Andrew J. Gunn

Radiology Reporting: Current Practices and an Introduction to Patient-Centered Opportunities for Improvement

OBJECTIVE As health care evolves, the radiology report must also change to satisfy referring physician and patient expectations. Knowledge of the issues and controversies regarding a patient-centered approach to reporting practices is important. This article will aid the radiologist in this endeavor by summarizing key facets of radiology reporting, including current reporting standards and emerging patient-centered concepts in report language, formatting, and delivery. CONCLUSION Future efforts to improve radiology reporting practices need to account for the needs of an increasingly heterogeneous audience that includes patients. Radiologists must exploit information technologies to craft and deliver meaningful patient-centered reports. A modern radiology report will be a powerful, flexible document that strengthens the connection between the radiologist and the patient.

Analysis of weight changes after left gastric artery embolization in a cancer-naive population

PURPOSE We aimed to evaluate weight changes after left gastric artery (LGA) embolization in a retrospective cancer-naive cohort. METHODS A retrospective study was conducted to identify patients who underwent LGA embolization for gastrointestinal bleeding (GI). Patients with known cancer diagnoses at the time of LGA embolization were excluded. Pre- and postprocedure weights were assessed. Statistical analysis was performed using paired t-test and Wilcoxon signed-rank test. RESULTS A total of 39 patients were identified. In 21 patients who had documented pre- and postprocedural weights, a median of 16.3 kg weight loss (P = 0.045) was observed over a median time of 12 months (range, 2-72). In patients who had pre- and postprocedure endoscopies (n=6), 2 had worsening ulcers following LGA embolization and 4 had stable or no abnormal findings. CONCLUSION Our preliminary observation suggests that LGA embolization is well tolerated and results in unintended weight loss. Larger studies are needed to confirm these preliminary findings.

Transarterial embolization of renal cell carcinoma as an adjunctive therapy prior to cryoablation: a propensity score matching analysis

PURPOSE We aimed to assess the safety and effectiveness of transarterial embolization (TAE) prior to percutaneous cryoablation (PCA) in the management of renal cell carcinoma (RCC) compared with PCA alone using a propensity score matching analysis to minimize confounding factors. METHODS A retrospective review of all PCAs performed for renal masses identified 9 patients who underwent TAE prior to PCA. These patients were matched in a 2:1 ratio with patients who underwent PCA only using age, gender, and tumor size to create the propensity score model for matching. Other demographic, clinical, and outcomes data were collected. RESULTS The TAE+PCA group included 5 males and 4 females with a mean age of 67.9 years and mean tumor diameter of 51.7 mm. The PCA only group included 11 males and 7 females with a mean age of 66.8 years and mean tumor diameter of 46.2 mm. No significant differences in these propensity score matched characteristics were identified. Further, the groups had no significant differences in tumor geometry (P = 0.831), R.E.N.A.L. nephrometry scores (P = 0.144), or comorbidity indices (P = 0.392). TAE was technically successful and without complication in all cases. PCA was technically successful in 8 of 9 patients in the TAE+PCA group and in 14 of 18 patients in the PCA only group (P = 0.483). No significant differences in the rate of complications (P = 0.483), change in eGFR (P = 0.691), or change in hematocrit (P = 0.152) were identified between the two groups. CONCLUSION TAE of RCC prior to PCA is safe and technically feasible; however, no objective benefits over PCA alone were identified by propensity score matching analysis. Due to small sample size and limitations of the study, no definite conclusions should be drawn. Larger, prospective studies of this therapeutic approach are warranted.

Role of Angio-Embolization for Renal Cell Carcinoma

Purpose of ReviewTo provide the technical aspects of, clinical indications for, status of the current literature on, and emerging concepts in trans-arterial embolization (TAE) for renal cell carcinoma.Recent FindingsTAE has been evaluated in several retrospective series as a neoadjuvant therapy prior to surgical resection of RCC to reduce tumor vascularity and minimize intra-operative blood loss. TAE has also been examined retrospectively as a neoadjuvant therapy prior to the percutaneous ablation of RCC to reduce blood loss and procedural complications. TAE can potentially palliate symptoms of RCC such as pain and hematuria. Trans-arterial chemoembolization and trans-arterial radioembolization are emerging concepts for RCC.SummaryAlthough there have been no prospective, randomized trials demonstrating improved clinical or oncologic outcomes from TAE for patients with RCC, several retrospective studies have shown encouraging results.

Trans-Arterial Embolization of Renal Cell Carcinoma prior to Percutaneous Ablation: Technical Aspects, Institutional Experience, and Brief Review of the Literature

This report describes the technical aspects of trans-arterial embolization (TAE) of renal cell carcinoma prior to percutaneous ablation. All patients (n = 11) had a single renal mass (mean tumor diameter = 50.2 mm; range: 28-84 mm). Selective TAE was performed via the common femoral artery. Embolic materials included: particles alone (n = 4), coils alone (n = 1), particles + ethiodized oil (n = 2), particles + coils (n = 1), ethiodized oil + ethanol (n = 2), and particles + ethanol (n = 1). All embolizations were technically successful and no complications have been reported. After embolization, 10 patients underwent cryoablation while 1 patient underwent microwave ablation. Ablations were technically successful in 10 of the 11 patients. Only 3 minor complications were identified but none required treatment. No adverse effect on the patients glomerular filtration rate was seen from the additional procedure (p = 0.84). TAE of renal cell carcinoma prior to percutaneous ablation is safe and technically-feasible.

Percutaneous Treatment of Iatrogenic and Traumatic Injury of the Biliary System

Purpose of ReviewTraumatic or iatrogenic bile duct injury (BDI) includes bile leaks, benign stenoses, and fistulae. These complications result in significant morbidity and mortality. This review will provide insight into the presentation, diagnosis, classification, and percutaneous management of BDI.Recent FindingsPrompt diagnosis through non-invasive imaging and minimally invasive procedures is paramount to improved patient outcomes. Numerous classifications of BDI exist, although none are universally accepted. Percutaneous approaches to the management of BDI offer a minimally invasive alternative to traditional surgery. Bile leaks are primarily treated with drainage and decompression; however, adjunctive techniques such as embolization are also presented. Fistulae are routinely treated with embolization even though limited literature exists to provide a consensus treatment algorithm. Benign stenosis is primarily treated with balloon dilation with long-term biliary intubation while placement of bile duct stents is often reserved for patients with recurrent stricture.SummaryIatrogenic or traumatic BDI typically requires a multidisciplinary team approach, although prompt diagnosis and advances in therapeutic approaches have improved patient outcomes.

Persistent Pulmonary Arteriovenous Malformations: Percutaneous Embolotherapy

Pulmonary arteriovenous malformations (PAVM) are an uncommon entity that interventional radiologists may face in their clinical practice. Many of these lesions are treated successfully using endovascular techniques with satisfactory long-term results. However, some PAVMs respond poorly to initial interventional techniques. This article reviews the signs and symptoms of persistent PAVMs, illustrates different imaging modalities used to diagnose these lesions, and outlines mechanisms by which these lesions may persist. The article highlights techniques and embolic agents used for percutaneous transcatheter embolotherapy of persistent PAVMs and discuss the outcomes of these interventions.