Journal of Medical Imaging and Radiation Oncology最新文献

{"title":"Imaging of Adrenal Incidentalomas: What Actually Happens in Everyday Clinical Practice?","authors":"Brian Ngo,&nbsp;Tracy Liu,&nbsp;Eddie Lau","doi":"10.1111/1754-9485.13853","DOIUrl":"10.1111/1754-9485.13853","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There are numerous guidelines offering varying advice on the management of adrenal incidentalomas. The American College of Radiology (ACR) white paper recommends no follow-up for lesions with benign appearances. Our aim was to audit the indications for adrenal CT in the context of the ACR recommendations and to assess the long-term follow-up and outcome of these incidental lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was performed identifying patients who had undergone adrenal CT from 1 January 2016 to 31 December 2018. Patients with symptoms of adrenal hypersecretion and malignancy were excluded. Radiology reports were analysed, with collected data also including patient demographics, referring team, lesion characteristics, radiologist recommendations, biochemical tests and histology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 168 adrenal CTs were performed in 130 patients during the study period. 88 CTs (52%) were not in accordance with the ACR recommendations, as they were for the evaluation of adrenal incidentalomas previously characterised as benign. 93% of lesions had benign imaging appearances, none of which demonstrated evidence of malignant transformation. 70% of patients with benign-appearing lesions had excess imaging deemed not required as per the ACR recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A large proportion of adrenal CTs are performed to evaluate incidental lesions previously characterised as benign. The ACR white paper recommends that these do not require further imaging; however, in most cases, this is not being followed. Radiologists should be encouraged to recommend no follow-up for benign-appearing adrenal lesions in accordance with the ACR recommendations and have confidence that it is reasonable and safe to do so.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"69 3","pages":"328-334"},"PeriodicalIF":2.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Application of Lutetium-177-Prostate Specific Membrane Antigen (LuPSMA) Radioligand Therapy for Metastatic Synovial Sarcoma","authors":"Rhiannon S. McBean,&nbsp;Annaleis M. Tatkovic,&nbsp;Sepinoud Firouzmand,&nbsp;Francis Tomlinson,&nbsp;Paul Eliadis,&nbsp;David C. Wong","doi":"10.1111/1754-9485.13838","DOIUrl":"10.1111/1754-9485.13838","url":null,"abstract":"<div>\u0000 \u0000 <p>Intracranial synovial sarcoma is exceedingly rare, with only 24 cases reported in the literature. Given prostate specific membrane antigen (PSMA) expression is found in the neovascular endothelium of solid tumours, including sarcomas, Lutetium-177-PSMA (LuPSMA) presents a potential therapeutic option. The case presented here describes the first application of LuPSMA in a patient with synovial sarcoma. Our patient, a 27-year-old female underwent seven LuPSMA treatment cycles over the last 8 months of her life. Disease stability and prolongation in time to progression was observed across the treatment course with subjective tumour regression also seen after two cycles. Overall, our initial experience with this novel approach demonstrates proof-of-principle of LuPSMA treatment beyond prostate cancer, for patients with other PSMA-expressing cancer diseases.</p>\u0000 </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"69 3","pages":"381-385"},"PeriodicalIF":2.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse Reactions to Urinary Contrast: A Case Report and Systematic Review","authors":"Shuang Xu,&nbsp;Nicholas Watson,&nbsp;Li Wang,&nbsp;Jie Ding,&nbsp;Aidan Callinan","doi":"10.1111/1754-9485.13848","DOIUrl":"10.1111/1754-9485.13848","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Intra-urinary iodinated contrast agents are commonly used in urological procedures, but research of allergic reactions is rare. This study presents a rare case of an intra-urinary contrast reaction, followed by a comprehensive literature review of adverse reactions to intra-urinary contrast.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed and Embase databases were searched using Medical Subject Headings terms related to urinary procedures and contrast reactions, with additional articles identified through reference reviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Adverse reactions to intra-urinary contrast agents are rare, with most reactions being mild. Severe reactions were infrequent, and both patient-related and contrast-related factors were identified as influencing the likelihood of adverse events. However, the role of previous intravenous contrast reactions as a predisposing factor and the effectiveness of premedication in preventing these reactions remain uncertain. Furthermore, clinical guidelines for diagnosing and managing such reactions are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although urinary contrast reactions are uncommon, they can range from mild to severe, including anaphylaxis. Further research is needed to establish standardized premedication protocols and management strategies, and a better understanding of predisposing factors could enhance patient safety in urological procedures involving contrast agents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"69 3","pages":"373-380"},"PeriodicalIF":2.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1754-9485.13848","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beware the Iron Rich Gravel: Implications for MRI Safety in Australia","authors":"Giles Kisby,&nbsp;Michael Paddock,&nbsp;Alicia Harvey,&nbsp;Peter Shipman,&nbsp;Rahul Lakshmanan","doi":"10.1111/1754-9485.13849","DOIUrl":"10.1111/1754-9485.13849","url":null,"abstract":"<div>\u0000 \u0000 <p>Through this case report of a child with intra-orbital and intra-cranial iron-rich gravel foreign bodies, shown on our testing to be strongly ferromagnetic, we aim to raise awareness about the potential for these environmental foreign bodies, which are ubiquitous in Australia, to cause serious harm to patients who undergo MRI. Importantly, environmental foreign bodies of very high (metallic) attenuation on CT should be treated as potentially MRI unsafe until proven otherwise.</p>\u0000 </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"69 2","pages":"159-161"},"PeriodicalIF":2.2,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiation Between Radiation Necrosis and True Tumour Progression After Radiotherapy to Intracranial Metastases","authors":"Arian Lasocki,&nbsp;Joseph Sia,&nbsp;Stephen L. Stuckey","doi":"10.1111/1754-9485.13847","DOIUrl":"10.1111/1754-9485.13847","url":null,"abstract":"<p>Differentiating between radiation necrosis and true tumour progression after radiotherapy is challenging due to overlapping imaging appearances. This review outlines useful techniques and imaging features for making this distinction, as well as potential pitfalls. Both radiation necrosis and true tumour progression commonly manifest as peripherally enhancing lesions on post-contrast T1-weighted imaging, but the enhancing rim should be thin in radiation necrosis, while more discrete nodular enhancement suggests active tumour. Other features on post-contrast MRI that suggest radiation necrosis include enhancing lesions across anatomical boundaries, clustering of enhancing lesions and a change in lesion shape. Central diffusion restriction corresponding to the central necrotic area favours radiation necrosis, but there are potential pitfalls to be aware of, including hypercellular tumours, coagulative necrosis due to bevacizumab and intra-lesional haemorrhage. Radiation necrosis typically results in small, clustered foci of magnetic susceptibility on susceptibility-sensitive sequences, and the absence of such foci should raise concern for active tumour. When uncertainty remains, ancillary techniques such as MR perfusion and amino acid PET can improve confidence. Atypical appearances of radiation necrosis can occur, for example, cystic radiation necrosis or radiation necrosis occurring after radiotherapy to adjacent structures. It is also important for the radiologist to be aware of additional factors that may increase the likelihood of either radiation necrosis or tumour necrosis or influence patient management.</p>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"69 3","pages":"414-424"},"PeriodicalIF":2.2,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1754-9485.13847","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How I Do It-How to Report the \"Complex\" Ovarian Mass on US.","authors":"Susanne Johnson","doi":"10.1111/1754-9485.13846","DOIUrl":"https://doi.org/10.1111/1754-9485.13846","url":null,"abstract":"<p><strong>Background: </strong>Transvaginal ultrasound (TV-US) of the pelvis is now a standard component of the diagnostic armamentarium in gynaecology. After undergoing specialised training, healthcare professionals (sonographers, gynaecologists, and radiologists) performing such scans can diagnose pelvic pathology accurately. TV-US is fast to perform and cheaper than cross-sectional imaging. Many gynaecology services now offer ultrasound as a well-established part of one-stop clinics, where a diagnosis can be made at the first visit and the patient pathway expedited.</p><p><strong>Purpose: </strong>Predicting the risk of malignancy in adnexal masses is so important. This review describes my systematic approach to reporting a \"complex ovarian mass\" on TV-US, as a subspecialist gynaecologist-sonologist.</p><p><strong>Conclusion: </strong>Using International Ovarian Tumour Analysis (IOTA) language and IOTA risk of malignancy algorithms allows us to describe and categorise adnexal masses on ultrasound and to predict the risk and stage of malignancy. With experience, experts can also predict the histopathological subtype. This level of diagnostic performance allows us to streamline the patient journey and to reach a diagnosis and management plan faster. You will never call an ovarian mass 'complex' again!</p>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation-Based Quality Improvement and Training to Improve Door to Puncture Time for Mechanical Thrombectomy","authors":"Sophie Dunkerton,&nbsp;Robert Fang,&nbsp;Nicole Sng,&nbsp;Greg Lock,&nbsp;Claire Muller,&nbsp;William Collins,&nbsp;Sandra Concha Blamey,&nbsp;Georgina Cameron,&nbsp;Laura Owens,&nbsp;Grace Aw","doi":"10.1111/1754-9485.13845","DOIUrl":"10.1111/1754-9485.13845","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Mechanical Thrombectomy (MT) exists as the gold standard for the management of acute ischaemic stroke secondary to large vessel occlusion. There is a direct correlation between reduced time to reperfusion and improved patient outcomes. Our study aimed to optimise processes and reduce the time from the patient's arrival at hospital to vascular puncture for MT (DTP time) through simulation-based quality improvement and staff training.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-centre prospective study involved two simulation exercises completed over 3 months from March to May 2023. The multidisciplinary simulations involved staff following the MT patient's hyperacute journey from the time of arrival to the Emergency Department triage. Data from all patients at our centre who underwent MT in the 6-month period pre- and post-simulation training were included. The primary outcome measured was the DTP time. For statistical analysis, a paired <i>t</i>-test was used to compare values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the period prior to the simulation exercises, our hospital recorded 19 direct-to-hospital presentations for patients requiring MT, where we recorded a mean DTP time of 132.38 min. Post the simulation training, we recorded 26 direct-to-hospital presentations, with a mean DTP time of 104.52 min (a reduction of 27.86 min, <i>p</i> = 0.02). Our study did not find any statistically significant difference in DTP time for patients who were inter-hospital transfer presentations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We validated simulation-based training as an effective intervention for reducing time to reperfusion for patients undergoing MT. Implementation of regular training for staff can improve patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"69 4","pages":"479-483"},"PeriodicalIF":2.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT Utilisation in Emergency Department (ED) Assessment of Patients With Suspected Polytrauma: Impact of a Dedicated Trauma Surgical Team","authors":"Rebecca Hong,&nbsp;Salma Qassin,&nbsp;Chris Zhao,&nbsp;Nihal Raju,&nbsp;Zemar Vajuhudeen,&nbsp;Danielle Thom,&nbsp;Casey Paton,&nbsp;Leonid Churilov,&nbsp;Odkhishig Ganbold,&nbsp;Natalie Yang,&nbsp;Gerard Smith,&nbsp;Ruth P. Lim","doi":"10.1111/1754-9485.13843","DOIUrl":"10.1111/1754-9485.13843","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We aimed to assess the impact of introduction of a dedicated trauma surgical unit (TSU) on CT utilisation for polytrauma in the Emergency Department (ED).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Single centre retrospective cohort study comparing adult patients undergoing CT for polytrauma following TSU introduction (Intervention group, <i>n</i> = 617) to a historical Baseline group (<i>n</i> = 257) over a matched time period. Patient impact, including initial clinical assessment, injuries, radiation exposure, incidental findings, ED disposition, and impact on radiology services were compared with Mann–Whitney and Fisher's exact tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Intervention patients were more likely to be examined by ED physicians (96.7% vs. 91.1%, <i>p</i> = 0.001) prior to CT. There was greater documented clinical suspicion for chest and abdominal injuries, with increased WBCT utilisation for Intervention (Baseline 17.1% vs. 47.8%, <i>p</i> &lt; 0.05), with no significant increase in positive scans by region. More CT chest (Intervention 38.4% vs. Baseline 14.8%, <i>p</i> &lt; 0.05), CT abdomen (42.6% vs. 12.6%, <i>p</i> &lt; 0.005) and CT pelvis (46.1% vs. 16%, <i>p</i> &lt; 0.001) was performed even with low documented clinical suspicion, with no significant increase in positive findings. The intervention group returned for more additional scans (12.48% vs. Baseline 5.45%), had more incidental findings (23.66% vs. 15.18%), and were more likely to be admitted for observation (21.7% vs. 14%), all <i>p</i> &lt; 0.05. Time to scan and total CT reporting time were significantly longer for Intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Introduction of a TSU was associated in a shift towards increased CT utilisation, with no increase in scan yield, increased incidental findings and impacts on Radiology workflow.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"69 3","pages":"317-327"},"PeriodicalIF":2.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1754-9485.13843","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainability in Radiology: Position Paper and Call to Action From ACR, AOSR, ASR, CAR, CIR, ESR, ESRNM, ISR, IS3R, RANZCR, and RSNA.","authors":"Andrea G Rockall, Bibb Allen, Maura J Brown, Tarek El-Diasty, Jan Fletcher, Rachel F Gerson, Stacy Goergen, Amanda P Marrero González, Thomas M Grist, Kate Hanneman, Christopher P Hess, Evelyn Lai Ming Ho, Dina H Salama, Julia Schoen, Sarah Sheard","doi":"10.1111/1754-9485.13842","DOIUrl":"https://doi.org/10.1111/1754-9485.13842","url":null,"abstract":"<p><p>The urgency for climate action is recognised by international government and healthcare organisations, including the United Nations (UN) and World Health Organisation (WHO). Climate change, biodiversity loss, and pollution negatively impact all life on earth. All populations are impacted but not equally; the most vulnerable are at highest risk, an inequity further exacerbated by differences in access to healthcare globally. The delivery of healthcare exacerbates the planetary health crisis through greenhouse gas emissions, largely due to combustion of fossil fuels for medical equipment production and operation, creation of medical and non-medical waste, and contamination of water supplies. As representatives of radiology societies from across the globe who work closely with industry, and both governmental and non-governmental leaders in multiple capacities, we advocate together for urgent, impactful, and measurable changes to the way we deliver care by further engaging our members, policymakers, industry partners, and our patients. Simultaneous challenges including global health disparities, resource allocation, and access to care must inform these efforts. Climate literacy should be increasingly added to radiology training programmes. More research is required to understand and measure the environmental impact of radiological services and inform mitigation, adaptation and monitoring efforts. Deeper collaboration with industry partners is necessary to support innovations in the supply chain, energy utilisation, and circular economy. Many solutions have been proposed and are already available, but we must understand and address barriers to implementation of current and future sustainable innovations. Finally, there is a compelling need to partner with patients, to ensure that trust in the excellence of clinical care is maintained during the transition to sustainable radiology. By fostering a culture of global cooperation and rapid sharing of solutions among the broader imaging community, we can transform radiological practice to mitigate its environmental impact, adapt and develop resilience to current and future climate and environmental threats, and simultaneously improve access to care.</p>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Efficacy and Safety of Transjugular Intrahepatic Portosystemic Shunt Combined With Concurrent Antegrade Embolization of Large Spontaneous Portosystemic Shunts","authors":"Ze Wang,&nbsp;Xiao-Yang Xu,&nbsp;Chen-You Liu,&nbsp;Jin-Tao Huang,&nbsp;Wan-Ci Li,&nbsp;Shuai Zhang,&nbsp;Jian Shen,&nbsp;Bin-Yan Zhong,&nbsp;Xiao-Li Zhu","doi":"10.1111/1754-9485.13832","DOIUrl":"10.1111/1754-9485.13832","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To compare the long-term efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with concurrent antegrade embolization in treating portal hypertension with oesophagogastric variceal bleeding in patients with and without large spontaneous portosystemic shunts (L-SPSSs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We retrospectively analysed data from patients with portal hypertension who underwent TIPS from November 2015 to April 2022. The patients were screened according to the inclusion criteria and were divided into L-SPSSs group (L-S group) and Non L-SPSSs group (Non L-S group). The primary outcome was the 2-year liver transplantation-free survival (TFS) rate. Secondary outcomes contained the incidence of overt hepatic encephalopathy (OHE), ectopic embolization and the 2-year rebleeding rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 259 patients were enrolled (64 patients in L-S group and 195 patients in Non L-S group). The average age was 57.2 years, and the success rate of procedure was 100%. Baseline data showed no significant differences between two groups. There was a statistically significant difference in the 2-year liver transplantation-free rate between two groups (L-S vs. Non L-S, 84.38% vs. 71.28%; <i>p</i> = 0.045). OHE occurred in 19 (29.69%) patients with L-SPSSs and 104 (53.33%) patients without L-SPSSs, with a statistically significant difference (<i>p</i> = 0.001). And no statistically significant difference was found in ectopic embolism incidence rate and the 2-year rebleeding rate between two groups. Multivariate Cox regression analysis identified male gender, portal vein thrombosis and preoperative high blood ammonia levels as independent risk factors for long-term survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Compared to Non L-S group, the patients in L-S group achieve longer liver transplantation-free survival and lower incidence rate of OHE without increasing the risk of 2-year rebleeding and ectopic embolization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"69 2","pages":"228-236"},"PeriodicalIF":2.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1754-9485.13832","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}