Charles T Hennemeyer

Interests

Research

Medical equipment designing of minimally invasive surgical devicesNeuromodulationNovel image guided medical interventionsVertebral augmentation and spinal painInterventional oncology, novel devices

Teaching

Vascular and Interventional Radiology training

Courses

Scholarly Contributions

Journals/Publications

• McGregor, H., Woodhead, G., Struycken, L., Khan, A., McNiel, D., Brunson, C., & Hennemeyer, C. (2025). Gallbladder Cryoablation for Calculous Cholecystitis Initially Treated with Percutaneous Drainage: A Prospective Trial in High-Risk Patients. Journal of Vascular and Interventional Radiology, 36(Issue). doi:10.1016/j.jvir.2025.02.021
  More info

  Purpose: To prospectively evaluate the safety and effectiveness of gallbladder cryoablation in patients with calculous cholecystitis initially treated with percutaneous drainage. Materials and Methods: High–operative risk patients with calculous cholecystitis treated with cholecystostomy tube drainage underwent gallbladder cryoablation. The primary end points were safety, defined as the absence of procedure-related adverse events during the follow-up period, and clinical success, defined as the absence of symptoms after cholecystostomy tube removal. The secondary end point was imaging success, defined as gallbladder involution on computed tomography (CT) or magnetic resonance (MR) imaging. Results: Ten patients underwent gallbladder cryoablation. Mean age was 71 years (SD ± 10; range, 53–90 years). Mean American Society of Anesthesiologists score was 3 (SD ± 1; range, 2–4), and mean modified Frailty Index was 4 (SD ± 2; range, 1–6). Cholecystostomy tubes were in situ for a mean of 60 days (SD ± 26; range, 18–94 days) prior to cryoablation. Mean duration of clinical follow-up was 563 days (SD ± 152; range, 326–799 days) and of imaging follow-up was 368 days (SD ± 235; range, 66–792 days). One infection and 1 mortality occurred, both in patients with gallstones >20 mm in size, prior pseudomonas infection, and iceball volumes >150 cm3. Institutional review board (IRB) review concluded that the cause of the mortality was a medication allergy. Clinical and imaging success was achieved in 9 of 10 patients. Conclusions: Gallbladder cryoablation may be an effective treatment for high-operative risk patients with calculous cholecystitis initially treated with percutaneous drainage, with 90% clinical and imaging success. Optimization of patient selection is indicated, with particular reference to gallstone size and bacterial colonization.
• Brunson, C. P., McGregor, H. J., Hennemeyer, C. T., Patel, M. V., Woodhead, G. J., & Young, S. J. (2024). Measurement of the Tumor-to-Normal Ratio for Radioembolization of Hepatocellular Carcinoma: A Prospective Study Comparing 2-Dimensional Perfusion Angiography, Technetium-99m Macroaggregated Albumin, and Yttrium-90 SPECT/CT. Journal of Vascular and Interventional Radiology, 35(Issue 1). doi:10.1016/j.jvir.2023.09.023
  More info

  Purpose: To calculate the preradioembolic tumor-to-normal (T:N) ratio in hepatocellular carcinoma (HCC) using 2-dimensional (2D) perfusion angiography and compare it with that calculated using technetium-99m macroaggregated albumin (99mTc MAA) single-photon emission computed tomography (SPECT)/computed tomography (CT). Materials and Methods: This prospective single-arm study enrolled 15 participants with HCC who underwent 2D perfusion angiography immediately before the enrollment and with the microcatheter located at the same location as 99mTc MAA injection, after which SPECT/CT was performed. Quantitative digital subtraction angiography was used to calculate the area under the curve for the tumor and normal hepatic parenchyma and subsequently calculate the T:N ratio. The T:N ratio was calculated from the 99mTc MAA SPECT/CT and post–yttrium-90 bremsstrahlung SPECT/CT using dosimetry software. Results: The mean participant age was 64.1 years ± 9.8, and the study included 14 (93%) men and 1 (7%) woman. The mean tumor size was 4.1 cm (SD ± 2.4), and all participants received segmental treatments with glass microspheres. The mean T:N ratio calculated by 99mTc MAA SPECT/CT was 2.28 (SD ± 0.89) vs 2.25 (SD ± 0.99) calculated by 2D perfusion angiography (P =.45). For the 13 participants who underwent selective internal radiation therapy (transarterial radioembolization), there was no significant difference between the T:N ratios calculated by 2D perfusion angiography and post-90Y SPECT/CT (2.25 [SD ± 1.05] vs 1.91 [SD ± 0.39]; P =.12). Conclusions: The T:N ratio calculated by 2D perfusion angiography correlated well with that calculated by 99mTc MAA SPECT/CT.
• Hennemeyer, C. T. (2016). A Classification System for the Spread of Polymethyl Methacrylate in Vertebral Bodies Treated with Vertebral Augmentation, manuscript #TOM-00196-16 Version 2. Tomography.
• Hennemeyer, C. T. (2020). EtAl, Quantitative Assessment of the Hemodynamic Effects of - Nitroglycerin on Hepatocellular Carcinoma Using 2-D Perfusion Angiography. JVIR.
• Hennemeyer, C. T. (2020). Incidence and Risk Factors for Sustained Hepatic Function Toxicity 6 Months after Y90 Radioembolization: Interim Analysis of the Radiation-Emitting SIR-spheres In Non-resectable liver tumor (RESIN) registry. JVIR 2020 Pending.
• Hennemeyer, C. T. (2020). Interventional Radiology Taking a More Prominent Role in Hospitals During the Pandemic. Radiology Business.
• Hennemeyer, C. T. (2020). Interventional Radiology is an Operational and Financial Hedge for Hhospitals During COVID-19. JVIR 7/2020.
• Hennemeyer, C. T. (2020). Post-angiographic Embolization Abscess Formation Associated With Traumatic Splenic, Hepatic, and Renal Lacerations: a Retrospective Review of 85 Cases.. South Western Journal of Pulmonary & Critical Care, in press 2020.
• Rouse, A. R., Barton, J. K., Utzinger, U., Woodhead, G. J., Hennemeyer, C. T., Gmitro, A. F., Larson, M., & Carlson, Q. (2020). Using FDA-approved drugs as off-label fluorescent dyes for optical biopsies: from in silico design to ex vivo proof-of-concept. Methods and Applications in Fluorescence.
• Brunson, C., Young, S., Hennemeyer, C., & Woodhead, G. (2023). A Novel Method of Calculating the Tumor to Normal Ratio for Radioembolization of Hepatocellular Carcinoma:  A Prospective Study Comparing 2-D Perfusion Angiography and Tc-99m MAA SPECT/CT.. Journal of Vascular and Interventional Radiology.
• C, B., Shamar, Y., Hennemeyer, C., & Gregory, W. (2023). A Novel Method of Calculating the Tumor to Normal Ratio for Radioembolization of Hepatocellular Carcinoma: A Prospective Study Comparing 2-D Perfusion Angi9ography and Tc-99m MAA SPECT/CT.. Journal of Vascular and Interventional Radiology.
• Patel, M. V., McNiel, D., Brunson, C., Kuo, P. H., Hennemeyer, C. T., Woodhead, G., & McGregor, H. (2023). Prior ablation and progression of disease correlate with higher tumor-to-normal liver 99mTc-MAA uptake ratio in hepatocellular carcinoma. Abdominal Radiology, 48(Issue 2). doi:10.1007/s00261-022-03718-8
  More info

  Purpose: Factors affecting tumor-to-normal tissue ratio (T:N) have implications for patient selection, dosimetry, and outcomes when considering radioembolization for HCC. This study sought to evaluate patient, disease specific, and technical parameters that predict T:N as measured on planning pre-90Y radioembolization 99mTc-MAA scintigraphy for hepatocellular carcinoma (HCC). Methods: 99mTc-MAA hepatic angiography procedures with SPECT/CT over a 4-year period were reviewed. Data recorded included patient demographics, details of underlying liver disease, tumor size, history of prior treatments for HCC and technical parameters from angiography. Anatomic-based segmentation was performed in 93 cases for measurement of tumor and perfused liver volumes and SPECT counts. T:N were calculated and correlated with collected variables. Results: Mean calculated T:N was 2.52. History of prior ablation was significantly correlated with higher T:N (mean 3.39 vs 2.24, p = 0.003). Cases in which mapping was being performed for treatment of disease progression was significantly correlated with higher T:N (mean 3.35 vs 2.14, p = 0.001). Larger tumor size trended toward lower T:N (p = 0.052). Conclusion: Patients with history of ablation and those undergoing treatment for disease progression have higher T:N and, therefore, could be considered for radioembolization preferentially over alternative treatments.
• Hennemeyer, C., Woodhead, G., Mahadevan, D., Haymaker, C., Babiker, H., Borazanci, E., Subbiah, V., Agarwala, S., Algazi, A., Schachter, J., Lotem, M., Maurice-Dror, C., Hendler, D., Rahimian, S., Minderman, H., Bernatchez, C., Murthy, R., Hultsch, R., Kaplan, N., , Chunduru, S., et al. (2022). Tilsotolimod Exploits the TLR9 Pathway to Promote Antigen Presentation and Type 1 IFN Signaling in Solid Tumors: A Multicenter International Phase I/II Trial (ILLUMINATE-101). Clinical Cancer Research, 28(23), 5079-5087. doi:10.1158/1078-0432.ccr-21-4486
• Kuo, P., Patel, M., Woodhead, G., Struycken, L., Mcgregor, H., & Hennemeyer, C. (2022). Clinical and Dosimetric Implications of Calculating Lung Shunt Fraction for Hepatic 90Y Radioembolization Using SPECT/CT Versus Planar Scintigraphy.. AJR. American journal of roentgenology, 218(4), 728-737. doi:10.2214/ajr.21.26663
  More info

  BACKGROUND. Accurate assessment of hepatopulmonary shunting, typically performed by planar scintigraphy, is critical in planning 90Y radioembolization. High lung shunt fractions (LSFs) may alter treatment. OBJECTIVE. The purpose of this study is to compare LSFs calculated from planar scintigraphy versus SPECT/CT in patients with high planar LSFs (> 15%) and to describe the potential clinical and dosimetric implications of SPECT/CT LSF calculations. METHODS. This retrospective study included 36 patients (29 men and seven women; mean age, 62.4 ± 9.8 [SD] years) who underwent 99mTc-macroaggregated albumin (MAA) planar scintigraphy for planning hepatic radioembolization, had a planar LSF greater than 15%, and underwent concurrent SPECT/CT. Clinically reported planar LSFs were recorded. SPECT/CT LSFs were retrospectively calculated using automatically generated volumetric ROIs around the lungs and liver with subsequent manual adjustments. Total lung and perfused liver doses were calculated using a medical internal radiation dose model. Values derived from planar and SPECT/CT data were compared using Mann-Whitney U tests. Multivariable regression analysis was performed of factors associated with the discrepancy in LSF between the techniques. RESULTS. Mean planar LSF was 25.1% ± 11.6%, and mean SPECT/CT LSF was 16.0% ± 9.3% (p < .001). Mean lung dose was 18.8 ± 8.0 Gy for planar LSF versus 12.3 ± 7.2 Gy for SPECT/CT LSF (p < .001). Mean perfused liver dose was 92.9 ± 36.1 Gy using planar LSF versus 102.7 ± 39.1 Gy using SPECT/CT LSF (p < .001). In multivariable analysis, a larger discrepancy in LSF between planar scintigraphy and SPECT/CT was associated with a body mass index (weight in kilograms divided by the square of height in meters) of 26 or higher (p = .02), maximum tumor size of less than 9 cm (p = .05), and left hepatic intraarterial injection (p = .02). Fourteen of 36 patients did not undergo upfront radioembolization due to a planar LSF greater than 20% and instead underwent shunt-reducing embolization with subsequent radioembolization (n = 7), transarterial chemoembolization (n = 5), or no treatment (n = 2). Five of these 14 patients had a SPECT/CT LSF of less than 20% and would have been eligible for upfront radioembolization based on SPECT/CT LSF. Seven of 29 patients treated with radioembolization underwent prescribed dose reductions based on planar LSF; six of these patients would have qualified for standard radioembolization without dose reduction using SPECT/CT LSF. CONCLUSION. Planar scintigraphy yields greater LSFs compared with SPECT/CT, possibly leading to unnecessary shunt-reducing procedures and prescribed dose reductions. CLINICAL IMPACT. SPECT/CT should be considered for clinical LSF calculations before radioembolization in patients with high LSFs.
• Sherman, N., Williams, K., Hennemeyer, C., Devis, P., Chehab, M., Joseph, B., & Tang, A. (2022). Authors' response to "the diameter of the gelatin sponge affects the outcome of pelvic internal iliac artery embolization". Journal of Trauma and Acute Care Surgery, 92(5). doi:10.1097/TA.0000000000003545
• Avery, R., Khan, A., Mcgregor, H., Woodhead, G., Palacio, D., Lecomte, M., & Hennemeyer, C. (2021). Cardiac MRI for Evaluation of Right Heart Function before and after Catheter-directed Therapy in Submassive Pulmonary Embolism: A Prospective Study of Feasibility and Potential Utility.. Radiology. Cardiothoracic imaging, 3(6), e210217. doi:10.1148/ryct.210217
  More info

  Cardiac MRI is clinically feasible in the setting of submassive pulmonary embolism and is able to demonstrate measurable differences of right heart function before and after catheter-directed therapy.
• Barton, J. K., Hennemeyer, C. T., Carlson, Q., Woodhead, G. J., Rouse, A. R., Utzinger, U., Gmitro, A. F., & Larson, M. (2021). Using FDA-approved drugs as off-label fluorescent dyes for optical biopsies: from in silico design to ex vivo proof-of-concept. Methods and Applications in Fluorescence.
  More info

  AbstractOptical biopsies bring the microscope to the patient rather than the tissue to the microscope, and may complement or replace the tissue-harvesting component of the traditional biopsy process with its associated risks. In general, optical biopsies are limited by the lack of endogenous tissue contrast and the small number of clinically approved in vivo dyes. This study tests multiple FDA-approved drugs that have structural similarity to research dyes as off-label in situ fluorescent alternatives to standard ex vivo hematoxylin & eosin tissue stain. Numerous drug-dye combinations shown here may facilitate relatively safe and fast in situ or possibly in vivo staining of tissue, enabling real-time optical biopsies and other advanced microscopy technologies, which have implications for the speed and performance of tissue- and cellular-level diagnostics.
• Carlson, Q., Larson, M., Gmitro, A. F., Hennemeyer, C. T., Woodhead, G. J., Utzinger, U., Barton, J. K., & Rouse, A. R. (2021). Using FDA-approved drugs as off-label fluorescent dyes for optical biopsies: from in silico design to ex vivo proof-of-concept. Methods and Applications in Fluorescence.
• Chehab, M., Devis, P., Hennemeyer, C. T., Joseph, B., Sherman, N. C., Tang, A. L., & Williams, K. N. (2021). Effects of nonselective internal iliac artery angioembolization on pelvic venous flow in the swine model.. The journal of trauma and acute care surgery, 91(2), 318-324. doi:10.1097/ta.0000000000003190
  More info

  Pelvic angioembolization (AE) is a mainstay in the treatment algorithm for pelvic hemorrhage from pelvic fractures. Nonselective AE refers to embolization of the bilateral internal iliac arteries (IIAs) proximally rather than embolization of their tributaries distally. The aim of this study was to quantify the effect of nonselective pelvic AE on pelvic venous flow in a swine model. We hypothesized that internal iliac vein (IIV) flow following IIA AE is reduced by half..Nine Yorkshire swine underwent nonselective right IIA gelfoam AE, followed by left. Pelvic arterial and venous diameter, velocity, and flow were recorded at baseline, after right IIA AE and after left IIA AE. Linear mixed-effect model and signed rank test were used to evaluate significant changes between the three time points..Eight swine (77.8 ± 7.1 kg) underwent successful nonselective IIA AE based on achieving arterial resistive index of 1.0. One case was aborted because of technical difficulties. Compared with baseline, right IIV flow rate dropped by 36% ± 29% (p < 0.05) and 54% ± 29% (p < 0.01) following right and left IIA AE, respectively. Right IIA AE had no initial effect on left IIV flow (0.37% ± 99%, p = 0.95). However, after left IIA AE, left IIV flow reduced by 54% ± 27% (p < 0.01). Internal iliac artery AE had no effect on the external iliac arterial or venous flow rates and no effect on inferior vena cava flow rate..The effect of unilateral and bilateral IIA AE on IIV flow appears to be additive. Despite bilateral IIA AE, pelvic venous flow is diminished but not absent. There is abundant collateral circulation between the external and internal iliac vascular systems. Arterial embolization may reduce venous flow and improve on resuscitation efforts in those with unstable pelvic fractures..Prognostic, level IV.
• Hennemeyer, C. T., Woodhead, G., Karime, C., Wang, J., Mody, K., Borad, M. J., Mahadevan, D., Chandana, S. R., & Babiker, H. (2021). Tilsotolimod: an investigational synthetic toll-like receptor 9 (TLR9) agonist for the treatment of refractory solid tumors and melanoma. Expert Opinion on Investigational Drugs, 31(1), 1-13. doi:10.1080/13543784.2022.2019706
• McGregor, H., Brunson, C., Woodhead, G., Khan, A., Hennemeyer, C., & Patel, M. (2021). Quantitative Assessment of the Hemodynamic Effects of Intra-Arterial Nitroglycerin on Hepatocellular Carcinoma using Two-Dimensional Perfusion Angiography. Journal of vascular and interventional radiology : JVIR, 32(2), 198-203.
  More info

  To determine the hemodynamic effects of intra-arterial nitroglycerin on hepatocellular carcinoma (HCC) using 2-dimensional (2D) perfusion angiography.
• Sherman, N., Williams, K., Hennemeyer, C., Devis, P., Chehab, M., Joseph, B., & Tang, A. (2021). Effects of nonselective internal iliac artery angioembolization on pelvic venous flow in the swine model. Journal of Trauma and Acute Care Surgery, 91(2). doi:10.1097/TA.0000000000003190
  More info

  BACKGROUND Pelvic angioembolization (AE) is a mainstay in the treatment algorithm for pelvic hemorrhage from pelvic fractures. Nonselective AE refers to embolization of the bilateral internal iliac arteries (IIAs) proximally rather than embolization of their tributaries distally. The aim of this study was to quantify the effect of nonselective pelvic AE on pelvic venous flow in a swine model. We hypothesized that internal iliac vein (IIV) flow following IIA AE is reduced by half. METHODS Nine Yorkshire swine underwent nonselective right IIA gelfoam AE, followed by left. Pelvic arterial and venous diameter, velocity, and flow were recorded at baseline, after right IIA AE and after left IIA AE. Linear mixed-effect model and signed rank test were used to evaluate significant changes between the three time points. RESULTS Eight swine (77.8 ± 7.1 kg) underwent successful nonselective IIA AE based on achieving arterial resistive index of 1.0. One case was aborted because of technical difficulties. Compared with baseline, right IIV flow rate dropped by 36% ± 29% (p < 0.05) and 54% ± 29% (p < 0.01) following right and left IIA AE, respectively. Right IIA AE had no initial effect on left IIV flow (0.37% ± 99%, p = 0.95). However, after left IIA AE, left IIV flow reduced by 54% ± 27% (p < 0.01). Internal iliac artery AE had no effect on the external iliac arterial or venous flow rates and no effect on inferior vena cava flow rate. CONCLUSION The effect of unilateral and bilateral IIA AE on IIV flow appears to be additive. Despite bilateral IIA AE, pelvic venous flow is diminished but not absent. There is abundant collateral circulation between the external and internal iliac vascular systems. Arterial embolization may reduce venous flow and improve on resuscitation efforts in those with unstable pelvic fractures. LEVEL OF EVIDENCE Prognostic, level IV.
• Woodhead, G. J., Yu, H., Tominna, B. S., Stavas, J. M., Sonntag, P. D., Nowakowski, F. S., Navuluri, R., Muller, R. D., Lazarowicz, M. P., Hennemeyer, C. T., Eifler, A. C., Caoili, E. M., & Bream, P. R. (2021). Safety and Feasibility of a Novel Percutaneous Locoregional Injection Technique of Renal Cellular Therapy for Chronic Kidney Disease of Diabetes.. Kidney international reports, 6(9), 2486-2490. doi:10.1016/j.ekir.2021.06.014
• Woodhead, G., Mcniel, D. B., Mcgregor, H., Hennemeyer, C., Mcgregor, H., Woodhead, G., Mcniel, D. B., & Hennemeyer, C. (2021). Gallbladder Cryoablation: A Novel Option for High-Risk Patients with Gallbladder Disease.. The American journal of medicine, 134(3), 326-331. doi:10.1016/j.amjmed.2020.10.007
  More info

  Management of high-risk surgical patients with cholecystitis poses a significant clinical problem. These patients are often left with the options of permanent cholecystostomy tube drainage or high-risk surgery. Numerous attempts have been made over the past 4 decades to fulfill the need for a minimally invasive, definitive treatment option for such gallbladder disease. These attempts have largely focused on endoluminal ablation with a variety of sclerosants and have been unable to reliably achieve permanent gallbladder devitalization. The advent of modern percutaneous devices and techniques have provided further opportunity to develop minimally invasive treatment options for high-risk patients. Cryoablation, a thermal ablation modality that induces cell death through tissue freezing, has recently emerged as a promising potential option to treat gallbladder disease. Early studies have demonstrated good technical and clinical success, and a prospective trial is ongoing. This manuscript explains the clinical need for gallbladder cryoablation, briefly revisits historical minimally invasive treatments, describes cryoablation technology and why it is well suited for the gallbladder, and reviews the preclinical and clinical studies evaluating the safety and efficacy of gallbladder cryoablation.
• Woodhead, G., Mcniel, D., Mcgregor, H., & Hennemeyer, C. (2021). The Reply.. The American journal of medicine, 134(11), e566. doi:10.1016/j.amjmed.2021.07.029
• Woodhead, G., Patel, M., Mcniel, D. B., Mcgregor, H., Kuo, P. H., Hennemeyer, C., Brunson, C., & Boros, D. (2021). Abstract No. 3 ▪ FEATURED ABSTRACT Clinical predictors of Yttrium-90 uptake in hepatocellular carcinoma: toward personalized dosimetry to maximize response to therapy. Journal of Vascular and Interventional Radiology, 32(5), S3. doi:10.1016/j.jvir.2021.03.414
• Woodhead, G., Struycken, L., Patel, M., Mcgregor, H., Kuo, P. H., & Hennemeyer, C. (2021). Abstract No. 34 Planar scintigraphy overestimates hepatopulmonary shunt fractions compared with quantitative SPECT/CT. Journal of Vascular and Interventional Radiology, 32(5), S16. doi:10.1016/j.jvir.2021.03.450
• Algazi, A. P., Ali, A., Anderson, P. M., Anderson, P. J., Babiker, H. M., Bernatchez, C., Borazanci, E., Caplan, N., Chunduru, S., Diab, A., Haymaker, C., Hendler, D., Hennemeyer, C., Hultsch, R., Lotem, M., Maurice-dror, C., Minderman, H., Murthy, R., Puzanov, I., , Rahimian, S., et al. (2020). Abstract CT134: Tilsotolimod engages the TLR9 pathway to promote antigen presentation and Type-I IFN signaling in solid tumors. Tumor Biology, 80(16_Supplement), CT134-CT134. doi:10.1158/1538-7445.am2020-ct134
  More info

  Abstract Background: Tilsotolimod, an investigational Toll-like receptor 9 (TLR9) agonist, modulates the tumor immune microenvironment and has single-agent antitumor activity in preclinical models. The ILLUMINATE-101 phase 1b study (NCT03052205) explored the safety, efficacy, and immune effects of intratumoral tilsotolimod in multiple solid tumors. Methods: Adults with a histologically- or cytologically-confirmed diagnosis of cancer not amenable to curative therapies received intratumoral tilsotolimod 8, 16, 23, or 32 mg into a single lesion on Days 1, 8, and 15 of Cycle 1 and Day 1 of each subsequent 3-week cycle, for up to 17 cycles. Additionally, patients with advanced melanoma were enrolled into an expansion cohort at the recommended phase 2 dose of 8 mg. The primary objective was to characterize safety (dose escalation cohort) and efficacy (expansion cohort). Secondary objectives included pharmacokinetics of tilsotolimod. Immunological assessment of injected and non-injected tumors was an exploratory objective. Blood samples and tumor biopsies of injected lesions were obtained at baseline and 24 hours post treatment for immune analyses. Results: A total of 54 patients were enrolled. Of the 38 patients in the dose escalation cohort, 35 had metastatic disease. Patients in this cohort had a median of 7 prior lines of treatment, and the most common cancer types were pancreatic (12 patients) and colorectal (7 patients). All 16 patients in the melanoma cohort had metastatic disease with a median of 3 lines of prior therapy, and 10 patients had elevated LDH. Injected lesions were deep and required interventional radiology in 52 of 54 patients. No dose-limiting toxicities were observed. The most common treatment-related adverse events were pyrexia, fatigue, chills, nausea, and vomiting. Compared to pretreatment, biopsies of injected tumors at 24 hours showed increased activation of the Type-I IFN pathway, upregulation of MHC class I/II, IFNγ expression, and expression of multiple immune checkpoints (i.e. PD-1, LAG3). Of the 35 evaluable patients in the dose escalation cohort, 12 (34%) achieved a best overall response of stable disease (SD). Of the 16 evaluable patients in the melanoma cohort, 3 had SD, 1 who had a 35% tumor reduction with no confirmatory scan. Conclusions: Tilsotolimod was generally well tolerated and induced alterations in the tumor microenvironment, including immune checkpoint upregulation, activation of dendritic cells, and induction of Type-I IFN signaling. Additional clinical studies of tilsotolimod in combination with checkpoint inhibitors are underway (NCT03445533, NCT03865082, and NCT02644967). Citation Format: Hani M. Babiker, Vivek Subbiah, Asim Ali, Alain Algazi, Jacob Schachter, Michal Lotem, Corinne Maurice-Dror, Daniel Hendler, Shah Rahimian, Hans Minderman, Cara Haymaker, Chantale Bernatchez, Ravi Murthy, Rolf Hultsch, Nadia Caplan, Gregory Woodhead, Charles Hennemeyer, Sri Chunduru, Peter Anderson, Adi Diab, Erkut Borazanci, Igor Puzanov. Tilsotolimod engages the TLR9 pathway to promote antigen presentation and Type-I IFN signaling in solid tumors [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT134.
• Hall, E. T., Gibson, B. A., Hennemeyer, C. T., Devis, P., Black, S., & Larsen, B. T. (2020). Segmental arterial mediolysis and fibromuscular dysplasia: what comes first, the chicken or the egg?. Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology, 25(2), 113-5.
  More info

  Segmental arterial mediolysis (SAM) is a rare vasculopathy characterized by lysis of the outer media in splanchnic arteries and formation of dissecting pseudoaneurysms that may spontaneously rupture, leading to massive and often fatal intraabdominal hemorrhage. The pathogenesis of SAM is poorly understood. Healed SAM lesions closely resemble fibromuscular dysplasia (FMD), leading some authors to postulate that SAM represents a precursor to FMD despite distinct clinical differences between these two disorders. Herein, we present a 61-year-old woman with fatal SAM who showed histologic features in her aorta suggesting the opposite pathogenetic relationship, with an unclassified "FMD-like" arteriopathy preceding development of SAM.
• McGregor, H., Brunson, C., Woodhead, G., Patel, M. V., & Hennemeyer, C. (2020). Caudal Migration and Endovascular Retrieval of Two VIATORR CX Stent Grafts during Transjugular Intrahepatic Portosystemic Shunt Placement. Journal of Vascular and Interventional Radiology, 31(Issue 3). doi:10.1016/j.jvir.2019.10.010
• McGregor, H., Brunson, C., Woodhead, G., Patel, M. V., & Hennemeyer, C. (2020). Caudal Migration and Endovascular Retrieval of Two VIATORR CX Stent Grafts during Transjugular Intrahepatic Portosystemic Shunt Placement. Journal of vascular and interventional radiology : JVIR, 31(3), 512-515.
• McGregor, H., Hennemeyer, C., Harms, C., Woodhead, G., & Patel, M. (2020). Stent Graft Reconstruction of the Lymphovenous Junction after Complete Transection of the Cervical Thoracic Duct. Journal of vascular and interventional radiology : JVIR, 31(11), 1918-1921.e1.
• McGregor, H., Woodhead, G., Hennemeyer, C., & Patel, M. (2020). Percutaneous Translumbar Inferior Vena Cava Filter Retrieval. Journal of vascular and interventional radiology : JVIR, 31(4), 690-692.
• McGregor, H., Woodhead, G., Patel, M., & Hennemeyer, C. (2020). THORACIC DUCT STENT-GRAFT DECOMPRESSION WITH 3-MONTH PATENCY: REVISITING A HISTORICAL TREATMENT OPTION FOR PORTAL HYPERTENSION. Lymphology, 53(Issue 2). doi:10.2458/lymph.4658
  More info

  This report introduces the rationale for thoracic duct stent-graft decompression in cirrhotic patients with portal hypertension and provides a case example with 3-month stent-graft patency. Thoracic duct flow and pressure are elevated in cirrhosis. Historically, complications of portal hypertension have been successfully treated with external drainage of the thoracic duct or surgical lymphovenous bypass. A 45-year-old woman with cirrhosis, chronic portosplenomesenteric thrombosis, and acute variceal hemorrhage underwent percutaneous thoracic duct stent-graft placement across the lymphovenous junction. The hemorrhage subsequently resolved and follow up endoscopy demonstrated decompression of the bleeding varices. Venography 40 days later demonstrated a partially patent stent-graft with fibrin sheath formation distally. The stent-graft was extended distally to the right atrium and was fully patent on venography 3 months later. The patient had no further episodes of hemorrhage.
• McGregor, H., Woodhead, G., Patel, M., & Hennemeyer, C. (2020). Thoracic duct stent-graft decompression with 3-month patency: Revisiting a historical treatment option for portal hypertension. Lymphology, 53(2), 81-87.
  More info

  This report introduces the rationale for thoracic duct stent-graft decompression in cirrhotic patients with portal hypertension and provides a case example with 3-month stentgraft patency. Thoracic duct flow and pressure are elevated in cirrhosis. Historically, complications of portal hypertension have been successfully treated with external drainage of the thoracic duct or surgical lymphovenous bypass. A 45-year-old woman with cirrhosis, chronic portosplenomesenteric thrombosis, and acute variceal hemorrhage underwent percutaneous thoracic duct stent-graft placement across the lymphovenous junction. The hemorrhage subsequently resolved and follow up endoscopy demonstrated decompression of the bleeding varices. Venography 40 days later demonstrated a partially patent stent-graft with fibrin sheath formation distally. The stent-graft was extended distally to the right atrium and was fully patent on venography 3 months later. The patient had no further episodes of hemorrhage.
• McGregor, H., Woodhead, G., Patel, M., Khan, A., Hannallah, J., Ruiz, D., Conrad, M., Tang, A., & Hennemeyer, C. (2020). Gallbladder Cryoablation for Chronic Cholecystitis in High-Risk Surgical Patients: 1-Year Clinical Experience with Imaging Follow-up. Journal of vascular and interventional radiology : JVIR, 31(5), 801-807.
  More info

  To assess the short-term safety and efficacy of gallbladder cryoablation in high-risk patients.
• McNiel, D., Hennemeyer, C., Woodhead, G., & McGregor, H. (2020). Gallbladder Cryoablation: A Novel Option for High-Risk Patients with Gallbladder Disease. The American journal of medicine.
  More info

  Management of high-risk surgical patients with cholecystitis poses a significant clinical problem. These patients are often left with the options of permanent cholecystostomy tube drainage or high-risk surgery. Numerous attempts have been made over the past 4 decades to fulfill the need for a minimally invasive, definitive treatment option for such gallbladder disease. These attempts have largely focused on endoluminal ablation with a variety of sclerosants and have been unable to reliably achieve permanent gallbladder devitalization. The advent of modern percutaneous devices and techniques have provided further opportunity to develop minimally invasive treatment options for high-risk patients. Cryoablation, a thermal ablation modality that induces cell death through tissue freezing, has recently emerged as a promising potential option to treat gallbladder disease. Early studies have demonstrated good technical and clinical success, and a prospective trial is ongoing. This manuscript explains the clinical need for gallbladder cryoablation, briefly revisits historical minimally invasive treatments, describes cryoablation technology and why it is well suited for the gallbladder, and reviews the preclinical and clinical studies evaluating the safety and efficacy of gallbladder cryoablation.
• Mcgregor, H., Patel, M., Woodhead, G., Patel, M., Mcgregor, H., Lecomte, M., Khan, A., & Hennemeyer, C. (2020). 3:18 PM Abstract No. 257 Fast scan cardiac magnetic resonance imaging in patients with acute pulmonary embolism undergoing catheter-directed therapy. Journal of Vascular and Interventional Radiology, 31(3), S115. doi:10.1016/j.jvir.2019.12.304
• Mcgregor, H., Patel, M., Woodhead, G., Patel, M., Oats, S., Mcgregor, H., Hennemeyer, C., & Abramyan, A. (2020). 3:45 PM Abstract No. 77 Necessity of common femoral arteriogram prior to deployment of an Angio-Seal closure device. Journal of Vascular and Interventional Radiology, 31(3), S37. doi:10.1016/j.jvir.2019.12.103
• Oats, S., Hennemeyer, C., Woodhead, G., & McGregor, H. (2020). Pulmonary Aspergilloma Removal Using a Large-Bore Suction Catheter System. Journal of vascular and interventional radiology : JVIR, 31(12), 2156-2159.
• Patel, M. V., Ahmed, O., Hennemeyer, C., Hatchett, S., Sacramento, M., & Funaki, B. (2020). IR is an Operational and Financial Hedge for Hospitals during COVID-19. Journal of vascular and interventional radiology : JVIR, 31(10), 1724-1726.
• Woodhead, G., Weise, L. B., Lecomte, M., Khan, A., & Hennemeyer, C. (2020). 3:45 PM Abstract No. 260 Survival analysis outcomes of catheter-directed therapy of submassive pulmonary embolism. Journal of Vascular and Interventional Radiology, 31(3), S116-S117. doi:10.1016/j.jvir.2019.12.307
• Hennemeyer, C., Khan, A., McGregor, H., Moffett, C., & Woodhead, G. (2019). Outcomes of Catheter-Directed Therapy Plus Anticoagulation Versus Anticoagulation Alone for Submassive and Massive Pulmonary Embolism. The American journal of medicine, 132(2), 240-246.
  More info

  Catheter-directed therapy (CDT) offers an alternative treatment to systemic thrombolysis for patients with massive and submassive pulmonary embolism.
• McGregor, H., Woodhead, G., Conrad, M., Tang, A., Ruiz, D., Khan, A., & Hennemeyer, C. (2019). First in-Human Gallbladder Cryoablation in a Patient with Acute Calculous Cholecystitis Initially Treated with a Cholecystostomy Tube. Journal of vascular and interventional radiology : JVIR, 30(8), 1229-1232.
  More info

  A 71-year-old poor surgical candidate with acute calculous cholecystitis was initially managed with cholecystostomy tube drainage for 28 days. He subsequently underwent gallbladder cryoablation under moderate sedation with 3 cryoprobes and 2 separate 10-8-10 freeze-thaw cycles targeting the gallbladder neck/body and fundus followed by cholecystostomy tube removal. He was discharged 1 day after ablation. Magnetic resonance and hepatobiliary iminodiacetic acid scan 1 month postablation demonstrated a thick-walled, distended gallbladder and no filling of the cystic duct. Magnetic resonance 3 months postablation demonstrated retraction of the gallbladder wall with luminal collapse. The patient denied any pain after discharge and is asymptomatic 3 months after ablation.
• Mcgregor, H., Mcgregor, H., Woodhead, G., Ruiz, D., Hennemeyer, C., Mcgregor, H., Woodhead, G., Tang, A., Ruiz, D., Khan, A., Hennemeyer, C., & Conrad, M. (2019). 04:03 PM Abstract No. 285 First in human gallbladder cryoablation to treat cholecystitis. Journal of Vascular and Interventional Radiology, 30(3), S127. doi:10.1016/j.jvir.2018.12.349
• Palmer, J., Hennemeyer, C. T., Woodhead, G. J., Patel, M. V., Ruiz, D., & McGregor, H. C. (2019). Intravascular Deployment of an Angio-Seal Device with Successful Endovascular Snare Retrieval. Journal of vascular and interventional radiology : JVIR, 30(10), 1703-1706.
• Ruiz, D., Khan, A., McGregor, H., Patel, M. V., Woodhead, G., Hennemeyer, C., & Hannallah, J. (2019). 03:09 PM Abstract No. 54 Hospital utilization outcomes of catheter-based intervention plus anticoagulation versus systemic anticoagulation alone for the treatment of submassive and massive pulmonary emboli. Journal of Vascular and Interventional Radiology. doi:10.1016/j.jvir.2018.12.095
• Ruiz, D., Mcgregor, H., Patel, M., Hannallah, J., Woodhead, G., Ruiz, D., Patel, M., Mcgregor, H., Khan, A., & Hennemeyer, C. (2019). 03:09 PM Abstract No. 54 Hospital utilization outcomes of catheter-based intervention plus anticoagulation versus systemic anticoagulation alone for the treatment of submassive and massive pulmonary emboli. Journal of Vascular and Interventional Radiology, 30(3), S27. doi:10.1016/j.jvir.2018.12.095
• Babiker, H. M., Borazanci, E. H., Catlett, M., Diab, A., Geib, J., Hennemeyer, C., Hultsch, R., Miller, C., Murthy, R., Rahimian, S., Shah, A. H., Subbiah, V., Swann, S., & Woodhead, G. (2018). Preliminary safety of deep/visceral (D/V) image guided (IG) intratumoral injection (ITI) of IMO-2125.. Journal of Clinical Oncology, 36(15_suppl), e15150-e15150. doi:10.1200/jco.2018.36.15_suppl.e15150
  More info

  e15150Background: Patients without palpable lesions who are candidates for intratumoral immunotherapy may need D/V IG agent delivery. Novel immuno-oncology (I-O) agents requiring ITI highlight the ...
• Babiker, H. M., Hennemeyer, C., Miller, C., Shah, A. H., & Woodhead, G. (2018). Right tumor, right time: Systematic methodology for fiducial marker placement to achieve reliable and reproducible image guided (IG) delivery of intratumoral immunotherapy into deep/visceral (D/V) lesions and target-lesion imaging follow-up.. Journal of Clinical Oncology, 36(15_suppl), e24137-e24137. doi:10.1200/jco.2018.36.15_suppl.e24137
  More info

  e24137Background: Immunotherapy is revolutionizing the treatment of many malignancies. Trials evaluating the safety and efficacy of image guided (IG) intratumoral injection (ITI) of immunotherapy a...
• Vercruysse, G. A., Bauman, Z. M., Hennemeyer, C. T., Devis, P., & Rhee, P. M. (2018). Man Lured with Alcohol, Takes Bait, and Gets Caught: A Cautionary Fish Tale. The American surgeon, 84(2), e85-e86.
• Vercruysse, G. A., Bauman, Z. M., Hennemeyer, C. T., Devis, P., & Rhee, P. M. (2018). Man lured with alcohol, takes bait, and gets caught: A cautionary fish tale. American Surgeon, 84(Issue 2).
• Black, S. M., Black, S., Devis, P., Hennemeyer, C., Ho, P., Janicek, A., Markus, H., Mushtaq, R., & Woodhead, G. (2017). Course of platelet count in chronic liver disease after correction of portal hypertension through TIPS: A retrospective analysis. Journal of Vascular and Interventional Radiology, 28(2), S232. doi:10.1016/j.jvir.2016.12.1171
• Nia, B. B., Nia, E. S., Avery, R. J., Kuo, P. H., & Hennemeyer, C. T. (2017). Punctate Radiation Dermatitis of the Foot and Ankle Caused by Distal Embolization of 90Y Microspheres During Liver Directed Therapy. Clinical nuclear medicine, 42(9), e422-e423.
  More info

  A 41-year-old man with gastric adenocarcinoma presented with hepatic metastases. The metastases were refractory to systemic chemotherapy, so radioembolization with Y microspheres was performed. Because of stasis or saturation of the tumor with embolic particles, 79% of the microspheres were injected. At follow-up, the patient complained of "red bumps" that had developed on his right foot/ankle the day after the radioembolization. Because a portion of the dose was still in the catheter when withdrawn from the right femoral artery, the interventional radiologist used a Geiger counter to confirm radioactivity in the cutaneous lesions and thus the distal embolization of the microspheres.
• Frankl, J., Hennemeyer, C., Flores, M. S., & Desai, A. P. (2016). Budd-Chiari Syndrome in a Patient with Hepatitis C. Case reports in hepatology, 2016, 7493970.
  More info

  Chronic Budd-Chiari syndrome can present with cirrhosis and signs and symptoms similar to those of other chronic liver diseases. We present a case of Budd-Chiari syndrome discovered during attempted transjugular intrahepatic portosystemic shunting in a patient with decompensated cirrhosis believed to be secondary to hepatitis C. Although the patient had hepatocellular carcinoma, the Budd-Chiari syndrome was a primary disease due to hepatic venous webs. Angioplasty was performed in this case, which resolved the patient's symptoms related to portal hypertension. Follow-up venography 5 months after angioplasty demonstrated continued patency of the hepatic veins. A biopsy was obtained in the same setting, which showed centrilobular fibrosis indicating that venous occlusion was indeed the cause of cirrhosis. It is important to consider a second disease when treating a patient with difficult to manage portal hypertension.
• Frankl, J., Sakata, M. P., Choudhary, G., Hur, S., Peterson, A., & Hennemeyer, C. T. (2016). A Classification System for the Spread of Polymethyl Methacrylate in Vertebral Bodies Treated with Vertebral Augmentation. Tomography (Ann Arbor, Mich.), 2(3), 197-202.
  More info

  In this study, we develop a classification system for describing polymethyl methacrylate (PMMA) spread in vertebral bodies after kyphoplasty or vertebroplasty for vertebral compression fractures (VCFs) and for assessing whether PMMA spread varies between operators, VCF etiology, or vertebral level. Intraoperative fluoroscopic images of 198 vertebral levels were reviewed in 137 patients (women, 84; men, 53; mean age, 75.8 ± 12.5; and those with a diagnosis of osteoporosis, 63%) treated with kyphoplasty between January 01, 2015 and May 31, 2015 at a single center to create a 5-class descriptive system. PMMA spread patterns in the same images were then classified by 2 board-certified radiologists, and a third board-certified radiologist resolved conflicts. A total of 2 primary PMMA spread patterns were identified, namely, acinar and globular, with subtypes of localized acinar, diffuse globular, and mixed, to describe an equal combination of patterns. Interrater reliability using the system was moderate ( = 0.47). After resolving conflicts, the most common spread class was globular (n = 63), followed by mixed (n = 58), diffuse globular (n = 30), acinar (n = 27), and localized acinar (n = 20). The spread class after treatment by the 2 most frequent operators differed significantly (n = 63, n = 70; < .0001). There was no difference in the spread class between VCF etiologies or vertebral levels. PMMA spread may, therefore, be a modifiable parameter that affects kyphoplasty and vertebroplasty efficacy and adverse events.
• Hennemeyer, C., Frankl, J., Flores, M. S., & Desai, A. P. (2016). Budd-Chiari Syndrome in a Patient with Hepatitis C. Case Reports in Hepatology, 2016, 1-3. doi:10.1155/2016/7493970
• Peterson, A., & Hennemeyer, C. (2016). Denver peritoneo-venous shunt (DPVS): an essential tool in the management of malignant ascites. Journal of Vascular and Interventional Radiology, 27(3), S248-S249. doi:10.1016/j.jvir.2015.12.634
• Black, S. M., Black, S., Devis, P., Hennemeyer, C., Jindal, R., Kalb, B., Krupinski, E., & Woodhead, G. J. (2015). Systematic MRI characterization of tissue outcomes following irreversible electroporation of hepatic tumors. Journal of Vascular and Interventional Radiology, 26(2), S60-S61. doi:10.1016/j.jvir.2014.12.166
• Frankl, J., & Hennemeyer, C. (2015). Vertebral Refracture after Unipedicular Kyphoplasty Resulting in Lateralized Cement Distribution. Journal of vascular and interventional radiology : JVIR, 26(12), 1906-8.
• Lee, J. Z., Tey, K. R., Mizyed, A., Hennemeyer, C. T., Janardhanan, R., & Lotun, K. (2015). Mitral valve replacement complicated by iatrogenic left ventricular outflow obstruction and paravalvular leak: case report and review of literature. BMC cardiovascular disorders, 15, 119.
  More info

  Left ventricular outflow tract (LVOT) obstruction and paravalvular leak (PVL) are relatively uncommon, but are serious complications of prosthetic valve replacement.
• Devis, P., Devis, P., Hennemeyer, C., Jindal, R., Kalb, B., & Woodhead, G. J. (2014). Systematic MRI characterization of tissue imaging outcomes following percutaneous irreversible electroporation of hepatic tumors. Journal of Vascular and Interventional Radiology, 25(3), S190-S191. doi:10.1016/j.jvir.2013.12.514
• Parikh, V., & Hennemeyer, C. (2014). Microspheres embolization of juvenile nasopharyngeal angiofibroma in an adult. International journal of surgery case reports, 5(12), 1203-6.
  More info

  Juvenile nasopharyngeal angiofibroma (JNA) is a benign though locally aggressive, highly vascular tumor primarily affecting adolescent males which has traditionally posed a significant intraoperative challenge during its resection due to the high risk of uncontrollable hemorrhage. Pre-operative angiographic embolization of the major feeding vessels to the tumor has become a valuable, even necessary, tool in the surgical treatment of these lesions.
• Hennemeyer, C. T., Wicklow, K., Feinberg, D. A., & Derdeyn, C. P. (2001). In vitro evaluation of platinum Guglielmi detachable coils at 3 T with a porcine model: safety issues and artifacts. Radiology, 219(3), 732-7.
  More info

  To evaluate safety-related issues and imaging artifacts of Guglielmi detachable coils in vitro with 3-T magnetic resonance (MR) imaging.
• Hennemeyer, C., & Sundaram, M. (2000). Radiologic case study. Post-transfusional reticuloendothelial system iron overload of sickle cell disease, secondary hemochromatosis. Orthopedics, 23(4), 303, 398-400.

Others

• Hennemeyer, C. T. (2016, Jan). Clinical Trials Co-PI, SIRTEX Treatment of Unresecatble Cholagiocarcinoma (Yttrium-90 Glass Microshperes), University of Arizona.
• Hennemeyer, C. T. (2016, Summer). Case Report:"Budd-Chiari Syndrome in a Patient with Hepatitis C" by Joseph Frankl, Charles Hennemeyer, Michael Flores and Archita Desai. Hindawi Publishing.
  More info

  Case Report in Hepatology
• Hennemeyer, C. T. (2017, Jun). PI, Radiation-Emitting SIR-Spheres in Non-resectable (RESIN) Liver Tumor Patient Registry, University of Arizona collaboration with Vanderbilt University.
• Hennemeyer, C. T. (2020, AUG). et All, How we do it: Fast Scan Cardiac MRI in Patients with Acute Pulmonary Embolism, Undergoing Catheter Directed Therapy A Single Center Pilot Project Experience,. JVIR.
• Hennemeyer, C. T. (2020, January). Using FDA-Approved Drugs as Off-Label Fluorescent Dyes for Optical Biopsies: from In-Silico Design to Ex-Vivo Proof-of-Concept H&E Alte. Pending Radiology Imaging Cancer.