Publications by authors named "Sarah B White"

52 Publications

Biliary-Caval Fistula following Y90 Radioembolization.

Semin Intervent Radiol 2021 Oct 7;38(4):488-491. Epub 2021 Oct 7.

Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.

The safety of radioembolization with yttrium-90 ( Y) is well documented and major complications are rare. Previous studies have demonstrated that biliary complications following Y, including bile duct injury and hepatic abscess formation, occur at an increased rate in patients who have had prior biliary surgery and interventions. This article reviews a case of a patient who developed recurrent cholangitis and sepsis as well as a biliary-caval fistula following radioembolization. Additionally, we review current data regarding biliary complications following radioembolization in patients with prior biliary intervention.
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http://dx.doi.org/10.1055/s-0041-1735605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497092PMC
October 2021

Quality of Life and Cost Considerations: Y-90 Radioembolization.

Semin Intervent Radiol 2021 Oct 7;38(4):482-487. Epub 2021 Oct 7.

Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.

 Transarterial radioembolization (TARE) offers a minimally invasive and safe treatment option for primary and metastatic hepatic malignancies. The benefits of TARE are manifold including prolonged overall survival, low associated morbidities, and improved time to progression allowing prolonged treatment-free intervals. The rapid development of new systemic therapies including immunotherapy has radically changed the treatment landscape for primary and metastatic liver cancer. Given the current climate, it is critical for interventional oncologists to understand the benefits of TARE relative to these other therapies. Therefore, this report aims to review quality-of-life outcomes and the cost comparisons of TARE as compared with systemic therapies.
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http://dx.doi.org/10.1055/s-0041-1735570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497083PMC
October 2021

Optimal Medical Therapy Following Deep Venous Interventions: Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel.

J Vasc Interv Radiol 2021 Sep 23. Epub 2021 Sep 23.

Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO.

The optimal medical management of patients following endovascular deep venous interventions remains ill-defined. As such, the SIR Foundation (SIRF) convened a multidisciplinary group of experts in a virtual Research Consensus Panel (RCP) to develop a prioritized research agenda regarding anti-thrombotic therapy following deep venous interventions. Panelists presented gaps in knowledge followed by discussion and ranking of research priorities based on clinical relevance, overall impact, and technical feasibility. The following research topics were identified as high priority: 1) characterization of biological processes leading to in-stent stenosis/re-thrombosis; 2) identification and validation of methods to assess venous flow dynamics and their effect on stent failure; 3) elucidation of the role of inflammation and anti-inflammatory therapies; and 4) clinical studies to compare anti-thrombotic strategies and improve venous outcome assessment. Collaborative, multicenter research is necessary to answer these questions and thereby enhance the care of patients with venous disease.
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http://dx.doi.org/10.1016/j.jvir.2021.09.009DOI Listing
September 2021

Interventional Radiology Obesity Therapeutics: Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel.

J Vasc Interv Radiol 2021 09;32(9):1388.e1-1388.e14

Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address:

The Society of Interventional Radiology Foundation commissioned a Research Consensus Panel to establish a research agenda on "Obesity Therapeutics" in interventional radiology (IR). The meeting convened a multidisciplinary group of physicians and scientists with expertise in obesity therapeutics. The meeting was intended to review current evidence on obesity therapies, familiarize attendees with the regulatory evaluation process, and identify research deficiencies in IR bariatric interventions, with the goal of prioritizing future high-quality research that would move the field forward. The panelists agreed that a weight loss of >8%-10% from baseline at 6-12 months is a desirable therapeutic endpoint for future IR weight loss therapies. The final consensus on the highest priority research was to design a blinded randomized controlled trial of IR weight loss interventions versus sham control arms, with patients receiving behavioral therapy.
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http://dx.doi.org/10.1016/j.jvir.2021.05.029DOI Listing
September 2021

Development of an Interventional Radiology Specific Algorithm for Pre-Procedural Laboratory Testing.

Cardiovasc Intervent Radiol 2021 Aug 13. Epub 2021 Aug 13.

Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, WI, USA.

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http://dx.doi.org/10.1007/s00270-021-02941-yDOI Listing
August 2021

Musculoskeletal Oncologic Interventions: Proceedings from the Society of Interventional Radiology and Society of Interventional Oncology Research Consensus Panel.

J Vasc Interv Radiol 2021 07;32(7):1089.e1-1089.e9

Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN.

Musculoskeletal interventions are increasingly used with palliative and curative intent in the multidisciplinary treatment of oncology patients with bone and soft-tissue tumors. There is an unmet need for high-quality evidence to guide broader application and adoption of minimally invasive interventional technologies to treat these patients. Therefore, the Society of Interventional Radiology Foundation and the Society of Interventional Oncology collaborated to convene a research consensus panel to prioritize a research agenda addressing the gaps in the current evidence. This article summarizes the panel's proceedings and recommendations for future basic science and clinical investigation to chart the course for interventional oncology within the musculoskeletal system. Key questions that emerged addressed the effectiveness of ablation within specific patient populations, the effect of combination of ablation with radiotherapy and/or immunotherapy, and the potential of standardization of techniques, including modeling and monitoring, to improve the consistency and predictability of treatment outcomes.
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http://dx.doi.org/10.1016/j.jvir.2021.04.008DOI Listing
July 2021

Defining the Value of Interventional Radiology to Healthcare Stakeholders: Proceedings from a Society of Interventional Radiology Research Consensus Panel.

J Vasc Interv Radiol 2021 07;32(7):1088.e1-1088.e8

Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.

Interventional radiology (IR) has collectively struggled to articulate and prove its value to several external stakeholders. The goal of this research consensus panel was to provide a summary of the existing knowledge, identify current gaps in knowledge, identify the strengths and weaknesses in existing data, and prioritize research needs related to the value of IR. Panelists were asked to identify the critical relationships/alliances that should be fostered to advance the prioritized research and determine how the Society of Interventional Radiology and the Society of Interventional Radiology Foundation can further support these initiatives. Following presentations and discussions, it was determined that proving and quantifying how IR decreases the length of stay and prevents hospital admissions are the most salient, value-related research topics to pursue for the specialty.
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http://dx.doi.org/10.1016/j.jvir.2021.04.011DOI Listing
July 2021

Standing Waves on Computed Tomography Angiography in Multiple Vessels in a Young Trauma Patient.

J Comput Assist Tomogr 2021 Mar-Apr 01;45(2):238-241

From the Department of Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee, WI.

Abstract: Standing waves are a phenomenon of uncertain etiology seen on imaging. We present the first case demonstrating standing waves on computed tomography angiography in multiple vessels in a single patient with imaging evidence of resolution in some of the vessels. Our case further supports the literature that standing waves are a physiologic phenomenon, likely because of flow mechanics, rather than modality.
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http://dx.doi.org/10.1097/RCT.0000000000001137DOI Listing
April 2021

Research Priorities in Lymphatic Interventions: Recommendations from a Multidisciplinary Research Consensus Panel.

J Vasc Interv Radiol 2021 05 18;32(5):762.e1-762.e7. Epub 2021 Feb 18.

Clinical Research and Registries Division, SIR Foundation, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.

Recognizing the increasing importance of lymphatic interventions, the Society of Interventional Radiology Foundation brought together a multidisciplinary group of key opinion leaders in lymphatic medicine to define the priorities in lymphatic research. On February 21, 2020, SIRF convened a multidisciplinary Research Consensus Panel (RCP) of experts in the lymphatic field. During the meeting, the panel and audience discussed potential future research priorities. The panelists ranked the discussed research priorities based on clinical relevance, overall impact, and technical feasibility. The following research topics were prioritized by RCP: lymphatic decompression in patients with congestive heart failure, detoxification of thoracic duct lymph in acute illness, development of newer agents for lymphatic imaging, characterization of organ-based lymph composition, and development of lymphatic interventions to treat ascites in liver cirrhosis. The RCP priorities underscored that the lymphatic system plays an important role not only in the intrinsic lymphatic diseases but in conditions that traditionally are not considered to be lymphatic such as congestive heart failure, liver cirrhosis, and critical illness. The advancement of the research in these areas will lead the field of lymphatic interventions to the next level.
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http://dx.doi.org/10.1016/j.jvir.2021.01.269DOI Listing
May 2021

Correlation and Agreement of Yttrium-90 Positron Emission Tomography/Computed Tomography with Ex Vivo Radioembolization Microsphere Deposition in the Rabbit VX2 Liver Tumor Model.

J Vasc Interv Radiol 2021 01 12;32(1):23-32.e1. Epub 2020 Nov 12.

Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Department of Biomedical Engineering, Northwestern University, Evanston, Illinois.

Purpose: To demonstrate a stronger correlation and agreement of yttrium-90 (Y) positron emission tomography (PET)/computed tomography (CT) measurements with explant liver tumor dosing compared with the standard model (SM) for radioembolization.

Materials And Methods: Hepatic VX2 tumors were implanted into New Zealand white rabbits, with growth confirmed by 7 T magnetic resonance imaging. Seventeen VX2 rabbits provided 33 analyzed tumors. Treatment volumes were calculated from manually drawn volumes of interest (VOI) with three-dimensional surface renderings. Radioembolization was performed with glass Y microspheres. PET/CT imaging was completed with scatter and attenuation correction. Three-dimensional ellipsoid VOI were drawn to encompass tumors on fused images. Tumors and livers were then explanted for inductively coupled plasma (ICP)-optical emission spectroscopy (OES) analysis of microsphere content. Y PET/CT and SM measurements were compared with reference standard ICP-OES measurements of tumor dosing with Pearson correlation and Bland-Altman analyses for agreement testing with and without adjustment for tumor necrosis.

Results: The median infused activity was 33.3 MBq (range, 5.9-152.9). Tumor dose was significantly correlated with Y PET/CT measurements (r = 0.903, P < .001) and SM estimates (r = 0.607, P < .001). Bland-Altman analyses showed that the SM tended to underestimate the tumor dosing by a mean of -8.5 Gy (CI, -26.3-9.3), and the degree of underestimation increased to a mean of -18.3 Gy (CI, -38.5-1.9) after the adjustment for tumor necrosis.

Conclusions: Y PET/CT estimates were strongly correlated and had better agreement with reference measurements of tumor dosing than SM estimates.
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http://dx.doi.org/10.1016/j.jvir.2020.09.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8086791PMC
January 2021

Localized and triggered release of oxaliplatin for the treatment of colorectal liver metastasis.

J Cancer 2020 12;11(23):6982-6991. Epub 2020 Oct 12.

Departments of Radiology & Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI.

The aim of this study was to develop and evaluate a liposome formulation that deliver oxaliplatin under magnetic field stimulus in high concentration to alleviate the off-target effects in a rat model of colorectal liver metastases (CRLM). Hybrid liposome-magnetic nanoparticles loaded with Cy5.5 dye and oxaliplatin (L-NIR- FeO/OX) were synthesized by using thermal decomposition method. CRLM (CC-531) cell viability was assessed and rats orthotopically implanted with CC-531 cells were treated with L-NIR-FeO/OX or by drug alone via different routes, up to 3 cycles of alternating magnetic field (AMF). Optical and MR imaging was performed to assess the targeted delivery. Biodistribution and histology was performed to determine the distribution of oxaliplatin. L-NIR-FeO/OX presented a significant increase of oxaliplatin release (~18%) and lower cell viability after AMF exposure (<0.001). Optical imaging showed a significant release of oxaliplatin among mesenteric vein injected (MV) group of animals. MR imaging on MV injected animals showed R2* changes in the tumor regions at the same regions immediately after infusion compared to the surrounding liver (<0.001). Biodistribution analysis showed significantly higher levels of oxaliplatin in liver tissues compared to lungs (<0.001) and intestines (<0.001) in the MV animals that received AMF after L-NIR- FeO/OX administration. Large tumor necrotic zones and significant improvement in the survival rates were noted in the MV animals treated with AMF. AMF triggers site selective delivery of oxaliplatin at high concentrations and improves survival outcomes in colorectal liver metastasis tumor bearing rats.
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http://dx.doi.org/10.7150/jca.48528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591990PMC
October 2020

Value in Interventional Radiology: Achieving High Quality Outcomes at a Lower Cost.

Authors:
Sarah B White

Radiology 2020 Nov 8;297(2):482-483. Epub 2020 Sep 8.

From the Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226.

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http://dx.doi.org/10.1148/radiol.2020203407DOI Listing
November 2020

Yttrium-90 Portal Vein Radioembolization in Sprague-Dawley Rats: Dose-Dependent Imaging and Pathological Changes in Normal Liver.

Cardiovasc Intervent Radiol 2020 Dec 16;43(12):1925-1935. Epub 2020 Aug 16.

Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.

Purpose: Portal vein embolization (PVE) is an established neoadjuvant method to induce future liver remnant hypertrophy prior to surgical resection of hepatic tumors. The purpose of our study was to examine the feasibility of PVE with glass Y microspheres (Y90 PVE) in Sprague-Dawley rats. We tested the hypothesis that increased doses of Y90 PVE would increase target lobe fibrosis and atrophy.

Methods: Twenty-two rats were assigned to four groups for Y90 PVE to the right median lobe: very high- (273.8 MBq; n = 2), high- (99.9 MBq; n = 10), medium- (48.1 MBq; n = 5), and low-dose (14.8 MBq; n = 5). An untreated control group included seven rats. Y PET/CT of Y distributions confirmed lobar targeting. MRI volumes were measured at baseline, 2-, 4-, 8- and 12-weeks. Explanted hepatic lobes were weighed, sectioned, and stained for H&E and immunohistochemistry. Digitized slides allowed quantitative measurements of fibrosis (20 foci/slide).

Results: Ex vivo measurements confirmed 91-97% activity was localized to the target lobe (n = 4). The percent growth of the target lobe relative to baseline was - 5.0% (95% CI - 17.0-6.9%) for high-, medium dose rats compared to + 18.6% (95% CI + 7.6-29.7%) in the low-dose group at 12-weeks (p = 0.0043). Radiation fibrosis increased in a dose-dependent fashion. Fibrotic area/microsphere was 22,893.5, 14,946.2 ± 2253.3, 15,304.5 ± 4716.6, and 5268.8 ± 2297.2 μm for very high- (n = 1), high- (n = 4), medium- (n = 3), and low-dose groups (n = 5), respectively.

Conclusion: Y90 PVE was feasible in the rat model, resulted in target lobe atrophy, and dose-dependent increases in hepatic fibrosis at 12 weeks. The onset of imaging-based volumetric changes was 8-12 weeks.
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http://dx.doi.org/10.1007/s00270-020-02614-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7655630PMC
December 2020

VenaTech Convertible Vena Cava Filter 6 Months after Conversion Follow-up.

J Vasc Interv Radiol 2020 Sep 11;31(9):1419-1425. Epub 2020 Aug 11.

Department of Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI 53226.

Purpose: To report device-related adverse events 6 months after placement or conversion of the VenaTech convertible vena cava filter (VTCF).

Materials And Methods: A review of 6-month follow-up data of an investigational device exemption multicenter, prospective, single-arm study was performed. The VTCF was implanted in 149 patients. Conversion was attempted in 64.4% of those patients (n = 96) and successfully in 96.9% of the patients (n = 93). A total of 76 patients completed imaging evaluation at 6 months after filter conversion. Patients who required continued venous thromboembolism prophylaxis at 6 months did not undergo a conversion attempt and were designated as nonconverted filter subjects. A total of 28 nonconverted filter subjects completed imaging evaluation at 6 months after implantation.

Results: Evaluation of patients at 6 months after conversion demonstrated 1 of 76 (1.3%) inferior vena cava (IVC) perforations with a filter strut greater than 3 mm outside of the caval lumen. No cases of recurrent PE, clinically significant filter migration, filter fracture, or IVC thrombosis were reported in the converted subjects. In the nonconverted filter subjects, there was a 14.3% (4 of 28) complete or nearly complete rate of IVC thromboses. There were no cases of recurrent pulmonary embolism, penetration, fracture, or spontaneous conversion in the nonconverted filter subjects. There was a significant reduction in the rate of IVC thrombosis and migration in the converted cohort compared to that in the nonconverted cohort.

Conclusions: At 6 months, the VTCF demonstrated low adverse event rates in the converted configuration, whereas a minority of patients with the nonconverted configuration demonstrated a high risk of IVC thrombosis.
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http://dx.doi.org/10.1016/j.jvir.2020.05.023DOI Listing
September 2020

Feasibility of Combination Intra-arterial Yttrium-90 and Irinotecan Microspheres in the VX2 Rabbit Model.

Cardiovasc Intervent Radiol 2020 Oct 12;43(10):1528-1537. Epub 2020 Jun 12.

Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA.

Purpose: To evaluate the combination of Y radioembolization (Y90) and drug-eluting bead irinotecan (DEBIRI) microspheres in the VX2 rabbit model.

Materials And Methods: An initial dose finding study was performed in 6 White New Zealand rabbits to identify a therapeutic but subcurative dose of Y90. In total, 29 rabbits were used in four groups: Y90 treatment (n = 8), DEBIRI treatment (n = 6), Y90 + DEBIRI treatment (n = 7), and an untreated control group (n = 8). Hepatic toxicity was evaluated at baseline, 24 h, 72 h, 1 week, and 2 weeks. MRI tumor volume (TV) and enhancing tumor volume were assessed baseline and 2 weeks. Tumor area and necrosis were evaluated on H&E for pathology.

Results: Infused activities of 84.0-94.4 MBq (corresponding to 55.1-72.7 Gy) were selected based on the initial dose finding study. Infusion of DEBIRI after Y90 was technically feasible in all cases (7/7). Overall, 21/29 animals survived to 2 weeks, and the remaining animals had extrahepatic disease on necropsy. Liver transaminases were elevated with Y90, DEBIRI, and Y90 + DEBIRI compared to control at 24 h, 72 h, and 1 week post-treatment and returned to baseline by 2 weeks. By TV, Y90 + DEBIRI was the only treatment to show statistically significant reduction at 2 weeks compared to the control group (p = 0.012). The change in tumor volume (week 2-baseline) for both Y90 + DEBIRI versus control (p = 0.002) and Y90 versus control (p = 0.014) was significantly decreased. There were no statistically significant differences among groups on pathology.

Conclusion: Intra-arterial Y90 + DEBIRI was safe and demonstrated enhanced antitumor activity in rabbit VX2 tumors. This combined approach warrants further investigation.
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http://dx.doi.org/10.1007/s00270-020-02538-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529870PMC
October 2020

Yttrium-90 Radioembolization and Tumor Hypoxia: Gas-challenge BOLD Imaging in the VX2 Rabbit Model of Hepatocellular Carcinoma.

Acad Radiol 2021 06 7;28(6):849-858. Epub 2020 Jun 7.

Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Biomedical Engineering, Northwestern University, Evanston, Illinois.

Rationale And Objectives: To use a rapid gas-challenge blood oxygen-level dependent magnetic resonance imaging exam to evaluate changes in tumor hypoxia after Y radioembolization (Y90) in the VX2 rabbit model.

Materials And Methods: White New Zealand rabbits (n = 11) provided a Y90 group (n = 6 rabbits) and untreated control group (n = 5 rabbits). R2* maps were generated with gas-challenges (O/room air) at baseline, 1 week, and 2 weeks post-Y90. Laboratory toxicity was evaluated at baseline, 24 hours, 72 hours, 1 hours, and 2 weeks. Histology was used to evaluate tumor necrosis on hematoxylin and eosin and immunofluorescence imaging was used to assess microvessel density (CD31) and proliferative index (Ki67).

Results: At baseline, median tumor volumes and time to imaging were similar between groups (p = 1.000 and p = 0.4512, respectively). The median administered dose was 50.4 Gy (95% confidence interval:44.8-55.9). At week 2, mean tumor volumes were 5769.8 versus 643.7 mm for control versus Y90 rabbits, respectively (p = 0.0246). At two weeks, ΔR2* increased for control tumors to 12.37 ± 12.36sec and decreased to 4.48 ± 9.00sec after Y90. The Pearson correlation coefficient for ΔR2* at baseline and percent increase in tumor size by two weeks was 0.798 for the Y90 group (p = 0.002). There was no difference in mean microvessel density for control versus Y90 treated tumors (p = 0.6682). The mean proliferative index was reduced in Y90 treated tumors at 30.5% versus 47.5% for controls (p = 0.0071).

Conclusion: The baseline ΔR2* of tumors prior to Y90 may be a predictive imaging biomarker of tumor response and treatment of these tumors with Y90 may influence tumor oxygenation over time.
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http://dx.doi.org/10.1016/j.acra.2020.04.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719607PMC
June 2021

Heritable modifiers of the tumor microenvironment influence nanoparticle uptake, distribution and response to photothermal therapy.

Theranostics 2020 6;10(12):5368-5383. Epub 2020 Apr 6.

Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA.

We report the impact of notch-DLL4-based hereditary vascular heterogeneities on the enhanced permeation and retention (EPR) effect and plasmonic photothermal therapy response in tumors. : We generated two consomic rat strains with differing DLL4 expression on 3 chromosome. These strains were based on immunocompromised Salt-sensitive or SS (DLL4-high) and SS.BN3 (DLL4-low) rats with 3rd chromosome substituted from Brown Norway rat. We further constructed three novel SS.BN3 congenic strains by introgressing varying segments of BN chromosome 3 into the parental SS strain to localize the role of SS DLL4 on tumor EPR effect with precision. We synthesized multimodal theranostic nanoparticles (TNPs) based on Au-nanorods which provide magnetic resonance imaging (MRI), X-ray, and optical contrasts to assess image guided PTT response and quantify host specific therapy response differences in tumors orthotopically xenografted in DLL4-high and -low strains. We tested recovery of therapy sensitivity of PTT resistant strains by employing anti-DLL4 conjugated TNPs in two triple negative breast cancer tumor xenografts. : Host strains with high DLL4 allele demonstrated slightly increased tumor nanoparticle uptake but consistently developed photothermal therapy resistance compared to tumors in host strains with low DLL4 allele. Tumor micro-environment with low DLL4 expression altered the geographic distribution of nanoparticles towards closer proximity with vasculature which improved efficacy of PTT in spite of lower overall TNP uptake. Targeting TNPs to tumor endothelium via anti-DLL4 antibody conjugation improved therapy sensitivity in high DLL4 allele hosts for two triple negative human breast cancer xenografts. : Inherited DLL4 expression modulates EPR effects in tumors, and molecular targeting of endothelial DLL4 via nanoparticles is an effective personalized nanomedicine strategy.
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http://dx.doi.org/10.7150/thno.41171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196309PMC
July 2021

Role of Radioembolization for Biliary Tract and Primary Liver Cancer.

Surg Oncol Clin N Am 2019 10;28(4):731-743

Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA. Electronic address:

Hepatocellular carcinoma and intrahepatic cholangiocarcinoma are often amenable to locoregional therapy, including percutaneous ablation, transarterial chemoembolization (TACE), or transarterial radioembolization (TARE). TARE is a technique that delivers a high dose of radiation to the tumor, while limiting the dose to the normal liver parenchyma and the adjacent organs. It has been shown to effectively provide disease control with relatively few toxicities, and in certain cases results in a complete response. It is the preferred therapy as a bridge to liver transplant and can provide necessary compensatory future liver remnant hypertrophy before planned surgical resection.
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http://dx.doi.org/10.1016/j.soc.2019.07.001DOI Listing
October 2019

Treatment of Hepatocellular Carcinoma: Time for a Paradigm Shift?

Authors:
Sarah B White

Radiology 2019 Sep 23;292(3):760-761. Epub 2019 Jul 23.

From the Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226.

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http://dx.doi.org/10.1148/radiol.2019191474DOI Listing
September 2019

Outcomes and Cost Comparison of Percutaneous Endovascular Aortic Repair versus Endovascular Aortic Repair With Open Femoral Exposure.

J Surg Res 2019 08 28;240:124-129. Epub 2019 Mar 28.

Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address:

Background: The objective of this study was to assess cost differences between patients who underwent percutaneous endovascular aortic repair (PEVAR) and open surgical femoral exposure in elective endovascular aortic repair (EVAR) of abdominal aortic aneurysms.

Materials And Methods: An IRB-approved single center retrospective analysis of patients who underwent elective EVAR for abdominal aortic aneurysms from 2009 to 2016 was performed. One hundred patients were selected with 50 patients who underwent PEVAR and 50 patients who underwent open surgical femoral exposure. Patient demographics, procedural variables, and hospital outcomes were collected and compared. Primary outcomes assessed used in cost calculations included operating time (OR time), hospital length of stay (LOS), and intensive care unit stay (ICU LOS). Extrapolated cost differences were based on known, published cost multipliers for the primary outcomes observed.

Results: Patients undergoing PEVAR had significant reduction in mean OR time (113.9 min versus 144.9 min, P < 0.001), mean ICU LOS (19.7 h versus 28.9 h, P = 0.094), and overall LOS (28.3 h versus 33.1 h, P = 0.020). There was no statistically significant difference in access related complications, although there was a trend toward less complication rates with PEVAR (0% versus 5%, P = 0.056). Calculated cost of procedures based on mean ICU LOS, hospital LOS, and OR time, showed significant reduction in mean hospital costs with PEVAR ($16,628.5 versus $21,705.8, P < 0.001). Multiple linear regression analysis demonstrated an overall 23% cost reduction with PEVAR.

Conclusions: Prior reports comparing PEVAR versus EVAR with open femoral exposures have shown improvement in overall patient time to ambulation and other hospital metrics such as LOS with PEVAR. There is, however, a paucity of overall cost comparison data regarding PEVAR. In this study, adoption of PEVAR was seen to significantly reduce OR times (19%) and overall hospital LOS (50%). The outcomes observed ultimately translated into significant reduction in hospital costs.
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http://dx.doi.org/10.1016/j.jss.2019.02.011DOI Listing
August 2019

Influence of Academic Productivity on Gender Disparity in Academic Interventional Radiology.

AJR Am J Roentgenol 2019 Mar 19:1-7. Epub 2019 Mar 19.

1 Department of Radiology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC V5Z 1M9, Canada.

Objective: This study aimed to determine the effect of academic productivity measured using surrogate metrics, including h-index, publication number, and citation number, on the advancement of academic interventional radiology (IR) staff.

Materials And Methods: Publicly available data on faculty members in IR departments across academic institutions in Canada and the United States were collected. Gender, academic ranking, leadership position (if any), publication number, citation number, years of active research, and h-index were collected for each faculty member, and these data were used to create a prediction equation.

Results: Four hundred twenty IR faculty members met the inclusion criteria for this study. Overall, women were the minority, representing 10% of all IR faculty. Women in academic IR attained academic ranks at a rate comparable to that of men, with 59% of women attaining the rank of assistant professor and 32% attaining associate professor, compared with 59% of men at the assistant professor and 25% at the associate professor level. A trend toward lower female representation was present at the full professor level (women, 8%; men, 15%) but this difference did not reach statistical significance. Leadership position by gender as a percentage of their overall representation in the field was also similar between women and men (first-in-command women, 15%; first-in-command men, 15%; second-in-command women, 2%; second-in-command men, 2%). No significant difference was found between women and men in terms of academic achievement metrics, including publication number, citation number, h-index, and years of active research.

Conclusion: Women in academic IR achieve similar publication metrics as men and attain promotion to higher academic rank and leadership positions equal to their overall representation in the field. However, women remain the minority among academic IR faculty across North America.
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http://dx.doi.org/10.2214/AJR.18.20130DOI Listing
March 2019

Research Priorities in Pelvic Venous Disorders in Women: Recommendations from a Multidisciplinary Research Consensus Panel.

J Vasc Interv Radiol 2019 Jun 8;30(6):781-789. Epub 2019 Mar 8.

Connecticut Image-Guided Surgery, Fairfield, Connecticut.

Pelvic venous disorders (PeVDs) in women can present with chronic pelvic pain, lower-extremity and vulvar varicosities, lower-extremity swelling and pain, and left-flank pain and hematuria. Multiple evidence gaps exist related to PeVDs with the consequence that nonvascular specialists rarely consider the diagnosis. Recognizing this, the Society of Interventional Radiology Foundation funded a Research Consensus Panel to prioritize a research agenda to address these gaps. This paper presents the proceedings and recommendations from that Panel.
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http://dx.doi.org/10.1016/j.jvir.2018.10.008DOI Listing
June 2019

Early Immunologic Response of Irreversible Electroporation versus Cryoablation in a Rodent Model of Pancreatic Cancer.

J Vasc Interv Radiol 2018 12 11;29(12):1764-1769. Epub 2018 Oct 11.

Department of Radiology, Northwestern University, Chicago, Illinois; Department of Biomedical Engineering, Northwestern University, Chicago, Illinois.

Purpose: To investigate the differences in immune responses between cryoablation and irreversible electroporation (IRE) in a preclinical mouse model.

Material And Methods: A mouse pancreatic cancer cell line (PANC-2) was implanted in the bilateral flanks of mice, and tumor-bearing mice were divided into 6 groups. One of the tumors was ablated either with contact cryoablation using an argon-cooled cryoablation probe for 1 minute at 5% power or by IRE for a total of 64 100-μs-duration, 1250-V/cm pulses with 100-ms spacing. The contralateral tumors in the same animal served as controls. At immediate, 6, 12, and 24 hours after ablation, the tumors were processed for immunostaining with F480 (macrophages), CD3 (T cells), and CD-56 (natural killer cells) antibodies.

Results: CD3 staining demonstrated significantly more T cells in the IRE group than in the cryoablation group at 6 hours (45 vs 16; P = .027), 12 hours (67 vs 33; P = .020), and 24 hours (161 vs 94; p = .003), with almost a 2-fold increase at every time point. Although the mean number of natural killer cells in the treated tumors was higher, no significant differences were observed between the 2 groups at any of the time points. A significant difference was observed in F480 positivity between the cryoablation group and the IRE group at 12 hours (210 vs 356; P = .0004) and 24 hours (220 vs 328; P = .04), respectively.

Conclusions: In a mouse model of pancreatic cancer, IRE evokes a more robust infiltration of macrophages and T cells than cryoablation within 24 hours.
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http://dx.doi.org/10.1016/j.jvir.2018.07.009DOI Listing
December 2018

Real time evaluation of tissue optical properties during thermal ablation of ex vivo liver tissues.

Int J Hyperthermia 2019 01 21;35(1):176-182. Epub 2018 Aug 21.

a Department of Biomedical Engineering , Marquette University and Medical College of Wisconsin , Milwaukee , WI , USA.

Complete ablation of liver tumors is vital for minimizing the risk of local tumor recurrence. Accurately identifying the hallmarks of tissue necrosis during thermal ablative therapies may significantly increase the efficacy of ablation, while minimizing unnecessary damage to the surrounding normal tissues or critical structures. Light propagation in biological tissues is sensitive to the tissue microstructure and chromophore concentrations. In our previous studies, we found that the wavelength (λ) averaged liver tissue absorption coefficient (µ) and reduced scattering coefficient (µ') change significantly upon heating which may be used for assessment of tissue damage during thermal ablation of solid tumors. Here, we seek to demonstrate the use of an integrated fiber-optic probe for continuous monitoring of the local tissue temperature (T), µ(λ) and µ'(λ) during thermal ablation of ex vivo porcine livers. The wavelength-averaged (435-630 nm) tissue absorption and scattering (µ and µ' ) increased rapidly at 45 °C and plateaued at 67 °C. The mean µ and µ' for liver tissue at 37 °C (n = 10) were 8.5 ± 3.7 and 2.8 ± 1.1 cm, respectively. The relative changes in µ and µ' at 37, 55, and 65 °C were significantly different (p < .02) from each other. A relationship between the relative changes in µ and µ' and the degree of tissue damage estimated using the temperature-based Arrhenius model for porcine liver tissues was established and studied.
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http://dx.doi.org/10.1080/02656736.2018.1488278DOI Listing
January 2019

Y Radioembolization for Hepatic Malignancy in Patients with Previous Biliary Intervention: Multicenter Analysis of Hepatobiliary Infections.

Radiology 2018 Sep 8;288(3):774-781. Epub 2018 May 8.

From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 505 Parnassus Ave, Room M-361, San Francisco, CA 94143 (K.K.D., N.F., A.A.L., R.K.K.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.C.S.); Department of Radiology, Indiana University Health University Hospital, Indianapolis, Ind (M.M., M.S.J.); H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, Fla (E.A., G.E.); Radiology Imaging Associates, Denver, Colo (C.N.); Dotter Interventional Institute, Oregon Health Sciences University, Portland, Ore (J.M., K.F.); Department of Radiology, University of Illinois Medical Center at Chicago, Chicago, Ill (R.P.L., R.C.G.); Department of Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (J.F., D.B.B.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (S.W.K.); Department of Radiology, University of California-San Diego Medical Center, San Diego, Calif (S.C.R.); Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada (K.A.P., D.L.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); and Department of Vascular and Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.G.).

Purpose To determine the frequency of hepatobiliary infections after transarterial radioembolization (TARE) with yttrium 90 (Y) in patients with liver malignancy and a history of biliary intervention. Materials and Methods For this retrospective study, records of all consecutive patients with liver malignancy and history of biliary intervention treated with TARE at 14 centers between 2005 and 2015 were reviewed. Data regarding liver function, Y dosimetry, antibiotic prophylaxis, and bowel preparation prophylaxis were collected. Primary outcome was development of hepatobiliary infection. Results One hundred twenty-six patients (84 men, 42 women; mean age, 68.8 years) with primary (n = 39) or metastatic (n = 87) liver malignancy and history of biliary intervention underwent 180 procedures with glass (92 procedures) or resin (88 procedures) microspheres. Hepatobiliary infections (liver abscesses in nine patients, cholangitis in five patients) developed in 10 of the 126 patients (7.9%) after 11 of the 180 procedures (6.1%; nine of those procedures were performed with glass microspheres). All patients required hospitalization (median stay, 12 days; range, 2-113 days). Ten patients required percutaneous abscess drainage, three patients underwent endoscopic stent placement and stone removal, and one patient needed insertion of percutaneous biliary drains. Infections resolved in five patients, four patients died (two from infection and two from cancer progression while infection was being treated), and one patient continued to receive suppressive antibiotics. Use of glass microspheres (P = .02), previous liver resection or ablation (P = .02), and younger age (P = .003) were independently predictive of higher infection risk. Conclusion Infectious complications such as liver abscess and cholangitis are uncommon but serious complications of transarterial radioembolization with Y in patients with liver malignancy and a history of biliary intervention.
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http://dx.doi.org/10.1148/radiol.2018170962DOI Listing
September 2018

Chronic Central Venous Access: From Research Consensus Panel to National Multistakeholder Initiative.

J Vasc Interv Radiol 2018 04 15;29(4):461-469. Epub 2018 Feb 15.

Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital.

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http://dx.doi.org/10.1016/j.jvir.2017.12.009DOI Listing
April 2018

Biofunctionalized Hybrid Magnetic Gold Nanoparticles as Catalysts for Photothermal Ablation of Colorectal Liver Metastases.

Radiology 2017 12 13;285(3):809-819. Epub 2017 Jul 13.

From the Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W., V.R.G.); Department of Radiology (S.B.W., D.H.K., Y.G., W.L., Y.Y., J.C., A.C.L.) and Robert H. Lurie Comprehensive Cancer Center (D.H.K., A.C.L.), Northwestern University, 710 N Fairbanks Ct, Olson 8th floor 8-317, Chicago, IL 60611; Department of Chemical and Biological Engineering (J.C.) and Department of Biomedical Engineering (A.C.L.), Northwestern University, Evanston, Ill.

Purpose To demonstrate that anti-MG1 conjugated hybrid magnetic gold nanoparticles (HNPs) act as a catalyst during photothermal ablation (PTA) of colorectal liver metastases, and thus increase ablation zones. Materials and Methods All experiments were performed with approval of the institutional animal care and use committee. Therapeutic and diagnostic multifunctional HNPs conjugated with anti-MG1 monoclonal antibodies were synthesized, and the coupling efficiency was determined. Livers of 19 Wistar rats were implanted with 5 × 10 rat colorectal liver metastasis cell line cells. The rats were divided into three groups according to injection: anti-MG1-coupled HNPs (n = 6), HNPs only (n = 6), and cells only (control group, n = 7). Voxel-wise R2 and R2* magnetic resonance (MR) imaging measurements were obtained before, immediately after, and 24 hours after injection. PTA was then performed with a fiber-coupled near-infrared (808 nm) diode laser with laser power of 0.56 W/cm for 3 minutes, while temperature changes were measured. Tumors were assessed for necrosis with hematoxylin-eosin staining. Organs were analyzed with inductively coupled plasma mass spectrometry to assess biodistribution. Therapeutic efficacy and tumor necrosis area were compared by using a one-way analysis of variance with post hoc analysis for statistically significant differences. Results The coupling efficiency was 22 μg/mg (55%). Significant differences were found between preinfusion and 24-hour postinfusion measurements of both T2 (repeated measures analysis of variance, P = .025) and T2* (P < .001). Significant differences also existed for T2* measurements between the anti-MG1 HNP and HNP-only groups (P = .034). Mean temperature ± standard deviation with PTA in the anti-MG1-coated HNP, HNP, and control groups was 50.2°C ± 7.8, 51°C ± 4.4, and 39.5°C ± 2.0, respectively. Inductively coupled plasma mass spectrometry revealed significant tumor targeting and splenic sequestration. Mean percentages of tumor necrosis in the anti-MG1-coated HNP, HNP, and control groups were 38% ± 29, 14% ± 17, and 7% ± 8, respectively (P = .043). Conclusion Targeted monoclonal antibody-conjugated HNPs can serve as a catalyst for photothermal ablation of colorectal liver metastases by increasing ablation zones. RSNA, 2017.
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http://dx.doi.org/10.1148/radiol.2017161497DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708290PMC
December 2017

Decision Making in Interventional Oncology: Intra-arterial Therapies for Metastatic Colorectal Cancer-Y90 and Chemoembolization.

Semin Intervent Radiol 2017 Jun 1;34(2):87-91. Epub 2017 Jun 1.

Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.

Colorectal cancer is the third most common cancer in the United States and the liver is the most common site of metastatic disease. The presence and extent of hepatic metastases are a major prognostic indicator. Although surgical resection is the accepted first-line therapy for colorectal liver metastasis, only 20 to 25% of patients are eligible for resection due to the extent and location of disease. This article discusses the current role of transarterial therapies in the treatment of colorectal liver metastases.
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http://dx.doi.org/10.1055/s-0037-1601854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453773PMC
June 2017
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