Embolic microspheres are important for the interventional treatment of solid tumors, but it is a dilemma for microspheres to keep sufficient strength and resilience. Herein, we propose a strategy to fabricate core-shell poly(vinyl alcohol) microspheres with gradient crosslinking (GCL) on an industrial scale to solve the dilemma. The synthesized GCL microspheres exhibit superior mechanical characteristics in comparison to the homogeneous microspheres and the conventional core-shell microspheres produced by standard one-step and two-step methods, respectively. An in vitro model is conducted to assess the distribution in the vascular network and migration over time of three microspheres. The GCL microspheres possess optimal strength and flexibility, facilitating distal vascular embolization and reducing the risk of microsphere migration over time. The performances are validated in vivo with the porcine renal model in large animal experiments. Clinical trials addressing liver cancer further confirm the embolic efficacy and safety of the GCL microspheres in humans. The relationship between mechanical properties and embolic efficiency offers valuable insights for the development of other embolic agents in the formulism of interventional therapy.

Background Mesenchymal stem cell (MSC)-derived endothelial-like cells exhibit enhanced angiogenic potential compared with undifferentiated MSCs. However, the role of N6-methyladenosine (m6A) RNA modification in MSC endothelial differentiation remains unclear. Methods Human bone marrow-derived MSCs were isolated and induced toward an endothelial phenotype using cytokine-enriched medium. Endothelial differentiation was evaluated using flow cytometry, western blotting, immunofluorescence staining, tube formation assays, and Dil-Ac-LDL uptake assays. MeRIP-seq and RNA-seq were performed to profile transcriptome-wide m6A methylation and gene expression changes. Bioinformatics analyses, including GO enrichment, KEGG pathway analysis, and protein–protein interaction (PPI) network construction, were conducted to identify key regulatory genes and pathways. Results Following induction, MSCs exhibited endothelial characteristics, including increased expression of CD31 and CD34, enhanced tube formation ability, and increased Dil-Ac-LDL uptake. Transcriptome-wide analysis identified 16,355 differentially methylated peaks and 2,732 differentially expressed genes, including 1,204 differentially methylated and expressed genes (DMEGs). Functional enrichment analysis revealed that DMEGs were mainly associated with extracellular matrix organization, endothelial differentiation, and cell adhesion. PPI network analysis identified a highly interconnected module, and integrin family genes (ITGA1, ITGAV, ITGA11, ITGB5) and ADAMTS2 were identified as key hub genes. Conclusions This study provides a transcriptome-wide landscape of m6A methylation during endothelial differentiation of BM-MSCs and identifies key regulatory pathways and hub genes potentially involved in this process. These findings suggest that m6A-mediated epitranscriptomic regulation plays an important role in MSC endothelial differentiation and angiogenesis.

Abstract Purpose To evaluate the technical feasibility, targeting accuracy and short-term safety of a novel integrated system of the robot-navigated, cone-beam CT (CBCT)-guided and transarterial chemoembolization (TACE)-assisted radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) in high-risk locations. Materials and methods This retrospective, single-center study enrolled 11 participants with HCC lesions in high-risk locations. All participants underwent TACE followed by RFA navigated by a novel robotic system. Trajectory planning was based on respiratory-gated CBCT images and the subsequent needle insertion was guided by real-time fluoroscopy. The evaluated outcomes included the first placement accuracy, the adequate placement accuracy, targeting time, repositioning times, radiation exposure dose, complications and the 1-month complete ablation rate. Results The cohort included 10 males and 1 female. Technical success was achieved in 100% (11/11) of cases. The median tumor diameter was 16.20 mm and the mean tumor depth was 79.37 mm. Seven tumors were located in the subdiaphragmatic position, three tumors were situated adjacent to major vascular structures and one tumor was located adjacent to extrahepatic organs. The median Euclidean error and angle error of the first placement were 6.2 mm and 3.0 degrees, respectively. The median Euclidean error and angle error of the adequate placement was 2.2 mm and 1.3 degrees. The median targeting time was 6.70 min (range, 1.55–29.52 min) and the median number of repositioning adjustments was 2. The mean cumulative air kerma was 216.34 mGy. The 1-month complete ablation rate was 81.8% (9/11) following adjunctive ablation in 2 patients. No major complications were reported. Conclusion The integrated platform of robotic-navigated, real-time CBCT-guided, and TACE-assisted RFA is technically feasible and demonstrates short-term safety. In this cohort, it achieves preliminary targeting accuracy for the ablation of HCC in high-risk locations.

Magnetic resonance imaging (MRI) and nuclear medicine imaging are widely used for cancer detection due to their high soft tissue resolution and sensitivity. Each modality has inherent limitations; therefore, integrated techniques such as positron emission tomography/magnetic resonance (PET/MR) have been developed. However, achieving simultaneous signal enhancement for both PET and MRI in clinical settings remains challenging. In this study, we employed gallium-68 (68Ga)-labelled NaGdF4@RGD nanoprobes as a model system to establish a synchronous PET/MR imaging strategy for tumor diagnosis. These nanoprobes exhibited suitable radiochemical half-life, and effective tumor-associated targeting, enabling successful PET/MR imaging across multiple tumor models, including hepatoma, renal cancer, and breast cancer in vivo. Notably, this imaging strategy allowed time-resolved visualization of nanoprobe distribution and prolonged retention behavior in orthotopic liver tumors during delayed imaging periods, providing imaging-based insights into nanomedicine pharmacodynamics.

Background:Ultrasound (US)-guided microwave ablation (MWA) for primary hyperparathyroidism (PHPT) is a relatively novel minimally invasive treatment. However, definitive evidence for the efficacy of thermal ablation in treating PHPT is not well characterized. This work aimed to evaluate the effectiveness and safety of US-guided MWA in patients with PHPT. Methods:This retrospective study analyzed the data of patients diagnosed with PHPT who underwent US-guided MWA at Peking University First Hospital between October 2020 and October 2024. Serum levels of parathyroid hormone (PTH), calcium, and phosphate were measured preoperatively and at 3, 6, and 12 hours post-MWA to assess immediate biochemical changes. Long-term therapeutic outcomes were evaluated by monitoring the volume of ablation areas and serum PTH, calcium, and phosphate levels at 1, 3, 6, and 12 months post-MWA or at the last follow-up. Results:A total of 30 clinical records were reviewed, of which 25 (15 female and 10 male; mean age: 60.04±17.38 years) met the inclusion criteria and were included in the final analysis. No clinically significant complications were observed during or following the MWA procedure. Serum PTH levels showed a significant reduction at 3, 6, and 12 hours post-MWA compared to baseline. Serum calcium levels began to decrease significantly at 3 hours post-MWA, whereas serum phosphate levels showed no significant changes within the first 12 hours. Serum PTH levels were significantly lower at the last follow-up (mean duration: 7.48 ± 4.8 months) compared to baseline (P=0.002). Serum calcium levels were significantly lower at 1 month and at the last follow-up (P=0.0021) compared to baseline. At the last follow-up, the volume reduction ratio (VRR) of the ablated masses was 71.5%±29%. Conclusions:Our study provides evidence that US-guided MWA is safe and effective for managing PHPT adenomas.

Previous research showed promising benefits of transarterial chemoembolization (TACE) plus anti-angiogenic agents and immune checkpoint inhibitors (ICIs) for unresectable hepatocellular carcinoma (uHCC). This study evaluated the efficacy and safety of cadonilimab combined with lenvatinib and TACE in this population. This was a multicenter, open-label, single-arm, phase 2 study conducted at 8 hospitals in China. Eligible patients had unresectable, non-metastatic hepatocellular carcinoma, with diagnoses confirmed histologically or cytologically, or confirmed clinically in cirrhotic patients according to American Association for the Study of Liver Diseases criteria. Patients received oral lenvatinib (8 mg or 12 mg based on body weight) and intravenous cadonilimab (10 mg/kg every 3 weeks) following the first TACE treatment (maximum of 4). The primary endpoint was progression-free survival (PFS) per RECIST v1.1. From June 2022 to May 2023, a total of 62 patients were enrolled. At data cut-off (June 25, 2025), the median follow-up duration was 25.7 months. According to RECIST v 1.1, the objective response rate (ORR) was 38.3

Background/objectiveTo investigate the effectiveness and safety of transarterial chemoembolization (TACE) plus percutaneous radiofrequency ablation (pRFA) (TACE-pRFA) for very early/early-stage hepatocellular carcinoma (HCC) with tumor diameters >3 cm versus ≤ 3 cm.MethodsIn this retrospective study, we enrolled 118 patients who underwent TACE-pRFA for a single HCC (≤ 5 cm) from February 2014 to December 2021. Patients were divided into two groups according to the maximum tumor diameter (≤ 3 cm versus > 3 cm). Regular follow-up was conducted after pRFA to assess progression-free survival (PFS). TACE-pRFA-related complications were evaluated. Univariable and multivariable Cox proportional-hazards regression analyses were performed to identify risk factors for PFS.ResultsThe median PFS of the total cohort was 35.0 months (95% confidence interval [CI], 24.3–45.7). The 1-, 3-, and 5-year cumulative PFS rates in the whole cohort were 84.7% (95% CI, 78.1–91.9%), 47.5% (95% CI, 38.2–59.0%), and 31.5% (95% CI, 22.2–44.9%), respectively. Univariable and multivariable analyses showed that the maximum tumor diameter (p = 0.023) was an independent prognostic factor for PFS after TACE-pRFA. Treatment-related complications were comparable between the ≤ 3 cm group and the > 3 cm group.ConclusionTACE combined with pRFA is safe for very early/early-stage single HCC ≤5 cm. Maximum tumor diameter is an independent prognostic factor for PFS, while treatment-related complications are comparable between tumors ≤3 cm and >3 cm.

Background:Liver cancer is a significant public health threat worldwide, yet data on its burden and trends are limited. This study aims to evaluate the global burden of liver cancer among global populations from 1990 to 2021, and to project its change to 2040. Methods:In this observational study, population-based registry data were extracted from the Global Burden of Diseases Study 2021. The database covers 204 countries and territories, ensuring global applicability of the results. Age-standardized rates of incidence, deaths, and disability-adjusted life-years (DALYs) were calculated per 100-000 population. Estimated rates of disease burden were calculated for 2040. Results:In 2021, global incident cases of liver cancer were 211460 (non-alcoholic steatohepatitis [NASH]-related), 1031830 (hepatitis B virus [HBV]-related), 770310 (hepatitis C virus [HCV]-related), 497720 (alcohol-related), 20240 (hepatoblastoma), and 114460 (other causes-related). HBV-related liver cancer exhibited the highest age-standardized rate of incidence (2.62 per 100-000 population; 95% uncertainty interval [UI], 2.15-3.19), deaths (2.30 per 100-000 population; 95% UI, 1.89-2.81), and DALYs (71.83 per 100-000 population; 95% UI, 59.65-87.25). In 2021, the 65-69 age group bore the heaviest burden, dominated by HBV-related cases. Higher sociodemographic indices correlated with greater burden for most subtypes. High-income Asia Pacific and East Asia had the highest regional burdens. Nationally, Mongolia, Taiwan (Province of China), Monaco, and Mali were most affected. Cross-country inequalities persisted. Projections to 2040 predict rising burden for all subtypes except hepatoblastoma, with NASH-related incident cases increasing by 51.97%. Conclusions:The global disease burden of all liver cancer subtypes, except hepatoblastoma, is increasing. There is an urgent need to strengthen interdisciplinary collaboration and integrate public health measures with clinical interventions to address the increasingly severe challenge of liver cancer.

To investigate magnetic resonance imaging (MRI)-based radiomics for predicting renal function response for patients treated for atherosclerotic renal artery stenosis (ARAS) by endoluminal means. A cohort of 146 ARAS patients who underwent stenting was analyzed, with retrospective training and prospective validation groups delineated based on the treatment timing. Patients were categorized into benefit and no-benefit groups based on postoperative renal function during follow-up. Optimal radiomics labels were selected from regions of interest (ROIs) including the stenotic side and both kidneys. The nomogram combined optimal radiomics signatures with independent clinical factors using multivariable logistic regression. Shapley Additive exPlanations (SHAP), decision curve analysis (DCA), the net reclassification index (NRI), and the total integrated discrimination index (IDI) were conducted to determine the clinical usefulness of the nomogram. Split renal function of the stenotic side and diabetes emerged as independent clinical predictors. A nomogram, incorporating these clinical factors and radiomics features from the stenotic side and both kidneys, achieved area under the curve (AUCs) of 0.927 (0.861–0.979) and 0.904 (0.819–0.972) in the training and test groups, respectively, for predicting benefits. The clinical-radiomics model significantly improved diagnostic performance (p = 0.001 and p = 0.011 for the training and test groups, respectively). DCA, NRI, and IDI analyses suggested the nomogram's superiority. SHAP analysis highlighted the radiomics feature from stenotic side kidney as the most critical predictive feature. Both MRI radiomics and clinical factors may be valuable in pre-treatment counseling of ARAS patients who may benefit from endovascular treatment.

Purpose: Portal vein tumor thrombus (PVTT)-related severe symptomatic portal hypertension (SPH) leads to a poor prognosis in patients with advanced hepatocellular carcinoma (HCC). Traditional transjugular intrahepatic portosystemic shunt (TIPS) using covered plus bare stent can effectively relieve SPH, however, the bare segment is susceptible to obstruction due to PVTT invasion. This study aimed to evaluate the safety and efficacy of fully covered stent-TIPS (FCS-TIPS) for treatment of PVTT-related SPH in Patients and Methods: This retrospective study enrolled 25 patients with advanced HCC who underwent FCS-TIPS for PVTTrelated severe SPH from June 2018 to January 2024. The evaluated outcomes included overall survival (OS), technical success rate, reduction in portal venous pressure gradient (PPG), stent patency rate, SPH control rate, liver function and complications. Results: The technical success rate was 100% without perioperative deaths or severe procedure-related adverse events. The average PPG decreased by 13.4 +/- 4.6 mmHg. The overall symptom control rate of SPH was 96.0%. Variceal bleeding, ascites/hydrothorax, and enteropathy control rates were 100%, 95.0%, and 100%, respectively. Liver function showed mild improvement one month after TIPS. One patient (4.0%) experienced overt hepatic encephalopathy (OHE) and three (12.0%) patients developed shunt dysfunction during the follow-up period. None of the patients experienced shunt-induced extrahepatic metastasis. The median OS was 6.0 months and the cumulative survival rates at 3, 6, 12 months were 80.0%, 52.0% and 21.3%. Conclusion: FCS-TIPS is safe and effective for treating PVTT-related severe SPH and can serve as a bridging therapy for advanced HCC.

ObjectiveOur study was to compare the therapeutic outcomes of radiofrequency ablation (RFA) with or without conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC) within Milan criteria in subcapsular versus nonsubcapsular locations by using propensity score matching.Materials and methodsThis retrospective study included 171 consecutive HCC patients meeting Milan criteria who initially received RFA with or without cTACE at a tertiary academic center between January 2017 to December 2022. Technical success rate, progression-free survival (PFS) were recorded. Factors predicting PFS after RFA with or without cTACE were investigated through a Cox proportional hazard model.ResultsThe cumulative 1-, 3-, and 5-year PFS were 73.9%%, 27.7%%, and 7.7%, respectively. The cumulative PFS rates were 76.1% and 17.3% at 1 and 3 years, respectively, in the subcapsular group and 71.8% and 37.2% in the nonsubcapsular group (p = 0.034). Matching yielded 49 matched pairs of patients. In the matched group, corresponding cumulative PFS rates were 75.6% and 14.6% at 1 and 3 years, respectively, in the subcapsular group and 69.6% and 30.2% in the nonsubcapsular group (p = 0.156). Multivariate analysis confirmed that subcapsular tumor location was not an independent risk factor for PFS. Additionally, differences in technical success rate were not significant between groups.ConclusionThe differences in PFS rates and technical success rate in HCC patients within the Milan criteria who received RFA with or without cTACE were not significant between the subcapsular and non-subcapsular groups. Future larger prospective multicenter trials are needed to validate these findings.

OBJECTIVE:To explore the potential of Intravoxel Incoherent Motion Diffusion (IVIM) and Arterial Spin Labeling (ASL) in predicting the short-term effectiveness of post-revascularization for severe atherosclerotic renal artery stenosis. MATERIAL AND METHODS:A retrospective analysis of 88 cases from October 2018 to February 2023 was conducted. Patients were divided into Responder and Non-Responder groups based on renal function outcomes at their last follow-up. Clinical data were compared between the groups, and preoperative functional MRI images were analyzed. ROIs were outlined for the affected and both kidneys. Measurements included ASL-derived renal blood flow (RBF), IVIM's pseudo-diffusion coefficient (D*), perfusion fraction (f), true diffusion coefficient (D), and the conventional apparent diffusion coefficient (ADC).Multivariate logistic regression identified independent clinical predictors of benefit, and a clinical prediction model was developed. Model performance was assessed using Receiver Operating Characteristic (ROC) curves and Decision Curve Analysis(DCA) curves. RESULTS:In the training cohort of 54 non-responders and 34 responders, no quantitative parameters of bilateral kidneys showed statistical significance in predicting Responders (all p > 0.05). Pre-treatment eGFR, presence of diabetes, and the D value of the affected kidney were identified as independent factors for predicting short-term treatment effectiveness. The combined clinical-functional imaging model yielded a higher AUC at 0.796 (95 % CI: 0.690-0.897). Decision curve analysis further confirmed the better net benefit of combined model. CONCLUSION:Beyond clinical characteristics, functional MRI had the potential to predict response of stenting for severe atherosclerotic renal artery stenosis.

Background:Drug-delivering devices have shown efficacy in clinical trials and are widely used for femoropopliteal artery disease. However, the optimal strategy for complex lesions, such as TransAtlantic Inter-Society Consensus (TASC) C and D lesions, remains debated in real-world practice. This propensity score-matched study aimed to compare the mid-term outcomes between a double-drug strategy [drug-coated balloon (DCB) combined with systemic drug-eluting stents (DES)] and a DCB bailout strategy (DCB with bailout bare-metal stents) in patients with TASC C and D femoropopliteal lesions. Methods:This retrospective single-center study included TASC C and D femoropopliteal patients treated with DCB from October 2016 to July 2024. Propensity score matching (PSM) was performed in a 1:3 ratio, with one patient in the double-drug strategy group for every three in the DCB bailout group. The primary endpoint was 24-month primary patency. Secondary endpoints included freedom from clinically-driven target lesion revascularization (CD-TLR), mortality, complications, symptom improvement, and risk factors for restenosis. Results:After PSM, 32 pairs of patients were analyzed. Baseline characteristics were well-balanced [standardized mean difference (SMD) <0.2 for all covariates]. Primary patency rates at 24 months were comparable (double-drug vs. DCB bailout: 64.5% vs. 76.4%, P=0.76). Freedom from CD-TLR showed no significant difference at 24 months (double-drug vs. DCB bailout: 95.8% vs. 79.1%, P=0.20). The double drug group demonstrated superior Rutherford category improvement (P=0.042). Mortality and complication rates were similar between groups. Dyslipidemia was identified as an independent predictor of loss of primary patency [hazard ratio (HR) =3.03, P=0.024]. Conclusions:The double-drug strategy and DCB bailout strategy yielded comparable 24-month patency and freedom from target lesion revascularization (TLR) in TASC C and D lesions.

Background: Atherosclerotic renal artery stenosis (ARAS) is a condition where the renal arteries become narrowed due to atherosclerosis, leading to reduced blood flow to the kidneys and various renal complications. The effectiveness of interventional treatments, such as renal artery angioplasty and stenting, remains debated, making patient selection for these procedures challenging. Summary: This review focuses on the diagnosis and management of ARAS, with a particular emphasis on the potential role of functional MRI in evaluating renal function and mechanisms. By summarizing current diagnostic approaches and outcomes of interventional treatments, the review highlights the importance of informed clinical decision-making in ARAS management. Functional MRI emerges as a promising non-invasive tool to assess renal function, aiding in patient stratification and treatment planning.Key Messages:The efficacy of interventional treatments for ARAS requires further investigation and careful patient selection. Functional MRI holds promise as a non-invasive means to assess renal function and mechanisms, potentially guiding more effective clinical decisions in ARAS management. Advancing research in diagnostic methods, particularly functional MRI, can enhance our understanding and improve the treatment outcomes for ARAS patients.

Background/objectiveThe aim of this study was to evaluate tumor progression and recurrence patterns of radiofrequency ablation (RFA) with or without transarterial chemoembolization (TACE) for treating hepatocellular carcinoma (HCC) that meets Milan criteria.MethodsThis retrospective study included consecutive HCC patients meeting Milan criteria who underwent percutaneous RFA with or without TACE as initial treatment at a tertiary academic center between December 2017 and 2022. Technical success rate, local recurrence-free survival (LRFS), progression-free survival (PFS) and recurrence patterns were recorded.ResultsA total of 135 HCC patients (109 male [80.7%]) with a mean age of 62 years and 147 target lesions were retrospectively enrolled. The technical success rate was 99.3%. The median LRFS was 60 months, and the cumulative 1-, 3-, and 5-year LRFS were 88.9%, 70.1%, and 30.0%, respectively. Additionally, the median PFS was 23 months, with cumulative 1-, 3-, and 5-year PFS of 74%, 30%, and 0%, respectively. Multivariate analysis confirmed that age > 60, alpha-fetoprotein (AFP) (> 10), and albumin were associated with PFS (2.34, p = 0.004; 1.96, p = 0.021; 0.94, p = 0.007, respectively). Six recurrence patterns were identified: local tumor progression (LTP) alone (n = 15, 25.0%), intrahepatic distant recurrence (IDR) alone (n = 34, 56.7%), extrahepatic recurrence (ER) alone (n = 2, 3.3%), IDR + ER (n = 2, 3.3%), LTP + IDR (n = 5, 8.8%), and LTP + IDR + ER (n = 2, 3.3%). IDR occurred most frequently as a sign of good local treatment.ConclusionsRFA in combination with TACE does not appear to provide an advantage over RFA alone in improving tumor progression in patients with HCC meeting the Milan criteria. However, further prospective studies are needed to confirm these findings and to determine the optimal treatment approach for this patient population.

Hepatocellular carcinoma(HCC)is the most common type of primary liver cancer and is a leading cause of cancer-related deaths worldwide[1].

Background/ObjectiveTreatment of hepatocellular carcinoma (HCC) with ablation alone often results in high rates of recurrence and metastasis, reaching up to 25.9% within two years. Therefore, this study aimed to examine the efficacy and safety of transarterial chemoembolization (TACE)-assisted multi-image guided radiofrequency ablation (RFA) for the treatment of stage Ia HCC according to the China liver cancer staging (CNLC).MethodsThis study enrolled and analyzed a total of 118 patients diagnosed with HCC, each with a single nodular lesion no larger than 5 cm, who received TACE-RFA as first-line therapy between February 1, 2014, and December 31, 2021. The median/mean follow-up period was 29.0 months [95% confidence interval (CI): 21.8-36.2 months] and 31.8 months (95% CI: 27.5-36.0 months), respectively. We assessed the treatment’s effectiveness, potential complications, and survival rate.ResultsThe technical success rate was 100% (118/118) after the initial treatment. Out of the total, 3 out of 118 patients (2.5%) developed local tumor progression (LTP) during the follow-up period. The median time for LTP was 29.0 months (95%CI: 21.9-36.1 months; mean: 31.5 months; range 1-92 months). At 1, 3, 5, and 7 years after treatment, the cumulative LTP rates were 0%, 4.6%, 4.6%, and 4.6%, respectively. The overall survival rates at 1, 3, 5, and 7 years were 100%, 95.2%, 95.2%, and 95.2%, respectively. In total, 28 patients experienced minor Grade B complications, and no major complications or treatment-related mortality occurred.ConclusionThe treatment of CNLC stage Ia HCC using TACE-assisted multi-image-guided RFA was found to be both safe and feasible.

HomeRadiologyVol. 310, No. 3 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyBilateral Eggshell-like Internal Iliac Artery AneurysmsYong Xie, Yinghua Zou Yong Xie, Yinghua Zou Author AffiliationsFrom the Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, No 8 Xishiku St, Xicheng District, Beijing 100034, China.Address correspondence to Y.Z. (email: [email protected]).Yong XieYinghua Zou Published Online:Mar 19 2024https://doi.org/10.1148/radiol.232524MoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In Supplemental material is available for this article.A 70-year-old man with a history of hypertension presented to our department with bilateral thigh pain. Physical examination revealed palpable pulsatile masses. Lower extremity CT angiography was performed to rule out vascular disease. The examination showed enormous bilateral internal iliac artery (IIA) aneurysms, with eggshell-like calcifications around the aneurysms (Figure, Movie). An interventional procedure (iliac artery stent implantation combined with bilateral IIA embolization) was performed on the sixth day after admission.Coronal lower extremity CT angiogram in a 70-year-old man shows enormous bilateral internal iliac artery aneurysms (★). Eggshell-like calcifications (arrowheads) are visible around the aneurysms.Download as PowerPoint Movie: Postoperative short-segment video from CT angiography shows bilateral internal iliac artery aneurysms.Download Original Video (2.8 MB)IIA aneurysms are extremely uncommon (1), with an estimated incidence of 0.03%–0.4% in the general population (2). Bilateral IIA aneurysms are even more rare, accounting for 10.9% of cases (3). Although most IIA aneurysms are asymptomatic, those at high risk of rupture should be treated surgically because mortality after rupture is 50%–75% (4).Disclosures of conflicts of interest: Y.X. No relevant relationships. Y.Z. No relevant relationships.References1. Wittkop B, Crowe PM. Quiz case of the month. Internal iliac aneurysm. Eur Radiol 2002;12(5):1228–1229. Crossref, Medline, Google Scholar2. Brunkwall J, Hauksson H, Bengtsson H, Bergqvist D, Takolander R, Bergentz SE. Solitary aneurysms of the iliac arterial system: an estimate of their frequency of occurrence. J Vasc Surg 1989;10(4):381–384. Crossref, Medline, Google Scholar3. Wilhelm BJ, Sakharpe A, Ibrahim G, Baccaro LM, Fisher J. The 100-year evolution of the isolated internal iliac artery aneurysm. Ann Vasc Surg 2014;28(4):1070–1077. Crossref, Medline, Google Scholar4. Krupski WC, Selzman CH, Floridia R, Strecker PK, Nehler MR, Whitehill TA. Contemporary management of isolated iliac aneurysms. J Vasc Surg 1998;28(1):1–13. Crossref, Medline, Google ScholarArticle HistoryReceived: Sept 19 2023Revision requested: Nov 9 2023Revision received: Nov 20 2023Accepted: Dec 18 2023Published online: Mar 19 2024 FiguresReferencesRelatedDetailsRecommended Articles Noninvasive Physiologic Vascular Studies: A Guide to Diagnosing Peripheral Arterial DiseaseRadioGraphics2016Volume: 37Issue: 1pp. 346-357Multiple Systemic Arterial Aneurysms in Kawasaki DiseaseRadioGraphics2022Volume: 42Issue: 3pp. E88-E89Roles of Trauma CT and CTA in Salvaging the Threatened or Mangled ExtremityRadioGraphics2022Volume: 42Issue: 2pp. E50-E67Radiologic Assessment of Native Renal Vasculature: A Multimodality ReviewRadioGraphics2017Volume: 37Issue: 1pp. 136-156Intravascular US: Applications in Interventional RadiologyRadioGraphics2022Volume: 42Issue: 6pp. 1742-1757See More RSNA Education Exhibits Below the Belt: Angiography of the Abdomen, Pelvis and Lower Extremities Digital Posters2020A Walk-through Lower Limb Arteries: Atherosclerosis And BeyondDigital Posters2021Go With The Flow: A Review of Uncommon and Unique Vascular Causes of Abdominal PainDigital Posters2020 RSNA Case Collection Persistent Sciatic ArteryRSNA Case Collection2022Arterioureteral fistulaRSNA Case Collection2021Coral Reef AortaRSNA Case Collection2022 Vol. 310, No. 3 Metrics Altmetric Score PDF download

478 Background: Immune-checkpoint inhibitors, in combination with targeted therapy and local therapy, have been developed as promising treatment for unresectable hepatocellular carcinoma (uHCC) of intermediate stage. This study aimed to assess the efficacy and safety of cadonilimab(a tetravalent PD-1/CTLA-4 bispecific antibody) plus Lenvatinib (Len) and transarterial chemoembolization (TACE) in the treatment of intermediate HCC. Methods: This open label, multicenter phase II trial enrolled patients with histologically or clinically confirmed intermediate uHCC to receive TACE followed by cadonilimab 10mg/kg every 3 weeks plus Len until disease progression or intolerable toxicity. The primary endpoint was progression free disease (PFS) according to RECIST v1.1. The secondary endpoint includes safety, overall survival (OS), PFS according to modified RECIST (mRECIST), and objective response rate (ORR), disease control rate (DCR) and duration of response (DoR) by both RECIST v1.1 and mRECIST. Results: From June 2022 to May 2023, 78 patients were screened and 60 patients enrolled. As of August 15, 2023, 60 patients received at least once cadonilimab and the median duration of follow-up was 5.1 months. The average number of TACE procedures per patient was 1.70. The median PFS and OS were not reached, while the 6-month PFS rate was 77.1% (95% CI, 60.8-87.3) per RECIST v1.1 and 75.6% (95% CI, 59.5-86.0) per mRECIST. The ORR and DCR were 35.0% (95% CI, 23.1-48.4) and 96.7% (95% CI, 88.5-99.6) according to RECIST v1.1 and 85.0% (95% CI, 73.4-92.9) and 95.0% (95% CI, 86.1-99.0) according to mRECIST. 9 patients (15.0%) achieved complete response per mRECIST. The incidence of grade≥3 treatment-related adverse events (TRAEs) was 68.9%. The incidence of grade≥3 adverse events related to cadonilimab was 45.9%.The most common TRAEs included thrombocytopenia, aspartate aminotransferase increased, and alanine aminotransferase increased. Conclusions: Combination of TACE and cadonilimab plus len showed promising efficacy and manageable toxicity in intermediate uHCC. Benefit of control on tumor progression after TACE and lasting survival can be expected. Clinical trial information: NCT05319431 . [Table: see text]