New Insights on Liver-Directed Therapies in Hepatocellular Carcinoma.

The incidence of hepatocellular carcinoma (HCC) has been increasing over the past decades, but improvements in systemic and locoregional therapies is increasing survival. Current locoregional treatment options include ablation, transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and stereotactic body radiotherapy (SBRT). There is ongoing research regarding the combination of systemic and local therapies to maximize treatment effect as well as in new non-invasive, image-guided techniques such as histotripsy.

Management of ectopic intestinal variceal bleeding following pancreatic transplant: Two cases.

Ectopic variceal bleeding is a potentially under recognized source of gastrointestinal (GI) hemorrhage. While vascular complications following pancreatic transplant are relatively common, the development of symptomatic ectopic venous varices has rarely been reported. We report two patients with a remote history of simultaneous kidney pancreas transplant (SPK) presenting two decades after transplant with an occult GI bleed.

Pelvic Venous Disorders: An Update in Terminology, Diagnosis, and Treatment.

Pelvic venous disorder (PeVD) is a term that encompasses all the interrelated causes of chronic pelvic pain (CPP) and perineal/lower extremity varicose veins of pelvic venous origin historically known as nutcracker syndrome, pelvic congestion syndrome, and May-Thurner syndrome, resulting in a more precise diagnosis that accounts for the underlying pathophysiology and anatomy. PeVD manifests as CPP with associated vulvar and lower-extremity varicosities, left flank pain and hematuria, and lower extremity pain and swelling secondary to obstruction or reflux in the left renal, ovarian, or iliac veins. This article will focus specifically on the most current nomenclature, evaluation, and management of CPP of venous origin.

Percutaneous Intentional Extraluminal Recanalization of Chronic Total Occlusions: A Review of Reentry Devices.

Percutaneous intentional extraluminal recanalization (PIER) is an endovascular subintimal crossing technique used to treat chronic total occlusions (CTOs) of the peripheral arteries. Intraluminal revascularization remains the standard over PIER when technically feasible; however, when intraluminal approaches fail, PIER may be preferred prior to pursuit of surgical bypass grafting. The major cause of failure of PIER is inability to reenter the true lumen after crossing the CTO.

Secondary Interventions After TEVAR for Aortic Dissection.

The goal of thoracic endograft placement in type B aortic dissection is to prevent aneurysmal degeneration and other complications. Although TEVAR is a highly effective tool for managing type B aortic dissection, many patients will require additional interventions. In this article, we present a case-based review of techniques for the management of persistent false lumen perfusion and stent-graft induced new entry tears after TEVAR for aortic dissection.

Role of Radioembolization for Biliary Tract and Primary Liver Cancer.

Hepatocellular carcinoma and intrahepatic cholangiocarcinoma are often amenable to locoregional therapy, including percutaneous ablation, transarterial chemoembolization (TACE), or transarterial radioembolization (TARE). TARE is a technique that delivers a high dose of radiation to the tumor, while limiting the dose to the normal liver parenchyma and the adjacent organs. It has been shown to effectively provide disease control with relatively few toxicities, and in certain cases results in a complete response.

Availability of Common Pediatric Radiology Studies: Are Rural Patients at a Disadvantage?

Background: Many families wish to have radiologic tests performed locally, especially when obtaining these tests in specialized pediatric centers would require long-distance travel with associated costs and inconveniences. The differential availability of specialized and common pediatric uroradiographic tests in rural and urban areas has not been described. We undertook this study to describe the availability of common radiographic tests ordered by pediatric urologists, and to identify disparities in the availability of radiographic tests between urban and rural locations.

Thoracic Endovascular Aortic Repair: Review of Current Devices and Treatments Options.

Thoracic endovascular aortic repair is a minimally invasive approach to repairing a number of mechanical defects of the thoracic aorta utilizing an intraluminally deployed stent graft, usually without the need for open surgery. A number of manufacturers have developed endograft systems, utilizing various stent materials (ie stainless steel vs nickel titanium [nitinol]), cover material (ie polytetrafluoroethylene vs woven polyester), radial force, flexibility, and seal zone attachment methods. The purpose of this review is to evaluate the four FDA-approved endografts currently used in the United States for descending thoracic aortic pathologies and compare their most salient features.

Bad for Breathing: A Pictorial of Drug-Induced Pulmonary Disease.

Drug-induced lung disease has been described with over 300 different agents, some of which are asymptomatic and may first present on imaging. These pulmonary diseases may present with variable imaging manifestations, and often overlap with other etiologies such as rejection, lymphoproliferative disorders, and infection that may be suspected in this patient population. However, there are several drugs that have classic imaging appearances, and in the proper clinical context, the radiologist should include their toxicity in the differential diagnosis, potentially expediting withdrawal of the drug and avoiding irreversible lung injury such as fibrosis.