By Eric Barnes, staff writer
    November 19, 2010

    Interventional radiology is tailor-made for an era of constrained budgets and patients who must hurry back to their daily lives. To that end, some of this year's most intriguing image-guided interventional techniques at the RSNA 2010 meeting promise to make interventional procedures safer, faster, and more economical than ever before, while offering shorter hospital stays -- or none at all if possible.

    Whether it's cancer therapy, venous or spine interventions, vascular imaging, drug therapy, or fibroid treatment, the benefits of interventional technology versus open surgery (or ongoing pharmacologic therapy in the case of atrial fibrillation) are significant. And patients are lining up for the procedures.

    This year's RSNA scientific sessions reflect the energy that is driving innovation in interventional radiology and the streamlining of procedures that are mainstays of the interventional toolkit. Examples include:

    • New techniques for unresectable hepatocellular carcinoma: Transarterial chemoembolization is standard, but transarterial ethanol ablation is a promising technique that just might provide better outcomes, a group from Hong Kong will report.

    • For some highly vascularized head and neck tumors, Onyx embolization is safe and more effective than standard embolization with polyvinyl alcohol, according to a group from Munich. The black color of Onyx helps identify masses as well.

    • In the breast, French investigators have found they can biopsy lesions they couldn't even see on 2D mammography, thanks to 3D breast tomosynthesis and a well-integrated biopsy system.

    See presentation information below for more on these sessions.

    Other studies are focused on finding usable new information in existing image data: In the liver, for example, hepatocellular carcinoma ablation has traditionally been limited by the inability of ultrasound to visualize smaller lesions when the time comes to ablate them. But fusion imaging can combine available images from multiple modalities, allowing the lesions to be treated with radiofrequency ablation. Methods that focus on seeing image data better include:

    • Research from Italy on a new real-time fusion technique that combines ultrasound with CT or MR to find what was missed on ultrasound alone
    • A study by radiologists from Mexico, who are predicting hepatocellular carcinoma recurrence after radiofrequency ablation by analyzing attenuation with CT images acquired immediately after the procedure
    • Research from Canada that showed an association between arterial diameter and perfusion in aneurysmal subarachnoid hemorrhage patients that helped predict the utility of intra-arterial therapy

    See presentation information below for more on these sessions.

    This being RSNA, there is much to see and hear beyond the scientific sessions. We recommend this year's opening session. The Annual Oration in Diagnostic Radiology will cover innovative new techniques in the evaluation and management of focal pulmonary lesions. The talk by Christian Herold, MD, a professor of radiology at the Medical University of Vienna, will be held in the Arie Crown Theater (Sunday, November 28, PS10, 8:30 a.m.-10:15 a.m.).

    In Hot Topics, a showcase of quality improvement projects to be presented on Monday, November 29, includes a presentation on patient safety for interventional radiology (4:45 p.m-4:55 p.m., SI24C, Room E353A). This is followed by a presentation on safety and efficiency during vascular interventional procedures (5:15 p.m.-5:25 p.m., SI24F, Room E353A).

    Refresher course highlights include:

    • A hands-on workshop in techniques for interventional sonography and thermal ablation (Sunday, November 28, 2:00 p.m.-3:30 p.m., RC152, Room E264)
    • A hands-on workshop in ultrasound-guided interventional breast procedures (Monday, November 29, 8:30 a.m.-10:00 a.m., RC252, Room E264)
    • A course on breast interventional procedures, including stereotactically guided breast biopsy, ultrasound-guided biopsy, and pathology management decisions (Tuesday, November 30; 8:30 a.m.-10:00 a.m.; RC315A, B, and C; Room E450A)
    • A course on interventional CT using navigation and robotics tools (Tuesday, November 30, 4:30 p.m.-6:00 p.m., RC432C, Room N228)
    • A course on new MR-guided interventional therapies, including interventional devices, interoperative procedures, and percutaneous and catheter-based procedures (Thursday, December 2, 8:30 a.m.-10:00 a.m., RC632A, Room S403A)
    • A course on interventional radiologic management of traumatic abdomen and pelvis, including bleeding and vascular injury (Friday, December 3, 8:30 a.m.-10:00 a.m., RC808C, Room N226)

    Notable education exhibits in the Lakeside Learning Center include:

    • Preoperative Breast Interventional Procedures for the Tailored Breast Conserving Surgery: Pictorial Review of Preoperative Localization Procedures and Appropriate Indications (LL-BRE2013)
    • CT-guided Transthoracic Core Needle Biopsy in the Molecular Profiling Era: Tips and Tricks (LL-CHE2140)
    • Approaches to Accessing Radiologic Nodal Stations of the Mediastinum and Hila: A Pictorial Review (LL-CHE2154)
    • Imaging-guided Percutaneous Parenchymal Liver Biopsy: What Every Radiologist Should Know (LL-GIE2296)
    Scientific and Educational Presentations
    Technical issues render US-guided HCC ablation unfeasible
    Sunday, November 28 | 10:45 a.m.-10:55 a.m. | SSA24-01 | Room E350
    Ultrasound-guided radiofrequency ablation is one of the best options for patients with small hepatocellular carcinoma (HCC) lesions, which are often considered inoperable. But the procedure is technically unfeasible in nearly 40% of candidates for a variety of reasons, say researchers from South Korea.
    CT attenuation changes after RFA predict 6-month HCC outcomes
    Sunday, November 28 | 10:55 a.m.-11:05 a.m. | SSA24-02 | Room E350
    Patients destined to show signs of recurrence after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) lesions reveal different CT attenuation patterns within 24 hours of the procedure, according to researchers from Mexico.
    Fusion imaging system enables ablation of liver tumors undetectable at US
    Sunday, November 28 | 11:05 a.m.-11:15 a.m. | SSA24-03 | Room E350
    A real-time fusion imaging system that combines ultrasound with CT or MRI allows liver tumors to be targeted and ablated that otherwise would not have been detected on ultrasound, according to this study to be presented on Sunday.
    Risk factors predict need for eventual reintervention after aneurysm repair
    Sunday, November 28 | 11:15 a.m.-11:25 a.m. | SSA23-04 | Room E352
    What are the chances an endovascular aneurysm repair for an abdominal aortic aneurysm will need reintervention? Using computer-aided detection, one can predict the odds before the procedure takes place -- and even better postoperatively, as soon as the patient is sewn up, say researchers from Kingston University in London.
    TEA edges out TACE for ablation of unresectable HCC
    Sunday, November 28 | 11:45 a.m.-11:55 a.m. | SSA24-07 | Room E350
    Transarterial chemoembolization (TACE) is the standard ablation method for unresectable hepatocellular carcinoma (HCC), but transarterial ethanol ablation (TEA) may gain a foothold as an alternative method due to its potential for better outcomes, Hong Kong researchers report.
    Good stroke outcomes seen after forced suction thrombectomy
    Monday, November 29 | 3:00 p.m.-3:10 p.m. | SSE17-01 | Room N229
    The Penumbra revascularization system is an excellent recanalization tool for ischemic stroke patients; however, it can't recanalize every occluded vessel. Fortunately, a simple modification of Penumbra makes it possible to recanalize many other cases, say researchers from South Korea.
    CTA parameters quantify arterial narrowing in aSAH patients
    Monday, November 29 | 3:20 p.m.-3:30 p.m. | SSE17-03 | Room N229
    In patients presenting with aneurysmal subarachnoid hemorrhage (aSAH), whole-brain CT perfusion (CTP) and CT angiography (CTA) provide baseline perfusion parameters for future comparison when CTA is performed for evaluating a suspected ruptured aneurysm, researchers will report in this Monday session.
    Onyx embolization feasible, safe for head and neck tumors
    Monday, November 29 | 3:50 p.m.-4:00 p.m. | SSE17-06 | Room N229
    For preoperative preparation of patients with highly vascularized head and neck tumors, embolization with Onyx is safe and more effective than standard preoperative endovascular embolization with polyvinyl alcohol microparticles, according to a German study.
    Breast biopsies successful with integrated 3D digital breast tomosynthesis
    Tuesday, November 30 | 3:00 p.m.-3:10 p.m.| SSJ01-01 | Room E352
    French researchers using 3D digital breast tomosynthesis are finding lesions that can't be visualized on conventional 2D mammography, and by integrating a tomosynthesis biopsy unit, they say they can biopsy and analyze a broader range of breast lesions compared with 2D digital mammography.
    Wide variations in left atrial anatomy seen in ablation patients
    Tuesday, November 30 | 3:00 p.m.-3:10 p.m. | SSJ05-01 | Room S504AB
    Left atrial anatomy is highly variable between patients, and this variability can affect the ablation strategy, according to John Hare and colleagues from the University of Wisconsin School of Medicine and Public Health in Madison.
    Preoperative MRI predicts upgrade of DCIS to invasive breast cancer
    Tuesday, November 30 | 3:50 p.m.-4:00 p.m. | SSJ01-06 | Room E352
    MRI of ductal carcinoma in situ (DCIS) can help determine which lesions are likely to upgrade to invasive cancers, researchers from New York University Medical Center in New York City will report in this Tuesday afternoon presentation.
    Brachytherapy plus cryotherapy cuts lung cancer recurrence
    Wednesday, December 1 | 10:30 a.m.-10:40 a.m. | SSK04-01 | Room S504AB
    Cryotherapy is a safe and effective option for lung cancer treatment, particularly in patients with unresectable tumors. In this scientific session, researchers from China will address the high recurrence rates that can affect this treatment.
    CT-guided cryoablation safe for kidney lesions
    Friday, December 3 | 10:30 a.m.-10:40 a.m. | SST16-01 | Room E353B
    There's more than one way to kill a kidney cancer without surgery. Freezing renal tumors percutaneously is safe and effective and delivers very low complication rates, say researchers from Duke University in Durham, NC.
    Radiofrequency ablation safe for multifocal renal neoplasms
    Friday, December 3 | 10:40 a.m.-10:50 a.m. | SST16-02 | Room E353B
    Radiofrequency ablation is a good renal sparing alternative to surgery for patients with multifocal renal tumors, and the complication rate is no higher than for patients with single tumors, researchers from Wake Forest University Baptist Medical Center in Winston-Salem, NC, have found.

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