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Abstract No. 290: Percutaneous irreversible electroporation in lung neoplasm: Our initial experience
Poster Sessions 䡲 JVIR
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TARE and TACE cohorts (TARE: 8.0 months, TACE: 10.3 months, p ⫽ 0.326). Post-embolization syndrome was significantly more severe in TACE patients leading to increased initial hospitalization rates (TARE: 0%, TACE 20.0%, p ⫽ 0.004) and longer hospitalizations for re-admissions (TARE: 3.6 ⫾ 0.6 days, TACE: 7.9 ⫾ 1.7 days, p ⫽ 0.025). The rate of other complications and 30-day rehospitalization was similar (TARE: 13.2%, TACE: 20.0%, p ⫽ 0.431). Increased age, Child-Pugh class B, hepatitis seropositivity, bilobar tumor distribution, tumor vascular invasion, and the presence of extrahepatic metastases were associated with reduced patient survival. Conclusion: This study provides further evidence of therapeutic equivalence in survival between TACE and TARE. However, analysis of toxicity and complications suggests that TARE has a favorable side-effect profile.
Abstract No. 289 Cholecystitis following hepatic embolization? Appearances may be deceiving
Poster Sessions
M.P. Underhill1, T.M. Getzen1, D. Myers2, S.E. Smolinski3, D.L. Croteau1, S. Sturza1, B. Crider1; 1 Interventional Radiology, Henry Ford Hospital, Detroit, MI; 2Diagnostic Radiology: Abdominal Imaging, Henry Ford Hospital, Detroit, MI; 3Wayne State Medical School, Detroit, MI Purpose: To identify the incidence of cholecystitis and imaging findings suspicious for cholecystitis following hepatic tumor embolization. To evaluate if one form of embolization is more prone to cholecystitis between bland, chemo, and Y90 radioembolization. Materials and Methods: All embolization procedures performed by Interventional Radiology at Henry Ford Hospital between May 2005 and May 2010 were reviewed. Per protocol the patients underwent dual phase liver CT 4 – 6 weeks following treatment. Additional exams including radionuclide hepatobiliary scans, ultrasound and MRI were viewed when available. Post therapy imaging was reviewed for imaging findings of acute cholecystitis including gallbladder wall thickening, pericholecystic fluid, gallbladder wall discontinuity and adjacent fat stranding. The electronic medical record was reviewed for clinical suspicion/ confirmation of acute cholecystitis. Both the post procedural imaging and clinical notes were independently reviewed by an Interventional Radiology fellow, Interventional Radiology staff, and an Abdominal Imaging staff member and then compared. Results: 208 embolizations were performed in 151 patients. 41 embolizations were excluded; 6 due to lack of follow up and 35 due to prior cholecystectomy. Of the remaining 167 embolization cases (110 patients), 50 (29.9%) demonstrated imaging findings of cholecystitis but only 6 (3.6%) had clinical signs of acute cholecystitis. Radiologic findings of cholecystitis were seen in 11.3% of those undergoing bland embolization, 34.5% of those undergoing chemoembolization, and 56.7% of those undergoing Y90 radioembolization. Of the 6 clinically symptomatic patients 2 underwent Y90 radioembolization and 4 underwent chemoembolization. Conclusion: 1) Radiologic gallbladder abnormalities significantly outnumber clinically symptomatic cases of acute cholecystitis following liver embolization. Imaging findings alone should not prompt aggressive therapy for cholecystitis. 2) Gallbladder imaging abnormalities are more common in those undergoing Y90 radioembolization, followed by chemoembolization, and lastly bland tumor embolization.
Educational Exhibit
Abstract No. 290
Percutaneous irreversible electroporation in lung neoplasm: Our initial experience D.A. Fuentes1,2, J.G. Sanchez1,2; 1Valley Radiologists and Associates, Harlingen, TX; 2Radiology, Valley Baptist Medical Center, Harlingen, TX Learning Objectives: This educational exhibit reviews our initial experience using irreversible electroporation (IRE) to ablate pulmonary lesions. The reviewer will be able to understand our procedural technique, potential complications, and lesion appearance during and after ablation. Background: IRE has been introduced as a non-thermal ablative tool. Using electrical impulses, IRE opens tiny pores in the treated cell membrane, which cause subsequent cell death. To date, IRE has been used to ablate soft tissue in over 300 cases in clinical practice. Clinical Findings/Procedure Details: We present our initial experience using IRE to treat both primary and metastatic pulmonary neoplasm. Using a case-based didactic and pictorial approach, we present and discuss our: 1) Pre-procedural evaluation. 2) Procedural technique. 3) Technique for avoiding and treating potential complications. 4) Outcomes. 5) Immediate and delayed post-procedure lesion appearance. Conclusion and/or Teaching Points: After reviewing this exhibit, the reviewer will understand how: 1) We have applied IRE to treat lung neoplasm. 2) To prevent, identify, and treat potential complications. 3) Pulmonary lesions treated with IRE appear during and after the ablation.
Abstract No. 291 Radiofrequency ablation of the lung tumors can be safely performed in patients previously treated with radiation therapy E.N. Petre, H. Schoellnast, W. Alago, Jr., R.H. Thornton, C.T. Sofocleous, S.B. Solomon; Interventional Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY Purpose: To retrospectively evaluate the rate of complications following radiofrequency ablation (RFA) of lung tumors in patients previously treated with radiation therapy. Materials and Methods: Between May 06 and May 10 we performed 246 RFA sessions to treat lung tumors. From these we excluded sessions that treated more than one tumor (46) and sessions that occurred in patients previously treated with lung RFA (35). Our group comprised 165 ablation sessions performed to treat 165 lung tumors in 165 patients. We reviewed medical records and imaging to determine occurrence of complications such as: pneumothorax, hemorrhage and infection following RFA. Patient’s demographics, tumor characteristics and procedure related factors were compared between the groups with and without pneumothorax. Results: 97 tumors were primary lung cancer and 68 metastatic. The mean size of the tumor was 2 ⫾ 1.1 cm (range, 0.5– 6.5 cm). 28 patients received radiation therapy before RFA, all in the primary lung cancer group. 53 of the patients underwent lung surgery prior to RFA. Pneumothorax occurred in 71 (43) % of the sessions with 47 (28%) requiring drainage. There were 4 cases of hemorrhage that
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TARE and TACE cohorts (TARE: 8.0 months, TACE: 10.3 months, p ⫽ 0.326). Post-embolization syndrome was significantly more severe in TACE patients leading to increased initial hospitalization rates (TARE: 0%, TACE 20.0%, p ⫽ 0.004) and longer hospitalizations for re-admissions (TARE: 3.6 ⫾ 0.6 days, TACE: 7.9 ⫾ 1.7 days, p ⫽ 0.025). The rate of other complications and 30-day rehospitalization was similar (TARE: 13.2%, TACE: 20.0%, p ⫽ 0.431). Increased age, Child-Pugh class B, hepatitis seropositivity, bilobar tumor distribution, tumor vascular invasion, and the presence of extrahepatic metastases were associated with reduced patient survival. Conclusion: This study provides further evidence of therapeutic equivalence in survival between TACE and TARE. However, analysis of toxicity and complications suggests that TARE has a favorable side-effect profile.
Abstract No. 289 Cholecystitis following hepatic embolization? Appearances may be deceiving
Poster Sessions
M.P. Underhill1, T.M. Getzen1, D. Myers2, S.E. Smolinski3, D.L. Croteau1, S. Sturza1, B. Crider1; 1 Interventional Radiology, Henry Ford Hospital, Detroit, MI; 2Diagnostic Radiology: Abdominal Imaging, Henry Ford Hospital, Detroit, MI; 3Wayne State Medical School, Detroit, MI Purpose: To identify the incidence of cholecystitis and imaging findings suspicious for cholecystitis following hepatic tumor embolization. To evaluate if one form of embolization is more prone to cholecystitis between bland, chemo, and Y90 radioembolization. Materials and Methods: All embolization procedures performed by Interventional Radiology at Henry Ford Hospital between May 2005 and May 2010 were reviewed. Per protocol the patients underwent dual phase liver CT 4 – 6 weeks following treatment. Additional exams including radionuclide hepatobiliary scans, ultrasound and MRI were viewed when available. Post therapy imaging was reviewed for imaging findings of acute cholecystitis including gallbladder wall thickening, pericholecystic fluid, gallbladder wall discontinuity and adjacent fat stranding. The electronic medical record was reviewed for clinical suspicion/ confirmation of acute cholecystitis. Both the post procedural imaging and clinical notes were independently reviewed by an Interventional Radiology fellow, Interventional Radiology staff, and an Abdominal Imaging staff member and then compared. Results: 208 embolizations were performed in 151 patients. 41 embolizations were excluded; 6 due to lack of follow up and 35 due to prior cholecystectomy. Of the remaining 167 embolization cases (110 patients), 50 (29.9%) demonstrated imaging findings of cholecystitis but only 6 (3.6%) had clinical signs of acute cholecystitis. Radiologic findings of cholecystitis were seen in 11.3% of those undergoing bland embolization, 34.5% of those undergoing chemoembolization, and 56.7% of those undergoing Y90 radioembolization. Of the 6 clinically symptomatic patients 2 underwent Y90 radioembolization and 4 underwent chemoembolization. Conclusion: 1) Radiologic gallbladder abnormalities significantly outnumber clinically symptomatic cases of acute cholecystitis following liver embolization. Imaging findings alone should not prompt aggressive therapy for cholecystitis. 2) Gallbladder imaging abnormalities are more common in those undergoing Y90 radioembolization, followed by chemoembolization, and lastly bland tumor embolization.
Educational Exhibit
Abstract No. 290
Percutaneous irreversible electroporation in lung neoplasm: Our initial experience D.A. Fuentes1,2, J.G. Sanchez1,2; 1Valley Radiologists and Associates, Harlingen, TX; 2Radiology, Valley Baptist Medical Center, Harlingen, TX Learning Objectives: This educational exhibit reviews our initial experience using irreversible electroporation (IRE) to ablate pulmonary lesions. The reviewer will be able to understand our procedural technique, potential complications, and lesion appearance during and after ablation. Background: IRE has been introduced as a non-thermal ablative tool. Using electrical impulses, IRE opens tiny pores in the treated cell membrane, which cause subsequent cell death. To date, IRE has been used to ablate soft tissue in over 300 cases in clinical practice. Clinical Findings/Procedure Details: We present our initial experience using IRE to treat both primary and metastatic pulmonary neoplasm. Using a case-based didactic and pictorial approach, we present and discuss our: 1) Pre-procedural evaluation. 2) Procedural technique. 3) Technique for avoiding and treating potential complications. 4) Outcomes. 5) Immediate and delayed post-procedure lesion appearance. Conclusion and/or Teaching Points: After reviewing this exhibit, the reviewer will understand how: 1) We have applied IRE to treat lung neoplasm. 2) To prevent, identify, and treat potential complications. 3) Pulmonary lesions treated with IRE appear during and after the ablation.
Abstract No. 291 Radiofrequency ablation of the lung tumors can be safely performed in patients previously treated with radiation therapy E.N. Petre, H. Schoellnast, W. Alago, Jr., R.H. Thornton, C.T. Sofocleous, S.B. Solomon; Interventional Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY Purpose: To retrospectively evaluate the rate of complications following radiofrequency ablation (RFA) of lung tumors in patients previously treated with radiation therapy. Materials and Methods: Between May 06 and May 10 we performed 246 RFA sessions to treat lung tumors. From these we excluded sessions that treated more than one tumor (46) and sessions that occurred in patients previously treated with lung RFA (35). Our group comprised 165 ablation sessions performed to treat 165 lung tumors in 165 patients. We reviewed medical records and imaging to determine occurrence of complications such as: pneumothorax, hemorrhage and infection following RFA. Patient’s demographics, tumor characteristics and procedure related factors were compared between the groups with and without pneumothorax. Results: 97 tumors were primary lung cancer and 68 metastatic. The mean size of the tumor was 2 ⫾ 1.1 cm (range, 0.5– 6.5 cm). 28 patients received radiation therapy before RFA, all in the primary lung cancer group. 53 of the patients underwent lung surgery prior to RFA. Pneumothorax occurred in 71 (43) % of the sessions with 47 (28%) requiring drainage. There were 4 cases of hemorrhage that