Using an Assumed Lung Mass Inaccurately Estimates the Lung Absorbed Dose in Patients Undergoing Hepatic 90Yttrium Radioembolization Therapy.

RATIONALE: Currently, the estimated absorbed radiation dose to the lung in 90Y radioembolization therapy is calculated using an assumed 1 kg lung mass for all patients. The aim of this study was to evaluate whether using a patient-specific lung mass measurement for each patient rather than a generic, assumed 1 kg lung mass would change the estimated lung absorbed dose. METHODS: A retrospective analysis was performed on 68 patients who had undergone 90Y radioembolization therapy at our institution. Individualized lung volumes were measured manually on CT scans for each patient, and these volumes were used to calculate personalized lung masses. The personalized lung masses were used to recalculate the estimated lung absorbed dose from the 90Y therapy, and this dose was compared to the estimated lung absorbed dose calculated using an assumed 1 kg lung mass. RESULTS: Patient-specific lung masses were significantly different from the generic 1 kg when compared individually for each patient (p < 0.0001). Median individualized lung mass was 0.71 (IQR: 0.59, 1.02) kg overall and was significantly different from the generic 1 kg lung mass for female patients [0.59 (0.50, 0.68) kg, (p < 0.0001)] but not for male patients [0.99 (0.71, 1.14) kg, (p = 0.24)]. Median estimated lung absorbed dose was 4.48 (2.38, 11.71) Gy using a patient-specific lung mass and 3.45 (1.81, 6.68) Gy when assuming a 1 kg lung mass for all patients. The estimated lung absorbed dose was significantly different using a patient-specific versus generic 1 kg lung mass when comparing the doses individually for each patient (p < 0.0001). The difference in the estimated lung absorbed dose between the patient-specific and generic 1 kg lung mass method was significant for female patients as a subgroup but not for male patients. CONCLUSIONS: The current method of assuming a 1 kg lung mass for all patients inaccurately estimates the lung absorbed dose in 90Y radioembolization therapy. Using patient-specific lung masses resulted in estimated lung absorbed doses that were significantly different from those calculated using an assumed 1 kg lung mass for all patients. A personalized dosimetry method that includes individualized lung masses is necessary and can warrant a 90Y dose reduction in some patients with lung masses smaller than 1 kg. LEVEL OF EVIDENCE: Level 3, Retrospective Study.

Management of patients with hepatocellular carcinoma and portal vein tumour thrombosis: comparing east and west.

Portal vein tumour thrombosis is common among patients with advanced hepatocellular carcinoma. Tremendous differences exist in the management of hepatocellular carcinoma with portal vein tumour thrombosis between the east and the west, which derive from heterogeneities in its epidemiology, causes, pathology, comorbidities, prognosis, and other demographics. These divergences between the east and the west are not only caused by hepatocellular carcinoma itself, but are also affected by many variables including social factors, physician preferences, accessibility to costly or novel treatments, and reimbursement schemes. In this Review, we compare and contrast the management of hepatocellular carcinoma with portal vein tumour thrombosis in the east and in the west in terms of systemic and surgical treatments, radiotherapy, transcatheter arterial therapies, and portal vein revascularisation. We conclude that a personalised, data-driven approach to care with active management from a multidisciplinary team, as well as increased communication and collaboration between clinicians and researchers based in east and the west, could help to reduce the differences in management and optimise treatment strategies.

Imaging work-up and endovascular treatment options for aorto-enteric fistula.

Aorto-enteric fistula (AEF) is a rare life-threatening condition. Early recognition and diagnosis are of paramount importance to improve outcome. In this article four cases of AEF with relevant pre- and post-procedural images are presented to demonstrate the utility of cross-sectional imaging in the work-up of AEF. The literature is reviewed to describe the typical presentation of AEF, the diagnostic work-up of AEF, and the different methods used to treat AEF. Endovascular repair of AEF is gaining increasing attention due to its decreased short-term mortality compared to open surgical techniques.

Minimally invasive treatments for venous compression syndromes.

The management of venous compression syndromes has historically been reliant on surgical treatment when conservative measures fail. There are, however, several settings in which endovascular therapy can play a significant role as an adjunct or even a replacement to more invasive surgical methods. We explore the role of minimally invasive treatment options for three of the most well-studied venous compression syndromes. The clinical aspects and pathophysiology of Paget-Schroetter syndrome (PSS), nutcracker syndrome, and May-Thurner syndrome are discussed in detail, with particular emphasis on the role that interventionalists can play in minimally invasive treatment.

Management of ureteral obstruction in crossed fused renal ectopia: A case report.

Crossed fused renal ectopia is a rare congenital malformation. We describe a case in which a 58-year-old male with left-sided crossed fused renal ectopia presented with urinary bladder outlet obstruction due to metastatic prostate adenocarcinoma. Glomerular filtration rate (GFR) was 13 mL/min, creatinine 4 mg/dL, and blood urea nitrogen (BUN) 58 mg/dL. The patient underwent successful image-guided placement of percutaneous nephrostomy tubes which were later converted to nephroureteral stents. Labs improved to a GFR of 28 mL/min, creatinine of 2.4 mg/dL, and BUN of 41 mg/dL. In this case standard image-guided renal decompression techniques were effective in treating a patient with crossed fused renal ectopia.