Techniques in Vascular and Interventional Radiology最新文献

Role of Liver Function Assessment in Portal Venous Interventions and Locoregional Therapies for Liver Tumors 肝功能评估在肝肿瘤门静脉干预和局部治疗中的作用

IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2025-10-09 DOI: 10.1016/j.tvir.2025.101089

Monika Neale DO , Jirapa Chansangrat MD , Amrit Khooblall MBA , Nicholas Austin DO , Chase J. Wehrle MD , Federico Aucejo MD , Ramanpreet Singh MS4 , Sameer Gadani MD

Functional liver assessment has undergone major evolution over the past 30 years. Assessment techniques have progressed from biochemical markers to advanced imaging techniques, particularly nuclear medicine imaging, to improve accuracy. The focus of assessment has also shifted from global hepatic function to precise segmental evaluation. This paradigm shift has greatly influenced liver-directed therapies such as hepatic resection, augmentation, transplantation, and interventional radiology. The aim of this review was to synthesize key developments in liver function assessment, including nuclear medicine techniques, hepatocyte-specific magnetic resonance imaging (MRI), and emerging multimodal and artificial intelligence (AI)-driven approaches. Select literature from the past three decades was examined, with an emphasis on innovations, validation studies, and clinical applications. Incorporating Tc-99 m mebrofenin hepatobiliary scintigraphy (HBS) into liver function assessment allowed quantitative, regional mapping of hepatocellular function. Gadoxetate-enhanced dynamic magnetic resonance imaging (MRI) has created an opportunity for high-contrast resolution images and noninvasive assessment of hepatocyte uptake and excretion. Novel positron emission tomography tracers such as C-11 acetate enabled the combined evaluation of parenchymal function and tumor biology. Studies exploring multimodal fusion, artificial intelligence (AI)-assisted image processing, and incorporating deep learning into predictive models for individualized risk assessment are underway. Overall, integrating anatomical and functional data has become increasingly widespread, allowing for a more precise evaluation of liver function and improvement of therapeutic outcomes. However, reproducibility, standardization, and accessibility remain potential impediments to broad implementation. Future directions for research include prospective validation studies, multimodal fusion, utilizing deep learning in risk stratification, and the development of individualized treatment strategies tailored to patient-specific risk profiles.

肝功能评估在过去30年中经历了重大的发展。评估技术已经从生化标记发展到先进的成像技术，特别是核医学成像，以提高准确性。评估的重点也从整体肝功能转移到精确的肝段评估。这种模式的转变极大地影响了肝定向治疗，如肝切除、肝强化、肝移植和介入放射学。本综述的目的是综合肝功能评估的关键进展，包括核医学技术，肝细胞特异性磁共振成像（MRI），以及新兴的多模式和人工智能（AI）驱动的方法。从过去三十年的选择文献进行了检查，重点是创新，验证研究和临床应用。将tc - 99m甲溴非宁肝胆闪烁成像（HBS）纳入肝功能评估，可以定量地绘制肝细胞功能的区域图。加多赛特增强的动态磁共振成像（MRI）为高对比度分辨率图像和肝细胞摄取和排泄的无创评估创造了机会。新型正电子发射断层扫描示踪剂，如C-11醋酸盐，可以综合评估实质功能和肿瘤生物学。探索多模态融合、人工智能（AI）辅助图像处理以及将深度学习纳入个性化风险评估预测模型的研究正在进行中。总的来说，整合解剖和功能数据已经变得越来越普遍，允许更精确的肝功能评估和改善治疗结果。然而，可重复性、标准化和可访问性仍然是广泛实施的潜在障碍。未来的研究方向包括前瞻性验证研究、多模式融合、在风险分层中利用深度学习，以及针对患者特定风险概况制定个性化治疗策略。

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引用次数: 0

TIPS Revision: Indications, Techniques, and What to Consider When Revision Fails TIPS修订：适应症、技术以及修订失败时应考虑的事项

IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2025-10-03 DOI: 10.1016/j.tvir.2025.101083

Nathan Loudon MD , Jonathan Lorenz MD , Ronald Arellano MD , Baljendra Kapoor MD

To review the current indications, surveillance strategies, and technical approaches for transjugular intrahepatic portosystemic shunt (TIPS) revision, with emphasis on ultrasound surveillance limitations, surveillance models, and management of refractory complications, including novel approaches such as parallel TIPS. Comprehensive review of current literature on TIPS revision procedures, surveillance protocols, and management of TIPS-related complications. TIPS dysfunction occurs in 10%-20% of patients within the first year despite covered stent technology. Ultrasound surveillance remains the cornerstone of monitoring but has significant limitations. Novel approaches including parallel TIPS placement and advanced management strategies for refractory ascites show promising results. TIPS revision requires careful patient selection, optimized surveillance protocols, and advanced technical expertise. Emerging technologies and treatment paradigms continue to evolve, improving outcomes for patients with complex portal hypertensive complications.

回顾目前经颈静脉肝内门体分流术（TIPS）翻修的适应症、监测策略和技术方法，重点是超声监测的局限性、监测模型和难治性并发症的处理，包括平行TIPS等新方法。全面回顾TIPS修订程序、监测方案和TIPS相关并发症管理的现有文献。尽管采用覆膜支架技术，仍有10%-20%的患者在第一年出现TIPS功能障碍。超声监测仍然是监测的基础，但有明显的局限性。包括平行TIPS放置和先进的难治性腹水管理策略在内的新方法显示出有希望的结果。TIPS修订需要仔细选择患者，优化监测方案和先进的技术专长。新兴技术和治疗模式不断发展，改善了复杂门脉高压并发症患者的预后。

引用次数: 0

Interventional Radiology Management of Pediatric Portal Venous Pathologies 小儿门静脉病变的介入放射学治疗

IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2025-10-03 DOI: 10.1016/j.tvir.2025.101085

Jakob Spogis MD , Gerd Grözinger MD

Portal venous pathology is a leading cause of prehepatic portal hypertension in children, most often resulting from portal vein thrombosis (PVT), either in the native liver or following liver transplantation. While surgical shunts such as the Meso-Rex shunt and Warren shunt remain the first-line therapy, interventional radiology (IR) now plays a central role in primary and adjunctive treatment strategies. This review outlines current IR techniques for managing pediatric portal venous disorders. These include portal vein recanalization (PVR), salvage of thrombosed Meso-Rex and Warren shunts, and transjugular intrahepatic portosystemic shunt (TIPS) placement. Technical aspects are emphasized, including pediatric-specific access strategies (eg, translienal puncture, CBCT guidance, wire targeting, and stent selection), and outcome data are presented where available.

门静脉病理是儿童肝前门静脉高压症的主要原因，大多数由门静脉血栓形成（PVT）引起，无论是在原生肝脏还是在肝移植后。虽然Meso-Rex分流器和Warren分流器等外科分流器仍然是一线治疗方法，但介入放射学（IR）现在在主要和辅助治疗策略中发挥着核心作用。这篇综述概述了目前用于治疗儿童门静脉疾病的IR技术。这些包括门静脉再通术（PVR），血栓形成的Meso-Rex和Warren分流术的挽救，以及经颈静脉肝内门静脉系统分流术（TIPS）的放置。强调技术方面，包括儿科特定的通路策略（例如，经脾穿刺、CBCT引导、导线瞄准和支架选择），并在可用的情况下提供结果数据。

引用次数: 0

Impact of Changes in Body Composition after Transjugular Intrahepatic Portosystemic Shunt Creation on Morbidity and Mortality: A Systematic Review 经颈静脉肝内门静脉系统分流术后机体成分变化对发病率和死亡率的影响：一项系统综述

IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2025-10-03 DOI: 10.1016/j.tvir.2025.101076

Takeshi Suzuki MD, PhD, Khashayar Farsad MD, PhD

Changes in body composition, including the reversal of sarcopenia, after transjugular intrahepatic portosystemic shunt (TIPS) creation have been reported to impact morbidity and mortality. This systematic review aims to identify changes in body composition that could serve as markers for post-TIPS outcomes in patients with cirrhosis. Electronic databases including Ovid Medline, Embase, and Central Register of Controlled Trials were searched from inception to February 5, 2025 to analyze the impact of changes in body composition on post-TIPS outcomes in patients with cirrhosis. A total of 16 studies were included in the review. Most studies reported that post-TIPS skeletal muscle gain often caused a reversal of sarcopenia (18%-66%) and contributed to improvements in morbidity and mortality. In particular, patients with pre-TIPS sarcopenia received the greatest benefit. Skeletal muscle index showed the most substantial increase within 6 months after TIPS creation, while the psoas muscle index or the transverse psoas muscle thickness/ height increased as early as 1-3 months after TIPS creation. Reversal of sarcopenia after TIPS creation may contribute to improvements in morbidity and mortality in cirrhosis. Skeletal muscle tends to show the most substantial increase within 6 months after TIPS creation, with the psoas muscle index observed as an early imaging biomarker. Further research is needed to identify the underlying physiologic mechanisms responsible for these observed body composition changes and to prospectively assess the impact on clinical outcomes.

经颈静脉肝内门静脉系统分流术（TIPS）产生后，身体成分的改变，包括肌肉减少症的逆转，已被报道影响发病率和死亡率。本系统综述旨在确定身体成分的变化，这些变化可以作为肝硬化患者tips后预后的标志物。从开始到2025年2月5日，检索了包括Ovid Medline、Embase和Central Register of Controlled Trials在内的电子数据库，以分析身体成分变化对肝硬化患者tips后结局的影响。本综述共纳入了16项研究。大多数研究报道，tips术后骨骼肌增加通常会导致肌肉减少症的逆转（18%-66%），并有助于改善发病率和死亡率。特别是，tips前肌肉减少症患者获益最大。在TIPS制作后6个月内，骨骼肌指数的增加最为明显，而腰肌指数或腰肌横肌厚度/高度在TIPS制作后1-3个月内增加。TIPS产生后肌肉减少症的逆转可能有助于改善肝硬化的发病率和死亡率。在TIPS形成后的6个月内，骨骼肌往往表现出最显著的增长，腰肌指数被观察为早期成像生物标志物。需要进一步的研究来确定导致这些观察到的身体成分变化的潜在生理机制，并前瞻性地评估对临床结果的影响。

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引用次数: 0

Endovascular Management of Bleeding Ectopic Varices 出血异位静脉曲张的血管内治疗

IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2025-10-03 DOI: 10.1016/j.tvir.2025.101080

Mario Dervishi MD, Alex Stevens DO, Christopher Sutter MD, Ignacio Chiong MD, Jon Davidson MD, FSIR

Ectopic varices are dilated nongastroesophageal mesoportal veins that occur due to hepatic portal hypertension, portomesenteric occlusion, or prior abdominal surgeries, with less common causes including congenital conditions. These varices can occur in various locations, including the duodenum, jejunum, large bowel, and biliary system, and can lead to clinically significant gastrointestinal hemorrhages warranting intervention. An understanding of ectopic variceal anatomy and the etiology of variceal bleeding is imperative to optimal treatment. Despite a lack of standardized treatment guidelines, endovascular management remains vital for controlling bleeding and improving patient outcomes.

异位静脉曲张是由肝门静脉高压、门静脉阻塞或既往腹部手术引起的非食道门静脉扩张，其常见原因包括先天性疾病。这些静脉曲张可发生在各个部位，包括十二指肠、空肠、大肠和胆道系统，并可导致临床上明显的胃肠道出血，需要干预。了解异位静脉曲张解剖和静脉曲张出血的病因是优化治疗的必要条件。尽管缺乏标准化的治疗指南，但血管内管理对于控制出血和改善患者预后仍然至关重要。

引用次数: 0

Evolving Strategies in the Management of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: A Narrative Review of Locoregional and Surgical Therapies 肝细胞癌合并门静脉肿瘤血栓形成的治疗策略的演变：局部和外科治疗的叙述回顾

IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2025-10-02 DOI: 10.1016/j.tvir.2025.101081

Juana Valentina Barrera BME, MS , Maria del Pilar Bayona Molano MD, FSIR

This narrative review aims to provide a comprehensive, chronological evaluation of current and emerging treatment strategies for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT), with a particular focus on the evolving role of locoregional therapies. Although PVTT is historically associated with poor prognosis and limited therapeutic options, advancements in systemic, surgical, and locoregional interventions have expanded the treatment landscape. The methodology involved a structured literature search using PubMed with therapy-specific keywords, supplemented by targeted queries in Open Evidence to identify relevant clinical trials and meta-analyses. Studies were organized in chronological order to reflect the evolution of therapeutic strategies. Systemic therapies, including tyrosine kinase inhibitors and immune checkpoint inhibitors, have shown steady improvements in overall survival (OS). Recent trials combining agents such as atezolizumab and bevacizumab have pushed median OS beyond 19 months. Locoregional therapies such as transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) have demonstrated survival benefits in selected PVTT cases, particularly when PVTT is limited to segmental or lobar branches. Combining TACE or TARE with systemic therapies further improves outcomes, with studies reporting higher objective response rates and extended progression-free survival. Surgical resection remains feasible in patients with preserved liver function and limited PVTT (Vp1–Vp2), with several studies and meta-analyses confirming superior OS compared to nonsurgical approaches. Moreover, liver transplantation, particularly after successful downstaging, has emerged as a potential curative option in highly selected patients, achieving 5-year survival rates above 60%. These findings highlight the importance of personalized, multidisciplinary treatment strategies in managing HCC with PVTT.

本文旨在对肝细胞癌（HCC）合并门静脉肿瘤血栓形成（PVTT）的当前和新兴治疗策略进行全面的、按时间顺序的评估，并特别关注局部治疗的发展作用。尽管PVTT历来与预后不良和治疗选择有限有关，但系统、手术和局部干预措施的进步扩大了治疗范围。该方法包括使用PubMed进行结构化文献检索，其中包含治疗特定关键词，并辅以公开证据中的目标查询，以确定相关的临床试验和荟萃分析。研究按时间顺序组织，以反映治疗策略的演变。包括酪氨酸激酶抑制剂和免疫检查点抑制剂在内的全身治疗已显示出总体生存期（OS）的稳步改善。最近的联合试验，如atezolizumab和bevacizumab，已将中位生存期推至19个月以上。局部治疗如经动脉化疗栓塞（TACE）和经动脉放射栓塞（TARE）已经证明在特定的PVTT病例中，特别是当PVTT局限于节段性或大叶性分支时，生存率提高。TACE或TARE联合全身治疗进一步改善了预后，研究报告了更高的客观缓解率和延长的无进展生存期。对于肝功能保留和PVTT （Vp1-Vp2）有限的患者，手术切除仍然是可行的，一些研究和荟萃分析证实，与非手术方法相比，手术切除的OS更好。此外，肝移植，特别是在成功降低分期后，已成为高度选择性患者的潜在治疗选择，其5年生存率超过60%。这些发现强调了个性化、多学科治疗策略在PVTT治疗HCC中的重要性。

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引用次数: 0

Interventional Radiology Management of Budd-Chiari Syndrome: Current Concepts Budd-Chiari综合征的介入放射学管理：当前的概念

IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2025-10-02 DOI: 10.1016/j.tvir.2025.101087

Mamadou L. Sanogo MD, Monica Chavan MD, Baljendra S. Kapoor MD

The purpose of this manuscript is to review current concepts, technical details, and outcomes of endovascular recanalization of hepatic venous outflow tracts for the management of Budd-Chiari Syndrome.

本文的目的是回顾当前的概念，技术细节，和肝静脉流出道血管内再通治疗Budd-Chiari综合征的结果。

引用次数: 0

Liver Vein Deprivation: Rationale, Technique, and Review of the Literature 肝静脉剥夺：原理、技术和文献回顾

IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2025-10-01 DOI: 10.1016/j.tvir.2025.101079

Aaron McBride MD , Abraham Levitin MD , Sasan Partovi MD , Sameer Gadani MD, FSIR

Liver resection can improve survival in patients with primary or secondary liver tumors, but insufficient future liver remnant (FLR) volume can be a contraindication to surgery in these patients. Portal vein embolization (PVE) has been the standard preoperative strategy used to induce FLR hypertrophy in this population; however, PVE provides only modest hypertrophy over a relatively long time frame. The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique offers rapid hypertrophy but is a more invasive and complex procedure. Liver vein deprivation (LVD) has therefore been introduced as an alternative, less invasive technique for inducing preoperative liver hypertrophy. This article outlines the rationale underlying the LVD procedure and the techniques that are commonly used for percutaneous portal and hepatic vein embolization. The literature is then reviewed to assess the outcomes associated with LVD vs with PVE and ALPPS. Contemporary case series have demonstrated that LVD is safe and more effective than PVE in achieving adequate FLR hypertrophy within a shorter interval. Additionally, although ALPPS remains the fastest method for FLR augmentation, LVD offers a less invasive alternative. LVD therefore expands the interventional radiologist’s armamentarium for liver regeneration, addressing PVE’s limitations by achieving greater and quicker hypertrophy without the surgical stress of ALPPS. Early clinical experience and emerging data suggest that LVD can improve the odds of successful resection and may narrow the gap between endovascular and surgical hypertrophy techniques.

肝切除术可以提高原发性或继发性肝肿瘤患者的生存率，但未来肝残体（FLR）容量不足可能是这些患者手术的禁忌症。门静脉栓塞（PVE）已成为该人群诱导FLR肥大的标准术前策略；然而，在相对较长的时间框架内，PVE仅提供适度的肥大。联合肝分区和门静脉结扎用于分期肝切除术（ALPPS）技术提供快速肥厚，但更具侵入性和复杂性。因此，肝静脉剥夺（LVD）已被引入作为一种替代的，侵入性较小的技术来诱导术前肝肥大。本文概述了LVD手术的基本原理以及经皮门静脉和肝静脉栓塞术中常用的技术。然后回顾文献以评估LVD与PVE和ALPPS的相关结果。目前的一系列病例表明，LVD比PVE更安全，更有效地在更短的时间间隔内实现充分的FLR肥大。此外，尽管ALPPS仍然是FLR增强最快的方法，但LVD提供了一种侵入性较小的替代方法。因此，LVD扩展了介入放射科医生的肝脏再生设备，通过在没有ALPPS手术压力的情况下实现更大更快的肥厚，解决了PVE的局限性。早期临床经验和新出现的数据表明，LVD可以提高成功切除的几率，并可能缩小血管内和手术肥厚技术之间的差距。

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引用次数: 0

Management of Portal Hypertension in Oncologic Patients 肿瘤患者门静脉高压的处理

IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2025-10-01 DOI: 10.1016/j.tvir.2025.101088

James Frencher MD, PhD, Monica Chavan MD, Jordan Ellis MD, Baljendra Kapoor MD

Portal hypertension significantly impacts the management and prognosis of patients with primary and secondary hepatic malignancies. Its presence may preclude curative surgical or locoregional therapies, increase perioperative risk, and worsen overall survival. Interventional radiology plays a central role in the management of portal hypertensive complications when medical and endoscopic therapies are insufficient. The mainstay intervention, transjugular intrahepatic portosystemic shunt (TIPS), is well-established for variceal bleeding, refractory ascites, and hepatic hydrothorax in cirrhotic patients, and emerging evidence supports its use in selected cancer patients, including those with hepatocellular carcinoma (HCC) and metastatic disease. Splenic artery embolization (SAE) serves as an alternative or adjunctive therapy in patients with contraindications to TIPS, in individuals who have persistent symptoms despite TIPS placement. This document outlines evidence-based management strategies for portal hypertension in cancer patients and discusses technical considerations in TIPS placement and splenic artery embolization.

门静脉高压对原发性和继发性肝脏恶性肿瘤患者的治疗和预后有显著影响。它的存在可能会妨碍手术治疗或局部治疗，增加围手术期风险，并使总生存期恶化。当药物和内窥镜治疗不足时，介入放射学在门静脉高压并发症的治疗中起着核心作用。经颈静脉肝内门静脉系统分流术（TIPS）是治疗肝硬化患者静脉曲张出血、难治性腹水和肝性胸水的主要干预措施，新出现的证据支持其在特定癌症患者中的应用，包括肝细胞癌（HCC）和转移性疾病患者。脾动脉栓塞（SAE）可作为TIPS禁忌症患者的替代或辅助治疗，即使放置TIPS仍有持续症状的个体。本文概述了癌症患者门静脉高压的循证管理策略，并讨论了TIPS放置和脾动脉栓塞的技术考虑。

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引用次数: 0

Liver Augmentation: Rationale, Current Status, and Future Directions 肝增强：基本原理、现状和未来方向

IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2025-10-01 DOI: 10.1016/j.tvir.2025.101086

Jirapa Chansangrat MD , Sameer Gadani MD, FSIR

Liver augmentation techniques are critical in managing primary liver cancer and liver metastases, particularly for patients with insufficient future liver remnants (FLR). These methods aim to reduce the risk of post hepatectomy liver failure (PHLF), a major cause of postoperative mortality. Techniques such as portal vein embolization (PVE), liver venous deprivation (LVD), and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) induce hypertrophy of the FLR, enabling curative surgery for patients previously deemed inoperable. Functional assessment tools, including hepatobiliary scintigraphy and MRI with hepatocyte-specific contrast, are increasingly utilized to evaluate liver function and predict postoperative outcomes. Pathophysiology and factors influencing liver regeneration including patient-specific conditions are explored. Additionally, tumor-specific considerations, such as hepatocellular carcinoma in cirrhotic livers, and biliary malignancies with cholestasis, highlight the need for tailored approaches. Emerging innovations, including artificial intelligence, show promise in improving volumetric assessments and patient selection. Advancements in liver augmentation techniques have expanded surgical eligibility, improved oncologic outcomes, and reduced complications, marking a transformative shift in the management of liver cancers.

肝增强技术在治疗原发性肝癌和肝转移中至关重要，特别是对于未来肝残体（FLR）不足的患者。这些方法旨在降低肝切除术后肝衰竭（PHLF）的风险，PHLF是术后死亡的主要原因。门静脉栓塞（PVE）、肝静脉剥夺（LVD）以及分阶段肝切除术（ALPPS）相关的肝分区和门静脉结扎等技术可诱导FLR肥大，使以前认为无法手术的患者能够进行根治性手术。功能评估工具，包括肝胆造影和肝细胞特异性对比MRI，越来越多地用于评估肝功能和预测术后预后。病理生理学和影响肝再生的因素包括患者的具体情况进行了探讨。此外，肿瘤特异性考虑，如肝硬化肝细胞癌和胆汁淤积的胆道恶性肿瘤，强调需要量身定制的方法。包括人工智能在内的新兴创新在改善容量评估和患者选择方面显示出希望。肝增强技术的进步扩大了手术资格，改善了肿瘤预后，减少了并发症，标志着肝癌治疗的革命性转变。

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引用次数: 0