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Clear cell renal cell carcinoma (ccRCC) is the most common subtype of renal cell carcinoma. Currently, there is a lack of noninvasive methods to stratify ccRCC prognosis prior to any invasive therapies. The purpose of this study was to preoperatively predict the tumor stage, size, grade, and necrosis (SSIGN) score of ccRCC using MRI-based radiomics. A multicenter cohort of 364 histopathologically confirmed ccRCC patients (272 low [

To compare the motivation, deterrents, knowledge, exposure, and other specialty considerations of first- to fourth-year medical students interested in interventional radiology (IR) with those who are not.Matriculants of 5 medical schools varying by region, public/private, class size, and National Institutes of Health research ranking received a 19-question survey with questions about demographics, specialty interests, motivations/deterrents, knowledge, and exposure to IR.A total of 25.8% (611/2370) of students completed the survey, of which 20.5% (125/611) expressed interest in IR, and 25% (47/186), 26% (40/153), 24% (34/143), and 3% (3/117) of first-year, second-year, third-year, and fourth-year medical students, respectively, were seriously considering IR. Those interested in IR were less motivated by direct patient care (mean, 2.8/5; 95% confidence interval [CI], 2.6-3.0) and longitudinal patient care (mean, 1.6/5; 95% CI, 1.4-1.7) (both, P.01) and more motivated by salary (2.6/5; 95% CI, 2.3-2.9), job market (2.8/5; 95% CI, 2.6-2.9), and procedures (3.1/5; 95% CI, 2.8-3.4) compared with their peers (all P.05). Those interested in IR were more certain about their IR knowledge (mean range, 1.6-2.0/3.0; 95% CI, 1.3-2.3) than their peers (mean range, 1.9-2.4/3.0; 95% CI, 1.6-2.1, in which 0 = certain, P ≤ .01); however, both groups scored low in actual knowledge (those considering IR: 35.0-73.2% correct; 95% CI, 23.5-81.4; those who were not: 26.6-66.7% correct; 95% CI, 24.3-75.9, P.05).Although medical students showed interest in IR, they had a limited understanding of IR. IR educators may increase IR interest and understanding among medical students by clarifying the procedural aspects and longitudinal care present in a comprehensive IR practice.

Clear cell renal cell carcinoma (ccRCC) is the most common subtype of renal cell carcinoma. Currently, there is a lack of noninvasive methods to stratify ccRCC prognosis prior to any invasive therapies. The purpose of this study was to preoperatively predict the tumor stage, size, grade, and necrosis (SSIGN) score of ccRCC using MRI-based radiomics.A multicenter cohort of 364 histopathologically confirmed ccRCC patients (272 low [ 4] and 92 high [≥ 4] SSIGN score) with preoperative T2-weighted and T1-contrast-enhanced MRI were retrospectively identified and divided into training (254 patients) and testing sets (110 patients). The performance of a manually optimized radiomics model was assessed by measuring accuracy, sensitivity, specificity, area under receiver operating characteristic curve (AUROC), and area under precision-recall curve (AUPRC) on an independent test set, which was not included in model training. Lastly, its performance was compared to that of a machine learning pipeline, Tree-Based Pipeline Optimization Tool (TPOT).The manually optimized radiomics model using Random Forest classification and Analysis of Variance feature selection methods achieved an AUROC of 0.89, AUPRC of 0.81, accuracy of 0.89 (95% CI 0.816-0.937), specificity of 0.95 (95% CI 0.875-0.984), and sensitivity of 0.72 (95% CI 0.537-0.852) on the test set. The TPOT using Extra Trees Classifier achieved an AUROC of 0.94, AUPRC of 0.83, accuracy of 0.89 (95% CI 0.816-0.937), specificity of 0.95 (95% CI 0.875-0.984), and sensitivity of 0.72 (95% CI 0.537-0.852) on the test set.Preoperative MR radiomics can accurately predict SSIGN score of ccRCC, suggesting its promise as a prognostic tool that can be used in conjunction with diagnostic markers.

After deep venous thrombosis (DVT), many patients have impaired quality of life (QOL). We aimed to assess whether pharmacomechanical catheter-directed thrombolysis (PCDT) improves short-term or long-term QOL in patients with proximal DVT and whether QOL is related to extent of DVT.The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial was an assessor-blinded randomized trial that compared PCDT with no PCDT in patients with DVT of the femoral, common femoral, or iliac veins. QOL was assessed at baseline and 1 month, 6 months, 12 months, 18 months, and 24 months using the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms (VEINES-QOL/Sym) disease-specific QOL measure and the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary general QOL measures. Change in QOL scores from baseline to assessment time were compared in the PCDT and no PCDT treatment groups overall and in the iliofemoral DVT and femoral-popliteal DVT subgroups.Of 692 ATTRACT patients, 691 were analyzed (mean age, 53 years; 62% male; 57% iliofemoral DVT). VEINES-QOL change scores were greater (ie, better) in PCDT vs no PCDT from baseline to 1 month (difference, 5.7; P = .0006) and from baseline to 6 months (5.1; P = .0029) but not for other intervals. SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1 month (difference, 2.4; P = .01) but not for other intervals. Among iliofemoral DVT patients, VEINES-QOL change scores from baseline to all assessments were greater in the PCDT vs no PCDT group; this was statistically significant in the intention-to-treat analysis at 1 month (difference, 10.0; P .0001) and 6 months (8.8; P .0001) and in the per-protocol analysis at 18 months (difference, 5.8; P = .0086) and 24 months (difference, 6.6; P = .0067). SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1 month (difference, 3.2; P = .0010) but not for other intervals. In contrast, in femoral-popliteal DVT patients, change scores from baseline to all assessments were similar in the PCDT and no PCDT groups.Among patients with proximal DVT, PCDT leads to greater improvement in disease-specific QOL than no PCDT at 1 month and 6 months but not later. In patients with iliofemoral DVT, PCDT led to greater improvement in disease-specific QOL during 24 months.

Purpose To demonstrate that random forest models trained on a large national sample can accurately predict relevant outcomes and may ultimately contribute to future clinical decision support tools in IR. Materials and Methods Patient data from years 2012–2014 of the National Inpatient Sample were used to develop random forest machine learning models to predict iatrogenic pneumothorax after computed tomography–guided transthoracic biopsy (TTB), in-hospital mortality after transjugular intrahepatic portosystemic shunt (TIPS), and length of stay > 3 days after uterine artery embolization (UAE). Model performance was evaluated with area under the receiver operating characteristic curve (AUROC) and maximum F1 score. The threshold for AUROC significance was set at 0.75. Results AUROC was 0.913 for the TTB model, 0.788 for the TIPS model, and 0.879 for the UAE model. Maximum F1 score was 0.532 for the TTB model, 0.357 for the TIPS model, and 0.700 for the UAE model. The TTB model had the highest AUROC, while the UAE model had the highest F1 score. All models met the criteria for AUROC significance. Conclusions This study demonstrates that machine learning models may suitably predict a variety of different clinically relevant outcomes, including procedure-specific complications, mortality, and length of stay. Performance of these models will improve as more high-quality IR data become available.

The objective of the study was to determine if time to positive (TTP), defined as the time from the start of (99m)Tc-labeled RBC scanning to the appearance of a radionuclide blush (considered to be a positive finding for acute lower gastrointestinal bleeding [LGIB]), and lag time (LT), defined as the time from the appearance of a radionuclide blush to the start of catheter angiography (CA), affected the yield of CA for the detection of acute LGIB.TTP and LT were retrospectively evaluated in 120 patients who had positive findings for acute LGIB on (99m)Tc-labeled RBC scanning and subsequently underwent CA for the diagnosis and localization of gastrointestinal bleeding. Two nuclear medicine fellowship-trained radiologists independently reviewed the (99m)Tc-labeled RBC scans. Two fellowship-trained interventional radiologists independently reviewed the angiograms. All data were analyzed using SAS software.When a TTP threshold of ≤ 9 minutes was used, the sensitivity, specificity, positive predictive value, and negative predictive value for a positive CA study were 92%, 35%, 27%, and 94%, respectively. In addition, the odds of detecting bleeding on CA increased 6.1-fold with a TTP of ≤ 9 minutes relative to a TTP of9 minutes (p = 0.020). A significant inverse relationship was found between LT and a positive CA study (p = 0.041).TTP and LT impact the rate of positive CA studies. A TTP threshold of ≤ 9 minutes allows the detection of almost all patients who would benefit from CA for treatment and allows a reduction in unnecessary negative CA studies. The likelihood of positive findings on CA decreases with a delay in the performance of CA.

This chapter recounts the history of thrombolytic agents, those agents currently available, and indications for use. Clinical agents have expanded over the 80 years since they were discovered, primarily in the pleural space. Thrombolytic agents can be administered systemically (i.e., intravenously) to treat ischemic stroke, massive pulmonary embolism (PE), and acute myocardial infarction. They also can be delivered directly to the site of a thrombus via catheter, also known as catheter-directed therapy (CDT). To perform CDT safely and effectively, an understanding of the pharmacology and technical aspects of delivering agents is critical. This chapter will review in detail the indications for use, contraindications to CDT, technical aspects, and specific recommendations for monitoring during use.

Stroke is the fourth leading cause of death and the number one cause of long-term disability in the United States. Carotid stenosis is an important cause of ischemic strokes, accounting for 20 to 25%. Previous studies have established carotid endarterectomy as standard of care of symptomatic patients with > 50% stenosis and asymptomatic patients with > 60% stenosis; recently, carotid artery stenting has emerged as an alternative treatment for carotid stenosis. Several studies have been published comparing carotid artery stenting with endarterectomy with mixed results. In this article, the authors discuss carotid artery stenting technique, the results from the most recent trials, and future directions.

Neuroangiography (NA) is an important part of diagnosis and treatment of patients with neurological disease. Although NA may be performed for diagnostic purposes, in many instances NA is performed with the intent to treat. Indications for NA range from extracranial diseases (vertebrobasilar insufficiency from subclavian steal, extracranial carotid stenosis, cavernous-carotid fistula, neck trauma, epistaxis, tumor invasion of the carotid artery, and tumor embolization) to intracranial diseases (nontraumatic subarachnoid hemorrhage, cerebral aneurysms, cerebral arteriovenous malformations, cerebral vasospasm, acute stroke, tumor embolization, and WADA test). Similar to peripheral angiography, appropriate preprocedural assessment and postprocedural care, along with understanding of anatomy, catheter technique, and disease processes, are vital to successful outcomes. This article will review the basic technique, equipment, and patient management in NA. With appropriate skill and knowledge, interventional radiologists can perform NA with safe and successful results.

Acute ischemic stroke is a leading cause of death and the leading cause of disability in the United States. Cerebral neuronal death begins within minutes after threshold values of blood oxygen saturation are crossed. Prompt restoration of oxygenated blood flow into ischemic tissue remains the common goal of reperfusion strategies. This article provides a brief overview of acute ischemic stroke, a summary of the major intra-arterial stroke therapy trials, and comments on current training requirements for the performance of intra-arterial therapies.

Percutaneous vertebroplasty has become widely accepted as a safe and effective minimally invasive procedure for the treatment of painful vertebral body compression fractures refractory to medical therapy. In this article, the authors review the indications and contraindications for vertebroplasty, principles of appropriate patient selection, useful techniques to achieve optimal outcomes, and the potential risks and complications of the procedure.

Metastases to the vertebral column are often due to hypervascular primary tumors, the most common of which is renal cell carcinoma. Clinical symptoms attributed to vertebral body metastases include localized pain, mechanical instability of the vertebral column, and neurologic deficits resulting from mass effect. Treatment options include targeted radiotherapy, percutaneous vertebral augmentation with or without thermal ablation, and surgical resection with subsequent fusion. Overall, surgical resection of the tumor and stabilization of the vertebral column provide the best prognosis for the patient in terms of symptomatic improvement and long-term survival; however, resection of hypervascular vertebral body metastases can result in significant intraoperative blood loss that can add to the morbidity of the procedure. Preoperative embolization of hypervascular metastases of the vertebral column has been shown to significantly reduce intraoperative blood loss at the time of surgery. The goal of this manuscript is to describe the role of embolization therapy in the management of patients with vertebral body metastases.

Involvement of the carotid artery by malignant processes of the head and neck with compromise of vessel integrity and rupture-"carotid blowout syndrome" (CBS)-is one of the most devastating complications of malignancy. Most often, it is associated with squamous cell cancer and almost always in patients who have undergone prior radiation therapy. CBS is classified as threatened, impending, or acute. Bleeding into the oral cavity or from areas of skin breakdown is a frightening experience for patients and their families and often a terminal event. Prognosis is poor with up to 50% mortality and morbidity, and surgical options are limited and risky. Endovascular management with vessel sacrifice or stent placement has become the principle treatment option in this patient population, though still associated with procedural complications, often neurologic, that can occur acutely or in a delayed fashion. This article reviews techniques and outcomes associated with endovascular treatment of CBS.

This article is intended to provide a review of clinically relevant neurovascular anatomy. A solid understanding of the vascular anatomy of the brain and spine are essential for the safe and effective performance of neurointerventional radiology. Key concepts to master include collateral pathways and anastomoses between the external and internal carotid circulation, the Circle of Willis as a route to otherwise inaccessible intracranial vascular distributions, and the origin of spinal arterial blood supply. These concepts will be highlighted using clinical angiographic examples with discussion of relevant embryology and pathology as needed.

A majority of the population will experience epistaxis at some time in their life. Most cases will be from an anterior source and can be treated with pressure, anterior nasal packing, or cautery. Intractable epistaxis is generally posterior in origin and may require endoscopic cautery, posterior packing, surgical ligation, or embolization. Embolization has been used to treat epistaxis for more than 30 years and success can be achieved in approximately 90% of patients, with major complications occurring in approximately 2%. These excellent results require thorough knowledge of the regional anatomy, familiarity with the equipment and various agents used to achieve this type of embolization, as well as attention to detail and meticulous technique. There remains debate on several aspects of embolization, including the agent of choice, preferred size of the embolic, and the number of vessels to embolize. Advances in endoscopic surgery have evolved to the point that similar success rates for embolization and modern surgical techniques in treating epistaxis may be expected. This detailed review of pertinent vascular anatomy, embolization technique, and surgical alternatives should allow practitioners to formulate treatment algorithms that result in optimal outcomes at their institutions.

To compare the diagnostic yield of abdominal radiography with that of computed tomography (CT) in adult patients presenting to the emergency department with nontraumatic abdominal pain.Records of 1,000 consecutive patients presenting to the emergency department with acute abdominal pain from April to June 1998 were retrospectively reviewed. A total of 871 patients underwent abdominal radiography, and 188 underwent abdominal CT. The report interpretations of the abdominal radiographs and CT scans were divided into normal, nonspecific, and abnormal categories. Final discharge diagnoses were compared with the interpretations of the imaging examination results, and sensitivities and specificities of each modality were calculated and compared.Interpretation of abdominal radiographs was nonspecific in 588 (68%) of 871 patients, normal in 200 (23%), and abnormal in 83 (10%). The highest sensitivity of abdominal radiography was 90% for intraabdominal foreign body and 49% for bowel obstruction. Abdominal radiography had 0% sensitivity for appendicitis, pyelonephritis, pancreatitis, and diverticulitis. Sensitivities of abdominal CT were highest for bowel obstruction and urolithiasis at 75% and 68%, respectively.Abdominal radiographs are not sensitive in the evaluation of adult patients presenting to the emergency department with nontraumatic abdominal pain.

Preoperative endovascular tumor embolization has been used for 40 years. Meningiomas are the most common benign intracranial tumor in which preoperative embolization has been most extensively described in the literature. Advocates of embolization report that it reduces operative blood-loss, and softens the tumor, thus making surgery safer and easier. Opponents suggest that it adds additional risk and cost for patients without controlled studies showing conclusive benefit. The literature suggests a 3 to 6% neurological complication rate related to embolization. The combined external and internal carotid artery blood supply and complex anastomoses of the meninges can make embolization challenging. Positive outcomes require thorough knowledge of the pertinent vascular anatomy, familiarity with the neurovascular equipment and embolics, and meticulous technique. There remains debate on several aspects of embolization, including tumors most appropriate for embolization, embolic agent of choice, ideal size of embolic, and the choice of vessel(s) to embolize. This detailed review of pertinent vascular anatomy, embolization technique, results, and complications should allow practitioners to maximize treatment outcomes in this setting.

It's a Tuesday afternoon. A local orthopedic spine surgeon calls your office, “I have this patient with a T10 RCC met. I need to stabilize the spine, and it will be a bloody mess. Can you help us out?” You are not a fellowship-trained neurointerventional radiologist (NIR). Your answer is: Sure, I did vertebral body embolizations in fellowship; I do it all the time. No way man! I'm not a NIR. I'd love to help. I did vertebral body embolizations in fellowship, but it may be a little too risky now. Let me think about it. Never did it. But, I do trauma embolizations in same anatomic region. Let me think about it. If you answered B, put this journal down. Politely demure and suggest your orthopedic surgeon consider a transfer of the patient or perhaps an attempt at the surgery without pretreatment. You should not perform interventions that could be considered NIR. You should also be lauded for your honesty, compassion, and self-knowledge. You should NOT feel that you are somehow a failure. You might consider discussing with your hospital or group the potential value of adding a staff member with the skillset your local orthopedic surgeon seeks. If you answered A, read on. We're hoping to refresh your memory and maybe even provide you a few pearls. If you answered C or D, this Seminars issue is designed for you! You were trained to do this sort of work. You can and you should use your knowledge and skillset to help as many patients as possible. Your work will make this patient's surgery much safer. You can really help this patient and the referring surgeon and will almost certainly further cement your already strong relationship with this referring provider. Before you perform your T10 embolization, and after reading this issue, you will probably begin by reviewing everything you can about spinal cord vascular anatomy. You should and probably will continue by rereading any texts or journal articles you can about safe vertebral body embolization. You might even talk to a few IR colleagues about their experiences in this clinical arena. You will plan diligently, prepare meticulously, and perform a safe and effective arteriogram and embolization. You will follow up your patient after the spine surgery. You will also see your patient in follow-up in your office. You are an excellent IR and have added value to your health-care system. Regardless of your answer, what you are NOT is a NIR. Though NIR is defined as “physicians providing neurointerventional management of patients with diseases of the brain, spine, head, and neck” by the vision statement of the Society of Neurointerventional Surgery (www.snisonline.org/mission), this edition does NOT propose to make you a NIR; reading it should not inspire you to begin coiling anterior communicating artery (ACOM) aneurysms or gluing cerebral arteriovenous malformation (AVMs) or spinal dural arteriovenous fistula (AVFs). It should rekindle your desire to help manage some clinical problems that share anatomic or pathologic features in common with those problems managed by our NIR brethren. These are the sort of issues that happen frequently and may go either untreated or treated in a delayed fashion if you don't help. Acute ischemic stroke, refractory epistaxis, arterial injuries from head and neck trauma, and severe back pain from compression fractures are diagnoses made every day at community hospitals and Level I trauma centers alike. Unfortunately, the former facility (and even some of the latter) may not have a NIR as readily available as you! Intra-arterial (IA) acute stroke management is a great example of a “neuro IR” area in which IRs can really have more impact. At our institution, more stroke interventions are performed by IR than by our superb NIR team. Although our NIR section is well staffed, there are still only two NIRs available and they are essentially on call every other night for extremely complex clinical issues such as subarachnoid hemorrhage due to aneurysms, dural AVFs, and AVMs. Our system of on-call coverage entails IR performing initial diagnostic cerebral angiography and calling in the NIR if and when they are needed for management. If the eight non-NIRs at our institution didn't do IA stroke care, either many folks would simply not benefit from catheter-directed approaches or our NIRs would likely burn out and look for a better gig! Couple this with the fact that our stroke outcomes between the IRs and NIRs are equal, and, at least for our institution, the math becomes pretty simple. Unofficial results of a recent Society of Interventional Radiology (SIR) stroke survey are interesting. The survey had 486 overall responders, all SIR members: 62% reported working in an accredited (primary or comprehensive) stroke center; 88% report that neurologists and 71% report that emergency department providers offer IV thrombolysis at their centers. Since only 64% of respondents report that their centers offer IA therapy, 36% of respondents' patients appear to be deprived of IA stand-alone or salvage approaches (which we find increasingly useful with drip and ship protocols and in the setting of failed IV therapy). Also, though 64% reported that their centers offer IA stroke care, 54% reported working in a setting with available NIR and only 35% reported that they provided IA stroke care themselves. This suggests that a significant amount of IA stroke management is done by services other than IR or NIR. Although drawing conclusions from this sort of survey may not be possible, keeping in mind the public health impact of acute stroke, it appears that non-NIR specialists are willing, capable, and indispensable in the management of this disease. Given our skillset and clinical acumen, shouldn't IR be one of these non-NIR specialties? In the end, there's no reason why IRs can't have a positive effect in stroke management and a similar impact in other areas involving CNS anatomy. Certainly, assuming this mantle will take effort, education, and—let's face it—some risk. But, I wouldn't want myself or any of my family members to be the patient who needs that vertebral surgery done without an IRs help. Would you?

A 58-year-old male smoker presented with fevers and chills. Chest radiograph demonstrated an upper lobe abscess with an associated mass. Subsequent chest computed tomography is shown. The patient underwent bronchoscopy, which produced washings with malignant cells. Mediastinoscopy and upper lobectomy with mediastinal lymph node dissection were performed. In the immediate postoperative setting, the patient developed acute bilateral lower extremity pain. Emergent bilateral lower extremity arteriography was performed.

Introduction Vesicular glutamate transporters (VGLUTs) are involved in the transport of transmitter glutamate into synaptic vesicles and are used as markers for glutamatergic neurons. Methods To assess which types of VGLUTs are involved in the glutamate signaling in pulpal axons and to investigate their distribution, we performed light microscopic immunohistochemistry by using antibodies against VGLUT1, VGLUT2, calcitonin gene-related peptide, and Western blot analysis in human dental pulp. Results VGLUT1 was expressed in a large number of pulpal axons, especially in the peripheral pulp where the axons branch extensively. The VGLUT1 immunopositive axons showed bead-like appearance, and the majority of these also expressed calcitonin gene-related peptide. VGLUT2 was expressed in few axons throughout the pulp. Conclusions Our findings suggest that VGLUT1 is involved mainly in the glutamate-mediated signaling of pain, primarily at the level of the peripheral pulp.

The Arc of Buhler (AOB) represents a persistence of the ventral anastomosis between the superior mesenteric artery (SMA) and the celiac arterial systems. The exact incidence of the AOB is not known, but it is believed to be ≤ 4%. Aneurysms of this rare anomaly are even more uncommon. We report a case of an aneurysm of the AOB with an intact pancreaticoduodenal artery arcade (PDAA) and near occlusive celiac origin stenosis. Stenoses or occlusions of the celiac origin have been reported in association with AOB aneurysms, as well as in patients with PDAA aneurysms. Transcatheter embolization (TCE) was successfully performed, thereby excluding the AOB aneurysm while preserving flow through the PDAA. To our knowledge, this is the first report of successful percutaneous treatment of an AOB aneurysm. The pathophysiology and management AOB and PDAA aneurysms are reviewed. Review of the literature suggests that TCE, when feasible, is at least as effective as conventional surgery in patients with PDAA aneurysms, but with lower morbidity and mortality. Based on this data and our experience, we believe that TCE should be the initial treatment of choice in patients with PDAA or AOB aneurysms.

A 44-year-old Korean male died of rapidly progressive respiratory failure and refractory hypoxemia in 8 days after being admitted with a fever and dyspnea. The patient was diagnosed with pseudomembranous necrotizing tracheobronchial aspergillosis by fibroptic bronchoscopy and it was not related to an invasion of the pulmonary parenchyma. To the best of our knowledge, this case represents a patient with pseudomembranous necrotizing tracheobronchial aspergillosis that developed in an immunocompetent host, rapidly resulting in airway obstruction with acute respiratory failure and refractory hypoxemia without an invasion of the pulmonary parenchyma.

Positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) is a rapidly emerging technique for tumor diagnosis and staging. Recent studies have reported several benign causes of FDG uptake. The authors present a unique case of increased FDG activity resulting from a hiatal hernia.

Purpose To determine the effectiveness of EVLA of symptomatic lower extremity varicosities with 1470 nm laser fiber, and to compare the effectiveness to EVLA with 980 nm laser fiber. Materials and Methods IRB and HIPAA compliance were obtained. A retrospective review of electronic medical records of patients who underwent EVLA with 1470 nm laser at a busy outpatient interventional radiology practice associated with a major medical center was performed. Data collected included age, sex, laterality, vein treated, and parameters of treatment—i.e. watts, length of vein treated, energy density (J/cm), and tumescent anesthesia volume. Follow up duplex Doppler ultrasound exam results and follow up intervals were recorded. Ultrasound recanalization was defined as compressibility of and/ or presence of color Doppler flow within the treated vein segment. Fisher's exact test was used to compare the recanalization rate of the 1470 nm wavelength group to those treated with 980 nm EVLA during the same time period. Results Between 9/2009 and 4/2012, 74 vein segments were treated with 1470 nm wavelength EVLA. The distribution of vein segments was 47 (63.5%) great saphenous vein (GSV), 13 (17.6%) small saphenous vein (SSV), 10 (13.5%) accessory lateral tributary (ALT), and 4 (5.4%) other. The average US follow-up duration was 215 days (range: 7 - 1022). Recanalization rate for 1470 nm group was 5.4% (4/74). During the same time period at the same center, there were 714 vein segments treated with 980 nm wavelength EVLA. The average US follow-up duration was 310 days (range: 7 - 776). The recanalization rate was 3.5% (25/714).There was no statistically significant difference in long term recanalization rates between those treated with 1470 nm laser compared with 980 nm EVLA (p=0.34). Conclusion EVLA performed with 1470 nm laser showed a low long term recanalization rate. There was no statistically significant difference in recanalization rate compared with segments treated with 980 nm EVLA during the same time period.

Purpose To determine if energy density (Joules/cm) effects long-term success of EVLA of lower extremity superficial venous reflux. Materials and Methods IRB and HIPAA compliance were obtained. A retrospective review of EVLA treatments performed at a busy outpatient interventional radiology office was performed. Data collected included age, sex, vein segment treated, energy density (J/cm), length of vein treated, ultrasound follow-up intervals, and recanalization. Vein segments treated were divided into 80 J/cm. Comparison of recanalization rates among varying energy density groups were performed. Results There were 2127 vein segments treated from July 2003 to March 2012. Average age of patients were 51.3 years (range 21-86 years) with 1458 women and 347 men treated. Average follow-up was 298.7 days (range 5-1983). Average energy density was 86 J/cm with recanalization rate of 3.24% (69 of 2127). The recanalization rates for 80 J/cm were 5.57% (23 of 413), 4.77% (24 of 502), and 1.82% (22 of 1211) respectively. There is statistically significant lower recanalization rate in the > 80 J/cm group compared to 80 J/cm compared to 60-80 J/cm group almost reached statistical significance (p=0.08). The lower recanalization rate in the 60-80 J/cm group compared to the Conclusion This retrospective review of 2127 vein segments treated showed that EVLA performed with energy density >80 J/cm had the lowest long term recanalization rate. The study suggests that target energy density should be >80 J/cm to obtain highest long term success.

Purpose To determine the effectiveness of endovenous laser ablation (EVLA) for non-great saphenous veins, and to compare to GSV EVLA outcomes. Materials and Methods IRB and HIPAA compliance were obtained. A retrospective review of electronic medical records of all patients with EVLA performed from July 2003 to March 2012, at a high volume outpatient interventional radiology office practice was performed. Data collected included age, sex, vein treated, and parameters of treatment - i.e. watts, length of vein treated, energy density (J/cm) and tumescent anesthesia volume. Follow-up ultrasound exam(s) and occlusion rates were obtained. Non- GSV veins were defined as small saphenous vein (SSV), accessory lateral tributary (ALT), and other (intersaphenous veins, perforators, non-named veins). Primary endpoint was primary occlusion rate (PO) of non-GSV ablations. PO was defined as US non-compressibility and lack of color Doppler flow in the vein segment treated with EVLA. Secondary endpoint was comparison of PO rates of non GSV veins segments with contemporaneously treated GSV. Fisher's exact and Pearson chi2 tests were performed. Results There were 504 non-GSV treated. The distribution of vein segments was 259 (51.4%) SSV, 141 (28.0%) ALT, and 104 (20.6%) other. The average US follow-up duration was 299.9 days (range 6 - 1863). The overall non GSV PO was 97.2% (490/504). PO for SSV, ALT, and other were 96.5% (250/259), 96.5% (136/141), and 100% (104/104) respectively. During the same time interval, 1301 GSV were treated with PO of 96.5% (1255/1301) with average US follow-up of 298.2 days (range 5 - 1983). The overall average age was 51.3 years (range 21-86) with sex distribution of 1458 (80.8%) women and 347 (19.2%) men. There was no statistically significant difference between non GSV and GSV in primary occlusion rates (p=0.42). There was also no statistically significant difference among SSV, ALT, other, and GSV in primary occlusion rates (p=0.207). Conclusion Non GSV (SSV, ALT, and other) EVLA has a high primary occlusion rate at long -term follow-up, with no difference compared to GSV EVLA. Results strongly support the clinically indicated treatment of non GSV with EVLA.

Gout is the most common crystal-associated arthropathy. Gout is caused by deposition of monosodium urate crystals within the joints, and it is often associated with hyperuricemia. Acute gout involves the first metatarsophalangeal joint (podagra) in approximately 50% of cases and its peak incidence occurs in middle age. Although the clinical features can help with making the diagnosis of gout, many inflammatory diseases such as cellulitis, pseudogout and septic arthritis can mimic or coexist with it. The definitive diagnosis requires polarized light microscopy of the fluid aspirated from the involved joint and this shows needle-shaped, negative birefringent monosodium urate crystals. However, joint aspiration can be technically difficult, and none of the conventional imaging modalities for gout specifically identifies the chemical composition of uric acid. The advent of Dual-Energy CT (DECT) is a noninvasive method that has the potential to confirm gout and monitor the response to treatment.

Many drugs have been known to induce lupus-like syndrome, composing approximately 10% of all SLE cases. Isoniazid-induced lupus erythematosus affects either sex equally and the most common presenting feature is arthralgia or arthritis with anemia. Fever and pleuritis occur in approximately half of the cases, and pericarditis in approximately 30% of cases. We discribe a 28-year-old woman receiving antituberculous medications including isoniazid for one month. She was hospitalized with fever, arthralgia and newly developed pleural effusion The analysis of pleural fluid and serum revealed an elevated level of antinuclear antibody. We suspected of drug induced lupus and stopped isoniazid medication. After discontinuation of isoniazid and short course of prednisolone treatment, her symptoms and pleural effusion disappeared. This case is to our knowledge, the fist report of isoniazid induced SLE in Korea.