It can be difficult to distinguish cases of benign portal venous gas (PVG) that can be managed conservatively from forms associated with ischaemic bowel. To identify CT, clinical and laboratory factors that may be assist in the decision-making regarding patient management. All patients in whom PVG was demonstrated on CT imaging were identified over an 8-year period. CT imaging was reviewed for 19 CT features. Clinical findings and laboratory values also retrospectively reviewed. Patients were divided into four groups based on management and outcomes; Group 1, conservatively managed and died, Group 2, conservatively managed and survived, Group 3, operative management and died and Group 4, operative managed and survived. Fifty-six patients had PVG. Overall mortality rate was 54

PurposeTo perform a qualitative systematic review of endovascular management of renal artery aneurysms (RAA).Materials and methodsA comprehensive electronic search of PubMed, MEDLINE, EMBASE, Google Scholar and Cochrane databases from 2000 to 2022 was performed using the search terms "renal artery," "aneurysm," AND "endovascular." Means of outcome measures were calculated with a primary endpoint focused on RAA-related mortality and rupture. Secondary end points included re-intervention rate and renal infarction.ResultsThere were 454 RAAs treated in 427 patients using endovascular techniques. Mean age was 53.77 years, with a female predominance (62%). A variety of endovascular treatments of RAA were utilized with excellent technical success (96%), renal parenchymal preservation, and a low rate of moderate/severe adverse events (AE). Primary coil embolization was the most commonly used technique (44.7%). There was an overall 22.9% AE rate, 6.7% of which were moderate/severe and 0% peri-procedural mortality. The most common AE was renal infarction (49 patients, 11.5%); however, renal function was preserved in 84% of patients. Nephrectomy rate was 0.4%. CTA was the most common imaging follow-up modality utilized in 72% of studies. Only nine studies (34%) reported anticoagulant use. Although the risk of delayed aneurysm reperfusion warrants clinical and imaging surveillance, relatively few patients (3%) required re-intervention in this cohort.ConclusionEndovascular management of RAA is a technically feasible treatment option with low rates of adverse events and reintervention. The present study highlights the technologies available for operators, a need for standardization of AE reporting, anticoagulation therapy and follow-up imaging.

Autophagy is a crucial mechanism for recycling intracellular materials, and under normal metabolic conditions, it is maintained at low levels in cells. However, when nutrients are deficient or under hypoxic conditions, the level of autophagy significantly increases. Particularly in cancer cells, which grow more rapidly than normal cells and tend to grow in a three-dimensional manner, cells inside the cell mass often face limited oxygen supply, leading to inherently higher levels of autophagy. Therefore, the initial development of anticancer drugs targeting autophagy was based on a strategy to suppress these high levels of autophagy. However, anticancer drugs that inhibit autophagy have not shown promising results in clinical trials, as it has been revealed that autophagy does not always play a role that favors cancer cell survival. Hence, this review aims to suggest anticancer strategies based on the changes in the role of autophagy according to survival conditions and tumorigenesis stage.

A living donor kidney transplant is the optimal treatment for chronic renal impairment. Our objective is to assess if lean skeletal muscle mass and donor factors such as body mass index, hypertension, and age impact on renal function following donor nephrectomy. Potential donors undergo CT angiography as part of their work-up in our institution. Using dedicated software (Horos®), standardized skeletal muscle area measured at the L3 vertebrae was calculated. When corrected for height, skeletal muscle index can be derived. Skeletal muscle mass index below predefined levels was classified as sarcopenic. The correlation of CT-derived skeletal muscle index and postoperative renal function at 12 months was assessed. Co-variables including donor gender, age, body mass index (BMI), and presence of pre-op hypertension were also assessed for their impact on postoperative renal function. 275 patients who underwent living donor nephrectomy over 10 years were included. Baseline pre-donation glomerular filtration rate (GFR) and renal function at one year post-op were similar between genders. 29

IntroductionEndovascular therapy is an established revascularization option for lower limb arterial stenosis with drug-eluting therapy demonstrating promising findings in inhibiting vessel restenosis and improving clinical outcomes post-intervention. However, a 2018 meta-analysis raised considerable concerns for an increased risk of death with paclitaxel-containing balloons and stents. The present study aims to provide an updated systematic review and meta-analysis of safety and efficacy outcomes with paclitaxel-containing devices.Materials & MethodsA systematic review and meta-analysis of RCTs investigating paclitaxel-containing balloons or stents in the treatment of femoropopliteal disease was performed. Pooled risk ratio (RR) was calculated using inverse variance, random effects model in the assessment of primary patency, all-cause mortality, target limb major-amputation, target lesion revascularization (TLR) and thrombosis.ResultsIn total, 19 RCTs were included comprising 4,284 participants. All-cause mortality rates did not differ significantly between the two arms at 12 months (RR 1.06; 95% CI 0.66-1.72; P=0.80), 24 months (RR 0.92; 95% CI 0.56-1.50; P=0.73), 36 months (RR 1.21; 95% CI 0.65-2.25; P=0.55) or 48-60 months post-intervention (RR 0.95; 95% CI 0.66-1.39; P=0.81). Primary patency was significantly higher at 12 months in the paclitaxel-containing arm: 80.92% (1,438/1,777) versus 57.48% (607/1056) in the control arm (RR 1.44; 95% CI 1.30-1.59; P<0.00001).ConclusionThe present study demonstrates no statistically significant difference in all-cause mortality, target limb major amputation or thrombosis with paclitaxel drug-eluting therapy to the femoropopliteal region. Additionally, improved and durable patency rates with a statistically significant lower risk of clinically driven-TLR with paclitaxel drug-eluting therapy have been demonstrated.

This invited article reviews the current status of Interventional Radiology (IR), in terms of its status as a speciality, and outlines the conditions needed for IR to function optimally within healthcare settings. Guidance is offered in terms of developing an IR department, ensuring high-quality practice, dealing with administrative and political challenges, dealing with industry and creating a legacy.

Primary liver malignancy, of which hepatocellular carcinoma (HCC) is the most common type, is the second most common cause of death due to cancer worldwide. Given the historically poor prognosis of liver cancer, there has been major research on its treatment options, with significant advancements over the last decade. Transarterial radioembolization (TARE) is a locoregional treatment option for HCC that involves transarterial delivery of the β-emitter yttrium-90 via resin or glass microspheres to arterialized tumor vasculature, delivering a tumoricidal dose to the tumor. The recent 2022 update of the Barcelona Clinic Liver Cancer (BCLC) treatment algorithm features a more prominent role for locoregional treatment, including the incorporation of radioembolization for very-early-stage (BCLC-0) and early-stage (BCLC-A) diseases. This review provides a contemporary summary of the evolving role of TARE in treatment of HCC in light of recent and upcoming trials.

Background Investigating patients with unprovoked venous thromboembolism (uVTE) for occult malignancy can prove a diagnostic dilemma and imaging is often used extensively in this patient group. Aims The primary objective of this study was to determine the incidence of malignancy on CT and other imaging over a 10-year period. A secondary objective was to evaluate the role of laboratory and other non-imaging tests performed. Methods A retrospective key word search of our hospital’s imaging system was performed to identify patients with unprovoked DVT/PE over the last 10 years. All imaging, histology, endoscopy, laboratory tests, and clinical follow-up over 2 years were analysed. Patients with provoked VTE were excluded. Results 150 patients had uVTE. 9 patients were diagnosed with occult malignancy by different investigations on index hospital admission (3 patients) or subsequently on clinical follow-up (6 patients). Mean age of patients was 62 years. 116 patients had CT body imaging. The incidence of malignancy diagnosed by initial CT imaging was 1.7% with a sensitivity of 22%, specificity 87%, and PPV 12.5%. Overall incidence of malignancy identified by imaging alone during the index hospital admission was 2%. Total incidence of malignancy including index admission and follow-up was 6%. Median time to cancer diagnosis was 12 months. Conclusion CT imaging had a low yield for diagnosing malignancy. Extensive imaging strategies increase cost and radiation exposure without improving mortality. Clinical follow-up, history taking, and physical examination guiding appropriate investigations remain the best tool for unmasking occult malignancy in patients with uVTE.

Autophagy plays a dual role in tumorigenesis by functioning as both a tumor suppressor and promoter, depending on the stage of tumorigenesis. However, it is still unclear at what stage the role of autophagy changes during tumorigenesis. Herein, we investigated the differences in the basal levels and roles of autophagy in five cell lines at different stages of cell transformation. We found that cell lines at higher transformation stages were more sensitive to the autophagy inhibitors, suggesting that autophagy plays a more important role as the transformation progresses. Our ptfLC3 imaging analysis to measure Atg5/LC3-dependent autophagy showed increased autophagic flux in transformed cells compared to untransformed cells. However, the Cyto-ID analysis, which measures Atg5-dependent and -independent autophagic flux, showed high levels of autophagosome formation not only in the transformed cells but also in the initiated cell and Atg5 KO cell line. These results indicate that Atg5-independent autophagy may be more critical in initiated and transformed cell lines than in untransformed cells. Specially, we observed that transformed cells maintained relatively high basal autophagy levels under rapidly proliferating conditions but exhibited much lower basal autophagy levels at high confluency; however, autophagic flux was not significantly reduced in untransformed cells, even at high confluency. In addition, when continuously cultured for 3 weeks without passage, senescent cells were significantly less sensitive to autophagy inhibition than their actively proliferating counterparts. These results imply that once a cell has switched from a proliferative state to a senescent state, the inhibition of autophagy has only a minimal effect. Taken together, our results suggest that autophagy can be differentially regulated in cells at different stages of tumorigenesis under stressful conditions.

BACKGROUND:To evaluate Inferior vena cava (IVC) filter retrieval practices over a 9-year period at an academic hospital with a prospectively maintained IVC filter registry.METHOD:An IVC filter registry was maintained prospectively within our institution. We reviewed cases between August 2011 and June 2020, following filter status, retrieval plans, and eventual retrieval date. The validity of the database was cross referenced with a Picture Archiving and Communication System and patient records.RESULTS:Three hundred forty-three patients had IVC filters inserted. Three filter types were used, Celect (Cook Medical) in 189, Gunther Tulip (GT) (Cook Medical) in 65, ALN (ALN) in 89. 196 (57%) filters were retrieved, 108 (31.5%) were made permanent, 36 (10.5%) died before retrieval, and 3 (1%) were yet to be retrieved. Retrieval rates were 92.5% overall (86% for GT, 93% for Celect and 94.5% for ALN). The mean dwell time for successful retrieval was 59 days with the majority of insertions (85%) removed in under 100 days. Failed initial retrieval occurred in 23 patients, 10 (43%) were retrieved at second attempt, 13/23 filters remained in-situ and were deemed permanent.CONCLUSION:The removal of IVC filters, when indication for insertion has past, is no longer the sole responsibility of the referring physician but also the responsibility of the Interventionalist. Our retrieval rates of 92.5% of eligible IVC filters highlights the value of maintaining a prospective IVC filter registry.

INTRODUCTION:'Button' gastrostomy insertion is traditionally a two-step procedure with an initial longer gastrostomy tube inserted followed by placement of the shorter 'button' gastrostomy in 6 weeks when the track is mature. The aim of this study is to assess whether the placement of a Button gastrostomy de novo is a safe and effective method of radiologically inserted gastrostomy (RIG) insertion.METHODS:Using our Picture Archive and Communication System (PACS) and electronic patient charts we identified all patients who underwent primary 'button' gastrostomy over an 8-year period with at least a 1-year follow-up period. We evaluated technical success rate, indications for insertion, major and minor complications, 30-day mortality and the number of exchanges performed.RESULTS:Overall, 482 patients underwent a primary button RIG insertion during this period with an overall success rate of 97.1%. Indications for RIG insertion included neurological and neurosurgical disorders 236 (48.9%), head and neck malignancy 182 (37.8%), oesophageal malignancy 27 (5.6%) and other indications in 37 (7.7%). The mean age was 59.55 years (range 18-88 years) with 290 men (60.2%) and 192 women (39.8%). Major complications were recorded in 0.8% and minor complications in 1.7%. A 30-day mortality of 1% was identified (five patients), mortality was directly related to the RIG insertion in one patient (0.2%). A total of 65 exchanges/replacements took place over this period of time, with 33 (50.1%) due to 'inadvertent removal'.CONCLUSION:Primary button RIG insertion is a procedure that has a high success rate and low morbidity and mortality. We believe it is a safe and effective alternative to deliver enteral nutrition.

The care of patients with venous thromboembolism (VTE) is delivered via a multidisciplinary team. The primary treatment for VTE is anticoagulation; however, placement of filter devices in the inferior vena cava (IVC) to prevent embolisation of deep venous thrombosis (DVT) is a well-established secondary treatment option. Many controversies remain regarding utilisation and management of filters.

Purpose Arteriovenous malformations (AVMs) are abnormal communications between arteries and veins without an intervening capillary system. The best endovascular treatment option for these is unclear and may involve multiple staged procedures using a variety of embolic materials. We report our initial experience using a modified version of a previously published neurointerventional technique to treat soft tissue AVMs with single-stage curative intent. Materials and methods Soft tissue AVMs treated endovascularly using either sole arterial or combined arterial and venous balloon-assisted techniques with liquid embolic agents were retrospectively identified over a 3.5 year period (January 2017 to June 2020)) at two centres. Clinical, pre-operative radiological, procedural technical and post treatment details were recorded. Results Seven patients were treated for symptomatic soft tissue arteriovenous malformations. These AVMs were located in the peripheral limbs (five), tongue (one) and uterus (one). Curative treatment was achieved in 6/7 patients with one patient requiring a second treatment approximately 1 year later. A variety of liquid embolisation agents (LEAs) including sclerosants and polymers were used. Clinical success rate was 100% following treatment. One patient experienced expected temporary post-operative tongue swelling requiring tracheostomy occurred following embolisation of the lingual AVM. A minor complication in a second patient was due to an access site haematoma developed following treatment of the hand AVM requiring surgical intervention. No long-term sequelae or additional complications were observed. Conclusion Endovascular arterial and venous balloon assisted LEA embolization of soft tissue AVMs with curative intent is feasible. This technique may provide an alternative treatment option for achieving durable occlusion for complex soft tissue AVMs.

INTRODUCTION:Unintentional weight loss is an important clinical problem. The role of CT is not firmly established in the workup of these patients. The aim of this study is to determine the diagnostic yield of CT Thorax, Abdomen and Pelvis (CT TAP) in patients with unexplained weight loss and to determine whether clinical or laboratory variables are associated with positive CT findings.METHODS:A retrospective review was performed of CT TAP examinations over 12 months with weight loss as an indication. Patients' electronic records and radiology reports were reviewed. Clinical and laboratory variables were assessed for correlation with positive findings on CT.RESULTS:461 CT TAP studies with weight loss as the primary indication were identified. 124 were excluded; 82 due to a recent history of malignancy, 41 because CT TAP was used for staging of a new malignancy and one study was incomplete. This left 337 eligible examinations. 217 studies had findings of no clinical relevance, 50 studies were normal, 40 studies identified a possible cause of weight loss and 30 studies identified a definite cause. Of the 40 where a possible cause was identified, further work up led to a diagnosis which explained the weight loss in 13 patients. The diagnostic yield of CT TAP was 12.8%. Age, abdominal symptoms, degree of weight loss, anaemia, tumour markers and LDH did not significantly correlate with positive findings on CT.CONCLUSION:CT TAP is a helpful investigation in patients with unexplained weight loss with a diagnostic yield of 12.8%.

Uterine artery/fibroid embolization (UAE/UFE) is a minimally invasive treatment for symptomatic uterine fibroids and/or adenomyosis. The terms menorrhagia, metrorrhagia, and dysfunctional uterine bleeding have been abandoned by the International Federation of Gynaecology and Obstetrics (FIGO) due to confusion surrounding their use; in their place abnormal uterine bleeding (AUB) has been adopted. [1] Munro M.G. Critchley H.O.D. Fraser I.S. Committee tFMD. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynecol Obstet. 2018; 143: 393-408 Crossref PubMed Scopus (150) Google Scholar This is an overarching term to describe any symptomatic variation from normal menstruation incorporating prolonged menstrual bleeding (>8 days), heavy menstrual bleeding (HMB), and intermenstrual bleeding. Premenopausal AUB affects up to one third of women during their life and the risk of cancer in those who proceed to endometrial biopsy has been estimated at 0.33% (95% CI 0.23–0.48%), and 0.11% (95% CI 0.04–0.32) in the subset with HMB. [2] Pennant M.E. Mehta R. Moody P. et al. Premenopausal abnormal uterine bleeding and risk of endometrial cancer. BJOG. 2017 Feb; 124 ([PubMed PMID: 27766759. Pubmed Central PMCID: PMC5297977. Epub 2016/10/22. eng]): 404-411 Crossref PubMed Scopus (41) Google Scholar

Appendiceal tumours are uncommon neoplasms of the gastrointestinal tract. An understanding of the imaging appearances facilitates an accurate radiological description, which guides surgical and oncological management. In this study, a retrospective review of the CT imaging and histopathology of all cases of appendiceal tumours discussed at the oncology multidisciplinary meetings in a single centre, over an 8-year period (2012-2019) is performed. The array and incidence of both common and rare pathologies are investigated, and important characteristic imaging findings for radiologists to recognize are highlighted.

Background Surveillance of sporadic renal angiomyolipomas is a growing issue for physicians and radiologists. Current treatment recommendations favor active surveillance. However, the evidence underlying these is based on small case series, which also typically include angiomyolipomas associated with tuberous sclerosis. Purpose To evaluate the natural growth pattern of sporadic renal angiomyolipomas in patients without tuberous sclerosis. Material and Methods A retrospective review was performed in three separate tertiary referral centers. A keyword search of each institutions PACS history was performed. Inclusion criteria were angiomyolipomas > 1 cm in size, three years of follow-up, and lesions requiring treatment before reaching three years of follow-up. Exclusion criteria included a diagnosis of tuberous sclerosis, pregnancy, prior treatment with embolization without any prior imaging, and lesions which were treated on presentation. Growth of the angiomyolipomas was evaluated on the basis of maximum dimension on initial and follow-up images. Results Sixty-three patients were identified in total, with 64 lesions eligible for inclusion. The majority of patients were women (55/63). The mean age at which the angiomyolipomas discovered was 56.4 years. Mean total growth was 0.085 mm and mean follow-up was 65.5 months. At initial measurement, the mean maximum dimension of the lesions in our cohort was 2.08 cm. After follow-up, this was 2.16 cm. The average rate of growth was 0.015 cm per year. Conclusion Sporadic angiomyolipomas exhibit minimal, if any, natural growth. Current surveillance strategies could be relaxed.