BACKGROUND:Bevacizumab (BEV) is commonly used to treat unresectable or metastatic colorectal cancer; however, it is associated with delayed wound healing. This study aimed to assess whether administration of BEV within 14 days after central venous (CV) port placement was associated with an increased incidence of delayed wound healing complications. METHODS:This retrospective cohort study included patients with unresectable or metastatic colorectal cancer who underwent CV port placement between January 2017 and January 2023. The primary outcome was the incidence of wound-healing complications within 90 days. The incidence of complications was examined in 29 patients who received BEV within 8 weeks prior to CV port placement. RESULTS:Data on 264 matched patient pairs, selected from 778 eligible patients, were included in the analysis. Wound healing complications occurred in 4/264 patients (1.5%; 95% confidence interval [CI], 0.4%-4.0%) in the BEV group and 3/264 patients (1.1%; 95% CI, 0.2%-3.4%) in the non-BEV group, a nonsignificant difference (P > .99). Additionally, no wound-healing events were observed among the 29 patients who received BEV before CV port placement; however, this finding should be interpreted with caution because of the limited sample size. CONCLUSIONS:Administration of BEV before and after CV port placement does not significantly increase the risk of delayed wound healing complications. These findings suggest that the risk of delayed wound healing associated with peri-CV port administration of BEV appears to be low in this specific clinical setting; however, this should be interpreted with caution and does not constitute definitive proof of safety.

Rare diseases are often difficult to diagnose, and their scarcity also makes it challenging to develop deep learning models for them due to limited large-scale datasets. Anterior mediastinal tumors—including thymoma and thymic carcinoma—represent such rare entities. A few diagnostic support systems for these tumors have been proposed; however, no prior studies have tested them across multiple institutions, and clinically applicable and generalizable models remain lacking. A total of 711 computed tomography (CT) images were collected from 136 hospitals, each from a different patient with pathologically proven anterior mediastinal tumors (339 males, 372 females). Of these, 485 images were used for training, 62 for tuning, and 164 for external testing. The external testing dataset comprised CT images from 121 unique institutions not involved in the other datasets. A 3D U-Net-based model was trained on the training dataset, and the model with the best performance on the tuning dataset was selected. This model was then evaluated on the external testing dataset for its segmentation and detection performance across different institutions. Based on the reference standards provided by board-certified diagnostic radiologists, the trained model achieved average Dice scores of 0.82, Intersection over Union (IoU) of 0.72, Precision of 0.85, and Recall of 0.82 for tumor segmentation at the CT-image level. The free-response receiver operating characteristic curve—derived from lesion-wise IoU thresholds—demonstrated high sensitivity and a low false-positive rate for tumor detection. Even under a stricter IoU threshold of 0.50, the model maintained a sensitivity of 0.87 with only 0.61 false positives per scan. Our model achieved clinically applicable segmentation and detection performance for anterior mediastinal tumors, demonstrating broad generalizability across 121 institutions and overcoming the data-scarcity challenges inherent to such rare diseases.

BACKGROUND:Assessing peritoneal cytology status is essential for determining the optimal treatment strategy in patients with pancreatic cancer. This study aimed to evaluate the safety and technical feasibility of percutaneous abdominal lavage cytology screening and its clinical utility in identifying patients unlikely to benefit from resection, thereby reducing nontherapeutic laparotomy. METHODS:We retrospectively analyzed 225 consecutive patients with pancreatic cancer referred for potential curative-intent resection who underwent percutaneous abdominal lavage cytology screening between May 2022 and February 2026. Percutaneous abdominal lavage cytology screening was performed under local anesthesia with ultrasound and fluoroscopic guidance using 100 mL of saline. Recovery of less than 10 mL of lavage fluid was defined as technical failure. Cytology was classified from class I to V, with classes IV and V considered positive for malignancy. RESULTS:A total of 315 procedures were performed, with a technical success rate of 99.7% and 1 procedure-related complication (0.3%). Percutaneous abdominal lavage cytology screening identified positive cytology in 16 patients (7.1%). Overall, 39 patients (17.3%) were deemed ineligible for surgery owing to newly identified unresectable disease during the preoperative period. Excluding 8 patients awaiting surgery, 178 underwent laparotomy, among whom 12 (6.7%) were found to have unresectable disease intraoperatively; R0/1 resection was achieved in 166 patients. Intraoperative cytology positivity was observed in 1 patient (0.6%). CONCLUSION:Percutaneous abdominal lavage cytology screening is a safe, technically feasible, and repeatable method for preoperative cytology assessment in patients with pancreatic cancer considered for curative-intent resection. Integration of percutaneous abdominal lavage cytology screening into preoperative evaluation may improve surgical selection and reduce the rate of nontherapeutic laparotomy.

Percutaneous transhepatic biliary drainage (PTBD) is an alternative approach for biliary drainage in patients for whom endoscopic retrograde biliary drainage is not available due to surgically altered anatomy or poor clinical status; however, it remains technically challenging with non-dilated bile ducts. This retrospective study evaluated the technical feasibility and safety of puncture of preexisting endoscopic biliary stents to opacify the biliary system and facilitate PTBD. Seventeen procedures in 15 patients with non-dilated bile ducts were included. Technical success, adverse events, procedural details, and subsequent stent management were assessed. All procedures were technically successful. No severe adverse events occurred, and stent puncture was not associated with stent damage or difficulty in subsequent stent management. Reintervention was required in 3 cases. Despite the retrospective design and small sample size, these findings suggest direct puncture of preexisting endoscopic stents is a safe and feasible option for PTBD in patients with non-dilated bile ducts.

PURPOSE:To compare transcatheter 4-dimensional (4D) and 3-dimensional (3D) computed tomography (CT) angiography for guiding selective renal artery embolization (SRAE). MATERIALS AND METHODS:This retrospective, single-center study included 111 patients (114 clear cell renal cell carcinomas [RCCs]) who underwent SRAE before cryoablation (2018-2025). Based on available angio-CT systems, 69 patients (70 tumors) underwent 3D CT angiography (6-second single-phase helical scan), and 42 (44 tumors) underwent 4D CT angiography (4.55-second volumetric scan, 13 continuous phases; up to 5 intermittent if feasible). On 4D CT angiography, 4D maximum intensity projection replaced digital subtraction angiography (DSA) for renal artery mapping. Intraprocedural automated feeding artery detection (AFD) was performed; success was defined as identifying all reference-standard feeding arteries without false positives. Outcomes were evaluated using univariable and multivariable analyses. RESULTS:Four-dimensional CT angiography patients were older (mean, 75.3 vs 68.4 years) and had lower estimated glomerular filtration rate (55 vs 65.6 mL/min/1.73 m2, both P < .01). Compared with 3D CT angiography, 4D CT angiography reduced median DSA runs (2 vs 5) and contrast volume (29 vs 71.5 mL, both P < .001), with similar procedure duration and acceptable radiation doses. AFD success was higher (84.1% vs 15.7%, P < .001) with optimized phase selection. Four-dimensional CT angiography independently predicted fewer DSA runs (β = -3.229) and lower contrast volume (β = -44.745) and was associated with higher AFD success (odds ratio, 41.46) (all P < .001). Renal function was maintained in both cohorts. CONCLUSIONS:Four-dimensional CT angiography showed higher AFD success and enabled time-resolved vascular mapping, with fewer DSA runs and lower contrast volume during preablation RCC embolization.

A liver abscess developed in the left subphrenic space in a 42-year-old man with liver metastases from gastric cancer. Because ultrasound did not detect the abscess, percutaneous drainage was planned with real-time fluoroscopic fusion imaging guidance using angio-computed tomography. A computed tomography scan was obtained, and the abscess cavity was manually delineated using dedicated software. On the basis of pre- and intra-procedural computed tomography images, the transhepatic epigastric approach was selected. The delineated area was overlaid onto fluoroscopy, and a needle was advanced toward the overlaid target. A drainage catheter was inserted using the Seldinger technique. No adverse events occurred, and the inflammatory markers improved after drainage. This case reveals the potential utility of real-time fluoroscopic fusion imaging guidance using angio-computed tomography for abscess drainage in anatomically challenging locations.

Palliative interventional radiology (IR) procedures are effective for managing refractory cancer pain, but their real-world utilization—including procedural volume, physicians’ perceptions, and barriers to implementation—remains unclear. This study aimed to assess the current implementation of these procedures in Japan and to explore IR physicians’ perceptions and barriers. A nationwide cross-sectional survey was conducted among 1,087 board-certified IR physicians in Japan from February to March 2020. A self-administered questionnaire assessed current practice for three procedures (celiac plexus/splanchnic nerve block [nerve block], percutaneous vertebroplasty/osteoplasty [bone augmentation], and transcatheter arterial embolization [TAE]), perceived effectiveness, willingness to perform in the future, and demographics. Barriers to implementation, which were predefined as questionnaire items, were evaluated using univariable and multivariable logistic regression analyses. A total of 554 valid responses were obtained (response rate: 51.1

Maxillary sinus squamous cell carcinoma (MS-SCC) is a rare malignancy that is often diagnosed at an advanced stage. We report a case of locally advanced MS-SCC that was successfully treated with super-selective intra-arterial cisplatin infusion concurrent with radiotherapy (RADPLAT) using gadolinium-based contrast agents due to a severe allergy to iodinated contrast media. Despite limitations in image quality, gadolinium-based contrast agents enable sufficient visualization with digital subtraction angiography and computed tomography angiography. Seven treatment sessions were completed without adverse events, using a maximum gadolinium dose of 28 mL per session. Post-treatment imaging revealed no residual tumors. This case illustrates the feasibility of using gadolinium-based contrast agents as an alternative to iodinated contrast media for angiographic guidance during RADPLAT in patients with contraindications to iodinated contrast. However, its long-term safety warrants further investigation.

Radiofrequency ablation (RFA) is generally considered a safe treatment for hepatocellular carcinoma. Although cardiovascular complications have been occasionally reported, they are primarily attributed to sedatives and analgesics or the vasovagal reflex. However, a unique case is presented where RFA itself was suspected of inducing a progressive atrioventricular disorder. An 80-year-old male underwent RFA for hepatocellular carcinoma. His electrocardiogram showed a first-degree atrioventricular block on admission. Prior to ablation, fentanyl and propofol were administered. Severe bradycardia developed immediately after initiation of ablation. RFA and propofol infusion were terminated, leading to prompt heart rate recovery. After approximately five minutes, ablation was resumed without propofol, but severe bradycardia recurred. The electrocardiogram during RFA revealed a complete atrioventricular block. Therefore, the procedure was terminated. A 12-lead electrocardiogram performed after the aborted procedure revealed progression to a second-degree AV block (Mobitz type II) requiring pacemaker implantation. The exact mechanism of this effect remains unclear, though progression of the atrioventricular conduction disorder was considered to be induced by RFA. Careful intraoperative patient management is crucial during RFA.

Abstract Background: In the ClarIDHy trial, ivosidenib significantly improved progression-free survival (PFS) compared with placebo in patients with previously treated IDH1-mutant cholangiocarcinoma (CCA) and is currently awaiting insurance approval in Japan. However, approximately 40% of patients in both arms experience disease progression within 2 months, suggesting underlying biological heterogeneity within IDH1-mutant CCA. We hypothesized that genomic co-alterations may serve as potential determinants of this heterogeneity. Methods: We analyzed patients with intrahepatic cholangiocarcinoma (iCCA) in the Center for Cancer Genomics and Advanced Therapeutics (C-CAT) database between June 2019 and June 2025. Point mutations were annotated using OncoKB, and copy number variants and rearrangements were evaluated using C-CAT (approval number CDU2021-001N). Additionally, we reviewed institutional patients with IDH1-mutant iCCA diagnosed between October 2001 and October 2025, with detailed pathological and radiological assessments (approval number 2018-149). Results: Among 2484 patients with iCCA, 353 had IDH1 mutations (14.2%). IDH1-mutant iCCA tended to show longer overall survival (OS) and time to treatment failure (TTF) for first-line therapy than IDH1-wild type (median OS, 22.4 vs. 20.1 months; HR, 0.83; P=0.054; median TTF, 7.8 vs. 6.4 months; HR, 0.87; P=0.068). In IDH1-mutant iCCA, KRAS mutations and CDKN2A loss were less frequent than IDH1-wild type (KRAS mutations, 11.6% vs. 27.6%, P<0.001; CDKN2A loss, 17.8% vs. 27.5%, P<0.001). Among IDH1-mutant iCCA, KRAS mutations showed a trend toward shorter OS (median, 17.0 vs. 23.2; HR, 1.60; P=0.069) and were associated with shorter TTF (median, 5.7 vs. 8.5 months; HR, 1.86; P=0.0039). CDKN2A loss was correlated with shorter OS (median, 17.6 vs. 23.7 months; HR, 1.58; P=0.037). IDH1-mutant iCCA without KRAS mutations or CDKN2A loss demonstrated significantly longer OS (median, 24.9 vs. 17.6 months; HR, 0.61, P=0.010) and TTF (median, 8.4 vs. 6.1 months; HR, 0.70, P=0.020) than the other subsets. In multivariate analysis, KRAS mutations predicted shorter OS (HR, 1.75; P=0.046) and TTF (HR, 1.77; P=0.012). In an institutional cohort of 37 patients, only one case was pathologically classified as large-duct type and harbored KRAS mutation, with all other cases classified as small-duct type. Radiologically, IDH1-mutant iCCA without KRAS mutations and CDKN2A loss tended to present in a peripheral location (60.0% vs. 33.3%) and intratumoral transversing vessels (84.0% vs. 55.6%). Conclusions: IDH1 mutations less frequently co-occur with KRAS mutations and CDKN2A loss. IDH1-mutant iCCA without these co-alterations exhibited favorable clinical outcomes and distinct radiopathological characteristics, highlighting the biological heterogeneity associated with genomic co-alterations in IDH1-mutant iCCA. Citation Format: Eiichiro So, Chigusa Morizane, Kouya Shiraishi, Nobuyoshi Hiraoka, Miyuki Sone, Takafumi Koyama, Rui Kitadai, Yusuke Okuma, Takashi Kohno, Tetsuro Shiraishi, Yuno Goto, Shiho Hakui, Kiyoaki Ochi, Keita Fujisaki, Kazunori Onuma, Yasuhiro Komori, Daiki Yamashige, Mao Okada, Shota Harai, Yuta Maruki, Yasuyuki Kawamoto, Yoshikuni Nagashio, Susumu Hijioka, Hideki Ueno, Kenro Hirata, Takanori Kanai, Takuji Okusaka. Prognostic impact and clinical characteristics of KRAS mutations and CDKN2A loss in IDH1-mutant intrahepatic cholangiocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 5346.

Purpose Malignant superior or inferior vena cava (SVC/IVC) syndrome, resulting from tumor invasion or compression, causes severe symptoms and reduces quality of life. Although stent placement is widely accepted as a palliative treatment, its safety in large, multicenter populations remains unclear. Methods We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination nationwide inpatient database. Patients who underwent SVC/IVC stent placement for malignant vena cava syndrome between April 2019 and March 2023 were included. Patient characteristics, underlying malignancies, adverse events, therapeutic interventions, 7-day mortality after stent placement, and 30-day in-hospital mortality after admission were assessed. Adverse events were identified using International Classification of Diseases, 10th Revision codes. Results We analyzed 301 patients from 137 hospitals (187 with SVC and 114 with IVC). Lung tumors were most common in the SVC group, whereas liver tumors predominated in the IVC group. Multiple stents were more frequently required in IVC cases. Overall, adverse events occurred in 34 patients (10.6%). Respiratory failure was significantly more common in the SVC group, while other complications were comparable between groups. Red blood cell transfusion was required in 10 patients (3.3%); no patient required invasive interventions such as embolization. Mortality was 5.0% at 7 days after stenting and 11.6% at 30 days after hospitalization, with no significant difference between the groups. Conclusion Stent placement for malignant vena cava obstruction demonstrated a relatively low complication rate and no serious adverse events requiring invasive intervention, supporting its safety and effectiveness as a palliative option, even in advanced malignancy.

Intraprocedural visualization of the iceball boundary is often limited at the fat-ice interface, where frozen fat-despite increased computed tomography (CT) values-remains within the negative range, thus yielding limited contrast with non-frozen fat. This limitation is relevant in CT-guided renal cryoablation involving perirenal fat. We evaluated a stepwise CT post-processing method of subtraction and scaled addition with probabilistically adjusted thresholding, using an in situ fat-muscle phantom. This two-step process involved fixed zero-threshold subtraction (Step 1: post-freezing image minus pre-freezing image) and kernel density estimation-based threshold subtraction (Step 2: Step 1 output minus post-freezing image), based on pixel-wise fat-attenuation distributions. Contrast-to-noise ratio improved in both fat and non-fat tissues. In fat tissue, boundary contrast selectively increased by reducing CT values in non-frozen regions, whereas in non-fat tissue, by reducing them in frozen regions. Iceball boundaries aligned with magnetic resonance imaging. This approach may improve iceball demarcation and warrants validation in clinical practice.

To characterize the radiological findings of desmoid-type fibromatosis (DF). This two-institution retrospective study included 152 patients with pathologically confirmed DF who underwent computed tomography (CT), magnetic resonance imaging (MRI), or 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT between January 2001 and February 2024. Two board-certified radiologists independently evaluated the CT, MRI, and FDG-PET/CT findings, and a third board-certified radiologist resolved discrepancies. Imaging was performed with and without contrast media: 70 patients underwent plain CT, 95 underwent contrast-enhanced (CE) CT, 115 patients underwent plain MRI examinations, 100 patients underwent CE-MRI, and 11 patients underwent FDG-PET/CT (most patients underwent several modalities). The median age of the patients was 40 years, with a female predominance (male, 39.5

ObjectivesThe safety and effectiveness of propofol in more complex endoscopic procedures, such as endoscopic retrograde cholangiopancreatography, remain unknown. Thus, we aimed to evaluate propofol sedation during endoscopic cholangiopancreatography, ultrasound-guided intervention, and gastroduodenal stenting and examine risk factors for excessive sedation.MethodsWe retrospectively analyzed data from 870 patients who underwent endoscopic treatment with propofol sedation for biliary and pancreatic disease between October 2020 and September 2021. Sedation included propofol and fentanyl, with continuous monitoring of vital signs and the bispectral index. The assessed risk factors included age, complications, body mass index, treatment duration, and specialty.ResultsDistal bile duct treatment (n = 367), hilar bile duct treatment (n = 197), post-small-intestinal reconstruction treatment (n = 75), endoscopic ultrasound-guided intervention (n = 140), and gastrointestinal obstruction treatment (n = 91) were performed. The rates of excessive sedation, hypoxemia, and hypotension were 7.8%, 6.0%, and 1.8%, respectively. Post-small-intestinal reconstruction treatment had the highest incidence rate of excessive sedation (16%), whereas endoscopic ultrasound-guided intervention had the lowest incidence rate (4.3%). Multivariate analysis revealed significant associations between excessive sedation and comorbid sleep apnea, obesity, and prolonged procedural time.ConclusionsObesity, sleep apnea syndrome, and prolonged procedure time are risk factors for excessive sedation related to propofol use. Thus, sedation techniques should be tailored for these patients.

Background Renal cell carcinomas (RCCs) adjacent to critical structures can be safely treated using percutaneous cryoablation with adjunctive techniques. However, there are only a few reports describing the factors affecting local tumor control after percutaneous cryoablation for such RCCs. Purpose To evaluate the factors affecting local tumor control in the percutaneous cryoablation of RCCs adjacent to critical structures. Material and Methods A total of 403 tumors from 328 patients were retrospectively reviewed. Patients with histologically proven RCCs adjacent to critical structures with at least 1 year of follow-up after treatment were included. Hereditary RCCs were excluded. Of the 403 tumors, 40 met the criteria. Owing to the tumor location, all procedures were performed using adjunctive techniques. Baseline, perioperative, and follow-up data were collected and factors affecting local tumor progression were evaluated. Comparisons between groups with and without local tumor progression were performed using Fisher's exact test or Wilcoxon's rank sum test. Results The median follow-up was 1289.5 days. Local tumor progression was observed in 7/40 (17.5%) patients. Univariate analysis revealed that significant factors affecting local tumor progression were situated adjacent to the ureter ( P = 0.005), requiring adjunctive techniques other than hydro- and/or pneumo-dissection ( P = 0.005), as well as the distance between tumors and critical structures ( P = 0.04). The ice-ball margin tended to be smaller in the group with local tumor progression but this was not significant ( P = 0.07). Conclusion Renal tumors adjacent to the ureter may result in local tumor progression after cryoablation compared with tumors adjacent to other organs.

Percutaneous nephrostomy (PCN) is a standard procedure to relieve urinary obstruction. Inadvertent catheter dislodgement occurs in up to 15

Background: Endoscopic retrograde cholangiopancreatography (ERCP) may not provide adequate drainage for patients with malignant hilar biliary obstruction (MHBO). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is a salvage method for malignant distal biliary obstruction (MDBO); however, its effectiveness for MHBO remains unclear. Objectives: We aimed to evaluate the short- and long-term outcomes of EUS-HGS for MHBO. Design: This was a single-center retrospective cohort study. Methods: Unresectable patients who underwent initial EUS-HGS because of ERCP failure were recruited. Distal biliary stenosis or Bismuth types I and II–IV were defined as MDBO and MHBO, respectively. We defined EUS-HGS for MDBO as the control and analyzed the outcomes for MHBO. Results: The MDBO group ( n = 208) was treated using EUS-HGS alone. In the MHBO group ( n = 63), EUS-HGS alone (unilateral drainage, n = 26), EUS-HGS with bridging (EUS-HGSB, bilateral drainage, n = 21), and ERCP + EUS-HGS (bilateral drainage, n = 16) were performed. In EUS-HGS (MDBO), EUS-HGS (MHBO), EUS-HGSB, and ERCP + EUS-HGS, the technical success rates were 98.6%, 96.3%, 95.5%, and 94.1%; clinical success rates were 88.5%, 76.9%, 85.7%, and 75.0%; adverse event rates were 19.7%, 15.4%, 9.5%, and 25.0%; and non-recurrent biliary obstruction (RBO) rates at 180 days were 45.5%, 19.8%, 61.9%, and 68.4%, respectively. In multivariate analysis of the MHBO group, EUS-HGSB tended to have a lower risk of RBO (adjusted hazard ratio (aHR), 0.39; p = 0.09), and ERCP + EUS-HGS showed a significantly lower risk (aHR, 0.25; p = 0.03) compared to EUS-HGS alone (unilateral drainage). Conclusion: ERCP + EUS-HGS followed by EUS-HGSB, providing bilateral drainage, can offer preferred palliation for MHBO. These drainages may serve as potential salvage options in the management of MHBO.

Detecting small pancreatic ductal adenocarcinomas (PDAC) is challenging owing to their difficulty in being identified as distinct tumor masses. This study assesses the diagnostic performance of a three-dimensional convolutional neural network for the automatic detection of small PDAC using both automatic tumor mass detection and indirect indicator evaluation. High-resolution contrast-enhanced computed tomography (CT) scans from 181 patients diagnosed with PDAC (diameter ≤ 2 cm) between January 2018 and December 2023 were analyzed. The D/P ratio, which is the cross-sectional area of the MPD to that of the pancreatic parenchyma, was identified as an indirect indicator. A total of 204 patient data sets including 104 normal controls were analyzed for automatic tumor mass detection and D/P ratio evaluation. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated to detect tumor mass. The sensitivity of PDAC detection was compared with that of the software and radiologists, and tumor localization accuracy was validated against endoscopic ultrasonography (EUS) findings. The sensitivity, specificity, PPV, and NPV for tumor mass detection were 77.0