینده‌نگر با گروه‌های مقایسه همزمان) را با حضور مردان بالای 40 سال مبتلا به LUTS وارد کردیم که نشانه‌هایشان به BPH نسبت داده ‌شد و تحت PAE در مقابل TURP یا سایر مداخلات جراحی قرار گفتند. گردآوری و تجزیه‌وتحلیل داده‌ها: دو نویسنده مرور به‌طور مستقل از هم مطالعات را برای ورود و خروج طبقه‌بندی کرده و داده‌ها را از مطالعات وارد شده خلاصه کردند. ما تجزیه‌وتحلیل آماری را با استفاده از یک مدل اثرات تصادفی انجام دادیم و آنها را مطابق با کتابچه راهنمای کاکرین برای مرورهای سیستماتیک مداخلات تفسیر کردیم. برای ارزیابی قطعیت شواهد RCTها و NRSها از راهنمایی GRADE استفاده شد. نتایج اصلی: ما داده‌هایی را برای آگاهی از دو مقایسه یافتیم: PAE در مقابل TURP (شش RCT و دو NRS)، و PAE در مقابل روش ساختگی (یک RCT). میانگین سنی، IPSS، و حجم پروستات شرکت‌کنندگان، به ترتیب 66 سال، 22.8 و 72.8 میلی‌لیتر بود. این چکیده متمرکز است بر مقایسه PAE در مقابل TURP به عنوان موضوع اصلی مورد نظر. PAE در مقابل TURP ما شش RCT و دو NRS را با پیگیری کوتاه‌مدت (تا 12 ماه) و یک RCT را با پیگیری طولانی‌مدت (13 تا 24 ماه) وارد کردیم. پیگیری کوتاه‌مدت: بر اساس شواهد به دست آمده از RCT، ممکن است تفاوتی اندک یا عدم تفاوت در بهبود نمره نشانه‌های اورولوژیک وجود داشته باشد (تفاوت میانگین [MD]: 1.55؛ 95% فاصله اطمینان [CI]: 0.40‐ تا 3.50؛ 369 شرکت‌کننده؛ 6 RCT؛ I² = 75%؛ شواهد با قطعیت پائین) که با نمره بین‌المللی نشانه‌های پروستات (International Prostatic Symptom Score; IPSS) در مقیاس 0 تا 35 اندازه‌گیری شد، و نمرات بالاتر نشانه‌های بدتر را نشان می‌دهد. در کیفیت زندگی نیز ممکن است تفاوتی اندک یا عدم تفاوت وجود داشته باشد (MD: 0.16؛ 95% CI؛ 0.37‐ تا 0.68؛ 309 شرکت‌کننده؛ 5 RCT؛ I² = 56%؛ شواهد با قطعیت پائین) که توسط سوال کیفیت زندگی IPSS در یک مقیاس 0 تا 6 اندازه‌گیری شد، و نمرات بالاتر نشانگر کیفیت زندگی بدتر به ترتیب بین PAE و TURP است. در حالی که ما در مورد تأثیر PAE بر عوارض جانبی عمده بسیار نامطمئن هستیم (خطر نسبی [RR]: 0.71؛ 95% CI؛ 0.16 تا 3.10؛ 250 شرکت‌کننده؛ 4 RCT؛ I² = 26%؛ شواهد با قطعیت بسیار پائین)، PAE ممکن است نیاز را به درمان مجدد افزایش دهد (RR: 3.64؛ 95% CI؛ 1.02 تا 12.98؛ 204 شرکت‌کننده؛ 3 RCT؛ I² = 0%؛ شواهد با قطعیت بسیار پائین). بر اساس 18 مورد درمان مجدد در هر 1000 مرد در گروه TURP، این عدد متناظر است با 47 مورد دیگر (0 مورد بیشتر تا 214 مورد بیشتر) در هر 1000 مرد تحت درمان با PAE. ما در مورد اثرات درمان بر عملکرد نعوظ بسیار نامطمئن هستیم (MD: ‐0.03؛ 95% CI؛ 6.35‐ تا 6.29؛ 129 شرکت‌کننده؛ 2 RCT؛ I² = 78%؛ شواهد با قطعیت بسیار پائین) که توسط شاخص بین‌المللی عملکرد نعوظ در 5 روی مقیاس 1 تا 25 اندازه‌گیری شد، که نمرات بالاتر نشان دهنده عملکرد بهتر است. شواهد NRS در صورت وجود، نتایج مشابهی را به همراه داشت. براساس شواهد به دست آمده از NRS، روش PAE ممکن است بروز اختلالات انزال را کاهش دهد (RR: 0.51؛ 95% CI؛ 0.35 تا 0.73؛ 260 شرکت‌کننده؛ 1 NRS؛ شواهد با قطعیت پائین). پیگیری طولانی‌مدت‌تر: براساس شواهد RCT، ما در مورد تأثیر PAE بر نمرات نشانه‌های اورولوژیک، در مقایسه با TURP، بسیار نامطمئن هستیم (MD: 0.30؛ 95% CI؛ 3.17‐ تا 3.77؛ 95 شرکت‌کننده؛ شواهد با قطعیت بسیار پائین). کیفیت زندگی ممکن است مشابه باشد (MD: 0.20؛ 95% CI؛ 0.49‐ تا 0.89؛ 95 شرکت‌کننده؛ شواهد با قطعیت پائین). ما همچنین در مورد حوادث عمده جانبی بسیار نامطمئن هستیم (RR: 1.96؛ 95% CI؛ 0.63 تا 6.13؛ 107 شرکت‌کننده؛ شواهد با قطعیت بسیار پائین). ما شواهدی را در مورد عملکرد نعوظ و اختلالات انزال پیدا نکردیم. بر اساس شواهد به دست آمده از NRS، روش PAE ممکن است نرخ درمان مجدد را افزایش دهد (RR: 1.51؛ 95% CI؛ 0.43 تا 5.29؛ 305 شرکت‌کننده؛ شواهد با قطعیت پائین)؛ بر اساس 56 مورد نیاز به درمان مجدد در هر 1000 مرد در گروه TURP. این متناظر است با 143 نفر بیشتر (25 نفر بیشتر تا 430 نفر بیشتر) در هر 1000 مرد در گروه PAE. نتیجه‌گیری‌های نویسندگان: در مقایسه با TURP تا 12 ماه (پیگیری کوتاه‌مدت)، PAE ممکن است میزان بهبودی مشابهی را در نمرات نشانه‌های اورولوژیک و کیفیت زندگی ایجاد کند. در حالی که در مورد عوارض جانبی عمده بسیار نامطمئن هستیم، PAE ممکن است نرخ درمان مجدد را افزایش دهد. ما در مورد عملکرد نعوظ اطمینان نداریم، اما PAE ممکن است اختلالات انزال را کاهش دهد. با پیگیری طولانی‌مدت‌تر (13 تا 24 ماه)، در مورد اینکه هر دو روش با توجه به نمرات نشانه‌های اورولوژیک چگونه مقایسه می‌شوند، بسیار نامطمئن هستیم، اما به نظر می‌رسد کیفیت زندگی مشابه باشد. در مورد عوارض جانبی عمده بسیار نامطمئن هستیم، اما PAE ممکن است نرخ درمان مجدد را افزایش دهد. شواهد طولانی‌مدت‌تری را در مورد عملکرد نعوظ و اختلالات انزال پیدا نکردیم. قطعیت شواهد برای پیامدهای اصلی این مرور، پائین یا بسیار پائین بود، این نشان دهنده آن است که اعتماد ما به اندازه تاثیرگذاری گزارش شده، محدود یا بسیار محدود است، و این موضوع باید در تحقیقات آینده بهتر بررسی شود.

The purpose of this study was to determine the local progression rate and identify factors that may predict local progression, in patients who achieve a complete response (CR) radiologically after undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).One-hundred-forty-seven patients, who achieved CR of 224 HCCs after TACE, were retrospectively reviewed. There were 109 men and 38 women with a mean age of 61.6 ± 6.8 (SD) years (range: 45.4-86.9 years). Logistic mixed-effects and Cox regression models were used to evaluate associations between clinical factors and local progression.A total of 75 patients (75/147; 51%) and 99 (99/224,44.2%) lesions showed local progression at a median of 289.5 days (Q1: 125, Q3: 452; range: 51-2245 days). Pre-treatment, international normalization ratio (INR) (1.17 ± 0.15 [SD] vs. 1.25 ± 0.16 [SD]; P0.001), model for end-stage liver disease (9.4 ± 2.6 [SD] vs. 10.6 ± 3.2 [SD]; P = 0.010) and Child-Pugh score (6 ± 1 [SD] vs. 6.4 ± 1.3 [SD]; P = 0.012) were significantly lower while albumin serum level (3.4 ± 0.62 [SD] vs. 3.22 ± 0.52 [SD]; P = 0.033) was significantly greater in those who showed local progression as compared to those who did not. In terms of local-recurrence free survival, the number of TACE treatments (hazard ratio [HR]: 2.05 [95% CI: 1.57-2.67]; P0.001), INR (HR: 0.13 [95% CI: 0.03-0.61]; P = 0.010) and type of TACE (P = 0.003) were significant. Patients with local progression on any tumor did not differ from those who did in terms of overall survival (P = 0.072), however, were less likely to be transplanted (20/75, 26.7%) than those who did not (33/72; 36.1%) (P = 0.016).A significant number of patients who achieve CR of HCC after TACE have local progression. This emphasizes the importance of long-term follow up.

To determine the realized tumor to normal ratios (TNRs) in patients undergoing radiation segmentectomies (RS); determine the relationship between TNRs and particle load in transarterial radioembolization (TARE).In total, 148 patients who underwent 184 TARE procedures for hepatocellular carcinoma were evaluated. Post treatment SPECT CT bremsstrahlung imaging was analyzed utilizing Simplicit90y™ to determine realized TNR. A model which normalized activity across all RS treatments to a level that would achieve 400 Gy by unicompartmental dosing was created to determine the affect realized TNR would have on tumor absorbed dose.The mean TNR in the setting of RS was 2.88 ± 1.60 and was higher for glass as compared to resin microspheres (3.07 ± 1.68 vs 2.24 ± 1.21, p = 0.01). The TNR was significantly greater in the RS as compared to the lobar deliveries (2.88 ± 1.60 vs 2.16 ± 1.12, p 0.01). When normalizing the activity of RS treatments to the level required to achieve 400 Gy by unicompartmental calculations, there was found to be significant differences in the predicted tumor absorbed dose when separated by the median tumor dose (601.2 ± 133.3 vs 1146.9 ± 297.5, p 0.01) or median realized TNR (1119.2 ± 341 Gy vs 635.7 ± 160.2 Gy, p 0.01). Particle load was found to be associated with TNR on univariate (p 0.01) and multivariate (p 0.01) analysis.Significant TNRs are seen in RS and perhaps argue for the use of multi-compartmental dosimetry techniques in this setting and particle load may affect TNR.• Tumor to normal ratios were significantly higher in radiation segmentectomies than lobar deliveries. • Tumor to normal ratios were significantly higher when utilizing glass, as compared to resin microspheres. • When creating a model that prescribed the activity required to reach 400 Gy by MIRD, realized tumor dose varied significantly in radiation segmentectomies.

Hemorrhoids are local vascular structure dilations in the lower rectum, associated with morbidity and reduced quality of life. Endovascular coil or particle embolization of the superior rectal arteries, known as Emborrhoid technique, is a minimally invasive, image-guided therapy that targets the hemorrhoidal plexus and reduces hemorrhage. The purpose of this review was to analyze the results of published studies to determine the efficacy, clinical outcomes, and morbidities associated with the endovascular occlusion of hemorrhoidal arteries for the treatment of internal hemorrhoids. Current evidences suggest that hemorrhoids treated by Emborrhoid technique using microcoils, embolic particles or a combination is safe with no reported serious complications. Hemorrhoid embolization can preserve the anal tone without direct anorectal trauma and maintain the hemorrhoidal tissue in place requiring minimal local wound care on an outpatient basis. However, due to the paucity of high-quality trials, further research is warranted to evaluate its long-term outcomes, compare its efficacy with other treatment modalities, and fully assess its role in the treatment of hemorrhoid.

Objective To assess the comparative effectiveness and ranking of minimally invasive treatments (MITs) for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Materials and methods We searched multiple databases up to 24 February 2021. We included randomized controlled trials assessing the following treatments: convective radiofrequency water vapour thermal therapy (WVTT or Rezum); prostatic arterial embolization (PAE); prostatic urethral lift (PUL or Urolift); temporary implantable nitinol device (TIND); and transurethral microwave thermotherapy (TUMT) compared to transurethral resection of the prostate (TURP) or sham surgery. We performed a frequentist network meta-analysis. Results We included 27 trials involving 3017 men. The overall certainty of the evidence of most outcomes according to GRADE was low to very low. Compared to TURP, PUL and PAE may result in little to no difference in urologic symptoms while WVTT, TUMT, and TIND may result in worse urologic symptoms. MITs may result in little to no difference in the quality of life (QoL), compared to TURP. MITs may result in a large reduction of major adverse events compared to TURP. We are uncertain about the effects of PAE and PUL on retreatment compared to TURP, however, TUMT may result in higher retreatment rates. We are very uncertain of the effects of MITs on erectile function and ejaculatory function. Among MITs, PUL and PAE have the highest likelihood of being the most efficacious for urinary symptoms and QoL, TUMT for major adverse events, WVTT and TIND for erectile function and PUL for ejaculatory function. Excluding WVTT and TIND, for which there were only studies with short-term (three months) follow-up, PUL had the highest likelihood of being the most efficacious for retreatment. Conclusions MITs may result in similar or worse effects concerning urinary symptoms and QoL compared to TURP at short-term follow-up.

Over the last decade, several publications have reported the safety and efficacy of liquid embolics in a wide range of clinical indications. The expansion of clinical scenarios in which liquid embolics are utilized has been in part driven by some of the advantages these materials hold over other embolic agents. For instance, liquid embolics do not rely on the patient's ability to form clot and can be delivered more distally then coils at times. While several liquid embolics are commercially available, and in some cases have been for decades, there are limitations to these materials as well. The potential benefits of liquid embolics combined with the limitations of available materials have led to the ongoing development of several new agents. This review aims to familiarize the reader with both available liquid embolics and those that are relatively new or in development.

In some patients undergoing radioembolization, lung toxicity is a limiting factor when calculating their dose. At the same time, it is known that the lung shunt fraction (LSF) is overestimated by the mapping exam. Furthermore, there are multiple methods to measure LSF. Planar measurement is both the most commonly utilized and easiest to perform, however new dosimetry software provides the ability to use more advanced 3D techniques. This paper reviews the different LSF calculation methods and elucidates the available data comparing the techniques, clinical relevance, and dose calculation.

To determine the accuracy and clinical significance of planar scintigraphy lung shunt fraction (PLSF) and single-photon emission computerized tomography (SPECT) computed tomography (CT) lung shunt fraction (SLSF) before Y-90 transarterial radioembolization.Seventy patients (46 men, 24 women; mean age, 64 ± 9.5 [SD] years) who underwent 83 treatments with Y-90 transarterial radioembolization for primary or secondary malignancies of the liver with a PLSF ≥ 7.5% were retrospectively evaluated. The patients mapping technetium 99 m (Tc-99 m) macroaggregated albumin (MAA) PLSF and SLSF were calculated and compared to the post Y-90 delivery SLSF. A model using modern dose thresholds was created to identify patients who would require dose reduction due to a lung dose ≥ 30 Gy, with patients who required50% dose reduction considered to be delivery cancelations.A significant difference was found between mean PLSF (14.7 ± 11.6 [SD]%; range: 7.5-84.1%) and mean SLSF (8.7 ± 8.5 [SD]%; range: 1.7-73.5) (P0.001). The mean realized LSF (7.1 ± 3 [SD]%; range:1.5-17.6) was significantly less than the PLSF (P0.001) but not the SLSF (P = 0.07). PLSF significantly overestimated the realized LSF by more than the SLSF (8.5 ± 5.3 [SD] % [range: -0.1-21.7] vs. 0.8 ± 3.6 [SD] % [range: -5-13.2], respectively) (P0.001). Based on the clinical significance model, 20 patients (20/83, 24.1%) would have required dose reduction or cancelation when using PLSF but would not require even a dose reduction when using the SLSF. Significantly more deliveries would have been be canceled if PLSF was used as compared to SLSF (22/83 [26.5%] vs. 6/83 [7.2%], respectively) (P0.001).SLSF is significantly more accurate at predicting realized LSF than PLSF and this difference is of clinical significance in a number of patients with a PLSF ≥ 7.5%.

A questionnaire regarding splenic embolization in trauma was submitted to an international sample of IR faculty members, to compare their practice to the available recommendations. A 21 multiple-choice questionnaire was sent to an international cohort of 96 IR faculty. Questions included the initial patient evaluation, embolization materials and techniques, post-procedure management, availability of an institutional protocol, and use of guidelines. For each question, there were from a minimum of 45 to a maximum of 52 responders: 94% require a CT with contrast prior to embolization, and 87% use the American Association for the Surgery of Trauma (AAST) scale to grade the splenic injuries. Embolization is performed across all values of the AAST scale. Of the patients with injuries of grade III or greater, embolization is primarily done for those patients who are hemodynamically stable. Unstable patients are embolized less frequently and primarily in cases in which the injuries are of a lower grade. Coils are the preferred material for proximal embolization (69%). Particles/Gelfoam is the preferred material for distal embolization (38%). In total, 63% administer intravenous antibiotics before the procedure and 15% administer intra-arterial antibiotics during the procedure. After embolization, follow-up imaging is recommended by 87%, antibiotics are administered regularly by 33%, clinical follow-up is recommended by 73%, and vaccination against encapsulated organisms is routinely recommended by 39%. There is significant variability among a heterogeneous cohort of respondents. Available recommendations may not be sufficiently addressing the practice of splenic embolization.

The purpose of this brief report was to retrospectively evaluate the safety and efficacy of cryoablation and compare the outcomes with those of percutaneous ethanol injection (PEI) for the treatment of metastatic cervical lymph nodes (CLNs) in patients with thyroid cancer at a single center. The study included 24 patients with 47 CLNs treated with PEI and 7 patients with 11 CLNs treated with cryoablation. Three of 7 (42.9%) patients did not respond to PEI and progressed to cryoablation. There were more local recurrences in CLNs treated with PEI (7/47, 14.9%) compared with cryoablation (0/11, 0%), but this did not reach significance (P = .33). There was no difference in mild/moderate (3/24, 12.5% vs 2/7, 28.6%; P = .31) or severe (1/24, 4.2% vs 0/7, 0%; P = 1) adverse events in the PEI and cryoablation cohorts. The number of treatments required for CLNs treated with PEI (2 ± 1.1) was significantly greater than those for CLNs treated with cryoablation (1 ± 0) (P = .002). These limited data suggest that the treatment of metastatic CLNs with cryoablation or PEI may be safe and effective; however, further data are needed.

To create and evaluate the ability of machine learning-based models with clinicoradiomic features to predict radiologic response after transarterial radioembolization (TARE).82 treatment-naïve patients (65 responders and 17 nonresponders; median age: 65 years; interquartile range: 11) who underwent selective TARE were included. Treatment responses were evaluated using the European Association for the Study of the Liver criteria at 3-month follow-up. Laboratory, clinical, and procedural information were collected. Radiomic features were extracted from pretreatment contrast-enhanced T1-weighted magnetic resonance images obtained within 3 months before TARE. Feature selection consisted of intraclass correlation, followed by Pearson correlation analysis and finally, sequential feature selection algorithm. Support vector machine, logistic regression, random forest, and LightGBM models were created with both clinicoradiomic features and clinical features alone. Performance metrics were calculated with a nested 5-fold cross-validation technique. The performances of the models were compared by Wilcoxon signed-rank and Friedman tests.In total, 1,128 features were extracted. The feature selection process resulted in 12 features (8 radiomic and 4 clinical features) being included in the final analysis. The area under the receiver operating characteristic curve values from the support vector machine, logistic regression, random forest, and LightGBM models were 0.94, 0.94, 0.88, and 0.92 with clinicoradiomic features and 0.82, 0.83, 0.82, and 0.83 with clinical features alone, respectively. All models exhibited significantly higher performances when radiomic features were included (P = .028, .028, .043, and .028, respectively).Based on clinical and imaging-based information before treatment, machine learning-based clinicoradiomic models demonstrated potential to predict response to TARE.

ObjectivesTo assess the effects of prostatic arterial embolization (PAE) compared to other procedures for treatment of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH).MethodsWe included randomized controlled trials (RCTs), as well as non-randomized studies (NRSs) enrolling men with BPH undergoing PAE versus other surgical interventions via a comprehensive search up until 8 Nov 2021. Two independent reviewers screened the literature, extracted data, assessed risk of bias, performed statistical analyses by using a random-effects model, and rated the certainty of evidence (CoE) of RCTs and NRSs.ResultsWe found data to inform two comparisons: PAE versus transurethral resection of prostate (TURP, six RCTs and two NRSs), and PAE versus sham (one RCT). This abstract focuses on the primary outcomes in a comparison of PAE versus TURP.Short-term follow-up: based on RCT evidence, there may be little to no difference in urologic symptom score improvement (mean difference [MD] 1.72, 95% confidence interval [CI] -0.37 to 3.81; low CoE) and quality of life (MD 0.28, 95% CI -0.28 to 0.84; low CoE) measured by International Prostatic Symptom Score. We are very uncertain about the effects of PAE on major adverse events (risk ratio [RR] 0.75, 95% CI 0.19 to 2.97; very low CoE).Long-term follow-up: based on RCT evidence, PAE may result in little to no difference in urologic symptom scores (MD 2.58, 95% CI -1.54 to 6.71; low CoE) and quality of life (MD 0.50, 95% CI -0.03 to 1.04; low CoE). We are very uncertain about major adverse events (RR 0.91, 95% CI 0.20 to 4.05; very low CoE).ConclusionCompared to TURP, the impact on urologic symptoms and quality of life improvement as perceived by patients appears to be similar. This review did reveal major uncertainty as to how major adverse events compare.

Please see the Editorial Comment by Christopher Malone discussing this article. BACKGROUND. TIPS placement is an effective method for treating a number of complications of portal hypertension. Alth...

Budd-Chiari syndrome (BCS) results from the occlusion or flow reduction in the hepatic veins or inferior vena cava and can be treated with transjugular intrahepatic portosystemic shunt when hepatic vein recanalization fails.1-3 Hypercoagulable patients with primary BCS are predisposed to development of new areas of thrombosis within the TIPS shunt or IVC. This case details a patient with BCS, pre-existing TIPS extending to the right atrium, and chronic retrohepatic IVC thrombosis who underwent sharp recanalization of the IVC with stenting into the TIPS stent bridging the patient until his subsequent hepatic transplantation.

Background Transjugular intrahepatic portosystemic shunt (TIPS) creation is an accepted treatment of portal hypertension. Lower-extremity edema (LEE) is an underreported complication of TIPS creation. Purpose To assess the epidemiologic findings of LEE after TIPS creation and their association with patient survival. Materials and Methods The medical records of patients who underwent TIPS creation between January 2003 and April 2019 at Oregon Health and Science University and patients who underwent TIPS creation between January 2006 and December 2016 at University of Minnesota were retrospectively reviewed. Clinical, laboratory, and technical parameters, development and outcome of edema, and survival data were collected. LEE was defined as new-onset or worsened edema up to 1 year after TIPS creation. Cardiac ventricular function was evaluated with transthoracic echocardiography. Risk factors for LEE were evaluated with logistic regression analysis, and critical P values were additionally assessed by using the false discovery rate. Survival curves were compared by using the log-rank test. Results Three hundred thirty-four patients were included (mean age, 55 years ± 11 [standard deviation]; 208 men). TIPS creation was primarily performed for ascites (159 of 334 patients, 48%), gastrointestinal bleeding (127 of 334 patients, 38%), or a combination of bleeding and ascites (38 of 334 patients, 11%). One hundred seventy of the 334 patients (51%) developed LEE (new onset, 120; worsened edema, 50). Three of 170 patients (2%) had abnormal left ventricular ejection fraction. Multivariable analysis showed TIPS creation for ascites (odds ratio, 1.7; 95% CI: 1.04, 2.7; P = .03) and hepatic hydrothorax (odds ratio, 2.2; 95% CI: 1.1, 4.2; P = .02) was likely associated with LEE; however, it did not reach significance at a critical P value of .009. Among 164 patients with data on the outcome of LEE, LEE eventually improved in 94 (57%). The median survival of patients with LEE was lower than that of patients without LEE (38 months vs 71 months, respectively; P = .02). Conclusion Lower-extremity edema developed in more than 50% of study patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) creation, regardless of left ventricular function. There was suggestion that TIPS creation for ascites might be an underlying risk factor. Lower-extremity edema portends worse survival. © RSNA, 2020 Online supplemental material is available for this article.

To evaluate the correlation of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), aspartate aminotransferase-to-lymphocyte ratio (ALRI), systemic inflammation index (SII), and lymphocyte count to oncologic outcomes in metastatic colorectal cancer (mCRC) patients undergoing transarterial radioembolization (TARE).All patients undergoing TARE for mCRC were retrospectively reviewed at a single academic institution. A receiver operating characteristics (ROC) curve analysis was performed using a landmark survival point of 12 months, with an area under the curve (AUC) calculated. A cutoff point was determined by Youden's index and used to separate patients for OS and PFS analysis. Cox proportional-hazards models which included pertinent clinical factors were also created to evaluate PFS and OS.In total, 41 patients who underwent 66 TARE treatments were included. A correlation was seen between post-treatment ALRI 45 (HR: 0.38 (95%CI: 0.17-0.86), p = 0.02) and PFS. Patients with a pretreatment ALRI score 20 had a significantly longer OS (HR: 0.49 (95%CI: 0.19-0.88), p = 0.02) as did those with a post-treatment lymphocyte count 1.1 10Inflammatory markers may be associated with OS and PFS in mCRC patients undergoing TARE.

OBJECTIVE. The purpose of this study was to compare the ability of the model for end-stage liver disease (MELD) and sodium MELD (MELD-Na) scoring systems to predict outcomes after transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS. Two hundred and nineteen consecutive patients who underwent TIPS placement were retrospectively reviewed. The primary outcomes were death within 30 days and 90 days after TIPS placement (30- and 90-day mortality, respectively), and secondary outcomes included death within 365 days after TIPS placement (365-day mortality), length of hospital stay, and readmission to the hospital within 30 days of TIPS placement. RESULTS. Mortality rates within 30, 90, and 365 days after TIPS placement were 2.3% (5/219), 8.2% (17/207), and 21.7% (41/189), respectively. Logistic regression showed that the MELD score predicted 30-day mortality (odds ratio [OR], 1.13; 95% CI, 1.00-1.27; p = 0.04) and trended toward predicting 90-day mortality (OR, 1.09; 95% CI, 1.00-1.18; p = 0.06), whereas the MELD-Na score did not predict 30-day mortality (OR, 1.02; 95% CI, 0.97-1.06; p = 0.51) or 90-day mortality (OR, 1.01; 95% CI, 0.98-1.15; p = 0.44). In a comparison of the ROC AUCs for MELD and MELD-Na, MELD showed improved prediction of 30-day mortality (p = 0.06) but did not significantly vary in prediction of 90- and 365-day mortality (p = 0.80 and p = 0.76, respectively). When the maximal inflection point for MELD and MELD-Na was analyzed on the basis of 90-day mortality, a score of 23 was found to be most significant for both MELD (OR, 6.6; 95% CI, 1.5-29.1; p = 0.01) and MELD-Na (OR, 3.3; 95% CI, 1.1-9.6; p = 0.03). MELD and MELD-Na both accurately predicted the length of hospital stay after TIPS placement (p = 0.005 and p = 0.01, respectively). CONCLUSION. MELD is superior to MELD-Na for predicting 30-day and, perhaps, 90-day mortality after TIPS placement. At present, decisions regarding patient selection for TIPS placement should be made on the basis of the MELD score rather than the MELD-Na score.

OBJECTIVE. Treatment options for hepatocellular carcinoma (HCC) continue to expand. However, given the complexity of the patients including factors such as codominant cirrhosis or portal hypertension and transplant status, it can be difficult to know which treatment is most advantageous. The choice of HCC treatment is perhaps most complex in the setting of HCCs that are 3-5 cm. This article reviews the evidence for locoregional therapies in treating 3- to 5-cm HCCs. CONCLUSION. Combination therapy with transarterial chemoembolization (TACE) and ablation has the most robust and highest level of evidence to support its efficacy and therefore should be considered first-line therapy for nonresectable HCCs that measure 3-5 cm. The studies support that TACE followed by ablation is superior to either TACE alone or ablation alone. Data for transarterial radioembolization (TARE) to treat HCCs in this specific size range are very limited. Additional data are needed about the comparative effectiveness of TACE-ablation combination and TARE and how the TACE-ablation combination compares with surgical resection.

Common femoral artery pseudoaneurysm is a known complication of percutaneous vascular access. Treatment options include surgical repair of the pseudoaneurysm or endovascular methods such as ultrasound-guided compression and direct thrombin injection into the pseudoaneurysm sac. Treatment of pseudoaneurysm is more challenging when a patient is undergoing concurrent catheter-directed or systemic thrombolytic therapy. This is a case report of endovascular treatment of an iatrogenic pseudoaneurysm of common femoral artery in a patient receiving concurrent catheter-directed thrombolytic therapy. This was performed successfully by precise deployment of a MicroVascular Plug into the pseudoaneurysm neck with immediate closure of pseudoaneurysm. Midterm follow-up confirmed sustained exclusion of the pseudoaneurysm sac with continued patency of the treated femoral artery.

Purpose To summarize the Society of Interventional Radiology Foundation's Research Consensus Panel development of a research agenda on prostate artery embolization (PAE). Materials and methods PAE for the treatment of lower urinary tract symptoms has been shown to be safe and effective in decreasing symptoms and prostate size. Lack of randomized controlled trials (RCTs) on PAE in the United States has prevented inclusion in American Urologic Association guideline recommendations for treatment of lower urinary tract symptoms resulting from benign prostatic hyperplasia. Recognizing the need for well-designed trials, the SIR Foundation funded a Research Consensus Panel to prioritize a research agenda. The panel included interventional radiologists, urologists, SIR Foundation leadership, and industry representatives. The goal of the meeting was to discuss weaknesses with current data and study design for development of US trials to report long-term outcomes data. Results Final consensus on a research design could not be made because the group was split on 3 research designs: (i) RCT of PAE versus sham with crossover of the sham group. (ii) RCT of PAE versus simple prostatectomy. (iii) RCT of PAE versus holmium laser enucleation of the prostate/thulium laser enucleation of the prostate. The panel recommended a nonindustry-funded registry to obtain real-world data. Conclusions Level 1 data are required to be included in the American Urologic Association guidelines for treatment of benign prostatic hyperplasia. Because of concerns with all 3 study designs, the panel did not reach a consensus. Further meetings are planned with the panel to select among these research designs.

Embolization has tremendously evolved in recent years and has expanded to treatment of a variety of pathologic processes. There has been emerging evidence that the level of arterial occlusion and the distribution of embolic particles may play an important role in the clinical outcome. This is a comprehensive literature review to identify variables that play important role in determination of level of occlusion of blood vessels and distribution of embolic particles. The literature searches between 1996 to 2020 through PubMed and Ovid-MEDLINE yielded over 1030 articles of which 30 studies providing details on the level of occlusion are reviewed here. We divided the playing factors into characteristics of the particles, solution/injection and vascular bed. Accordingly, particle size, type and aggregation, compressibility/deformability, and biodegradability are categorized as the factors involving particles' behavioral nature. Infusion rate and concentration/dilution of the medium are related to the carrying solution. Hemodynamics and the arterial resistance are characteristics of the vascular bed that also play an important role in the distribution of embolic particles. Understanding and predicting the level of embolization is a complex multi-factor problem that requires more evidence, warranting further randomized controlled trials, and powered human and animal studies.

Shamar Young,1 Ranjan Ragulojan,1 Ting Chen,1 Joshua Owen,1 Donna D’souza,1 Tina Sanghvi,2 Jafar Golzarian,1 Siobhan Flanagan1 1University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA; 2Minneapolis VA Medical Center, Department of Radiology, Minneapolis, MN, 55455, USACorrespondence: Shamar Young, Tel +1 612-624-6189, Email youn1862@umn.eduObjective: To evaluate the dynamic changes of lymphocytes following transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC) and their relationship to normal liver dose (NLD).Materials and Methods: A total of 93 patients who underwent 102 treatments were retrospectively reviewed. Absolute lymphocyte counts pretreatment and at 1, 3, 6, and 12 months were evaluated. Kaplan–Meier, Spearman correlation, receiver operating characteristic (ROC) curve, and area under the curve (AUC) analyses were performed.Results: The mean absolute lymphocyte count at baseline was 1.25 ± 0.79 103/μL which was significantly greater than 1 (0.71 ± 0.47 103/μL, p< 0.0001), 3 (0.79 ± 0.77 103/μL, p=0.0003), and 6 (0.81 ± 0.44 103/μL, p=0.0001) months, but not significantly different than 12 (0.92 ± 0.8 103/μL, p=0.12) months post treatment. There was a modest negative correlation between NLD and lymphocyte count at 1 month (rho= − 0.216, p=0.03), which strengthened at 3 months post treatment (rho= − 0.342, p=0.008). AUC of ROC analysis between absolute lymphocyte count ≤ 1 103/μL or > 1 103/μL at 1, 3, 6, and 12 months post treatment was 0.625, 0.676, 0.560, and 0.794, respectively. Univariate analysis of overall survival when separating patients by a lymphocyte count of ≤ 1 103/μL and > 1 103/μL demonstrated a significant difference at 1 (HR: 0.56, 95% CI: 0.33– 0.95, p=0.03), 3 (HR: 0.41, 95% CI: 0.18– 0.94, p=0.035) and 6 (HR: 0.36, 95% CI: 0.17– 0.77, p=0.008) months post treatment, but not pretreatment or at 12 months.Conclusion: NLD may correlate with lymphocyte depression at 1 and 3 months and lymphopenia may portend a worse overall survival in the post treatment setting.Keywords: hepatocellular carcinoma, transarterial radioembolization, lymphocytes

Embolization is an important and widely utilized technique in interventional radiology. There are a variety of different categories and individual products which can be utilized to perform embolization. Understanding the different classes of embolic agents, the important features of each of these classes including strengths and limitations, and the variation in individual products within the classes is critical for interventional radiologist to practice safely and effectively. This article reviews the different kinds of embolics and relays some of the pertinent physical and chemical properties of individual products which should be considered when determining which embolic to select for a given purpose.

We report the case of a 54-year-old male with alcoholic cirrhosis who presented several times to the emergency department (ED) with right upper quadrant abdominal pain. Ten days after his initial presentation, the patient represented with hypotension and anemia. An abdominal CT angiogram identified hemorrhage from an ectopic varix successfully treated with emergent glue embolization of mesenteric, omental, and periumbilical varices. Intraperitoneal bleeding from ectopic varices in cirrhosis patients is a rare, life-threatening condition. Consideration and recognition of ectopic variceal hemorrhage in patients with cirrhosis can facilitate prompt life-saving treatment in a population susceptible to significant morbidity and mortality.

To evaluate the ability of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), aspartate aminotransferase-to-lymphocyte ratio (ALRI) and systemic-inflammation index (SII) to predict clinical outcomes in hepatocellular carcinoma (HCC) patients undergoing transarterial radioembolization (TARE).One hundred forty-five patients who underwent treatment of 167 HCCs had their pretreatment and 1 month post treatment laboratory values evaluated. Overall survival (OS), progression-free survival (PFS) and local PFS models were performed with patients separated by median inflammatory scores.The median pretreatment NLR, PLR, ALRI and SII were 3.0 (range: 0.5-176), 104.4 (range: 25-830), 55.7 (range: 7.5-2090) and 360.2 (range: 51.1-7207.8), respectively. While the median post treatment NLR, PLR, ALRI and SII were 6.2 (range: 0.4-176), 180 (range: 35-2100), 125 (range: 15.9-5710) and 596.8 (range: 28.9-19,320), respectively. OS models showed significant differences when separating the groups by median post treatment NLR (p = 0.003) and SII (p = 0.003). Multivariate Cox regression models for OS with all pre and post treatment inflammatory markers (log-scale) as well as tumor size, AFP and Child-Pugh score showed significant pretreatment NLR [HR: 0.22 (95% CI:0.06-0.75), p = 0.016] and SII [3.52 (95% CI: 1.01-12.3), p = 0.048], as well as post treatment NLR [6.54 (95% CI: 1.57-27.2), p = 0.010] and SII [0.20 (95% CI: 0.05-0.82), p = 0.025] association. The post treatment ALRI (p = 0.010) correlated with PFS while, post treatment NLR (p 0.001), ALRI (p = 0.024) and SII (p = 0.005) correlated with local PFS.Pretreatment and post treatment NLR and SII may be associated with OS and post treatment ALRI may be associated with both PFS and local PFS in HCC patients undergoing TARE.

Shamar Young,1 Isa Cam,1 Mehmet Gencturk,1 Nathan Rubin,2 Donna D’souza,1 Siobhan Flanagan,1 Jafar Golzarian,1 Tina Sanghvi3 1University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA; 2Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA; 3Minneapolis VA Medical Center, Department of Radiology, Minneapolis, MN, USACorrespondence: Shamar YoungUniversity of Minnesota, Department of Radiology, Division of Interventional Radiology, 420 Delaware St SE, Minneapolis, MN, 55455, USATel +612-624-6189Email youn1862@umn.eduBackground: The purpose of this study is to determine and compare the ability of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), aspartate-aminotransferase-to-lymphocyte ratio (ALRI), systemic-inflammation index (SII) and lymphocyte count to predict oncologic outcomes in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE).Materials and Methods: A single-center retrospective review of 296 patients who were treated for 457 HCCs was performed. Pre- and post-treatment laboratory and treatment outcome variables were collected. Objective radiologic response (ORR), progression-free survival (PFS), and overall survival (OS) were evaluated. Patients were categorized into above and below median scores and compared.Results: The median pretreatment NLR, PLR, ALRI, SII, and lymphocyte count were 2.7 (range: 0.4– 55), 88.3 (range: 0.1– 840), 71.8 (range: 0.1– 910), 238.1 (range: 0.1– 5150.8), and 1 (range: 0.1– 5.2) 103/μL, respectively. Patients with above median ALRI scores were less likely to achieve an ORR as compared to those with below median ALRI values (132 (132/163, 81%) vs 150 (150/163, 92%), p = 0.004). On univariate analysis, patients with above median pretreatment NLR (HR 1.41, 95% CI: 1.09– 1.83, p = 0.01) and below median lymphocyte count (HR 0.69, 95% CI: 0.53– 0.92, p = 0.01) had significantly worse PFS. The relationship between PFS and NLR (p = 0.08) as well as lymphocytes (p = 0.20) no longer remained on multivariate analysis. On univariate analysis, below median pretreatment NLR (HR 1.72, 95% CI: 1.2– 2.45, p = 0.003) and ALRI (HR 1.52, 95% CI: 1.05– 2.2); p = 0.03) as well as above median lymphocyte count (HR 0.48, 95% CI: 0.34– 0.7, p < 0.0001) were associated with improved OS. The significant relationship between lymphocytes and OS remained on multivariate analysis (HR 0.50, 95% CI: 0.28– 0.9, p = 0.02), but the relationship with NLR (p = 0.94) did not persist.Conclusion: NLR is predictive of PFS and OS in patients with HCC undergoing TACE and may be superior to other inflammatory scores (PLR, ALRI, and SII) in this setting. However, lymphocyte count may be most predictive of OS.Keywords: hepatocellular carcinoma, chemoembolization, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, aspartate-aminotransferase-to-lymphocyte ratio, systemic-inflammation index

To evaluate the oncologic outcomes and complication profile in nonalcoholic steatohepatitis (NASH)-induced cirrhosis leading to hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). Two hundred and twenty patients who underwent treatment of 353 HCCs were retrospectively reviewed, including 30 NASH patients who received TACE for 46 HCCs. Patient charts were evaluated for time to progression (TTP), complications and overall survival (OS). The group was split into NASH and non-NASH cohorts for comparison and additional analyses were done using propensity score matching (PSM). Patients in the NASH cohort presented with significantly larger lesions (4.9 ± 5.8 cm vs 3.1 ± 2.4 cm, p = 0.05). There was no significant difference in TTP overall [Median NASH 396 days (95% CI 308–526 days) vs non-NASH cohort 307 days (95% CI 272–364), p = 0.25) or after PSM [259 days non-NASH (95% CI 215–490) vs 396 days NASH (95% CI (349–not reached), p = 0.43]. There was a non-significant increased OS in the non-NASH [median 1078 days (95% CI 668–1594)] as compared to the NASH cohort [median 706 days (95% CI 314–not reached)] (p = 0.08) which decreased following PSM [853 days (95% CI 526–1511) non-NASH vs 706 days (95% CI 314–not reached) NASH, p = 0.48]. The number of complications did not differ significantly between the two groups (p = 0.23). The oncologic outcomes and complication profile of TACE for HCC induced by NASH cirrhosis appear to be similar to that of other etiologies of cirrhosis. NASH patients presented with larger tumors emphasizing the need for early surveillance.

Purpose The goal of this retrospective review was to determine the clinical relevance of one-month post-treatment imaging in the selective internal radiation therapy (SIRT) patient population by reporting the incidence of change in clinical management. Materials and methods Between January 2012 and January 2016, 85 patients underwent 109 SIRT treatments for either primary or secondary hepatic malignancies. There were 59 men and 26 women with a mean age of 62.4 years (range: 39–89 years). Patients’ medical records were retrospectively reviewed for procedural, historical, laboratory and imaging information. The imaging study was considered to have changed patients’ clinical management if it resulted in the addition of a new procedure, canceling of a planned procedure or change in systemic therapy. Results The one-month post-treatment imaging findings led to management changes in 10 of 109 (9.2%) of treatments. When evaluated by cancer type, 2/61 (3.3%) hepatocellular carcinoma (HCC) treatments had management changed while 8/48 (16.7%) non-HCC treatments underwent management change (P = 0.03). This difference was also significant at multivariate analysis (P = 0.03; odds ratio: 0.17 [0.03–082]). Conclusion Management is rarely changed by one-month post-SIRT imaging in patients with HCC and thus is likely unwarranted. Conversely, in non-HCC patients, one month post-SIRT imaging led to a significant percentage of clinical management changes suggesting that one month imaging in this setting is likely warranted.

Purpose The purpose of this study was to review and compare outcomes between percutaneous sclerotherapy and transjugular intrahepatic portosystemic shunt (TIPS) treatments in patients with peristomal variceal bleeding. Materials and methods Ten patients who underwent sclerotherapy (n = 3 patients), TIPS placement (n = 5 patients) or both (n= 2 patients) for peristomal variceal bleeding were retrospectively reviewed. There were 6 women and 4 men, with a mean age of 62.6 years (range: 44–84 years). Data pertaining to the technical aspects of the procedure, demographics, and information regarding the underlying cause of ostomy and portal hypertension were collected. Treatment was considered a primary success if no further hemorrhage occurred. Results No differences in primary success were found between TIPS cohort (100%) and sclerotherapy cohort (40%) (P = 0.4). Sclerotherapy patients had a poorer nutritional status (mean albumin serum level of 2.04 g/dL in the sclerotherapy group and 2.95 g/dL in theTIPS group; P = 0.04) and worse liver function (mean total bilirubin serum level of 4.9 mg/dL in the sclerotherapy group and 1.6 mg/dL in the TIPS group; P = 0.07). Conclusion While further investigation is needed, TIPS may be more effective than sclerotherapy in treating peristomal variceal bleeding. However, sclerotherapy may serve as an effective bridging mechanism in critically ill patients.