1. To determine the effectiveness, feasibility and safety of irreversible electroporation (IRE) in VX2 liver tumor ablation. 2. To evaluate and correlate radiographic findings with pathological results of IRE-induced liver tumor ablation. Upon ARC approval, 15 New Zealand white rabbits underwent partial treatment of liver VX2 tumors with IRE (90 pulses at 2500V/lesion), while 15 others served as untreated controls. Twenty-one days after tumor implantation, the size in volume, presence of local and distant metastases in macroscopic examination and histological analysis using immunostaining comparing IRE-treated versus untreated tumor was performed. Size comparison between ultrasound (US) and gross measurement was also investigated. At 21 days, the mean volume of untreated tumors was increased by 250% when compared to IRE-treated tumors (p < 0.001). Numerous lung and liver metastases were found in the untreated group, whereas no macroscopic metastases were observed in IRE-treated group. A mean difference of 2.1±3.1mm between US and gross measurements was observed. H&E staining of IRE-treated tumors demonstrated a sharp demarcation between ablated and non-ablated areas, with markedly increased neutrophilic infiltration and severe congestion suggesting cellular death. These findings were noted as early as 3 hours post-procedure. P53 and Ki-67 immunostaining demonstrated complete destruction of cellular proliferating activity in IRE-treated tumors. vWF and VEGFR staining showed complete preservation of blood vessels and bile ducts in all treated livers. Positive TUNEL assay indicated involvement of apoptosis in the cell death process. Lastly, positive CD30 staining demonstrated stem cell involvement of the healing process in IRE-treated regions. 1. IRE is a novel, effective and non-thermal method of hepatic tumor ablation which creates focused tumor cell death without damaging adjacent healthy tissue or critical structures (e.g. vessels and bile ducts). 2. Further evaluation of the apoptotic pathway, stem cell involvement, monitoring with different imaging modalities and complete eradication of tumor should also be attempted in future studies.

Purpose1. To provide a comprehensive review of the anatomical and vascular variants encountered during vertebral interventional procedures. 2. To demonstrate the radiographic findings of vertebral tumor interventions (vertebroplasty, embolization to ablation) with the use of magnetic resonance (MR) imaging, computer tomography (CT) and angiographic imaging.Materials & MethodsFrom the interventional radiology database and meta-analysis of current literature review, we will present the following in a didactic format: 1. Review of MR, CT and angiographic images of vertebral bone tumor. 2. Pictorial presentation of vertebral bone tumor after various interventions including vertebroplasty, kyphoplasty, embolization and ablation.Teaching PointsTo learn:1. Adjunctive role of vertebral tumor interventions in both treatment and palliation. 2. Safety and feasibility of various interventional procedures on vertebral bone tumors. 3. Imaging characteristics of vertebral bone tumors pre- and post-intervention. Purpose1. To provide a comprehensive review of the anatomical and vascular variants encountered during vertebral interventional procedures. 2. To demonstrate the radiographic findings of vertebral tumor interventions (vertebroplasty, embolization to ablation) with the use of magnetic resonance (MR) imaging, computer tomography (CT) and angiographic imaging. 1. To provide a comprehensive review of the anatomical and vascular variants encountered during vertebral interventional procedures. 2. To demonstrate the radiographic findings of vertebral tumor interventions (vertebroplasty, embolization to ablation) with the use of magnetic resonance (MR) imaging, computer tomography (CT) and angiographic imaging. Materials & MethodsFrom the interventional radiology database and meta-analysis of current literature review, we will present the following in a didactic format: 1. Review of MR, CT and angiographic images of vertebral bone tumor. 2. Pictorial presentation of vertebral bone tumor after various interventions including vertebroplasty, kyphoplasty, embolization and ablation. From the interventional radiology database and meta-analysis of current literature review, we will present the following in a didactic format: 1. Review of MR, CT and angiographic images of vertebral bone tumor. 2. Pictorial presentation of vertebral bone tumor after various interventions including vertebroplasty, kyphoplasty, embolization and ablation. Teaching PointsTo learn:1. Adjunctive role of vertebral tumor interventions in both treatment and palliation. 2. Safety and feasibility of various interventional procedures on vertebral bone tumors. 3. Imaging characteristics of vertebral bone tumors pre- and post-intervention. To learn: 1. Adjunctive role of vertebral tumor interventions in both treatment and palliation. 2. Safety and feasibility of various interventional procedures on vertebral bone tumors. 3. Imaging characteristics of vertebral bone tumors pre- and post-intervention.

1. To evaluate the effectiveness of PEOT with trisacryl-gelatin microspheres (TM) versus non-microspheres (NM) in reducing intraoperative blood loss (BL). 2. To examine differences in post-surgical complication rates between TM and NM. Upon IRB approval, the Interventional Radiology database was reviewed to retrieve all patients who underwent PEOT between 01/2005 and 01/2008. Details of patient demographics, site of primary tumor, bone tumor characteristics, angiographic findings, time interval between PEOT and surgery, intraoperative BL and post-surgical complications were recorded. A total of 29 PEOTs were performed in 26 patients. 14 patients received TM and 12 received a combination of polyvinyl alcohol and coils (NM). The average age in TM and NM groups were 61.3 and 60 years, respectively. Majority of bone tumors were metastases from renal cell carcinoma (36% vs. 58%, TM vs. NM), followed by hepatocellular carcinoma (28% vs. 0%). Both groups shared a similar average tumor volume (6.3x5.1x2.5cm3 vs. 5.7x4.0x2.3cm3). The most targeted sites of PEOT with TM vs. NM were the proximal femur (50%) and vertebral spine (61.5%), respectively. On average, surgeries occurred 1.75 and 2.7 days (TM vs. NM) after PEOT. The least amount of average BL (258mL) was observed in TM patients with ≥ 95% obliteration in tumor blush post-PEOT, while the most blood was lost in TM patients with < 95% tumor blush obliteration (600ml). NMs were associated with intraoperative BL of 356 and 425mL when tumor blush was reduced by ≥95% and <95%, respectively. In terms of complication rates, a higher rate of tumor recurrence was observed with NM (25% vs. 7%). No neurological complications were reported in either group. 1. TM is superior to NM in reducing intraoperative BL when complete embolization is achieved. 2. PEOT with TM is safe and effective and is associated with a lower rate of tumor recurrence post-operatively. 3. Our findings suggest a highly specific occlusion of tumoral vasculature with the use of TM.

To evaluate and compare complication rates of traditional portacath (TP) vs. power-injectable portacath (PIP). Upon IRB approval, the IR database was reviewed retrospectively to retrieve all patients who had received an IR-guided implantable venous access device (IVAD) between January 2006 and January 2008. A total of 146 patients received IVAD. Patient demographics, site of venous access, as well as details of IVAD including type (TP vs. PIP), duration, purpose and any associated complications were investigated. In total, PIPs were placed in 106 patients and TPs in 40 patients (Mean age = 57, Female = 63%, Right venous access = 79%). PIPs were 8F or 9.6F and TPs were 6.6F or 8F in size. Majority of patients (83%) required IVAD for chemotherapy (n = 121). In terms of complications leading to port removal, PIP was associated with a significantly higher rate of venous thrombosis (partial or complete occlusion, 3.8%, n = 4), compared with 0% in the TP group (p<0.01), with an average duration until port removal (DUPR) of 138 days. Three of the four patients with PIP-associated venous thrombosis had a PIP catheter that was 9.6F in size (75%). No single chemotherapeutic agent appeared to be the main culprit of this complication. Both PIPs and TPs were associated with malpositioning leading to poor aspiration and eventual discontinuation of the port (PIPS 2.8% vs. TPS 2.5%, n = 3 vs. 1, average DUPR = 83 vs. 145 days). Lastly, there were three cases of culture-positive port infection/suspected infection in the TP group which was not observed with PIPs (7.5% vs. 0%, n = 3 with DUPR = 152). 1. Power-injectable port (PIP) is a new generation IVAD that allows long term multi-functional venous access with the advantage of allowing higher resolution contrast-enhanced CT with its 'power injections' feature. 2. In our study, PIPs had a statistically significant rate of catheter-related venous thrombosis that was not present in the TP group. This appears to correlate well with the larger size of catheter in PIP placement, but not with any specific chemotherapeutic drugs used.

Recently Transjugular Intrahepatic Portosystemic Shunts (TIPS) have become an effective treatment option for relief of portal hypertension (PHTN) and other more lethal complications associated with PHTN. During the TIPS procedure, identification of portal and hepatic anatomy can be extremely challenging due to the presence of normal variants, congenital variants and acquired collateralization of vessels. In this comprehensive pictorial review, we will demonstrate various anatomical vascular variants seen in TIPS with different imaging modalities including angiography, CT/A, MRI/A and ultrasound. The aims of this presentation are: 1. To provide a comprehensive review of the anatomical vascular variants encountered in TIPS procedures. 2. To provide a pictorial review of various radiological and pathological images of liver diseases requiring TIPS. From the interventional radiology database and meta-analysis of current literature review, we will present followings in the didactic format: 1. Background review on TIPS. 2. Pictorial review and presentation of various anatomical vascular variants seen in TIPS procedures. 3. Pictorial review of various radiological presentations of liver diseases requiring TIPS placement. 4. Pictorial review of various pathological images of liver diseases requiring TIPS placement. After reviewing this educational exhibit, radiologists should be able to: 1. Recognize the different imaging presentations of liver diseases for which TIPS placement is indicated. 2. Recognize the different anatomical vascular variants often seen in TIPS procedures. 3. Gain an in-depth knowledge on TIPS that will allow for more efficient communication between clinicians leading to optimal patient management.