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Transhepatic percutaneous cholangioscopy (PC) can be used for the diagnosis and treatment of biliary pathology. It allows for direct visualization of the biliary system to identify pathologic changes, perform biopsies, and treat biliary obstruction. The effectiveness and safety of PC in adults have been established. However, the data on the use of PC in pediatric patients are limited. In this case series, the outcomes in 4 pediatric patients (3 girls; mean age, 4 [range, 1-8] years) who underwent 6 PC procedures were examined. Three out of the 6 (50%) PC procedures were performed for diagnostic visualization of the biliary tree and/or small intestine, whereas the remaining 3 (50%) were performed for the treatment of biliary obstruction causing chronic cholestasis. The technical and procedural success rate was 100%, and no complications were encountered during or 30 days after the procedure. This study supports the feasibility and safety of PC in pediatric patients for the management of biliary pathology.

The autosomal dominant trait hereditary hemorrhagic telangiectasia (HHT) causes multiorgan dysplastic lesions of the vasculature that can activate multiple physiological cascades leading to a broad array of cardiovascular diseases. Up to 78% of patients with HHT develop hepatic arteriovenous malformations (AVMs), which cause a hyperdynamic circulatory state secondary to hepatic/portal shunting. This condition can eventually progress to high-output cardiac failure (HOCF) with continued peripheral tissue hypoxemia. Treatment for HOCF is often limited to supportive measures (diuretics and treatment of anemia); however, recent studies using systemic bevacizumab have shown promise by substantially reducing the cardiac index. In the context of liver AVMs and high cardiac output, the pulmonary vasculature can also experience high flow. Without adequate dilation of pulmonary vessels, post-capillary pulmonary hypertension can develop. Another form of pulmonary hypertension observed in HHT, pulmonary arterial hypertension, is caused by HHT-related mutations in

Biliary leaks and bilomas are significant complications that arise more commonly from iatrogenic or traumatic bile duct injury. These are increasingly occurring primarily due to the growing number of laparoscopic cholecystectomies performed. Diagnosis can be challenging because of nonspecific patient symptoms, but early recognition and treatment is crucial for improving patient outcomes. Detection of biliary leaks involves a strong clinical suspicion and multimodal imaging studies, including magnetic resonance cholangiopancreatography, cholescintigraphy, endoscopic retrograde cholangiopancreatography, or percutaneous transhepatic cholangiography. Definitive treatment most often requires the endoscopic placement of biliary stents to decrease pressure in the biliary system and the placement of a percutaneous drain for drainage if a biloma is found. However, biliary leaks are heterogeneous in their severity and location, and some are refractory to the standard approach. In such cases, novel and minimally invasive techniques, rather than surgical procedures, have been described for the treatment of biliary leaks. Diagnosis and management require a multidisciplinary approach by diagnostic radiologists, interventional radiologists, gastroenterologists, and surgeons.

Obesity is a well-known major public health concern that causes significant morbidity and mortality with severe effects on the healthcare system and its financial status. Classic treatment options for obesity include lifestyle interventions, pharmacotherapy, and bariatric surgery. However, there is a treatment gap for patients in whom lifestyle modifications were not sufficient or satisfactory, and yet bariatric surgery is not a suitable option. Bariatric artery embolization (BAE) is a novel, minimally invasive, image-guided endovascular procedure that induces weight loss by reducing the production of appetite-mediating hormones following transarterial embolization of the gastric fundus. Recent evidence has shown that BAE is safe and effective in inducing clinically significant weight. This article will review the existing preclinical and clinical evidence on BAE, and discuss the future directions for this procedure.

A majority of patients with cholangiocarcinoma and malignant biliary obstruction cannot undergo surgery for treatment as they present late in the disease course. It is crucial to relieve biliary obstruction in these conditions, for which metallic stents are commonly used. However, these stents have a high rate of occlusion due to the ingrowth of malignant tissue. In this review, we will discuss the use of direct endobiliary therapies that can be used either independently or in combination with metallic stents.

Objectives: Cone beam computed tomography (CBCT) imaging is becoming an indispensable intraoperative tool; however, the current field of view prevents visualization of long anatomical sites, limiting clinical utility. Here, we demonstrate the longitudinal extension of the intraoperative CBCT field of view using a multi-turn reverse helical scan and assess potential clinical utility in interventional procedures. Materials and methods: A fixed-room robotic CBCT imaging system, with additional real-time control, was used to implement a multi-turn reverse helical scan. The scan consists of C-arm rotation, through a series of clockwise and anticlockwise rotations, combined with simultaneous programmed table translation. The motion properties and geometric accuracy of the multi-turn reverse helical imaging trajectory were examined using a simple geometric phantom. To assess potential clinical utility, a pedicle screw posterior fixation procedure in the thoracic spine from T1 to T12 was performed on an ovine cadaver. The multi-turn reverse helical scan was used to provide postoperative assessment of the screw insertion via cortical breach grading and mean screw angle error measurements (axial and sagittal) from 2 observers. For all screw angle measurements, the intraclass correlation coefficient was calculated to determine observer reliability. Results: The multi-turn reverse helical scans took 100 seconds to complete and increased the longitudinal coverage by 370% from 17 cm to 80 cm. Geometric accuracy was examined by comparing the measured to actual dimensions (0.2 ± 0.1 mm) and angles (0.2 ± 0.1 degrees) of a simple geometric phantom, indicating that the multi-turn reverse helical scan provided submillimeter and degree accuracy with no distortion. During the pedicle screw procedure in an ovine cadaver, the multi-turn reverse helical scan identified 4 cortical breaches, confirmed via the postoperative CT scan. Directly comparing the screw insertion angles (n = 22) measured in the postoperative multi-turn reverse helical and CT scans revealed an average difference of 3.3 ± 2.6 degrees in axial angle and 1.9 ± 1.5 degrees in the sagittal angle from 2 expert observers. The intraclass correlation coefficient was above 0.900 for all measurements (axial and sagittal) across all scan types (conventional CT, multi-turn reverse helical, and conventional CBCT), indicating excellent reliability between observers. Conclusions: Extended longitudinal field-of-view intraoperative 3-dimensional imaging with a multi-turn reverse helical scan is feasible on a clinical robotic CBCT imaging system, enabling long anatomical sites to be visualized in a single image, including in the presence of metal hardware.

To evaluate interventional radiology (IR) research over time based on the study type of published articles and the visibility of articles to non-radiology clinicians.We performed a search of all PubMed-indexed literature from January 1, 1991, through November 11, 2020, for clinical IR articles classified by their study type, categorized as: 1) meta-analyses/systematic reviews/practice guidelines; 2) randomized controlled trials; 3) non-randomized controlled trials; and 4) longitudinal/observational studies. Clinical IR articles were defined as those that met keyword criteria constructed from Society of Interventional Radiology procedure guides. Data were also collected on medical specialty journal categories that published IR-related articles.When we examined the first vs. the last decade of our study period, the number of IR articles published increased across all study types: randomized controlled trials (374 to 2620; 601% change), longitudinal/observational studies (2324 to 12,447; 436%), meta-analyses/systematic reviews/practice guidelines (1179 to 6135; 420%), non-randomized controlled trials (471 to 2161; 359%). The journal categories with the highest mean percentage increase of IR articles across all study types were obstetrics and gynecology (659%), peripheral vascular disease (342%), and emergency medicine (221%). We found a decrease of IR articles published in surgery (-6.0%), pediatrics (-14%), and pulmonary (-21%) journals.The number of IR articles grew quickly and at a similar rate compared with all PubMed-indexed articles and increased as a proportion of articles published in non-imaging specialty journals. This indicates greater visibility of IR studies for all clinicians and is encouraging towards the advancement of IR techniques.

Gastrostomy tubes (G-tubes) provide long-term feeding assistance to children with severe feeding dysfunction. Although there are a host of complications that occur at home with current pediatric G-tube feeding, their prevalences and outcomes remain relatively unstudied. This study aims to identify and describe such complications.A dual-round survey was administered to 98 participants through the Feeding Tube Awareness Foundation, a 501(c)(3) organization that supports parents and caretakers of G-tube-fed children. Information was collected broadly regarding G-tube complications, causes, and attitudes toward such complications.Infection (56%), itching/irritation/redness (52%), and leakage (51%) were the leading G-tube related complications. The average time that G-tubes were replaced was 3.4 ± 1.2 months as compared to the typical recommended period of up to 6 months. Of the caretakers who had not experienced G-tube displacement, 7.9% wanted to see a change in current G-tubes to address the issue, compared with 75% of those who had experienced displacement. This 67.1% differential in caretakers' attitudes toward G-tubes based on their prior experience with a particular complication was the largest gap among all other listed complications.G-tube complications are prevalent and varied. A sizable portion of G-tube users experience complications severe enough to require intervention. Of these, G-tube displacement is particularly critical and frequently precedes other prevalent complications, namely gastric leakage, infection, and tissue granulation.

Kidney transplantation (KT) experts did not support the use of subjective unintentional weight loss to measure shrinking in the Physical Frailty Phenotype (PFP); a clinically feasible and predictive measure of shrinking is needed. To test whether unintentional weight loss could be replaced by an assessment of sarcopenia using existing CT scans, we performed a prospective cohort study of adult KT recipients with original PFP (oPFP) measured at admission (12/2008–2/2020). We ascertained sarcopenia by calculating skeletal muscle index from available, clinically obtained CTs within 1-year pre-KT (male

This study aims to identify the ideal arteriole size to target in bariatric embolization, with the goal of maximizing weight loss efficacy while maintaining patient safety. Although all published clinical trials of bariatric embolization have used embolic microspheres that were at least 300 μm in diameter, optimal weight loss outcomes have been achieved safely in swine using 50-μm embolics. Human fundal remnants from bariatric surgery were compared with swine fundal sections after bariatric embolization with 50-μm embolic microspheres to assess the ideal fundal vessel size for bariatric embolization. In swine, the 50-μm embolic microspheres deposited in the luminal half of the submucosa with a mean arteriole size of 49 ± 30 μm. The mean arteriole diameter in the corresponding submucosal layer of the human gastric fundi was 40 ± 30 μm. These measurements are intended to inform future clinical trials and direct the development of embolic agents for bariatric embolization.

Background Pre-liver transplant (LT) sarcopenia is associated with poor survival. Methods exist for measuring body composition with use of CT scans; however, it is unclear which components best predict post-LT outcomes. Purpose To quantify the association between abdominal CT-based body composition measurements and post-LT mortality in a large North American cohort. Materials and Methods This was a retrospective cohort of adult first-time deceased-donor LT recipients from 2009 to 2018 who underwent pre-LT abdominal CT scans, including at the L3 vertebral level, at Johns Hopkins Hospital. Measurements included sarcopenia (skeletal muscle index [SMI]50 in men and39 in women), sarcopenic obesity, myosteatosis (skeletal muscle CT attenuation41 mean HU for body mass index [BMI]25 and33 mean HU for BMI ≥25), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and VAT/SAT ratio. Covariates in the adjusted models were selected with use of least absolute shrinkage and selection operator regression with lambda chosen by means of 10-fold cross-validation. Cox proportional hazards models were used to quantify associations with post-LT mortality. Model discrimination was quantified using the Harrell C-statistic. Results A total of 454 recipients (median age, 57 years [IQR, 50-62 years]; 294 men) were evaluated. In the adjusted model, pre-LT sarcopenia was associated with a higher hazard ratio (HR) of post-LT mortality (HR, 1.6 [95% CI: 1.1, 2.4]; C-statistic, 0.64

Hemorrhagic hereditary telangiectasia (HHT) is a rare autosomal dominant disorder that causes multisystem vascular malformations including mucocutaneous telangiectasias and arteriovenous malformations (AVMs). Clinical and genetic screening of patients with signs, symptoms, or a family history suggestive of HHT is recommended to confirm the diagnosis on the basis of the Curaçao criteria and prevent associated complications. Patients with HHT frequently have epistaxis and gastrointestinal bleeding from telangiectasias. Pulmonary AVMs are common right-to-left shunts between pulmonary arteries and veins that can result in dyspnea and exercise intolerance, heart failure, migraine headaches, stroke or transient ischemic attacks, brain abscesses, or in rare cases, pulmonary hemorrhage. Primary neurologic complications from cerebral AVMs, which can take on many forms, are less common but particularly severe complications of HHT. Multimodality imaging, including transthoracic echocardiography, Doppler US, CT, and MRI, is used in the screening and initial characterization of vascular lesions in patients with HHT. Diagnostic angiography is an important tool in characterization of and interventional treatments for HHT, particularly those in the lungs and central nervous system. A multidisciplinary approach to early diagnosis, treatment, imaging, and surveillance at high-volume HHT Centers of Excellence is recommended. Although a variety of idiopathic, traumatic, or genetic conditions can result in similar clinical and imaging features, the Curaçao criteria are particularly useful for the proper diagnosis of HHT. Imaging and treatment options are reviewed, with a focus on screening, diagnosis, and posttreatment findings, with the use of updated international guidelines.

PURPOSE: Cone-beam CT has become commonplace for 3D guidance in interventional radiology (IR), especially for vascular procedures in which identification of small vascular structures is crucial. However, its long image acquisition time poses a limit to image quality due to soft-tissue deformable motion that hampers visibility of small vessels. Autofocus motion compensation has shown promising potential for soft-tissue deformable motion compensation, but it lacks specific target to the imaging task. This work presents an approach for deformable motion compensation targeted at imaging of vascular structures. METHODS: The proposed method consists on a two-stage framework for: i) identification of contrast-enhanced blood vessels in 2D projection data and delineation of an approximate region covering the vascular target in the volume space, and, ii) a novel autofocus approach including a metric designed to promote the presence of vascular structures acting solely in the region of interest. The vesselness of the image is quantified via evaluation of the properties of the 3D image Hessian, yielding a vesselness filter that gives larger values to voxels candidate to be part of a tubular structure. A cost metric is designed to promote large vesselness values and spatial sparsity, as expected in regions of fine vascularity. A targeted autofocus method was designed by combining the presented metric with a conventional autofocus term acting outside of the region of interest. The resulting method was evaluated on simulated data including synthetic vascularity merged with real anatomical features obtained from MDCT data. Further evaluation was obtained in two clinical datasets obtained during TACE procedures with a robotic C-arm (Artis Zeego, Siemens Healthineers). RESULTS: The targeted vascular autofocus effectively restored the shape and contrast of the contrast-enhanced vascularity in the simulation cases, resulting in improved visibility and reduced artifacts. Segmentations performed with a single threshold value on the target vascular regions yielded a net increase of up to 42% in DICE coefficient computed against the static reference. Motion compensation in clinical datasets resulted in improved visibility of vascular structures, observed in maximum intensity projections of the contrast-enhanced liver vessel tree. CONCLUSION: Targeted motion compensation for vascular imaging showed promising performance for increased identification of small vascular structures in presence of motion. The development of autofocus metrics and methods tailored to vascular imaging opens the way for reliable compensation of deformable motion while preserving the integrity of anatomical structures in the image.

Objective To explore baseline characteristics, comorbidities, and clinical diagnoses in the prediction of outcomes for inpatient percutaneous biliary interventions in the United States. Methods Hospitalizations for percutaneous transhepatic cholangiography and percutaneous biliary drainage were studied using the National Inpatient Sample 2012 to 2015. Associations between baseline characteristics, comorbidities, clinical diagnoses, and outcomes were analyzed using multivariable regression modeling. Regional variations were studied in an exploratory analysis. Results Hospitalizations for percutaneous biliary interventions had average inpatient mortality of 3.8% ± 0.8% and length of stay of 7.6 ± 0.3 days. Hypertension was the most common comorbidity (50.5% ± 0.8%), and paralysis was associated with the highest inpatient mortality (19.1% ± 5.7%) and length of stay (11.4 ± 1.3 days). Compared with nonmalignant biliary-pancreatic disorders, sepsis was associated with the highest inpatient mortality (6.5% ± 1.1%; adjusted odds ratio [aOR]: 5.2 [3.9-7.0]) and length of stay (9.0 ± 3.0 days; aOR: 2.2 [1.9-2.5]), followed by underlying malignancy (mortality of 5.5% ± 0.6%; aOR: 2.3 [1.7-3.0]; length of stay of 8.3 ± 0.2 days; aOR: 1.6 [1.4-1.8]). The observed associations were independent of baseline characteristics and comorbidities. With regard to regional variations, the Middle Atlantic states had the lengthiest hospital stays (38.8% ± 2.0% >8 days) and the East South Central states had the highest inpatient mortality (6.6% ± 1.6%) while having the highest frequency of malignancy (37.9% ± 3.7%) and the lowest frequency of postoperative cases (15.2% ± 2.4%). Conclusion In addition to baseline characteristics and comorbidities, sepsis and malignancy were determinants of higher mortality and increased length of stay in hospitalizations for percutaneous biliary interventions. We observed significant regional variations in clinical diagnoses and outcomes across the United States.

The Society of Interventional Radiology Foundation (SIRF) aims to support interventional radiology (IR) investigators by awarding numerous grants to promote the advancement of scientific knowledge in IR. Over the last 19 years, SIRF has awarded 227 research grants, amounting to more than $4.7 million. To increase the engagement of interventional radiologists and IR scientists with the National Institutes of Health (NIH), SIRF created a SIRF/NIH taskforce in 2020. Over the past couple of years, the task force has been working to assess the return on investment of SIRF grants in terms of NIH funding because this metric is an effective measure of assessing the early success of foundation funding. The objectives of this report are to assess SIRF funding from 2002 to 2020 and investigate the conversion of this funding into NIH grants by the same investigators. During the study period, more than $37.6 million in NIH funds were awarded to SIRF awardees, which shows a return of 8 NIH dollars for every 1 SIRF dollar invested.

This study aimed to investigate the prevalence of hepatic steatosis in racially diverse adults presenting to the emergency department at a tertiary healthcare system in the United States using attenuation values on unenhanced computed tomography (CT) as the reference standard. The utility of known risk factors for predicting the presence of hepatic steatosis was assessed. Additionally, reporting of hepatic steatosis in original radiology reports was evaluated. For 381 consecutive adults (193 women and 188 men; mean age 55.2 ± 17.2 years), hepatic (left medial, left lateral, right anterior, and right posterior) and splenic (upper, middle, and lower) CT attenuation values (Hounsfield units) were obtained by drawing a 1 cm

In recent years there has been increased interest in using the immune contexture of the primary tumors to predict the patient’s prognosis. The tumor microenvironment of patients with cancers consists of different types of lymphocytes, tumor-infiltrating leukocytes, dendritic cells, and others. Different technologies can be used for the evaluation of the tumor microenvironment, all of which require a tissue or cell sample. Image-guided tissue sampling is a cornerstone in the diagnosis, stratification, and longitudinal evaluation of therapeutic efficacy for cancer patients receiving immunotherapies. Therefore, interventional radiologists (IRs) play an essential role in the evaluation of patients treated with systemically administered immunotherapies. This review provides a detailed description of different technologies used for immune assessment and analysis of the data collected from the use of these technologies. The detailed approach provided herein is intended to provide the reader with the knowledge necessary to not only interpret studies containing such data but also design and apply these tools for clinical practice and future research studies.

Upper gastrointestinal (GI) bleeding is a common cause of hospital admission in the United States and is frequently treated by endoscopy. Recent studies have shown an increasing role for treatment using transcatheter embolization.Data from the national inpatient sample (1993-2015) were used for trend analysis and to compare patient characteristics, comorbidities, and outcomes for endoscopic and transcatheter treatments of gastric and duodenal bleeding.Despite the continued decline in the rate of hospitalization for upper GI bleeding (-43% since 1993, P.01), admissions for embolization (21.1% per year since 2005, P.01) and endoscopic treatments (1.2%-6.1% per year since 1993, P.01) have increased in the past decade. Patients with multiple comorbidities that include coagulopathy (25.6% versus 11.9%, P.05), liver disease (16.0% versus 10.7%, P.05), fluid and electrolyte disorder (51.0% versus 35.4%, P.05), and metastatic cancer (6.9% versus 2.4%, P.05) were more likely to receive embolization. Embolization was associated with higher crude risk of death (9.2% versus 2.1%, P.01), lengthier hospital stays (9.1 days versus 5.1 days, P.01), and greater average total hospital charges (US$135,000 versus US$46,000). The association between embolization (versus endoscopy) and mortality and length of stay diminished after controlling for disease severity and other procedures in propensity score-matched groups and by covariate adjustment.Though endoscopy remains the main treatment of upper GI bleeding, embolization is associated with comparable mortality and length of stay after accounting for disease severity and the need for additional procedures.

OBJECTIVE. The objective of our study was to help academic researchers avoid predatory publishers by characterizing the problem with respect to radiology and medical imaging and to test an intervention to address aggressive e-mail solicitation. MATERIALS AND METHODS. In total, 803 faculty from 10 U.S. academic radiology departments and 193 faculty in the senior author's department were surveyed about their experiences with soliciting journals. To document the characteristics of these journals and their publishers, we retrospectively reviewed the academic institutional e-mail box of one radiologist over 51 days. Journals' bibliometric parameters were compared with those of established medical imaging journals offering open access publishing. We tested filters for selected syntax to identify spam e-mails during two time periods. RESULTS. Of 996 faculty, 206 responded (16% nationally, 42% locally). Most (98%) received e-mails from soliciting publishers. Only 7% published articles with these publishers. Submission reasons were invitations, fee waivers, and difficulty publishing elsewhere. Overall, 94 publishers sent 257 e-mails in 51 days, 50 of which offered publishing opportunities in 76 imaging journals. Six journals were indexed in PubMed, and two had verifiable impact factors. The six PubMed-indexed journals had a lower mean publication fee ($824) than top medical imaging journals ($3034) (p < 0.001) and had a shorter mean duration of existence (9.5 vs 49.0 years, respectively; p = 0.005). The e-mail filters captured 71% of soliciting e-mails during the initial 51-day period and 85% during the same period 1 year later. CONCLUSION. Soliciting publishers have little impact on scientific literature. Academicians can avoid soliciting e-mails with customized e-mail filters.

PURPOSE: To examine the safety and efficacy of bariatric arterial embolization (BAE) with X-ray-visible embolic microspheres (XEMs) and an anti-reflux catheter in swine. MATERIAL AND METHODS: BAE with selective infusion of XEMs (n = 6) or saline (n = 4, control) into the gastric fundal arteries was performed under X-ray guidance. Weight and plasma hormone levels were measured at baseline and weekly for four weeks after embolization. Cone beam CT (CBCT) images were acquired immediately after embolization and weekly for four weeks. Hormone-expressing cells in the stomach were assessed by immunohistochemical staining. RESULTS: BAE pigs lost weight at one week after embolization followed by significantly impaired weight gain relative to controls (14.3% vs 20.9% at 4 weeks, P = 0.03). Plasma ghrelin levels were significantly lower in embolized animals than those in controls (1221.6 vs 1706.2 at 4 weeks, P < 0.01). XEMs were visible on X-ray and CBCT during embolization and their radiopacity persisted over four weeks (165.5 HU at week-1 vs. 158.5 HU at week-4, P = 0.9). Superficial mucosal ulcerations were noted in 1 of 6 BAE animals. Ghrelin-expressing cell counts were significantly lower in the gastric fundus (17.7 vs 36.8, P < 0.00001) and antrum (24.2 vs 46.3, P < 0.0001) than those in controls. Gastrin-expressing cell counts were markedly reduced in BAE pigs relative to controls (98.5 vs 127.0, P < 0.02). Trichrome staining demonstrated significantly more fibrosis in BAE animals compared with controls (13.8% vs 8.7%, P < 0.0001). CONCLUSION: XEMs enabled direct visualization of the embolic material during and after embolization. BAE with XEMs and anti-reflux microcatheters was safe and effective.

Purpose Venous malformations (VMs) are low-flow vascular anomalies that are commonly treated with image-guided percutaneous sclerotherapy. Although many VMs can be safely accessed and treated using ultrasonography and fluoroscopy, some lesions may be better treated with magnetic resonance imaging (MRI)–guided sclerotherapy. The aim of this study is to evaluate the feasibility, efficiency, and outcomes of MRI-guided sclerotherapy of VMs using a 3T MRI system. Methods Six patients with VMs in the neck (n = 2), chest (n = 1), and extremities (n = 3) underwent sclerotherapy with 3T MRI guidance. Feasibility was assessed by calculating the technical success rate and procedural efficiency. Efficiency was evaluated by using planning, targeting, intervention, and total procedure times. Outcomes were assessed by measuring VM volumes before and after sclerotherapy, patient-reported pain scores, and occurrence of complications. Results Technical success was achieved in all 6 procedures. There was a non-significant 30% decrease in mean VM volume after the procedure (P = .350). The procedure resulted in a decrease in mean pain score (on an 11-point scale) of 2.6 points (P = .003). After the procedure, 4 patients reported complete pain resolution, 1 reported partial pain resolution, and 1 reported no change in pain. Procedural efficiency was consistent with similar sclerotherapy procedures performed at our institution. There were no major or minor complications. Conclusion 3T MRI guidance is feasible for percutaneous sclerotherapy of VMs, with promising initial technical success rates, procedural efficiency, and therapeutic outcomes without complications.

Objectives The aim of this study was to test the hypothesis that clinically used magnetic resonance (MR)-conditional needles of varying lengths, orientations, locations, and pulse sequences can result in excessive heating during MR imaging (MRI)-guided interventions that can be minimized to physiological ranges with proper selection of the needle length, needle position, and modification of pulse sequence parameters. Materials and methods We simulated a clinical interventional MRI setting with 2 standard American Society for Testing and Materials F2182-11A phantoms and measured temperatures with fiber optic sensors. Temperature profiles were monitored for commercial 10, 15 and 20 cm MR-conditional cobalt-chromium needles in clinically relevant perpendicular, 45-degree oblique, and parallel orientations relative to the static magnetic field (B0) and center, right off-center, and left off-center needle tip locations in the z = 0 plane. Clinically available interventional MRI pulse sequences including turbo spin echo (TSE), fast TSE, slice encoding for metal artifact correction, compressed sensing slice encoding for metal artifact correction, half-Fourier acquisition single-shot TSE (HASTE), HASTE inversion recovery, fluoroscopic steady-state gradient echo (3.0 T only), fast low-angle shot gradient echo, and volumetric interpolated breath-hold examination gradient echo pulse sequences were tested at 1.5 and 3.0 T field strengths. Acquired temperature data were analyzed using Friedman and Wilcoxon signed-rank tests with Bonferroni correction. Results After 5-minute of continuous MRI, less than 2.5°C heating occurred when needles were oriented perpendicular and 45-degree oblique to B0, regardless of field strengths. Higher temperature rises capable of causing permanent tissue damage were observed when needles were oriented in parallel to B0 (1.5 T: 22°C with 20 cm needles, 3.0 T: 8°C with 10 and 15 cm needles) using higher radiofrequency energy pulse sequences, such as TSE and HASTE. Left off-center location, parallel orientation, and needle lengths close to half of the radiofrequency pulse wavelength were positively associated with higher temperature rises. Conclusions Under the herein used experimental conditions, clinically used MR-conditional needles can heat to supraphysiologic temperatures during prolonged MRI at 1.5 and 3.0 T field strengths; however, the temperature rise can be balanced to physiological ranges with proper selection of needle length, needle orientation, and pulse sequence parameters. Caution must be exercised when using different MRI systems, as results may not directly translate.

To identify perioperative factors that are significantly associated with complications requiring interventional radiology (IR) treatment after hepatectomy. We retrospectively reviewed data from 11,243 patients in the USA who underwent hepatectomy from 2014 to 2016 using the National Surgical Quality Improvement Program database. Data on the following IR procedures were extracted: abscess drain placement, endovascular treatment for bleeding, and postoperative percutaneous biliary drain (PBD) placement up to 30 days postoperatively. Patients’ clinical and intraoperative factors were examined. Population, univariate, and multivariable analyses were performed. P

The obesity epidemic is a growing public health concern that has a severe effect on the health care system with significant morbidity, mortality, and cost. Treatment options for obesity include lifestyle modifications, pharmacotherapy, and bariatric surgery. Newer, less-invasive therapies including endoscopic bariatric procedures have been developed in recent years to fill the treatment gap that exists between noninvasive approaches and surgery. Bariatric artery embolization (BAE) is a novel minimally invasive endovascular procedure that has been developed to treat obesity. Recent evidence has suggested that bariatric embolization is well tolerated and can induce clinically significant weight loss through a hormonally mediated mechanism. This article will review existing preclinical and clinical data, and explore future directions of the endovascular treatment of obesity.