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To evaluate the influence of sarcopenia on survival in patients with hepatocellular carcinoma (HCC) treated with 90Y radioembolization. This single-center retrospective cohort study analyzed 82 consecutive patients (65 men and 17 women, mean age 65 years, range 31–83 years) with HCC treated with 90Y radioembolization between December 2013 and December 2017. Sarcopenia was assessed on pre-procedure MRI performed within 100 days prior to 90Y radioembolization by segmenting the paraspinal musculature at the level of the superior mesenteric artery origin and subtracting fat-intensity pixels to yield fat-free muscle area (FFMA). Sarcopenia was defined as FFMA ≤31.97 cm2 for men and ≤28.95 cm2 for women. Survival at 90 days, 180 days, 1 year, and 3 years following initial treatment was assessed using medical and public obituary records. Sarcopenia was identified in 30% (25/82) of patients. Death was reported for 49% (32/65) of males and 71% (8/17) of females (mean follow-up 19.6 months, range 21 days–58 months). Patients with sarcopenia were found to have increased mortality at 180 days (31.8% vs. 8.9%) and 1 year (68.2% vs. 21.2%). Sarcopenia was an independent predictor of mortality adjusted for BCLC stage and sub-analysis demonstrated that sarcopenia independently predicted increased mortality for patients with BCLC stage B disease. Sarcopenia was associated with increased 180-day and 1-year mortality in HCC patients undergoing 90Y radioembolization. Sarcopenia was an independent predictor of survival adjusted for BCLC stage with significant deviation in the survival curves of BCLC stage B patients with and without sarcopenia.

To evaluate the influence of sarcopenia on survival in patients with hepatocellular carcinoma (HCC) treated withThis single-center retrospective cohort study analyzed 82 consecutive patients (65 men and 17 women, mean age 65 years, range 31-83 years) with HCC treated withSarcopenia was identified in 30% (25/82) of patients. Death was reported for 49% (32/65) of males and 71% (8/17) of females (mean follow-up 19.6 months, range 21 days-58 months). Patients with sarcopenia were found to have increased mortality at 180 days (31.8% vs. 8.9%) and 1 year (68.2% vs. 21.2%). Sarcopenia was an independent predictor of mortality adjusted for BCLC stage and sub-analysis demonstrated that sarcopenia independently predicted increased mortality for patients with BCLC stage B disease.Sarcopenia was associated with increased 180-day and 1-year mortality in HCC patients undergoing

Insulinomas are the most common functional pancreatic neuroendocrine tumor. Most insulinomas can be localized non-invasively with cross-sectional and nuclear imaging. Selective arterial calcium stimulation and hepatic venous sampling is an effective and safe minimally-invasive procedure for insulinoma localization that may be utilized when non-invasive techniques are inconclusive. The procedure’s technical success and proper interpretation of its results is dependent on the interventional radiologist’s knowledge of normal and variant pancreatic arterial perfusion. Accurate pre-operative localization aids in successful surgical resection. Technical and anatomic considerations of insulinoma localization with selective arterial calcium stimulation and hepatic venous sampling are reviewed.

Angiography and transcatheter embolization are critical treatment options as part of the standard of care in the management of pelvic hemorrhage, either as primary treatment or as an adjunct to surgical techniques. Advances in dynamic contrast enhanced multidetector CT have facilitated the triage of patients from conservative management with supportive care to catheter directed therapy or open surgery. Preprocedural CT provides differentiation of venous and arterial injury, rapid identification of the site of hemorrhage as well as detection of associated skeletal and soft tissue injuries. Modern endovascular techniques allow timely embolization by selective catheterization and employ a wide variety of embolic agents. Optimal patient outcome requires a team effort with active participation from trauma surgery, intensive care medicine, perfusion and respiratory therapy, and critical care nursing. Pelvic embolization has a high rate of technical and clinical success in the treatment of active pelvic hemorrhage. Embolization in the setting of major pelvic fracture or visceral trauma has a success rate of up to 95%. Optimal treatment frequently requires the interventionalist to identify the site of active bleeding, but the clinical team must ensure there will be no lapse in therapy during the embolization procedure. With this teambased approach, patients can safely undergo endovascular therapy for pelvic hemorrhage and avoid open surgery, the results of which can be compromised by difficult operative exposure, complex vascular anatomy, and active hemorrhage at the time of the procedure, resulting in excessive operative mortality.

To evaluate the feasibility and benefits of performing yttrium-90 radioembolization in an office-based lab (OBL) compared to a hospital setting.A radioembolization program was established in March 2019 in an OBL that is managed by the radiology department of a tertiary care center. Mapping and treatment angiograms performed in the OBL from March 2019 through January 2020 were compared to mapping and treatment angiograms performed in the hospital during the same time period.One hundred seventy-six mapping and treatment angiograms were evaluated. There was no difference in the proportion of mapping versus treatment angiograms performed at each site, the proportion of lobar versus selective dose vial administrations, or the mean number of dose vials administered per treatment procedure. Procedure start delays were longer in the hospital than in the OBL (28.6 minutes vs 0.8 minutes; P.0001), particularly for procedures that were not scheduled as the first case of the day (hospital later case delay, 38.8 minutes vs OBL later case delay, 0.5 minutes; P.0001). Procedures performed in the hospital took longer on average than procedures performed in the OBL (2 hours, 1.8 minutes vs 1 hour, 44.4 minutes; P = .0004), particularly for procedures that were not scheduled as the first case of the day (hospital later case duration, 2 hours, 7.4 minutes vs OBL later case duration, 1 hour, 43 minutes; P = .0006).Establishing a radioembolization program within an OBL is feasible and might provide more efficient procedure scheduling than the hospital setting.

Purpose To calculate the volume of greenhouse gases (GHGs) generated by a hospital-based interventional radiology (IR) department. Materials and Methods Life cycle assessment (LCA) was used to calculate GHGs emitted by an IR department at a tertiary care academic medical center. The volume of waste generated, amount of disposable supplies and linens used, and the operating times of electrical equipment were recorded for procedures performed between 7:00 AM and 7:00 PM on 5 consecutive weekdays. LCA was then performed using purchasing data, plug loads for electrical hardware, data from temperature control units, and estimates of emissions related to travel in the area surrounding the medical center. Results Ninety-eight procedures were performed on 97 patients. The most commonly performed procedures were drainages (30), placement and removal of venous access (21), and computed tomography–guided biopsies (13). Approximately 23,500 kg CO2e were emitted during the study. Sources of CO2 emissions in descending order were related to indoor climate control (11,600 kg CO2e), production and transportation of disposable surgical items (9,640 kg CO2e), electricity plug load for equipment and lighting (1,060 kg CO2e), staff transportation (524 kg CO2e), waste disposal (426 kg CO2e), production, laundering, and disposal of linens (279 kg CO2e), and gas anesthetics (19.3 kg CO2e). Conclusions The practice of IR generates substantial GHG volumes, a majority of which come from energy used to maintain climate control, followed by emissions related to single-use surgical supplies. Efforts to reduce the environmental impact of IR may be focused accordingly.

This section provides a comprehensive procedural report for transcatheter embolization for the treatment of renal trauma procedure with up-to-date explanatory notes, synopsis of the indications, and contraindications and potential complications in an organized and practical format.

Despite progress in noninvasive imaging with computed tomography and magnetic resonance imaging, conventional angiography still contributes to the diagnostic workup of oncologic and other diseases. Arteriography can reveal tumors not evident on cross-sectional imaging, in addition to defining aberrant or unexpected arterial supply to targeted lesions. This additional and potentially unanticipated information can alter management decisions during interventional procedures.

tively acquired database of patients undergoing either Y TARE with resin microspheres or TACE for metastatic hepatic NET over a 5-year period was performed. Patients treated with hepatotoxic systemic chemotherapy were excluded. Collected data included liver/spleen volumes on CT/MR, platelet count, INR, albumin, total protein, AST, ALT, bilirubin, and creatinine before therapy and approximately 1-3 and 4-6 months after. Results: Of 47 patients, 22 patients (11M; age 62 12 y) underwent TARE and 25 patients (16M; age 58 12 y) underwent TACE. The two groups had similar baseline demographics, pretreatment spleen and liver volumes and lab data. After TARE, mean splenic volume showed a non-significant increase of 9% at 3 months post treatment (p1⁄40.3), which increased to 15% at 6 months compared with the pretreatment volumes (p1⁄40.008). Mean liver volume showed no significant change at 3 months post treatment (avg. decrease of 1%) but showed a significant decrease of 11% at 6 months (p1⁄40.01). After TACE, at 1-3 months there was transient increase in mean splenic volume of 40% (p1⁄40.03). Splenic volume subsequently normalized at the 4-6 month follow-up to a 4% increase from baseline (p1⁄40.6). Mean liver volume showed a decreasing trend of 8% at 3 months (p1⁄40.6) and 10% at 6 months (p1⁄40.08). There was a significant 12.8% decrease in platelet count at 6 months in the TACE group (p1⁄40.02) and a trend toward a decreased platelet count of 12.6% in the TARE group at 6 months (p1⁄40.1). Changes in all other serologic data were not statistically significant. Conclusion: In chemo-naive patients with metastatic NET both TACE and TARE appear to cause splenic enlargement although the change appears to be earlier and more transient after TACE. With the exception of a decrease in platelet values, there appears to be no significant change in major markers of hepatic injury/function within 6 months after either treatment.

A multidisciplinary study of the Spiro Sandstone shows that in Pittsburg and Latimer counties, Oklahoma, along the Choctaw fault trend, the thrusted Spiro is predominantly a barrier island deposit consisting of reservoir-quality progradational and aggradational sandstones; however, to the east from Le Flore County, Oklahoma, through Yell County, Arkansas, along the structural trend, the Spiro is composed predominantly of tight, nonproductive, retrogradational sandstones. Petrographic observations of the progradational Spiro show that sands in the west are medium to fine grained, and in the east they are very fine grained. Chlorite coatings that inhibit quartz cementation are present only in the west. Vitrinite reflectance data indicate that the Spiro in the west is within the gas window (~1.5% R0), but in the east it is overmature (>2.5% R0). The term "overmature" applies to reservoirs that have insufficient porosity for commercial production due to destructive diagenesis caused by thermal stress. The simultaneous multidisciplinary approach is economically significant because exploration analysis time for this study was decreased, and decisions were made with more reliability.