The Natural History of Splenic Artery Aneurysms: Factors That Predict Aneurysm Growth.

Purpose: To examine the natural history of splenic artery aneurysms (SAAs) at a single institution and assess the effect of patient factors and aneurysm characteristics on aneurysm growth.

Materials And Methods: This single-center retrospective study included patients with SAAs who underwent serial imaging over 30 years (1990-2020). Data regarding patient demographics and aneurysm characteristics were collected.

Individualized Ultrasound-Guided Intervention Phantom Development, Fabrication, and Proof of Concept.

Commercial ultrasound vascular phantoms lack the anatomic diversity required for robust pre-clinical interventional device testing. We fabricated individualized phantoms to test an artificial intelligence enabled ultrasound-guided surgical robotic system (AI-GUIDE) which allows novices to cannulate deep vessels. After segmenting vessels on computed tomography scans, vessel cores, bony anatomy, and a mold tailored to the skin contour were 3D-printed.

ACR Appropriateness Criteria® Pulsatile Abdominal Mass, Suspected Abdominal Aortic Aneurysm: 2023 Update.

Abdominal aortic aneurysm (AAA) is defined as abnormal dilation of the infrarenal abdominal aortic diameter to 3.0 cm or greater. The natural history of AAA consists of progressive expansion and potential rupture.

Preventing inadvertent drain removal using a novel catheter securement device.

Percutaneous drains have provided a minimally invasive way to treat a wide range of disorders from abscess drainage to enteral feeding solutions to treating hydronephrosis. These drains suffer from a high rate of dislodgement of up to 30% resulting in emergency room visits, repeat hospitalizations, and catheter repositioning/replacement procedures, which incur significant morbidity and mortality. Using ex vivo and in vivo models, a force body diagram was utilized to determine the forces experienced by a drainage catheter during dislodgement events, and the individual components which contribute to drainage catheter securement were empirically collected.

Provocative mesenteric angiography for occult gastrointestinal bleeding: a systematic review.

Occult gastrointestinal bleeding (GIB) is a challenge for physicians to diagnose and treat. A systematic literature search of the PubMed and Embase databases was conducted up to January 1, 2023. Eligible studies included primary research studies with patients undergoing provocative mesenteric angiography (PMA) for diagnosis or localization of occult GIB.

Interventional radiological therapies in colorectal hepatic metastases.

Colorectal malignancy is the third most common cancer and one of the prevalent causes of death globally. Around 20-25% of patients present with metastases at the time of diagnosis, and 50-60% of patients develop metastases in due course of the disease. Liver, followed by lung and lymph nodes, are the most common sites of colorectal cancer metastases.

ACR Appropriateness Criteria® Nontraumatic Aortic Disease.

Nontraumatic aortic disease can be caused by a wide variety of disorders including congenital, inflammatory, infectious, metabolic, neoplastic, and degenerative processes. Imaging examinations such as radiography, ultrasound, echocardiography, catheter-based angiography, CT, MRI, and nuclear medicine examinations are essential for diagnosis, treatment planning, and assessment of therapeutic response. Depending upon the clinical scenario, each of these modalities has strengths and weaknesses.

Postprocessing Imaging Techniques of the Computed Tomography Angiography in Trauma Patients for Preprocedural Planning.

Computed tomography provides a wealth of diagnostic information in the trauma patient including the presence of organ, bone, and vasculature injuries for the rapid triage of trauma patients. In the context of interventional radiology, appropriately protocoled studies can be reviewed for vascular injury and help focus the angiographic assessment of bleeding patients to ideally achieve earlier hemostasis. This article outlines various image-processing techniques such as multiplanar reformats, curved planar reformats, maximum intensity projections, and volume rendering to identify and more thoroughly characterize vascular injuries as a preprocedural planning tool to expedite endovascular hemostasis in a case-based format.

Interventional Treatment of Hepatic Metastases from Colorectal Cancer.

Modern systemic therapies provide a significant survival benefit in metastatic colorectal cancer. Despite these advances, the durability of response remains limited and nearly all patients progress on systemic treatment. Colorectal liver metastases (CLM) develop in approximately half of patients with metastatic disease and contribute to mortality in most patients.

Assessing the safety of transarterial locoregional delivery of low-density lipoprotein docosahexaenoic acid nanoparticles to the rat liver.

Hepatic-arterial infusion (HAI) of low-density lipoprotein (LDL) nanoparticles reconstituted with docosahexaenoic acid (DHA) (LDL-DHA) has been shown in a rat hepatoma model to be a promising treatment for hepatocellular carcinoma. To date, little is known regarding the safety of HAI of LDL-DHA to the liver. Therefore, we aimed to investigate the deposition, metabolism and safety of HAI of LDL-DHA (2, 4 or 8 mg/kg) in the rat.

Capacity Prioritization Initiative Reduced the Wait Time for Port Placement and Facilitated Increased Volume of Port Placements at a Large County Health System.

Description Of The Problem: Wait time from request to placement of ports in interventional radiology had increased from 14 to 27 days over a 4-month period. The goal of this project was to reduce the wait time by 15% within 4 months while accommodating additional volume.

Instituional Approach To Address Problem: Capacity analysis revealed 2 bottlenecks: (1) inadequate provider capacity for preprocedural visits in interventional radiology clinic and (2) inadequate number of spots for port placement in the angiography schedule.

Comparison of radiofrequency and microwave ablation and identification of risk factors for primary treatment failure and local progression.

Purpose: To compare percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of Hepatocellular carcinoma (HCC) and to identify risk factors for treatment failure and local progression.

Methods: 145 unique HCC [87 (60%) RFA, 58 (40%) MWA] were retrospectively reviewed from a single tertiary medical center. Adverse events were classified as severe, moderate, or mild according to the Society of Interventional Radiology Adverse Event Classification system.

ACR Appropriateness Criteria® Thoracic Outlet Syndrome.

Thoracic outlet syndrome (TOS) is the clinical entity that occurs with compression of the brachial plexus, subclavian artery, and/or subclavian vein at the superior thoracic outlet. Compression of each of these structures results in characteristic symptoms divided into three variants: neurogenic TOS, venous TOS, and arterial TOS, each arising from the specific structure that is compressed. The constellation of symptoms in each patient may vary, and patients may have more than one symptom simultaneously.

ACR Appropriateness Criteria® Radiologic Management of Iliofemoral Venous Thrombosis.

Iliofemoral venous thrombosis carries a high risk for pulmonary embolism, recurrent deep vein thrombosis, and post-thrombotic syndrome complicating 30% to 71% of those affected. The clinical scenarios in which iliofemoral venous thrombosis is managed may be diverse, presenting a challenge to identify optimum therapy tailored to each situation. Goals for management include preventing morbidity from venous occlusive disease, and morbidity and mortality from pulmonary embolism.

Liquid Biopsy for Cancer: Review and Implications for the Radiologist.

Imaging and image-guided procedures play an imperative role in the screening, diagnosis, and surveillance of cancer. Although emerging imaging techniques now enable more precise molecular characterization of tumors, multigenetic tumor profiling for targeted therapeutic selection remains limited to direct tissue acquisition. Even in the context of targeted therapy, tumors adapt to acquire resistance.

ACR Appropriateness Criteria® Clinically Suspected Vascular Malformation of the Extremities.

Vascular malformations of the extremities represent a wide spectrum of lesions, broadly divided into high-flow and low-flow categories. High-flow lesions include arteriovenous malformations and arteriovenous fistulas, while the more common low-flow lesions consist of venous and lymphatic malformations. The clinical presentation of vascular malformations is variable and can include extremity pain, discoloration, focal mass, or diffuse extremity enlargement.

Retrospective Comparison of Pulmonary Arteriovenous Malformation Embolization with the Polytetrafluoroethylene-Covered Nitinol Microvascular Plug, AMPLATZER Plug, and Coils in Patients with Hereditary Hemorrhagic Telangiectasia.

Purpose: To evaluate effectiveness of the polytetrafluoroethylene-covered nitinol mesh microvascular plug (MVP) and compare it with other devices in pulmonary arteriovenous malformation (PAVM) embolization in patients with hereditary hemorrhagic telangiectasia (HHT).

Materials And Methods: Twenty-five patients (average age 35 y; range, 15-56 y) with hereditary hemorrhagic telangiectasia (HHT) and de novo PAVM embolization with at least 1 MVP between November 2015 and May 2017 were retrospectively evaluated. Retrospective data were also obtained from prior embolization procedures in the same patient population with other embolic devices dating back to 2008.

ACR Appropriateness Criteria Abdominal Aortic Aneurysm Follow-up (Without Repair).

Abdominal aortic aneurysm (AAA) is defined as aneurysmal dilation of the abdominal aorta to 3 cm or greater. A high degree of morbidity and mortality is associated with AAA rupture, and imaging surveillance plays an essential role in mitigating the risk of rupture. Aneurysm size and growth rate are factors associated with the risk of rupture, thus surveillance imaging studies must be accurate and reproducible to characterize aneurysm size.

ACR Appropriateness Criteria Nonatherosclerotic Peripheral Arterial Disease.

A broad range of nonatherosclerotic diseases affect the peripheral arteries. The appropriate initial diagnostic imaging studies vary, depending upon the clinical presentation and suspicion of disease. Accurate vascular imaging relies upon visualization of the vessel lumen, vessel wall, and surrounding soft-tissue structures, with some modalities also offering the ability to characterize blood flow direction and velocity.