Journal of Vascular and Interventional Radiology最新文献

Histotripsy is a noninvasive ablation modality approved for the treatment of liver tumors. As the technique sees greater clinical use, the incidence and ramifications of vascular complications in humans needs to be established. Four academic medical centers were included in this preliminary study. At the study centers, 139 patients were treated with hepatic histotripsy. A total of four (4/139 = 2.9%) patients were diagnosed with serious vascular injuries (SIR grade III [severe] adverse event), all of which were diagnosed on post-procedure contrast-enhanced CT. Three of four cases required embolization to control hemorrhage. The majority (n = 3/4) recovered, but two required prolonged hospitalization, and one expired. This preliminary case series demonstrates that vascular adverse events are possible after histotripsy. Immediate post-treatment contrast-enhanced CT may help to identify (and subsequently manage) possible vascular adverse events, emergent embolization may be required for treatment. Post-histotripsy hemorrhage can have serious long-term consequences despite early intervention.

Purpose: To assess the performance of an adverse event (AEs) detection algorithm designed to more accurately identify and classify bleeding AEs among all percutaneous liver and renal biopsies at a single institution over a 3-year period to a provider-reported quality tracking (QT) system.

Materials and methods: All percutaneous liver and renal biopsies performed at a single institution over a 3-year period were evaluated. An algorithm developed to detect biopsy-related bleeding AEs using key words and events in the electronic medical record (EMR) was employed. Charts flagged by the AE detection algorithm, QT system or biopsy database review were manually reviewed. AE incidence, sensitivity and specificity of the algorithm based on retrospective chart review was compared to provider-reported QT data. Fisher test was used to calculate p-values.

Results: 4821 liver and 1320 renal biopsies were performed during the study period. Retrospective review identified 57 (1.16%) and 104 (7.8%) bleeding-related AEs in the liver and renal biopsy groups, respectively. The detection algorithm reported 82 and 116 AEs, in the liver (sensitivity 100%, specificity 99.5%) and renal (sensitivity 99%, specificity 98.9%) biopsy cohorts, respectively. The QT system reported 37 and 31 bleeding-related AEs, in the liver (sensitivity 63.2%, specificity 99.9%) and renal (sensitivity 29.8%, specificity 100%) biopsy cohorts, respectively. The algorithm outperformed QT in AE detection in both liver and renal biopsy (p<0.001) cohorts.

Conclusion: A procedure-specific detection algorithm improves identification of bleeding AEs among percutaneous liver and renal biopsies compared to a provider-reported system alone.

This proof-of-concept study with short-term follow-up reports the development of a mouse hepatic artery embolization (HAE) model for translational research of interventional oncology. To induce liver metastases, luciferase-expressing colon cancer cells were injected into the spleens of BALB/c mice. After confirming hepatic tumor engraftment, HAE was performed by retrograde puncture of the lienogastric artery using a 34G needle under microscopy. Six mice received microbead injections (HAE group), and five served as controls. Technical success rate was 100%; however, 2-day survival was 67% (4/6) for the HAE group. Bioluminescent imaging the day after the procedure showed a significant reduction in luciferase activity for the HAE group (p < 0.001), but not for controls (p = 0.367). Histological analysis revealed larger necrotic areas in the HAE group than in controls (IQR, 18.2% vs. 0.0%; p < 0.05). This model might provide a valuable platform for translational research of interventional oncology.

Purpose: To identify the optimal tumor absorbed dose (TAD) thresholds predictive of radiological complete response (CR) in patients with localized hepatocellular carcinoma (HCC) undergoing resin-based Y-90 transarterial radioembolization (TARE).

Materials and methods: This retrospective single-center study included 160 HCC patients treated with resin-based Y-90 TARE, four dosimetric metrics-mean absorbed dose (mAD), pre-treatment TAD (Pre-TAD), post-treatment TAD (Post-TAD), and virtual TAD (vTAD)-were analyzed. Pre-TAD and Post-TAD were retrospectively measured using SPECT/CT and PET/CT images, respectively. The vTAD was calculated assuming that Y-90 microspheres were distributed exclusively within the tumor. Tumor response was assessed using modified RECIST criteria. Cut-off thresholds for predicting CR were determined using maximally selected rank statistics.

Results: Mean tumor size was 8.6cm (median size, 7.9 cm [IQR, 5.6-10.2 cm]), and 68 (42.5%) patients had single nodular tumor. Median mAD, Pre-TAD, Post-TAD, and vTAD were 178Gy (IQR, 124 - 228 Gy), 375 Gy (IQR, 219 - 514 Gy), 427 Gy (IQR, 283 - 605 Gy), and 728 Gy (IQR, 417 - 1105 Gy), respectively. Complete response was achieved in 37.5% (60/160) of patients. Multivariate analysis identified vTAD > 597 Gy as the independent predictor of CR (p = 0.004).

Conclusion: A vTAD ≥ 600 Gy represents a practical and reliable threshold for predicting CR in resin-based TARE. Given its ease of calculation and independence from registration artifacts, vTAD may serve as a valuable dosimetric tool in both clinical practice and treatment planning.

Purpose: To compare the efficacy of preemptive oxycodone versus sufentanil for acute and delayed pain control after transcatheter arterial chemoembolization (TACE).

Materials and methods: In this prospective, double-blind trial, 40 patients scheduled for TACE were randomized to receive intravenous oxycodone (0.1 mg/kg) or sufentanil (0.1 μg/kg) 15 minutes pre-TACE. Pain intensity was assessed using a visual analogue scale (VAS) during acute (0-24h) and delayed (days 2-7) phases. Inflammatory biomarkers (white blood cell count, neutrophil percentage, C-reactive protein, interleukin-6 [IL-6]) were measured at baseline and 24 hours post-TACE. The primary outcome was the highest acute-phase VAS scores; secondary outcomes included delayed-phase pain, changes in inflammatory biomarkers, and adverse events.

Results: Oxycodone demonstrated superior analgesia, with lower (median, interquartile range[IQR]) intraprocedural VAS scores (0[0-1.0] vs 3.5[1.3-4.8], P<0.001) and reduced incidence of moderate-to-severe pain (5% vs 50%, P=0.003). This benefit persisted at 1-6 hours post-TACE (0[0-1.0] vs 2[0-3.0], P=0.042). During the delayed phase, oxycodone maintained lower pain scores (0[0-0] vs 0[0-3.8], P=0.042) and fewer episodes of moderate pain (0% vs 25%, P=0.047). IL-6 elevation was greater in patients developing delayed pain (671.16% vs 135.97% increase, P=0.030). Adverse event rates were comparable.

Conclusion: Preemptive oxycodone provided more effective acute and delayed pain control after TACE compared to sufentanil, with comparable safety. The association between IL-6 elevation and delayed pain suggests an inflammatory pain component, supporting further investigation of combined opioid and anti-inflammatory strategies.

Purpose: To investigate dose heterogeneity in liver tumors and non-tumor target liver following transarterial radioembolization (TARE) by developing an experimental magnetic resonance imaging (MRI)-compatible ex vivo perfusion model based on human tumor-bearing livers, and to validate the observed heterogeneity patterns against in vivo data.

Materials and methods: Fractionated TARE was performed under MRI in four machine-perfused human tumor-bearing liver explants using fluorescent holmium microspheres. Dose heterogeneity was quantified by calculating the homogeneity index (HI) from MRI-based dose maps (voxel size <2.5 mm). These results were validated against HI values from two TARE-treated patients. Fluorescence microscopy was used to assess the microscopic distribution of four distinct microsphere fractions.

Results: MRI-based dose maps revealed lower heterogeneity in liver tumors (mean HI 2.41, range 0.72-4.43) compared to non-tumor target liver (mean HI 2.95, range 1.58-5.94), but this difference was not significant (p = 0.06) and was primarily driven by higher microsphere concentrations in tumors, which were associated with reduced heterogeneity (ρ = -0.88, p < 0.001). Microspheres administered in consecutive fractions decreased the HI while mostly preserving the spatial distribution pattern of earlier fractions, as confirmed by fluorescence microscopy.

Conclusion: TARE induces heterogeneous dose distributions in both liver tumors and non-tumor target liver at a scale below the resolution of nuclear imaging. While these findings provide insight into microsphere distribution and dose heterogeneity, the clinical significance of fine-scale dose heterogeneity and its potential impact on treatment outcomes remains uncertain and warrants further investigation.

Purpose: To evaluate the safety and effectiveness of coil-only middle meningeal artery (MMA) embolization for the treatment of subacute to chronic subdural hematoma (SDH) in patients with cancer.

Materials and methods: A single-center retrospective analysis was performed of 30 cancer patients with SDH, 12 of whom had bilateral hematomas, who underwent MMA embolization of the affected side(s) using coils alone between 2022 and 2025. Clinical and radiographic outcomes were evaluated, including hematoma resolution, change in SDH thickness, need for reoperation, and overall survival.

Results: Median SDH thickness declined from 12 mm (IQR 9) pre-embolization to 3.6 mm (IQR 8.8) on final imaging (Wilcoxon signed-rank z = 4.59, p < 0.001). A ≥50% reduction was observed in 56% of SDHs, and complete radiographic resolution in 37%. One patient (3%) required surgical evacuation after MMAE. Seventeen patients (59%) died due to cancer progression during follow-up. Median survival was significantly longer among patients with reduced hematoma thickness at initial follow-up imaging (148 vs 29 days, log-rank p = 0.0002).

Conclusion: Coil-only MMAE may be a safe and effective treatment option for SDH in patients with cancer. Reduction in hematoma thickness was associated with longer survival in this high-risk population.

Purpose: To evaluate differences in burnout, perceived stress, and job satisfaction among physicians, nurses, and technologists working in interventional radiology (IR) and cardiology (IC) teams within a high-volume, 24/7 tertiary care center.

Material and methods: This cross-sectional, questionnaire-based study was conducted at XXXXX's largest high-volume tertiary interventional center. Data were collected on-site using standardized instruments: the Maslach Burnout Inventory (MBI), the Perceived Stress Scale (PSS-14), and the Minnesota Satisfaction Questionnaire (MSQ). Group comparisons were performed using Mann-Whitney U and chi-square tests. Structural equation modeling (SEM) was used to explore direct and indirect effects among stress, burnout, and job satisfaction.

Results: IR physicians reported significantly higher emotional exhaustion (median: 26.0 vs. 20.0, p=0.025) and depersonalization (17.0 vs. 8.0, p<0.001) compared to IC physicians. Among staff, burnout levels were greater in IC personnel than in IR staff, with higher scores in emotional exhaustion (20.5 vs. 15.0, p=0.002) and depersonalization (9.5 vs. 5.0, p=0.010). IC staff also demonstrated significant lower job satisfaction across all subscales (all p<0.001). SEM revealed that perceived stress negatively impacted job satisfaction directly (β = -0.903, p<0.001) and indirectly via emotional exhaustion. The model explained for 34.4% of the variance in job satisfaction.

Conclusion: Burnout, perceived stress, and job satisfaction levels differed between interventional radiology and cardiology teams. IR physicians reported higher levels of burnout, while IC staff demonstrated lower job satisfaction. These findings highlight the need for targeted institutional strategies tailored to the specific needs of each group.