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▪ FEATURED ABSTRACT Percutaneous image-guided cryoablation of soft-tissue venous vascular malformations: a study of safety and efficacy
S134
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Tuesday
Scientific Session
and 103 days (po0.01) in cancer and non-cancer patients, respectively. Conclusions: Post-procedural nephrostomy tube related complications are more common in patients with underlying cancer. Tube obstruction necessitating tube changes occurred more frequently and at a short interval in these patients compared to those without cancer. In these patients, routine 3 month change may not be sufficient and routine change at 67 weeks interval is recommended.
4:12 PM
Abstract No. 294
Optimization of the non perfusion zone in focused ultrasound ablation of fibroids: the “vascular” effect
TUESDAY: Scientific Sessions
R. Hanna1, T. Maraj2, Y. Huang3, E. David1; 1Sunnybrook Health Sciences Centre, Toronto, ON; 2Sunnybrook Health Sciences Centre, Toronto, Ontario; 3Sunnybrook Research Institute, Toronto, Ontario. Purpose: To highlight the potential benefits of inferiorly placed sonication cells for treatment of symptomatic uterine fibroids using volumetric Magnetic Resonance guided High Intensity Focused Ultrasound (MR-HIFU). Materials: Ten patients received treatment between January 2012 and March 2015 using the Philips Sonalleve MR-HIFU. They were grouped by the placement of the treatment cells. One group targeted the inferior segment of the fibroid (n¼5), and the other targeted the center of the fibroid (n¼5). Nonperfused volume (NPV) measurements, from contrastenhanced T1-weighted imaging were done immediately after treatment and repeated within 3 months. Results: Immediately following treatment, there was no difference between the NPV measured between groups (p¼0.83). After 3 months, however, the group treated with predominantly inferiorly placed sonication cells achieved complete ablation (100%) of the targeted fibroid perfusion, which was significant compared with the centrally treated group, with a mean NPV of 22% (po0.01). Mean fibroid volume reduction was 87.4 þ 34.0 cm3 or 39.1% of the original size in the inferior targeted group and 53.8 þ 24.5 cm3 or 19.5% of the original size in the centrally targeted group (p¼0.11). There were no differences in demographic data or other treatment parameters between groups. Conclusions: Inferiorly placed sonication cells may provide an important mechanism for achieving complete ablation of target lesions presumably by heat transfer to uterine arterial branches. This type of cell placement may produce a delayed vascular effect and subsequent blooming of the non-perfused volume.
4:21 PM
Abstract No. 295
Safety and feasibility of the expanded role of interventional radiology in implantable contraceptive device retrieval I. Iyamu1, P. Sutphin2, S. Hsu3; 1Emory University, Atlanta, GA; 2N/A, Dallas, TX; 3University of Texas Southwestern Medical Center, Dallas, TX.
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JVIR
Purpose: To review a single center experience in removal of subcutaneous implantable contraceptive devices (ICD) following unsuccessful retrieval attempts by primary care providers. Materials: A single institution, IRB-approved retrospective cohort of 34 women (mean age 28.1 years; range 19-39 years) who underwent imaged guided ICD retrieval by an interventional radiologist between August 2013 and May 2015 was undertaken. The average length of implantation was 3.28 years (range 1 to 6 years). The reasons for ICD retrieval included; implant expiration 27/34 (79%), adverse symptoms 5/34 (15%), and desired fertility 2/34 (6%). Attempt at ICD removal by primary care provider was unsuccessful in 12/34 (35%) patients. Localization ultrasound was present in 22/34 (65%) patients prior to interventional radiology retrieval, with mean ICD depth of 5.67 ± 2.7 mm. All patients underwent ultrasound guided ICD retrieval with the interventional radiology service using hydrodissection, “U” technique, or blunt dissection. Patient medical records were reviewed for ICD location, procedural approach, and technical and clinical outcomes. Results: Technical success was obtained in 32/34 (94%) cases, with non-visualization of the ICD in the 2 unsuccessful cases. Implanon was removed in 11/12 (92%) patients, who underwent prior unsuccessful attempt at removal by primary care physicians. A complication was present in 1 (3%) case, transient paresthesia was experienced by a patient and resolved within one month. Conclusions: The ability of interventional radiologist to perform image guided procedures provides a safe and effective atmosphere for retrieval of implantable contraceptive devices when primary care physicians are unsuccessful.
Scientific Session 31 Nonvascular: MSK Tuesday, April 5, 2016 3:00 PM – 4:30 PM Room: 217/218 3:00 PM
Abstract No. 296
’ FEATURED ABSTRACT Percutaneous image-guided cryoablation of soft-tissue venous vascular malformations: a study of safety and efficacy F. Cornelis, F. Marin, C. Labreze, C. Castermans, V. Pinsolle, D. Midy, N. Grenier; CHU Bordeaux, Bordeaux, France. Purpose: To report the safety and efficacy of percutaneous image-guided cryoablation of soft tissue venous vascular malformations.
JVIR
’
Scientific Session
Tuesday
Materials: HIPAA approved mono-institutional retrospective study of 26 patients presenting venous vascular malformation in soft tissue and treated with cryoablation for symptomatic recurrences after sclerosis (N¼16) or in case of non-indication of sclerosis (N¼9). Eligibility criteria included initial radiological diagnosis of venous or glomovenous vascular malformation proved by Doppler ultrasound and MRI and follow-up of at least 6 months. The safety was evaluated according to the classification of the toxicity scale NCI-CTCAE and the quality of life by EORTC QLQ-C30 questionnaire. The number and proportion of success of cryoablation at 6 months was described on clinical evaluation performed at 7 days, 1 and 6 months and with MRI at 6 months according to RECIST 1.1. Results: Patients’ ages ranged from 13 to 64 years (mean: 31,7). 6 were male and 20 female. Procedures were performed under local (N¼3) and general (N¼23) anesthesia. A technical success was observed in all cases using 2 cryoprobes in all cases. Only one severe adverse effect related to cryoablation occurred. Pain decreased significantly from 4 in mean (range 0 -10) before treatment to 2 (range 0-5) after 1 month (Po0.05) and 1.4 (range 0-6) after 6 months (Po0.05). After a transitory swelling (o15 days) occurring in all cases, a complete response was observed with a significant decrease of the mean volume from 12.5 cm3 (range: 1.1-62.3) to 4.3 cm3 (range: 0-53.5) at 6 months (P o0.05). Conclusions: Percutaneous cryoablation appears safe and effective to treat venous vascular malformation even in case of multiple previous treatments.
Abstract No. 297
A biomechanical testing model for evaluating the feasibility of percutaneous osteoplasty in weightbearing bones N. Koirala1, S. Duffy1, G. McLennan2; 1Cleveland State University, Cleveland, OH; 2N/A, Chagrin Falls, OH. Purpose: While percutaneous osteoplasty is common in the treatment of osseous tumors, weak mechanical strength and the lack of consistent testing methods limit its use in weightbearing bones. In this study, we performed percutaneous fracture fixation using stent-wire scaffold and cement augmentation, and evaluated the scope of procedure from four point bend test. Materials: Nine explanted pig femurs were divided into: stentwire-cementoplasty group (Group 1), cementoplasty only group (Group 2), and intact bones (controls). Mid-shaft circumferential fractures were simulated on the first two groups followed by fixation procedure under fluoroscopy, which involved stent placement, insertion of Lunderquist wires, and cement augmentation for Group1 while only cement augmentation for Group 2. Biomechanical properties of the samples were examined from four point bend test, fatigue test, and load-until-failure test. Fatigue test was performed for 500 cycles under repeated cyclic loads (50-300 N). Flexural stiffness and energy absorption at fracture were also quantified for all samples to evaluate the strength of fixation.
S135
Results: The accompanying table shows the mechanical properties of the specimen for different groups. The average displacement for Groups 1, 2 and controls from fatigue test were 1.12±0.1um, 1.65±0.48um, and 0.8±0.05um respectively. Conclusions: The presence of stent-wire scaffolding resulted into improved mechanical properties of the fractured bone; however, the strength of fixation was not significantly higher compared to cementoplasty alone or control. Further development in scaffolding technique could result into a potential therapeutic model for metastatic or surgical risk group patients. Mechanical Properties of the Specimen
Group 1 2 Control
3:18 PM
Flexural
Energy
Peak Load (N)
Stiffness (Nm/degree)
Absorption (Nmm)
864±185 747±136N
16±2.2 11.5±1.9
479±55 402±85
2752±458
19±3.8
7270±258
Abstract No. 298
Real-time fluoroscopic needle guidance using syngo iGuide for percutaneous bone biopsies at a pediatric institution S. Shellikeri1, X. Zhu2, R. Setser3, G. Krishnamurthy2, M. Nazario2, S. Vatsky2, A. Srinivasan4, M. Keller2, A. Cahill2; 1Children’s Hospital of Philadelphia, Philadelphia, PA; 2The Children’s Hospital of Philadelphia, Philadelphia, PA; 3Siemens Healthcare, Beachwood, OH; 4The Children’s Hospital of Philadelphia, Philadlephia, PA. Purpose: syngo iGuide (Siemens) navigational software provides real-time needle guidance for percutaneous procedures in the Interventional Radiology (IR) suite. This study describes our experience with syngo iGuide for pediatric percutaneous bone biopsies in the IR suite and compares the radiation dose and procedure time with that of CT-guided biopsies. Materials: iGuide-assisted and CT-guided bone biopsies performed on pediatric patients from 2008-2015 were included in this IRB approved study. Different C-arm CT protocols were used for iGuide cases depending on anatomic detail required: (i) institution developed low dose (0.1 or 0.17 Gy/projection), (ii) regular dose (0.36 Gy/projection), or (iii) a combination of low/ regular dose protocols. Effective radiation dose (estimated using PCXMC software) and procedure times were compared between iGuide assisted and CT-guided biopsies using 2-sample t-test. Results: Twenty-two patients (13M/9F; mean age 10yrs) underwent iGuide-assisted biopsies (12 pelvic, 6 lumbar and 4 lower extremity) and 33 patients (13M/20F; mean age 9yrs) underwent CT-guided biopsies (22 pelvic, 7 lumbar and 4 lower extremity). 21/22 iGuide-assisted and 29/33 CT-guided biopsies
TUESDAY: Scientific Sessions
3:09 PM
’
’
Tuesday
Scientific Session
and 103 days (po0.01) in cancer and non-cancer patients, respectively. Conclusions: Post-procedural nephrostomy tube related complications are more common in patients with underlying cancer. Tube obstruction necessitating tube changes occurred more frequently and at a short interval in these patients compared to those without cancer. In these patients, routine 3 month change may not be sufficient and routine change at 67 weeks interval is recommended.
4:12 PM
Abstract No. 294
Optimization of the non perfusion zone in focused ultrasound ablation of fibroids: the “vascular” effect
TUESDAY: Scientific Sessions
R. Hanna1, T. Maraj2, Y. Huang3, E. David1; 1Sunnybrook Health Sciences Centre, Toronto, ON; 2Sunnybrook Health Sciences Centre, Toronto, Ontario; 3Sunnybrook Research Institute, Toronto, Ontario. Purpose: To highlight the potential benefits of inferiorly placed sonication cells for treatment of symptomatic uterine fibroids using volumetric Magnetic Resonance guided High Intensity Focused Ultrasound (MR-HIFU). Materials: Ten patients received treatment between January 2012 and March 2015 using the Philips Sonalleve MR-HIFU. They were grouped by the placement of the treatment cells. One group targeted the inferior segment of the fibroid (n¼5), and the other targeted the center of the fibroid (n¼5). Nonperfused volume (NPV) measurements, from contrastenhanced T1-weighted imaging were done immediately after treatment and repeated within 3 months. Results: Immediately following treatment, there was no difference between the NPV measured between groups (p¼0.83). After 3 months, however, the group treated with predominantly inferiorly placed sonication cells achieved complete ablation (100%) of the targeted fibroid perfusion, which was significant compared with the centrally treated group, with a mean NPV of 22% (po0.01). Mean fibroid volume reduction was 87.4 þ 34.0 cm3 or 39.1% of the original size in the inferior targeted group and 53.8 þ 24.5 cm3 or 19.5% of the original size in the centrally targeted group (p¼0.11). There were no differences in demographic data or other treatment parameters between groups. Conclusions: Inferiorly placed sonication cells may provide an important mechanism for achieving complete ablation of target lesions presumably by heat transfer to uterine arterial branches. This type of cell placement may produce a delayed vascular effect and subsequent blooming of the non-perfused volume.
4:21 PM
Abstract No. 295
Safety and feasibility of the expanded role of interventional radiology in implantable contraceptive device retrieval I. Iyamu1, P. Sutphin2, S. Hsu3; 1Emory University, Atlanta, GA; 2N/A, Dallas, TX; 3University of Texas Southwestern Medical Center, Dallas, TX.
’
JVIR
Purpose: To review a single center experience in removal of subcutaneous implantable contraceptive devices (ICD) following unsuccessful retrieval attempts by primary care providers. Materials: A single institution, IRB-approved retrospective cohort of 34 women (mean age 28.1 years; range 19-39 years) who underwent imaged guided ICD retrieval by an interventional radiologist between August 2013 and May 2015 was undertaken. The average length of implantation was 3.28 years (range 1 to 6 years). The reasons for ICD retrieval included; implant expiration 27/34 (79%), adverse symptoms 5/34 (15%), and desired fertility 2/34 (6%). Attempt at ICD removal by primary care provider was unsuccessful in 12/34 (35%) patients. Localization ultrasound was present in 22/34 (65%) patients prior to interventional radiology retrieval, with mean ICD depth of 5.67 ± 2.7 mm. All patients underwent ultrasound guided ICD retrieval with the interventional radiology service using hydrodissection, “U” technique, or blunt dissection. Patient medical records were reviewed for ICD location, procedural approach, and technical and clinical outcomes. Results: Technical success was obtained in 32/34 (94%) cases, with non-visualization of the ICD in the 2 unsuccessful cases. Implanon was removed in 11/12 (92%) patients, who underwent prior unsuccessful attempt at removal by primary care physicians. A complication was present in 1 (3%) case, transient paresthesia was experienced by a patient and resolved within one month. Conclusions: The ability of interventional radiologist to perform image guided procedures provides a safe and effective atmosphere for retrieval of implantable contraceptive devices when primary care physicians are unsuccessful.
Scientific Session 31 Nonvascular: MSK Tuesday, April 5, 2016 3:00 PM – 4:30 PM Room: 217/218 3:00 PM
Abstract No. 296
’ FEATURED ABSTRACT Percutaneous image-guided cryoablation of soft-tissue venous vascular malformations: a study of safety and efficacy F. Cornelis, F. Marin, C. Labreze, C. Castermans, V. Pinsolle, D. Midy, N. Grenier; CHU Bordeaux, Bordeaux, France. Purpose: To report the safety and efficacy of percutaneous image-guided cryoablation of soft tissue venous vascular malformations.
JVIR
’
Scientific Session
Tuesday
Materials: HIPAA approved mono-institutional retrospective study of 26 patients presenting venous vascular malformation in soft tissue and treated with cryoablation for symptomatic recurrences after sclerosis (N¼16) or in case of non-indication of sclerosis (N¼9). Eligibility criteria included initial radiological diagnosis of venous or glomovenous vascular malformation proved by Doppler ultrasound and MRI and follow-up of at least 6 months. The safety was evaluated according to the classification of the toxicity scale NCI-CTCAE and the quality of life by EORTC QLQ-C30 questionnaire. The number and proportion of success of cryoablation at 6 months was described on clinical evaluation performed at 7 days, 1 and 6 months and with MRI at 6 months according to RECIST 1.1. Results: Patients’ ages ranged from 13 to 64 years (mean: 31,7). 6 were male and 20 female. Procedures were performed under local (N¼3) and general (N¼23) anesthesia. A technical success was observed in all cases using 2 cryoprobes in all cases. Only one severe adverse effect related to cryoablation occurred. Pain decreased significantly from 4 in mean (range 0 -10) before treatment to 2 (range 0-5) after 1 month (Po0.05) and 1.4 (range 0-6) after 6 months (Po0.05). After a transitory swelling (o15 days) occurring in all cases, a complete response was observed with a significant decrease of the mean volume from 12.5 cm3 (range: 1.1-62.3) to 4.3 cm3 (range: 0-53.5) at 6 months (P o0.05). Conclusions: Percutaneous cryoablation appears safe and effective to treat venous vascular malformation even in case of multiple previous treatments.
Abstract No. 297
A biomechanical testing model for evaluating the feasibility of percutaneous osteoplasty in weightbearing bones N. Koirala1, S. Duffy1, G. McLennan2; 1Cleveland State University, Cleveland, OH; 2N/A, Chagrin Falls, OH. Purpose: While percutaneous osteoplasty is common in the treatment of osseous tumors, weak mechanical strength and the lack of consistent testing methods limit its use in weightbearing bones. In this study, we performed percutaneous fracture fixation using stent-wire scaffold and cement augmentation, and evaluated the scope of procedure from four point bend test. Materials: Nine explanted pig femurs were divided into: stentwire-cementoplasty group (Group 1), cementoplasty only group (Group 2), and intact bones (controls). Mid-shaft circumferential fractures were simulated on the first two groups followed by fixation procedure under fluoroscopy, which involved stent placement, insertion of Lunderquist wires, and cement augmentation for Group1 while only cement augmentation for Group 2. Biomechanical properties of the samples were examined from four point bend test, fatigue test, and load-until-failure test. Fatigue test was performed for 500 cycles under repeated cyclic loads (50-300 N). Flexural stiffness and energy absorption at fracture were also quantified for all samples to evaluate the strength of fixation.
S135
Results: The accompanying table shows the mechanical properties of the specimen for different groups. The average displacement for Groups 1, 2 and controls from fatigue test were 1.12±0.1um, 1.65±0.48um, and 0.8±0.05um respectively. Conclusions: The presence of stent-wire scaffolding resulted into improved mechanical properties of the fractured bone; however, the strength of fixation was not significantly higher compared to cementoplasty alone or control. Further development in scaffolding technique could result into a potential therapeutic model for metastatic or surgical risk group patients. Mechanical Properties of the Specimen
Group 1 2 Control
3:18 PM
Flexural
Energy
Peak Load (N)
Stiffness (Nm/degree)
Absorption (Nmm)
864±185 747±136N
16±2.2 11.5±1.9
479±55 402±85
2752±458
19±3.8
7270±258
Abstract No. 298
Real-time fluoroscopic needle guidance using syngo iGuide for percutaneous bone biopsies at a pediatric institution S. Shellikeri1, X. Zhu2, R. Setser3, G. Krishnamurthy2, M. Nazario2, S. Vatsky2, A. Srinivasan4, M. Keller2, A. Cahill2; 1Children’s Hospital of Philadelphia, Philadelphia, PA; 2The Children’s Hospital of Philadelphia, Philadelphia, PA; 3Siemens Healthcare, Beachwood, OH; 4The Children’s Hospital of Philadelphia, Philadlephia, PA. Purpose: syngo iGuide (Siemens) navigational software provides real-time needle guidance for percutaneous procedures in the Interventional Radiology (IR) suite. This study describes our experience with syngo iGuide for pediatric percutaneous bone biopsies in the IR suite and compares the radiation dose and procedure time with that of CT-guided biopsies. Materials: iGuide-assisted and CT-guided bone biopsies performed on pediatric patients from 2008-2015 were included in this IRB approved study. Different C-arm CT protocols were used for iGuide cases depending on anatomic detail required: (i) institution developed low dose (0.1 or 0.17 Gy/projection), (ii) regular dose (0.36 Gy/projection), or (iii) a combination of low/ regular dose protocols. Effective radiation dose (estimated using PCXMC software) and procedure times were compared between iGuide assisted and CT-guided biopsies using 2-sample t-test. Results: Twenty-two patients (13M/9F; mean age 10yrs) underwent iGuide-assisted biopsies (12 pelvic, 6 lumbar and 4 lower extremity) and 33 patients (13M/20F; mean age 9yrs) underwent CT-guided biopsies (22 pelvic, 7 lumbar and 4 lower extremity). 21/22 iGuide-assisted and 29/33 CT-guided biopsies
TUESDAY: Scientific Sessions
3:09 PM
’