Abstract No. 280: Radiation Lobectomy: A Hepatic Volumetric Response to Lobar Yttrium-90 Radioembolization

were male,171 female, 4 children, ages 11-88 years. Material collected from LSU Medical Center, V.A.Hospital N.O., Tulane Health Science Center, SUNY Downstate Medical Center, Johns Hopkins Bayview Center, 19852007. Selection criteria were: dehiscences of urinary tract due to trauma, inflammatory or neoplastic disease without compromise of vascular supply or excessive separation of margins.

sponse, and of residual and recurrent HCC following TACE.

RESULTS: 4 of 13 fistulae from bowel or pancreas to the renal collecting system closed managed minimally invasively by PCN, antegrade stent with or without drainage. Likewise 145 of 197 traumatic fistulae of ureter and bladder without vascular compromise nor significant separation of margins closed when treated by PCN, antegrade stent, with or without drainage. Conversely, only 51 of 104 such fistulae with compromise of their vascular supply closed under treatment by PCN, antegrade stent, sometimes drainage and antegrade ureteroneocystostomy. 59 of 132 fistulae attributable to neoplastic disease responded satisfactorily to such radiologic management, as did 37 of 80 fistulae caused by inflammatory disease. In 12 patients IR techniques failed and surgical urologic correction had to be instituted. In another 197 patients PCN often with drainage was successfully used as temporizing measure until definitive urologic intervention could be carried out. In 8 patients the follow-up period was inadequate.

PURPOSE: To introduce the balanced scorecard as a strategic assessment tool at an academic medical center.

CONCLUSION: Minimally invasive IR techniques definitively treated 60% (317 of 522) of select urinary tract fistulae, and moreover proved useful in temporizing conditions in another 197 patients awaiting definitive urologic intervention . The minimally invasive nature and attendant lower cost and reconvalescence period recommend use of this modality. Abstract No. 278 EE Diagnostic Utility of Magnetic Resonance Imaging for Evaluation of Treatment Response of Hepatocellular Carcinoma to Transcatheter Arterial Chemoembolization. M.K. Ford, K. Elsayes, H. Hussain; University of Michigan, Ann Arbor, MI. PURPOSE: The purpose of this educational exhibit is to illustrate the utility of MRI for the diagnosis of normal and abnormal appearances of hepatocellular carcinoma (HCC) following transcatheter arterial chemoembolization (TACE). Findings indicating response, as well as those concerning for or consistent with residual and recurrent tumor, will be discussed. MATERIALS & METHODS: MRI studies of patients who underwent TACE for HCC were reviewed. Unenhanced, gadolinium-enhanced, and diffusion-weighted images together with Apparent Diffusion coefficient (ADC) maps were assessed to identify features of response to treatment or the lack of it. Imaging follow-up and pathology were used as the reference standard. TEACHING POINTS: The exhibit will focus on the following in responders and non responders to therapy: 1. Changes in the enhancement characteristics of HCC following TACE at short and long term imaging follow-up. 2. Changes in tumor size over time. 3. Findings on diffusion-weighted imaging and changes in the ADC values. 4. Examples of “pitfalls” on MRI which are therapy related but can simulate residual or recurrent HCC. 5. Examples of complete reS106

Abstract No. 279 EE Implementing the Balanced Scorecard Strategic Assessment Tool in Interventional Radiology. J. Friese; Mayo Clinic, Rochester, MN.

MATERIALS & METHODS: The balanced scorecard is a strategic assessment and planning tool used to align professional activities with a defined strategy. Its use can help improve internal and external communications and monitor a division/group’s performance against strategic goals. Scorecards should address four key elements: learning and growth, business processes, customer, and financial. Each practice must define strategic goals prior to considering components of their scorecard. Subsequent metrics should be simple and directly address the defined strategy. HI-IQ software can be used to monitor and collect the data, which can then be easily exported to a spreadsheet program. Learning and growth can be tracked via diligent measurement of complications and near misses. Procedural and process improvements can be input for each patient following relevant cases. Procedure time and inventory management are important factors easily gleaned. Patient and referring physician surveys can be monitored on HI-IQ with reminders for office staff conducting the phone or mail questionnaires. Financial metrics regarding inventory management can be obtained using the program and should be a part of the financial strategy. TEACHING POINTS: 1) The balanced scorecard can help interventional radiology practices align ongoing learning, business processes, customer satisfaction, and financial metrics with their strategic goals. 2) HI-IQ can be an effective tool to help monitor and track key metrics. 3) Care must be taken to keep the process simple with overly complicated measurements detracting from the beauty of the balanced scorecard tool. Abstract No. 280 Radiation Lobectomy: A Hepatic Volumetric Response to Lobar Yttrium-90 Radioembolization. R.C. Gaba, S.M. Ibrahim, R.K. Ryu, K.T. Sato, A. Riaz, R.A. Omary, R.J. Lewandowski, R. Salem; Northwestern Memorial Hospital, Chicago, IL. PURPOSE: To describe volumetric changes of “radiation lobectomy,” or extensive hepatic lobar atrophy-hypertrophy complex formation, a manifestation of hepatic parenchymal response to lobar yttrium-90 (90Y) microsphere radioembolization, and to quantitatively compare this hepatic parenchymal response to that seen in surgical resection and portal vein embolization (PVE). MATERIALS & METHODS: Ten patients exhibiting extensive hepatic lobar atrophy-hypertrophy complex formation following lobar 90Y glass microsphere radioembolization at a single institution were identified. CT or MR imaging studies (baseline and last follow-up) were used to calculate pre- and post-treatment hepatic lobar volumes (HLV) on a 3D computer workstation. Pre- and post-treatment absolute right and left HLV, relative HLV (rHLV ⫽ HLV / total liver volume), and degree of lobar atrophy (DA) or hypertrophy

(DH) (DA or DH ⫽ post-treatment rHLV - pre-treatment rHLV ) were compared to surgical resection and PVE. RESULTS: Ten patients with primary (hepatocellular carcinoma, n ⫽ 7) or secondary (intrahepatic cholangiocarcinoma, n ⫽ 2; metastatic colorectal carcinoma, n ⫽ 1) liver malignancies demonstrated findings of radiation lobectomy following 22 (mean 2.2, range 1-5) right lobar 90Y radioembolization sessions. The initial absolute right HLV was 1015 cm3 (range 644-1842 cm3, rHLV ⫽ 58%), and initial absolute left HLV was 750 cm3 (range 467-1387 cm3, rHLV ⫽ 42%). Following 90Y radioembolization, absolute right HLV decreased to 403 cm3 (range 185-739 cm3, 61% reduction, rHLV ⫽ 26%, DA ⫽ 32%), while absolute left HLV increased to 1104 cm3 (range 776-1541 cm3, 59% increase, rHLV ⫽ 74%, DH ⫽ 32%) at mean 25 months follow-up (range 8-49 months). None of these patients exhibited bilirubin toxicities. By comparison, surgical resection and PVE demonstrate DHs around 33% and 7-16%, respectively.

recurrent hemorrhage. Although these findings support variceal coil embolization during TIPS performed for variceal hemorrhage, larger series with longer clinical follow-up are necessary to substantiate these results. Abstract No. 282 Outcome of Uterine Artery Embolization: Is It Affected by the Menstrual Cycle? A. Ganeshan, R. Jones, P. Gibert, M. Martin, L. Machan; University of British Coulmbia, Vancouver, BC, Canada. PURPOSE: Uterine artery embolization (UAE) is a wellestablished and effective treatment for uterine leiomyoma(fibroids). Uterine artery blood flow parameters have been shown to vary throughout the normal menstrual cycle. We hypothesise it is plausible that there maybe an optimal time to carry out UAE during the menstrual cycle. To our knowledge there is no published data on this subject.

CONCLUSION: The atrophy-hypertrophy complex seen following 90Y radioembolization may be as extensive as that seen following surgical resection and more profound than that seen after PVE. Further investigation is necessary to determine contributing factors for radiation lobectomy, predict which patients may manifest this response, and correlate with patient survival.

MATERIALS & METHODS: Over a 13 month period (August2007- September 2008), every patient attending our institution for UAE was given an optional questionnaire on the day of procedure. Five questions asked: 1.Days in cycle 2.Days of flow 3.Day of cycle 4.1st day of last period 5.Contraceptive pill. In addition, pre-procedural and 3-month follow-up uterine and dominant fibroid dimensions were recorded along with clinical outcome.

Abstract No. 281

RESULTS: Over 130 patients underwent UAE in the 13 months. 84 patients had follow-up during the time period. Follow-up was not due in the remainder at the time of analysis. We did not demonstrate a significant relationship between day of cycle when UAE took place and degree of shrinkage of uterus and dominant fibroid. The cohort was further subdivided by phase of menstrual cycle when UAE took place and no significant relationship was seen between phase of cycle and shrinkage of uterus or fibroid.

Rebleeding Rates Following TIPS for Variceal Hemorrhage in the Viatorr Era: TIPS Alone Versus TIPS with Variceal Embolization. R.C. Gaba, O.T. Mengin, B.K. Martinez, J.T. Bui, M. Knuttinen, C.A. Owens; University of Illinois at Chicago, Chicago, IL. PURPOSE: To compare rebleeding rates following transjugular intrahepatic portosystemic shunt (TIPS) treatment of gastroesophageal variceal hemorrhage with TIPS alone versus TIPS with concurrent variceal embolization.

RESULTS: TIPS and/or variceal coil embolization were successful in all cases. Mean pre- and post-TIPS portosystemic pressure gradients were 19 mm Hg and 7 mm Hg over all patients. There were no statistically significant differences in mean Child-Pugh score, MELD score, or portosystemic pressure gradients between each group. 3/17 (18%) patients in the TIPS alone group rebled while 0/8 (0%) patients in the TIPS with coil embolization group rebled during mean clinical follow-up time periods of 5 and 6 months, respectively. CONCLUSION: Treatment of gastroesophageal variceal hemorrhage with TIPS alone was associated with non-trivial rebleeding rates in this series, whereas TIPS performed with concurrent variceal coil embolization resulted in no cases of

Abstract No. 283 EE Interventional Oncology 101: A Comprehensive Review of the Armamentariums of Interventional Oncology (Liver Tumors). J.D. Grant, E.W. Lee, C.T. Loh, S.T. Kee; UCLA Medical Center, Los Angeles, CA.

POSTER SESSIONS

MATERIALS & METHODS: In this retrospective study, 25 patients (M:F ⫽ 14:11, mean age 52 years) with hepatic cirrhosis and gastroesophageal variceal hemorrhage underwent TIPS insertion between 2006 and 2008. Mean ChildPugh score was 8, and mean Model for End Stage Liver Disease (MELD) score was 17. TIPS was performed using 10 mm diameter stent-grafts (Viatorr; W.L. Gore and associates, Flagstaff AZ). TIPS alone was performed in 17 patients, while TIPS with concurrent variceal coil embolization was performed in 8 patients. Rates of rebleeding, defined as gastrointestinal bleeding requiring transfusion of two or more units of blood, were compared for each group.

CONCLUSION: The overall outcome to date highlights an important negative, and strongly suggests that there is not an optimal time during the menstrual cycle to carry out UAE. We are continuing to recruit and collect data to strengthen this suggestion.

PURPOSE: 1. To provide a complete review of the different armamentariums of interventional oncology in treating liver tumors. 2. To present a pictorial review of various presentations of liver tumors treated with these interventional oncology techniques. MATERIALS & METHODS: From the interventional radiology database and meta-analysis of current literature review, we will present following in the didactic format: 1. Background review on interventional oncology. 2. Review of various tumor ablation methods (RFA, Cryo, HIFU, Microwave, IRE). 3. Review of available transarterial chemoembolization (TACE) agents (embolic agents, chemotherapeutic agents, radioembolization). 4. Pictorial review of various imaging presentations (CT/MR/US/Angio) of liver tumors treated with interventional oncology techniques. S107