To determine if treatment-naive Child-Pugh class A patients aged 60 to 80 with hepatocellular carcinoma (HCC) within Milan criteria, who had thermal ablation with complete response at 6 months, benefited from subsequent orthotopic liver transplantation (OLT) versus surveillance with on-demand re-treatment. Patients aged 60 to 80 with Child-Pugh class A cirrhosis who underwent radiofrequency or microwave ablation of previously untreated, unresectable HCC within Milan criteria at a single institution between 1/1/2011 and 12/31/2020 were retrospectively reviewed. Those patients who achieved complete mRECIST response at 6-months made up the study population, which was separated into two groups according to those who did and who did not receive subsequent OLT. Patients in both groups received routine follow-up and treatment of HCC recurrence was performed on an as-needed basis. Review of the electronic medical record was performed to determine date of death or last known follow-up for patients in both groups. Kaplan-Meier survival curves and a log-rank test with a significance level of 0.05 were used to compare overall survival from date of ablation between the two groups, as well as sub-group analysis of Child-Pugh A5 patients and Child-Pugh A6 patients. A total of 101 patients met the study criteria and composed the study population. 24 patients received OLT at a mean of 2.4 years post-ablation, while 77 patients did not receive OLT. Mean follow-up time from the ablation date was 8.2 years for the OLT group and 5.6 years for the non-OLT group. Kaplan-Meier survival analysis showed similar survival between the two groups (p=0.18). 5-year survival was 90.5% for the OLT group versus 76.6% for the non-OLT group. Subgroup analysis of Child-Pugh A5 patients (n=81) showed identical survival between the OLT and non-OLT groups (p=0.98), with 5-year survival of 88.2% for the OLT group and 86.8% for the non-OLT group. Subgroup analysis of Child-Pugh A6 patients (n=20) showed superior survival for the OLT group (p=0.008), with 5-year survival of 100% for the OLT group versus 33.3% for the non-OLT group. Child-Pugh class A cirrhotic patients of advanced age in whom complete response is achieved with thermal ablation showed similar long-term survival with surveillance and on-demand re-treatment compared with OLT. Subgroup analysis showed that Child-Pugh class A5 patients had equal survival with surveillance versus OLT, while Child-Pugh class A6 patients demonstrated significant survival benefit with OLT.

PURPOSE:The purpose of this study was to characterize the hemodynamics of peripheral artery stent grafts to guide intelligent stent redesign. MATERIALS AND METHODS:Two surgically explanted porcine arteries were mounted in an ex vivo system with subsequent deployment of an Xpert self-expanding nitinol stent or Viabahn stent graft. The arteries were casted with radiopaque resin, and the cast then scanned using micro-computed tomography at 8μm isotropic voxel resolution. The arterial lumen was segmented and a computational mesh grid surface generated. Computational fluid dynamics (CFD) analysis was subsequently performed using COMSOL Multiphysics 5.1. RESULTS:CFD analysis demonstrated low endothelial shear stress (ESS) involving 9.4 and 63.6% surface area of the central stent graft and bare metal stent, respectively. Recirculation zones were identified adjacent to the bare metal stent struts, while none were identified in the central stent graft. However, the stent graft demonstrated malapposition of the proximal stent graft edge with low velocity flow between the PTFE lining and arterial wall, which was associated with longitudinally and radially oriented recirculation zones and low ESS. CONCLUSION:Computational hemodynamic analysis demonstrates that peripheral artery stent grafts have a superior central hemodynamic profile compared to bare metal stents. Stents grafts, however, suffer from malapposition at the proximal stent edge which is likely a major contributor to edge stenosis.

After viewing this exhibit, attendees will be able to 1) describe the prevalence and risk of malignancy of thyroid nodules in children, 2) understand the diagnostic workup for clinically detected thyroid nodules and indications for fine needle aspiration (FNA), 3) formulate a differential diagnosis for pediatric thyroid nodules, 4) understand how to safely perform an FNA in children, 5) recognize the imaging features and cytologic appearance of ectopic thymus mimicking a thyroid nodule. Thyroid nodules are less common in children than adults, with a prevalence of <1.5%, but are more likely to be malignant (26% vs 5%). Workup of a clinically detected thyroid nodule includes laboratory evaluation, thyroid ultrasound, and FNA. FNA exhibits sensitivity and specificity for malignancy of 94% and 81%. The differential diagnosis for pediatric thyroid nodules is similar to adults, but also includes pediatric specific entities such as acute suppurative thyroiditis, congenital cysts, and ectopic thymus. Thymic tissue may be located anywhere along the thymopharyngeal duct, from the hypopharynx to the superior mediastinum, and demonstrates characteristic features on ultrasound. Sedation is usually required for ultrasound-guided FNA in children to reduce the risk of motion and injury to surrounding structures. A 22- to 27-gauge needle may be used, depending on the preference of the interventionalist and pathologist. Smaller gauge needles may produce less hemorrhagic specimens with lower nondiagnostic rates. Yield may be maximized by obtaining specimens with both aspiration and capillary techniques. On-site review by cytopathology is employed in our institution to ensure sample adequacy and decrease need for repeat procedures. If thymic tissue is suspected, the interventionalist should notify the pathologist, since without the use of special stains the sample may falsely appear inadequate due to lack of follicular cells. The pediatric interventional radiologist plays a key role in the evaluation of pediatric thyroid nodules. Ectopic thymus may mimic thyroid nodules in children, and requires high suspicion to prevent incorrect diagnosis and unnecessary surgery.

Current reporting practices in IR are widely variable across different practitioners and centers. This variability results in inconsistent completeness of procedural reports, and makes it difficult to extract data for research, billing, or quality improvement purposes. This investigation sought to create standardized reports for IR procedures that address these shortcomings, and to implement these reports in an academic IR practice. Standardized report templates were created for 10 common IR procedures based on existing, SIR-approved templates, and with input from academic experts. Compliance data on the use of the standardized templates were collected at 2 and 4 months post implementation. Data were collected on the completeness of all dictated reports (with respect to inclusion of all SIR-specified information) in a 2 month time period pre-intervention and post-intervention. In addition, data were collected on time required for dictation in the pre- and post-intervention periods. Structured surveys were sent to radiology residents and fellows, and to referring clinicians to elicit their feedback on the standardized reports. Compliance with use of the standardized templates was 53% in the first 2 months post-implementation, and 62% in the second 2 months. In the pre- and post-implementation periods, reports included 57.5% and 76.7% of SIR-specified information, respectively. Reports that used the standardized templates included 99% of SIR-specified information. Pre- and post-intervention average dictation times were 4.3 minutes and 13.3 minutes, respectively. Qualitative feedback from residents and fellows was mixed, some favoring the templates and others complaining that they took longer to complete. Feedback from referring clinicians was strongly positive, with 80% expressing an overall preference for the standardized reports. Standardized reporting for interventional radiology procedures has the potential to address shortcomings of current reporting practices. The implementation of standardized reporting in an academic IR practice is feasible, and may result in more complete reports.