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Epithelioid hemangioma is a rare, histologically benign but locally aggressive primary vascular neoplasm that can rarely arise in bone. Mainstay treatment is surgical resection or curettage with bone grafting. We report a novel multidisciplinary, joint-sparing treatment approach for an epithelioid hemangioma of bone arising in the acetabulum causing severe thinning of the subchondral bone plate. After 4 sessions of transarterial bland particle and ethanol embolization, the resultant increased ossification of the tumor allowed preservation of the articular surface during surgical resection. Imaging follow-up 14 months after surgical resection showed no evidence of recurrence and continued ossification of the portions of the lesion treated only with embolization.

The purpose of this study is to evaluate the impact of eliminating a preprocedural planning computed tomography during CT-guided bone marrow biopsy on the technical aspects of the procedure, including patient dose, sample quality, procedure time, and CT fluoroscopy usage. Retrospective analysis of 109 patients between 1 June 2018 and 1 January 2021 was performed. Patients were grouped based on whether they received a planning CT scan. Relative radiation exposure was measured using dose-length product (DLP). Secondary metrics included number of CT fluoroscopic acquisitions until target localization, total number of CT fluoroscopic acquisitions, biopsy diagnostic yield, and procedure time. A total of 43 bone marrow biopsies with planning CT scans (Group 1) and 66 bone marrow biopsies without planning CT scans (Group 2) were performed. The average total DLP for Group 1 and Group 2 was 268.73 mGy*cm and 50.92 mGy*cm, respectively. The mean radiation dose reduction between the groups was 81% (p &lt, 0.0001). Significantly more CT fluoroscopy acquisitions were needed for needle localization in Group 2 than Group 1 (p &lt, 0.0001). Total number of CT fluoroscopy acquisitions was four for Group 1 and eight for Group 2 (p = 0.0002). There was no significant difference between the groups in procedure time or diagnostic yield. Patients without a planning CT scan received more fluoroscopic CT acquisitions but overall were exposed to significantly less radiation without an increase in procedure time.

Cardiac angiosarcoma is a rare malignancy with an aggressive course and poor prognosis. We present a 26‐year old man who came to our clinic with shortness of breath and was diagnosed with a right‐sided atrial mass. He underwent urgent resection of the mass. The pathology confirmed the mass to be cardiac angiosarcoma with positive microscopic margins (R1 resection). Since reresection was not feasible, the patient started treatment with concurrent paclitaxel (80 mg/m2 weekly) and proton beam therapy (61 Cobalt equivalent delivered over five weeks). After completing the concurrent chemotherapy and radiation therapy, he was treated with adjuvant chemotherapy using gemcitabine (900 mg/m2 on Days 1 and 8) and docetaxel (100 mg/m2 on Day 8) every three weeks. After three cycles, the patient developed severe dermatitis, and hence further chemotherapy was withheld. The patient is alive at 26 months since receiving his surgery and 18 months since the completion of treatment. Patients with cardiac angiosarcoma who undergo R1 resection have a median survival of six months. More radical approaches such as orthotopic heart‐lung transplant or prolonged durations of chemotherapy lead to minimal improvement in survival at the cost of increased morbidity. Here, we describe a novel approach to a rare disease that resulted in prolonged survival and led to a better quality of life without any long‐term morbidity to the patient., Cardiac angiosarcoma is a rare tumor of the heart associated with a poor prognosis. Patients who undergo R1 resection have a median survival of six months. Multiple efforts to improve the outcome have resulted in severe morbidity and mortality, without increasing survival. Here, we report a novel approach of concurrent chemotherapy and proton beam therapy followed by adjuvant chemotherapy that resulted in continued survival beyond two years without any recurrence or any toxicity to the heart.

Long-term soil acidification monitoring was initiated in 1981 to track potential effects of acidic atmospheric deposition on soils in Alberta, Canada. Six of eight long-term sampling sites were located in forest ecosystems on sandy soils in northern and central Alberta, and two were situated in grasslands on sandy and fine-loamy soils in southern Alberta. Sampling was undertaken every four or five years, with 12 replicate samples taken from seven depth increments from 0–60 cm at each site. The statistical analysis of pH, exchangeable base saturation (BS) percentage, and solution base cation (BC) to aluminum (Al) ratio was conducted in the topmost soil layers (0–2, 2–5 and 5–10 cm). Analysis of variance (ANOVA) and linear regression indicated decreasing trends in pH and BS percentage in some of the sites. Comparison of the initial and most recent monitoring data indicated decreases of up to 0.5 pH units in these layers at five of the forested sites. At two forested sites located in the vicinity of oil sands and heavy oil processing plants, decreasing BS was observed early in the monitoring period, but the trend showed more variability since 2000, even though pH has continued to decline since 1981. BC to Al ratio showed statistically significant variations within some sites over time, but except for a downward trend at one central Alberta site, there were no overall patterns evident at the other sites over time. Both grassland sites had much higher BC to Al ratio and exchangeable BS percentages than the forested sites, and acidification trends were not detected at either of these sites. ANOVA and linear modelling approaches showed significant differences even in instances where pH differed by 0.1–0.2 units, or where other parameters showed very small differences. It is therefore necessary to distinguish between statistically important and biologically important differences in this monitoring program, which is intended to continue for several more years.

11565 Background: Accounting for >15,000 cases annually, soft tissue sarcomas (STSs) represent a large spectrum of tumors with varying histology and clinical course. However, diagnosis of STSs on MRI is challenging due to its heterogeneous imaging phenotypes, such as surrounding soft tissue edema, vascular lesion characteristics, and specific imaging signs, such as splitting of fat between muscles. The goal of this study was to evaluate the utility of radiomic feature analysis for characterizing subtle heterogeneity patterns on T2-weighted MRI to distinguish benign and malignant STSs. Methods: T2-weighted MRI of N = 176 patients with STS were retrospectively obtained from a single institution. (Table) Tumor regions were manually annotated by a radiologist. The radiomic features included textural features, e.g. gray-level co-occurrence matrix features, which quantify the correlation between textural patterns within annotated regions. Maximum relevance minimum redundancy feature selection was employed to identify top 10 radiomic features that are associated with STS malignancy. Then, the identified features were integrated to generate a radiomic risk score (RRS) via logistic regression on a 10-fold cross validation to differentiate benign and malignant STS. Multivariate analysis and the area under the receiver operating characteristic curve (AUC) were employed to evaluate the association of RRS and clinical parameters, including age, gender, and STS location, with STS malignancy. Results: Multivariate analysis illustrated that age and RRS are independent variables in predicting STS malignancy (p < 0.05). The RRS yielded AUC as 0.76 (confidence interval (CI): 0.69-0.83), age 0.71 (CI: 0.64-0.79) and the combination of the RRS and age 0.84 (CI: 0.78-0.90). Conclusions: The RRS generated by radiomic features was found to be a significant predictor of STS malignancy. Furthermore, RRS could provide complementary information to the clinical parameters in differentiating benign and malignant STSs.[Table: see text]

Background and objectives Success rates for initial image-guided biopsy of musculoskeletal (MSK) lesions have been well documented; evidence regarding success rates for repeat biopsy following initially nondiagnostic (ND) image-guided biopsy of MSK lesions is more limited. This study evaluates the outcomes of repeat computerized tomography-guided MSK biopsies following ND biopsies using a multidisciplinary approach. Materials and methods Electronic medical record search covering a 10-year period identified patients that received two or more biopsies for an MSK tumor or tumor-like process. The decision for initial and repeat image-guided biopsy of each lesion was made following multidisciplinary MSK tumor board review. Lesion location, histopathology results, size of biopsy needle when available, and change in technique between biopsy attempts was documented. Results Repeat biopsy rate was 1.6%. 23 patients with repeat MSK biopsy were identified. A total of 17 of 23 (74%) repeat biopsy attempts were diagnostic. A total of 22 of 23 (96%) repeat biopsy attempts were clinically useful. Diagnostic repeat biopsies were described as employing one or more of five technical differences compared to the first biopsy attempt, the most common being improved targeting of the lesion itself. Conclusions A multidisciplinary approach may yield improved repeat-biopsy rates and clinical utility of repeat MSK biopsies compared to prior reports.

A 67-year-old male presented with papilledema and back pain localized to the T10 level. Initial workup revealed multifocal spinal ependymoma which was resected and treated with external beam radiotherapy. Nine years after treatment, the patient had a relapse of back pain, and MRI was inconclusive in distinguishing posttreatment radiation necrosis from recurrent tumor. We present the first described report with the utilization of multiparametric positron emission tomography-magnetic resonance imaging and perfusion MRI to distinguish recurrent spinal ependymoma from radiation necrosis.

Purpose To evaluate the imaging, histologic changes and safety of computed tomography (CT)–guided cryoablation of the parotid glands in a porcine model. Materials and Methods Unilateral CT–guided parotid gland cryoablation was performed in 5 juvenile miniature pigs. The ablated parotid glands underwent 2 cycles of 10-minute freeze and 5-minute thaw using three 17-g cryoprobes. The animals were monitored daily for complications including pain, frostbite, infection, and sialocele or fistula formation. Follow-up CT was performed at 6 weeks postcryoablation. Pathologic evaluation was performed on 2 of the ablated parotid glands. Results All cryoablations in 5 right parotid glands, with 3 sites in each gland, were technically successful. No symptoms suggestive of facial nerve damage were observed during 6-week follow-up. One pig developed an infected sialocele, which was treated with percutaneous drainage and oral antibiotic therapy. No CT evidence of sialocele or other abnormality was identified at the 6-week follow-up in all pigs. Histologic evaluation was performed on 2 of the parotid gland specimens, 1 with the treated sialocele, and 1 of the remaining pigs without sialocele. Both glands demonstrated postprocedural intraglandular lymph nodes and reactive changes without evidence of sialocele or abscess on histopathology. Conclusions Cryoablation of parotid glands was technically feasible in a porcine model. Only 1 pig developed sialocele, which was successfully treated. Further research is warranted to determine the potential use of salivary gland cryoablation to treat patients with drooling.

The locally injected blood elements (LIBE) technique represents a useful alternative to systemic administration of blood products to reduce the risk of periprocedural hemorrhage in coagulopathic patients. The LIBE technique results in the creation of a “seroma” of platelets and/or blood products along the expected needle or instrument path to allow a high-quality blood clot to form, and it requires relatively less blood products compared to the more traditional systemic administration technique. Indications for LIBE include and expand on those for systemic administration of blood products to reverse pre-procedural coagulopathy, including contraindications to systemic reversal of pharmacologic anticoagulation, precarious fluid volume status, severe coagulopathy unlikely to normalize with systemic administration of blood products, patient history of adverse reaction to systemic administration of blood products, and limited availability of the desired blood product.

Preprocedural evaluation of patients in an interventional radiology (IR) clinic is a complex synthesis of physical examination and imaging findings, and as IR transitions to an independent clinical specialty, such evaluations will become an increasingly critical component of a successful IR practice and quality patient care. Prior research suggests that preprocedural evaluations increased patient's perceived quality of care and may improve procedural technical success rates. Appropriate documentation of a preprocedural evaluation in the medical record is also paramount for an interventional radiologist to add value and function as an effective member of a larger IR service and multidisciplinary health care team. The purpose of this study is to examine the quality of radiology resident notes for patients seen in an outpatient IR clinic at a single academic medical center before and after the adoption of clinic note template with reminders to include platelet count, international normalized ratio, glomerular filtration rate, and plan for periprocedural coagulation status. Before adoption of the template, platelet count, international normalized ratio, glomerular filtration rate and an appropriate plan for periprocedural coagulation status were documented in 72%, 82%, 42%, and 33% of patients, respectively. After adoption of the template, appropriate documentation of platelet count, international normalized ratio, and glomerular filtration rate increased to 96%, and appropriate plan for periprocedural coagulation status was documented in 83% of patients. Patient evaluation and clinical documentation skills may not be adequately practiced during radiology residency, and tools such as templates may help increase documentation quality by radiology residents.

The trace metal content of municipal solid waste (MSW) compost affects the quality and potential end uses of the finished product. The impact of typical contaminants found in the organic fraction of MSW on the trace metal content of compost was investigated. Contaminants including alkaline batteries, galvanized nails, zinc-plated screws, copper wires, and electronic cables were exposed to a thermophilic composting process for three weeks. The increase in trace metal content in the compost product was measured at the end of the composting process. The results showed that low-quality alkaline batteries, galvanized nails, zinc-plated nails, and copper wires had a significant impact on the zinc, copper, arsenic, lead, and cobalt contents of compost. Copper wires showed the highest impact on copper content, which was 52% of the Canadian Council of Ministers of the Environment (CCME) Category A limit in the final compost. Galvanized nails contributed to final levels of zinc reaching 30% of the CCME Category A l...

A concern regarding MSW compost quality is the trace metal content. A study was initiated to assess the impact of various metal contaminants on compost quality. One critical step in the study was to estimate metal transfer during composting, which was achieved by measuring the corrosion rate of different contaminants during the high rate composting stage for 3 weeks using alfalfa hay and straw as composting substrate. A corrosion quantification technique, weight loss/gain of metal specimens, was employed to estimate metal release into composting substrate. Among the 7 types of contaminants, stainless steel screws, brass screws, and light bulb aluminum alloy thread contacts showed little weight changes. This suggests minimum concerns for these materials in terms of metal release during composting. The highest metal release per unit area was from light bulb foot contacts, which was 3.66 × 10−3 g cm−2, while galvanized steel nails and zinc plated screw had a metal release rate in the range of 1.5 to 1.9 × 10...

Patient is a 29-year-old with a history of recurrent growth hormone-secreting pituitary macroadenoma diagnosed 12 years prior to presentation. Eight years prior to current presentation, the patient underwent re-resection and received 50.4 Gy external beam radiotherapy (EBRT) in 28 fractions of 1.8 Gy each. Serial postradiation MRIs demonstrated regression in pituitary tumor size. Patient presented with new headaches 7.5 years after completing EBRT. Brain MRI demonstrated new FLAIR hyperintensity and contrast enhancement within the pons and medulla, corresponding to the 36 Gy isodose line of each radiation dose fraction. Differential diagnosis included radiation necrosis and radiation-induced glioma (RIG). The patient's neurologic exam worsened over the following 4 months. MRI showed progressive increase in mass effect, extent of FLAIR hyperintensity, and contrast enhancement in the brainstem. Stereotactic-assisted biopsy showed infiltrating astrocytoma with moderate atypia. A PubMed search showed this is the first case of histologically verified brainstem RIG correlated with 3-dimensional conformational radiation therapy dose and volume planning following EBRT for a pituitary adenoma. The rare occurrence of brainstem RIG after radiation therapy for pituitary tumor supports the need for long-term imaging monitoring of such patients.

Radiofrequency ablation technique for treatment of OO including ablation time and temperature vary greatly between and within reported studies. This study evaluates the immediate and long-term efficacy and complication rate of a two sequential RFA technique for OO. We retrospectively reviewed medical records and attempted interview follow-up for 25 patients treated with RFA for OO. Each treatment included 2 consecutive RFAs at 90 °C for 6 min with inter-ablation cooling to 40 °C and occasional inter-ablation probe adjustment. Additionally, we statistically compared the proportion of successful ablations using the DCRFA technique with published studies that utilized alternative OO ablation procedures. Long-term follow-up was obtained for 24 patients (96 %). Mean patient age at DCRFA was 17.2 years (range, 2.2–50.0 years). Mean time to follow-up was 60 ± 42 months (range 12–152 months). No acute DCRFA-related complications nor long-term recurrences were reported. All 24 interviewed patients reported partial relief of pre-procedural pain within 1 day of DCRFA and total relief within 1 week of DCRFA. One patient ultimately developed a major late complication (complex regional pain syndrome of the left ankle) after DCRFA of a cuboid lesion. Additionally, the DCRFA success rate was significantly higher when compared to two other published OO RFA treatment results. DCRFA employing two sequential 6-min cycles is an effective treatment of OO. The 100 % primary success rate, 0 % long-term recurrence rate, and low complication rate compare favorably and may be superior to results of prior reports.

Patient satisfaction is becoming an increasingly important part of America's healthcare system. Patient satisfaction is now a metric assessed for value-based incentive payments by the Center for Medicare and Medicaid Services, and the healthcare market is becoming increasingly consumer-driven as patients are provided with more options regarding where they receive care as well as improved access to medical information. Radiologists, while less involved with direct patient care than other medical specialties, are not immune to the changing medical landscape and need to adapt to a progressively value- and patient-oriented healthcare system. At our institution, first-year radiology residents take an active role in our outpatient interventional radiology clinic by performing clinical histories and physical exams in a dedicated radiology clinic examination rooms. Stressing the various opportunities for patient interaction and the potential benefits of patient- centered radiology in the evolving healthcare system may increase its perceived value among both radiology residents as well as practicing radiologists. ​Directly engaging patients may be unfamiliar territory for the practicing radiologist and an unexpected prospect for current residents, but available data suggests that patients do value direct interaction with radiologists during the course of their care.

PURPOSE: In a prior study of malignant brain tumors, we found 18F-FDG PET/MR to be superior to 18F-FDG PET/CT for distinguishing between progressive disease (PD) and radiation change (RC) (unpublished data). The purpose of this study is to compare the diagnostic accuracy of 18F-FDG PET/CT vs. 18F-FDG PET/MR in differentiating PD from RC in a subpopulation of malignant gliomas. METHODS: We evaluated 10 patients with high-grade gliomas whom had previously undergone chemoradiation therapy and developed MR evidence of PD per RANO criteria. All patients underwent 18F-FDG PET/CT, 18F-FDG PET/MR (MR attenuation correction, PET/MRAC), and conventional diagnostic MR (PET/MRD). pMR was also performed. Separate consensus blinded readings by two fellowship-trained radiologists (1 neuroradiology; 1 nuclear) were performed to assess the diagnostic efficacy of PET/CT, PET/MRAC, and PET/MRD. A qualitative subjective rating was given to each lesion (1 = definite RC; 2 = probable RC; 3 = equivocal; 4 = probable PD; 5 = definite PD). Sensitivity, specificity, and accuracy were determined for the three interpretation sessions after binary reclassification, with a rating of 1-3 defined as RC and 4-5 defined as PD. Wilcoxon-rank test was used for rating comparison between the three interpretations. RESULTS: PET/CT yielded sensitivity, specificity, and accuracy of 0.78, 1.00, and 0.80, respectively. Both PET/MRAC and PET/MRD demonstrated a sensitivity, specificity, and accuracy of 1.00, 1.00, and 1.00. There was no statistically significant difference in interpretation between PET/CT, PET/MRAC or PET/MRD. CONCLUSION: In this small series, 18F-FDG PET/MR utilizing either diagnostic or attenuation-only MR sequences had higher sensitivity and overall accuracy in delineating progressive disease from radiation change in glioma patients compared to 18F-FDG PET/CT. However, the difference was not statistically significant. A larger series is in progress to increase the power of the study in interpretation between 18F-FDG PET/MR and 18F-FDG PET/CT.

Contrast enhancement of the vertebral body marrow may be seen secondary to collateral venous blood flow via the vertebral venous plexus in the setting of superior vena cava obstruction. We report a 48-year-old woman presenting with bilateral brachiocephalic vein obstruction and multilevel thoracic spine hyperdensities as seen on venous-phase CT angiography (CTA), initially concerning for sclerotic neoplastic lesions. A contrast-enhanced CT of the neck obtained 1 day prior to the chest CTA did not demonstrate any osseous abnormality, and inspection of the chest CTA demonstrated filling of perivertebral venous collateral vessels. The abnormal vertebral body enhancement was therefore feltsecondary to retrograde collateral venous flow via the basivertebral venous plexus in the setting of functional SVC obstruction. Vertebral body enhancement should be considered in patients with thoracic central venous obstruction when enhancement or apparent sclerosis of the vertebral bodies is seen on CTA.

The objectives of the study were to determine the chemical composition and layer charge of smectite found in calcareous till of the Interior Plains region of western Canada and to examine the effects of acidification on alteration of the smectite. Samples of acidified and non-acidified (calcareous) late- Wisconsin till were obtained from four soil pits located immediately adjacent to an elemental sulfur block located in southern Alberta. Samples of the surface material (0-10 cm depth) had been subjected to extreme acidity for 25 years due to the oxidation of elemental sulfur and displayed pH values of about 2.0. Samples of the till obtained at depth (65-75 cm) remained calcareous with pH values between 7.3 and 7.6. A combination of analytical methods was used to determine the chemical composition of the smectite found in the samples. The layer charge of the smectite was determined independently using X-ray diffraction data for n-alkylammonium saturated specimens. Smectite found in the non-acidified calcareous material was characteristic of montmorillonite with a low content of Fe and very little sub- stitution of A1 for Si in the tetrahedral sheet. The smectite had a structural formula of M+o 40(Si3.96A10 04)(ml= 56Fe3+o.~oMgo.33)O~o(OH)2 , which compared well with a mean value for layer charge of 0.399 mol(-)/O~o(OH)2 determined using X-ray diffraction data for n-alkylammonium treated spec- imens. Smectite remaining in the till material subjected to extreme acidity underwent incongruent dis- solution with a net loss of layer charge and preferential loss of octahedral Mg.

Equation 5 appearing in Warren, C. J., M. J. Dudas, and S. A. Abboud. 1992. Effect of acidification on the chemical composition and layer charge of smectite from calcareous till. Clays & Clay Miner. 40: 731–739 for the calculation of the total amount of expandable 2:1 clay assigned to each charge range is incorrect.