Shamar J Young

Interests

Research

My research interest lie in the are of local regional therapy. Specifically I have been active in evaluating dose thresholds for cancer treated with transarterial radioembolization, evaluating how transarterial radioembolization affects the immune system and prediction models for thermal ablation.

Courses

No activities entered.

Scholarly Contributions

Journals/Publications

• 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 : JVIR, 35(1), 94-101.
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  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 (Tc MAA) single-photon emission computed tomography (SPECT)/computed tomography (CT).
• Brunson, C., Struycken, L., Schaub, D., Ref, J., Goldberg, D., Hannallah, J., Woodhead, G., & Young, S. (2024). Comparative outcomes of trans-arterial radioembolization in patients with non-alcoholic steatohepatitis/non-alcoholic fatty liver disease-induced HCC: a retrospective analysis. Abdominal Radiology, 49(8). doi:10.1007/s00261-024-04295-8
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  Purpose: Tumorigenesis in NAFLD/NASH-induced HCC is unique and may affect the effectiveness of trans-arterial radioembolization in this population. The purpose of this study was to retrospectively compare the effectiveness of trans-arterial radioembolization for the treatment of hepatocellular carcinoma (HCC) between patients with non-alcoholic steatohepatitis (NASH)/non-alcoholic fatty liver disease (NAFLD) and non-NASH/NAFLD liver disease. Materials and methods: Consecutive patients with HCC who underwent TARE at a single academic institution were retrospectively reviewed. Outcome measures including overall survival (OS), local progression-free survival (PFS), and hepatic PFS as assessed by modified response evaluation criteria in solid tumors (mRECIST) were recorded. Kaplan–Meier and Cox proportional hazard models were utilized to compare progression-free survival and overall survival. Results: 138 separate HCCs in patients treated with TARE between July 2013 and July 2022 were retrospectively identified. Etiologies of HCC included NASH/NAFLD (30/122, 22%), HCV (52/122, 43%), alcoholic liver disease (25/122, 21%), and combined ALD/HCV (14/122, 11%). NASH/NAFLD patients demonstrated a significantly higher incidence of type 2 diabetes mellitus (p < 0.0001). There was no significant difference in overall survival (p = 0.928), local progression-free survival (p = 0.339), or hepatic progression-free survival between the cohorts (p = 0.946) by log-rank analysis. When NASH/NAFLD patients were compared to all combined non-NASH/NAFLD patients, there was no significant difference in OS (HR 1.1, 95% C.I. 0.32–3.79, p = 0.886), local PFS (HR 1.2, 95% C.I. 0.58–2.44, p = 0.639), or hepatic PFS (HR 1.3, 95% C.I. 0.52–3.16, p = 0.595) by log-rank analysis. Conclusion: TARE appears to be an equally effective treatment for NASH/NAFLD-induced HCC when compared to other causes of HCC. Further studies in a larger cohort with additional subgroup analyses are warranted. Graphical abstract: (Figure presented.)
• Golzarian, J., Young, S., Gençtürk, M., Önder, H., & İnce, O. (2024). Improving Clinical Decisions in IR: Interpretable Machine Learning Models for Predicting Ascites Improvement after Transjugular Intrahepatic Portosystemic Shunt Procedures. Journal of Vascular and Interventional Radiology. doi:10.1016/j.jvir.2024.09.022
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  Purpose: To evaluate the potential of interpretable machine learning (ML) models to predict ascites improvement in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) placement for refractory ascites. Materials and Methods: In this retrospective study, 218 patients with refractory ascites who underwent TIPS placement were analyzed. Data on 29 demographic, clinical, and procedural features were collected. Ascites improvement was defined as reduction in the need of paracentesis by 50% or more at the 1-month follow-up. Univariate statistical analysis was performed. Data were split into train and test sets. Feature selection was performed using a wrapper-based sequential feature selection algorithm. Two ML models were built using support vector machine (SVM) and CatBoost algorithms. Shapley additive explanations values were calculated to assess interpretability of ML models. Performance metrics were calculated using the test set. Results: Refractory ascites improved in 168 (77%) patients. Higher sodium (Na; 136 mEq/L vs 134 mEq/L; P = .001) and albumin (2.91 g/dL vs 2.68 g/dL; P = .03) levels, lower creatinine levels (1.01 mg/dL vs 1.17 mg/dL; P = .04), and lower Model for End-stage Liver Disease (MELD) (13 vs 15; P = .01) and MELD-Na (15 vs 17.5, P = .002) scores were associated with significant improvement, whereas main portal vein puncture was associated with a lower improvement rate (P = .02). SVM and CatBoost models had accuracy ratios of 83% and 87%, with area under the curve values of 0.83 and 0.87, respectively. No statistically significant difference was found between performances of the models in DeLong test (P = .3). Conclusions: ML models may have potential in patient selection for TIPS placement by predicting the improvement in refractory ascites.
• Sag, A. A., Agritelley, E., Ronald, J., Young, S. J., & Kim, C. Y. (2024). Vortex-assisted resin y90 delivery via 175 cm Truselect microcatheter: case factors for high residual despite double-flush protocol. Nuclear medicine communications, 45(1), 61-67.
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  To report efficiency of resin y90 delivery using SIROS via 175 cm TruSelect microcatheter with double-flush protocol (40 ml dextrose total).
• Torkian, P., Wallace, S., Lim, N., Flanagan, S., Golzarian, J., & Young, S. J. (2024). Pre-existing Hepatic Encephalopathy: Really a Contraindication to Elective TIPS?. Cardiovascular and interventional radiology, 47(1), 69-77.
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  To evaluate the impact of pre-transjugular intrahepatic portosystemic shunt (TIPS) hepatic encephalopathy (HE) on developing post-TIPS HE.
• Trivedi, P., & Young, S. (2024). The Evolution of Interventional Radiology: How Far Will the Apple Land From the Tree?. Journal of the American College of Radiology, 21(5). doi:10.1016/j.jacr.2024.02.011
• Woodhead, G., & Young, S. (2024). Another hammer, but we need a wrench, and a screwdriver—positron emission tomography/magnetic resonance imaging represents another tool for post-delivery 90Y dosimetry, but what are we still missing?. Journal of Gastrointestinal Oncology, 15(4). doi:10.21037/jgo-24-460
• Young, S., & Golzarian, J. (2024). The Perfect Fit: Unraveling the Treatment Algorithms for Symptomatic Hepatic Hemangiomas. CardioVascular and Interventional Radiology, 47(7). doi:10.1007/s00270-024-03749-2
• Young, S., Abamyan, A., Goldberg, D., Hannallah, J., Schaub, D., Kalarn, S., Fitzgerald, Z., & Woodhead, G. (2024). Cryoablation in the liver: how accurately does the iceball predict the ablation zone?. Abdominal Radiology, 49(2). doi:10.1007/s00261-023-04117-3
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  Purpose: To evaluate the accuracy with which the iceball predicts the realized ablation zone in patients undergoing cryoablation of the liver. Materials and methods: Continuous patients who underwent cryoablation of primary or secondary malignancies of the liver were retrospectively reviewed. Iceball and ablation zone dimensions on 1 month follow up imaging were collected in three orientations, the long axis (LA), perpendicular transverse (PTR), and perpendicular craniocaudal (PCC). Factors which may predict differences in the measurements were evaluated with regression analysis. Oncologic outcomes were also collected. Results: The mean size of the iceball was 5.5 ± 1.1 cm, 3.9 ± 1.1 cm, and 4.4 ± 1.4 cm in the LA, PTR, and PCC orientations, respectively. The mean size of the one-month ablation cavity was 4.3 ± 1.3 cm, 3 ± 1.1 cm, and 3 ± 1.3 cm in the LA, PTR, and PCC orientations, respectively. The iceball was significantly larger than the ablation zone in all orientations (p < 0.001). When comparing HCC and non-HCC patients the Kaplan–Meier analysis of TTLP, the Kaplan Meier curves deviated significantly (p = 0.015, HR 2.26 (95%CI 1.17–4.37)). When a similar analysis was performed looking at TTP again the curves diverged significantly (p = 0.002, HR 2.4 (95%CI 1.37–4.19)). Conclusion: The iceball seems to overestimate the realized ablation zone by about 1 cm in all orientations during hepatic cryoablation.
• Young, S., Hannallah, J., Goldberg, D., Khreiss, M., Shroff, R., Arshad, J., Scott, A., & Woodhead, G. (2024). Liver-Directed Therapy Combined with Systemic Therapy: Current Status and Future Directions. Seminars in Interventional Radiology, 40(6). doi:10.1055/s-0043-1777711
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  In the past several decades, major advances in both systemic and locoregional therapies have been made for many cancer patients. This has led to modern cancer treatment algorithms frequently calling for active interventions by multiple subspecialists at the same time. One of the areas where this can be clearly seen is the concomitant use of locoregional and systemic therapies in patients with primary or secondary cancers of the liver. These combined algorithms have gained favor over the last decade and are largely focused on the allure of the combined ability to control systemic disease while at the same time addressing refractory/resistant clonal populations. While the general concept has gained favor and is likely to only increase in popularity with the continued establishment of viable immunotherapy treatments, for many patients questions remain. Lingering concerns over the increase in toxicity when combining treatment methods, patient selection, and sequencing remain for multiple cancer patient populations. While further work remains, some of these questions have been addressed in the literature. This article reviews the available data on three commonly treated primary and secondary cancers of the liver, namely, hepatocellular carcinoma, cholangiocarcinoma, and metastatic colorectal cancer. Furthermore, strengths and weaknesses are reviewed and future directions are discussed.
• Young, S., Sanghvi, T., Ragulojan, R., Torkian, P., Todatry, S., D'Souza, D., Flanagan, S., & Golzarian, J. (2024). Local recurrence following a complete radiologic response in hepatocellular carcinoma patients: comparison of transarterial chemoembolisation and transarterial radioembolisation. Clinical Radiology, 79(5). doi:10.1016/j.crad.2024.01.014
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  AIM: To evaluate and compare the rates of local recurrence in hepatocellular carcinoma (HCC) patients who undergo selective transarterial radioembolisation (TARE) or transarterial chemoembolisation (TACE) and achieve a complete response (CR) radiologically. MATERIALS AND METHODS: All patients undergoing treatment with TARE or TACE at a single academic institution were reviewed retrospectively. Those who had been treated previously, presented with multifocal disease, had non-selective TARE or TACE, or did not achieve a complete response (CR) radiologically were excluded. RESULTS: In total 110 patients were included (TACE n=60 [54.5%]; TARE n=50 [45.5%]). TARE patients were older (66.4 ± 9.4 versus 61.2 ± 5.6 years, p
• Young, S., Walker, L., & Huber, T. (2024). Thermal Ablation of Thyroid Nodules, From the AJR “How We Do It” Special Series. American Journal of Roentgenology. doi:10.2214/ajr.24.30950
• Caplin, D., Young, S., Kassin, M., Dowell, J., Makary, M., Metwalli, Z., Charalel, R., Halin, N., Kleedehn, M., Lewis, P., Ward, T., & Shah, R. (2023). A History and Modern Framework for Quality Improvement in Interventional Radiology. Journal of Vascular and Interventional Radiology, 34(11). doi:10.1016/j.jvir.2023.07.019
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  Quality improvement (QI) initiatives have benefited patients as well as the broader practice of medicine. Large-scale QI has been facilitated by multi-institutional data registries, many of which were formed out of national or international medical society initiatives. With broad participation, QI registries have provided benefits that include but are not limited to establishing treatment guidelines, facilitating research related to uncommon procedures and conditions, and demonstrating the fiscal and clinical value of procedures for both medical providers and health systems. Because of the benefits offered by these databases, Society of Interventional Radiology (SIR) and SIR Foundation have committed to the development of an interventional radiology (IR) clinical data registry known as VIRTEX. A large IR database with participation from a multitude of practice environments has the potential to have a significant positive impact on the specialty through data-driven advances in patient safety and outcomes, clinical research, and reimbursement. This article reviews the current landscape of societal QI programs, presents a vision for a large-scale IR clinical data registry supported by SIR, and discusses the anticipated results that such a framework can produce.
• Cebeci, H., Golzarian, J., Young, S., Gençtürk, M., Önder, H., & İnce, O. (2023). Prediction of Response of Hepatocellular Carcinoma to Radioembolization: Machine Learning Using Preprocedural Clinical Factors and MR Imaging Radiomics. Journal of Vascular and Interventional Radiology, 34(2). doi:10.1016/j.jvir.2022.11.004
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  Purpose: To create and evaluate the ability of machine learning–based models with clinicoradiomic features to predict radiologic response after transarterial radioembolization (TARE). Materials and Methods: 82 treatment-naïve patients (65 responders and 17 nonresponders; median age: 65 years; interquartile range: 11) who underwent selective TARE were included. Treatment responses were evaluated using the European Association for the Study of the Liver criteria at 3-month follow-up. Laboratory, clinical, and procedural information were collected. Radiomic features were extracted from pretreatment contrast-enhanced T1-weighted magnetic resonance images obtained within 3 months before TARE. Feature selection consisted of intraclass correlation, followed by Pearson correlation analysis and finally, sequential feature selection algorithm. Support vector machine, logistic regression, random forest, and LightGBM models were created with both clinicoradiomic features and clinical features alone. Performance metrics were calculated with a nested 5-fold cross-validation technique. The performances of the models were compared by Wilcoxon signed-rank and Friedman tests. Results: In total, 1,128 features were extracted. The feature selection process resulted in 12 features (8 radiomic and 4 clinical features) being included in the final analysis. The area under the receiver operating characteristic curve values from the support vector machine, logistic regression, random forest, and LightGBM models were 0.94, 0.94, 0.88, and 0.92 with clinicoradiomic features and 0.82, 0.83, 0.82, and 0.83 with clinical features alone, respectively. All models exhibited significantly higher performances when radiomic features were included (P = .028, .028, .043, and .028, respectively). Conclusions: Based on clinical and imaging-based information before treatment, machine learning–based clinicoradiomic models demonstrated potential to predict response to TARE.
• Goldberg, D., Woodhead, G., Hannallah, J., & Young, S. (2023). Role of the Interventional Radiologist in the Treatment of Desmoid Tumors. Life (Basel, Switzerland), 13(3).
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  Desmoid tumors are locally aggressive soft tissue tumors with variable clinical presentation. As is the case with most relatively rare tumors, a multidisciplinary team approach is required to best manage these patients. Surgical resection, systemic therapy, and radiation therapy have classically been mainstays of treatment for desmoid tumors; however, a more conservative "wait-and-see" approach has been adopted given their high recurrence rates and significant morbidity associated with the aforementioned therapies. Given the challenges of classical treatment methods, interventional radiologists have begun to play a significant role in minimally invasive interventions for desmoid tumors. Herein, the authors review imaging characteristics of desmoid tumors, current management recommendations, and minimally invasive therapeutic intervention options.
• Golzarian, J., Young, S., Gençtürk, M., Önder, H., & İnce, O. (2023). Machine Learning Insights: Predicting Hepatic Encephalopathy After TIPS Placement. CardioVascular and Interventional Radiology, 46(12). doi:10.1007/s00270-023-03593-w
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  Purpose: To develop and assess machine learning (ML) models' ability to predict post-procedural hepatic encephalopathy (HE) following transjugular intrahepatic portosystemic shunt (TIPS) placement. Materials and Methods: In this retrospective study, 327 patients who underwent TIPS for hepatic cirrhosis between 2005 and 2019 were analyzed. Thirty features (8 clinical, 10 laboratory, 12 procedural) were collected, and HE development regardless of severity was recorded one month follow-up. Univariate statistical analysis was performed with numeric and categoric data, as appropriate. Feature selection is used with a sequential feature selection model with fivefold cross-validation (CV). Three ML models were developed using support vector machine (SVM), logistic regression (LR) and CatBoost, algorithms. Performances were evaluated with nested fivefold-CV technique. Results: Post-procedural HE was observed in 105 (32%) patients. Patients with variceal bleeding (p = 0.008) and high post-porto-systemic pressure gradient (p = 0.004) had a significantly increased likelihood of developing HE. Also, patients having only one indication of bleeding or ascites were significantly unlikely to develop HE as well as Budd-Chiari disease (p = 0.03). The feature selection algorithm selected 7 features. Accuracy ratios for the SVM, LR and CatBoost, models were 74%, 75%, and 73%, with area under the curve (AUC) values of 0.82, 0.83, and 0.83, respectively. Conclusion: ML models can aid identifying patients at risk of developing HE after TIPS placement, providing an additional tool for patient selection and management. Graphical Abstract: [Figure not available: see fulltext.].
• Sag, A., Agritelley, E., Ronald, J., Young, S., & Kim, C. (2023). Vortex-assisted resin y90 delivery via 175 cm Truselect microcatheter: case factors for high residual despite double-flush protocol. Clinical Journal of Pain, 40(1). doi:10.1097/AJP.0000000000001166
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  Purpose To report efficiency of resin y90 delivery using SIROS via 175 cm TruSelect microcatheter with double-flush protocol (40 ml dextrose total). Methods IRB-approved retrospective review of all patients undergoing SIROS injection of y90 Sir-Spheres via TruSelect from 2019 through 2022 at one quaternary-care academic institution, including medical records. Results Included were 48 infusions in 25 patients across 11 cancer histologies. Mean planned, delivered, and residual activities were 28 ± 17, 27 ± 17, 1.1 ± 0.56 mCi respectively (mean residual 4.9% ± 2.8%) across flex-dosing precalibrations including 1-day, 2-day, and 3-day SIROS (4/51, 16/51, and 28/51). Mean liver treatment volume was 483 ± 306 ml with target dose mean of 128 ± 26 Gy in non-segmentectomy cases; Radiation segmentectomy was performed in 15/48 (31%). Arterial stasis was documented in 9/48 (19%) of cases. Use of a 3-day precalibrated SIROS dose, use of activity
• Sag, A., Agritelley, E., Ronald, J., Young, S., & Kim, C. (2023). Vortex-assisted resin y90 delivery via 175 cm Truselect microcatheter: case factors for high residual despite double-flush protocol. Nuclear Medicine Communications, 45(1). doi:10.1097/MNM.0000000000001784
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  Purpose To report efficiency of resin y90 delivery using SIROS via 175 cm TruSelect microcatheter with double-flush protocol (40 ml dextrose total). Methods IRB-approved retrospective review of all patients undergoing SIROS injection of y90 Sir-Spheres via TruSelect from 2019 through 2022 at one quaternary-care academic institution, including medical records. Results Included were 48 infusions in 25 patients across 11 cancer histologies. Mean planned, delivered, and residual activities were 28 ± 17, 27 ± 17, 1.1 ± 0.56 mCi respectively (mean residual 4.9% ± 2.8%) across flex-dosing precalibrations including 1-day, 2-day, and 3-day SIROS (4/51, 16/51, and 28/51). Mean liver treatment volume was 483 ± 306 ml with target dose mean of 128 ± 26 Gy in non-segmentectomy cases; Radiation segmentectomy was performed in 15/48 (31%). Arterial stasis was documented in 9/48 (19%) of cases. Use of a 3-day precalibrated SIROS dose, use of activity
• Torkian, P., Haghshomar, M., Farsad, K., Wallace, S., Golzarian, J., & Young, S. J. (2023). Cancer Immunology: Impact of Radioembolization of Hepatocellular Carcinoma on Immune Response Modulation. AJR. American journal of roentgenology, 220(6), 863-872.
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  Hepatocellular carcinoma (HCC) is the most prevalent primary liver cancer and the fourth most common cause of cancer mortality. The tumor microenvironment is increasingly recognized as having a central role in HCC carcinogenesis; factors such as tumor and immune cell interactions, cytokines, and extracellular matrix have key roles. Transarterial radioembolization (TARE) is a locoregional therapy for HCC that not only has a direct tumoricidal effect but also induces an immune response against tumor cells with subsequent immunogenic cell death. This TARE-induced tumor immunogenicity occurs through enhancement of tumor-associated antigen expression and recruitment and diversification of tumor-infiltrating lymphocytes. In addition, immunologic biomarkers, including neutrophil-to-lymphocyte ratio, lymphocyte count, and cytokine levels, may be useful for predicting outcomes after TARE. Early data are promising regarding the potential synergistic benefit of treatment algorithms that combine TARE and immunotherapies, and interest is growing in the clinical application of such combinations. The purpose of this article is to provide an overview of cancer immunology, summarize the available data on the biologic effects of TARE on local and systemic immune responses, and explore the potential role of the combination of TARE and immunotherapy for HCC.
• Young, S. (2023). Cost Matters: A Rigorous Economic Analysis of PAE with Comparison to TURP. Cardiovascular and interventional radiology, 46(8), 1036-1037.
• Young, S. (2023). Prostate Artery Operator Learning Curves, Affirmation of the Safety of Widespread Adaption. Cardiovascular and interventional radiology, 46(2), 238-239.
• Young, S. J., Golzarian, J., Wallace, S., Farsad, K., Haghshomar, M., & Torkian, P. (2023).

  Cancer Immunology: Impact of Radioembolization of Heptocellular Carcinoma on Immune Response Modulation

  . American Journal of Roentgenology. doi:10.2214/ajr.22.28800
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  Hepatocellular carcinoma (HCC) is the most prevalent primary liver cancer and the fourth most common cause of cancer mortality. The tumor microenvironment (TME) is increasingly recognized as having a central role in HCC carcinogenesis, with factors such as tumor and immune cell interactions, cytokines, and extracellular matrix serving key roles. Transarterial radioembolization (TARE) is a locoregional therapy for HCC that not only has a direct tumoricidal effect, but induces an immune response against tumor cells with subsequent immunogenic cell death. This TARE-induced tumor immunogenicity occurs through enhancement of tumor-associated antigen expression, as well as recruitment and diversification of tumor-infiltrating lymphocytes. In addition, immunologically related biomarkers, including the neutrophil-to-lymphocyte ratio, lymphocyte count, and cytokine levels, may be useful tools to predict outcomes after TARE. Early data are promising regarding the potential synergistic benefit from treatment algorithms that combine TARE and immunotherapies, and interest is growing in the clinical application of such combinations. This review provides an overview of cancer immunology, summarizes the available data regarding the biologic effects of TARE on local and systemic immune responses, and explores the potential role of the combination of TARE and immunotherapy for HCC.
• Young, S., Abamyan, A., Goldberg, D., Hannallah, J., Schaub, D., Kalarn, S., Fitzgerald, Z., & Woodhead, G. (2023). Cryoablation in the liver: how accurately does the iceball predict the ablation zone?. Abdominal radiology (New York).
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  To evaluate the accuracy with which the iceball predicts the realized ablation zone in patients undergoing cryoablation of the liver.
• Young, S., Chen, T., Golzarian, J., & Sanghvi, T. (2023). Ablation of Cervical Lymph Nodes in Patients with Thyroid Cancer: A Comparison between Cryoablation and Percutaneous Ethanol Injection. Journal of vascular and interventional radiology : JVIR, 34(5), 777-781.e1.
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  The purpose of this study was to retrospectively evaluate the safety and efficacy of cryoablation and compare the outcomes with those of percutaneous ethanol injection (PEI) for the treatment of metastatic cervical lymph nodes (CLNs) in patients with thyroid cancer. The study included 24 patients with 47 CLNs treated with PEI and 7 patients with 11 CLNs treated with cryoablation. Three of 7 (42.9%) patients did not respond to PEI and progressed to cryoablation. There were more local recurrences in CLNs treated with PEI (7/47, 14.9%) compared with cryoablation (0/11, 0%), but this did not reach significance (P = .33). There was no difference in mild/moderate (3/24, 12.5% vs 2/7, 28.6%; P = .31) or severe (1/24, 4.2% vs 0/7, 0%; P = 1) adverse events in the PEI and cryoablation cohorts. The number of treatments required for CLNs treated with PEI (2 ± 1.1) was significantly greater than those for CLNs treated with cryoablation (1 ± 0) (P = .002). These limited data suggest that the treatment of metastatic CLNs with cryoablation or PEI may both be safe and effective; however, further data are needed to confirm superiority of cryoablation.
• Young, S., Flanagan, S., D'Souza, D., Todatry, S., Ragulojan, R., Sanghvi, T., & Golzarian, J. (2023). Lung shunt fraction calculations before Y-90 transarterial radioembolization: Comparison of accuracy and clinical significance of planar scintigraphy and SPECT/CT. Diagnostic and interventional imaging, 104(4), 185-191.
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  To determine the accuracy and clinical significance of planar scintigraphy lung shunt fraction (PLSF) and single-photon emission computerized tomography (SPECT) computed tomography (CT) lung shunt fraction (SLSF) before Y-90 transarterial radioembolization.
• Young, S., Goldberg, D., Woodhead, G., & Hannallah, J. (2023).

  Role of the Interventional Radiologist in the Treatment of Desmoid Tumors

  . Life, 13(3), 645. doi:10.3390/life13030645
• Young, S., Hannallah, J., Goldberg, D., Sanghvi, T., Arshad, J., Scott, A., & Woodhead, G. (2023). Friend or Foe? Locoregional Therapies and Immunotherapies in the Current Hepatocellular Treatment Landscape. International journal of molecular sciences, 24(14).
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  Over the last several decades, a number of new treatment options for patients with hepatocellular carcinoma (HCC) have been developed. While treatment decisions for some patients remain clear cut, a large numbers of patients have multiple treatment options, and it can be hard for multidisciplinary teams to come to unanimous decisions on which treatment strategy or sequence of treatments is best. This article reviews the available data with regard to two treatment strategies, immunotherapies and locoregional therapies, with a focus on the potential of locoregional therapies to be combined with checkpoint inhibitors to improve outcomes in patients with locally advanced HCC. In this review, the available data on the immunomodulatory effects of locoregional therapies is discussed along with available clinical data on outcomes when the two strategies are combined.
• Young, S., Ragulojan, R., Todatry, S., Golzarian, J., Flanagan, S., Sanghvi, T., & D’Souza, D. (2023). Evaluation of Inflammatory Scores in Metastatic Colorectal Cancer Patients Undergoing Transarterial Radioembolization. CardioVascular and Interventional Radiology, 46(2). doi:10.1007/s00270-022-03313-w
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  Purpose: To evaluate the correlation of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), aspartate aminotransferase-to-lymphocyte ratio (ALRI), systemic inflammation index (SII), and lymphocyte count to oncologic outcomes in metastatic colorectal cancer (mCRC) patients undergoing transarterial radioembolization (TARE). Materials and Methods: All patients undergoing TARE for mCRC were retrospectively reviewed at a single academic institution. A receiver operating characteristics (ROC) curve analysis was performed using a landmark survival point of 12 months, with an area under the curve (AUC) calculated. A cutoff point was determined by Youden’s index and used to separate patients for OS and PFS analysis. Cox proportional-hazards models which included pertinent clinical factors were also created to evaluate PFS and OS. Results: In total, 41 patients who underwent 66 TARE treatments were included. A correlation was seen between post-treatment ALRI < 45 (HR: 0.38 (95%CI: 0.17–0.86), p = 0.02) and PFS. Patients with a pretreatment ALRI score < 20 had a significantly longer OS (HR: 0.49 (95%CI: 0.19–0.88), p = 0.02) as did those with a post-treatment lymphocyte count > 1.1 109/L (HR: 0.27 (95%CI: 0.11–0.68), p = 0.005). In multivariate analysis of PFS, post-treatment lymphocyte count (HR: 8.46 (95%CI: 1.14–62.89), p = 0.044) was the only significantly associated inflammatory marker and presence of extrahepatic disease (HR:8.46 (95%CI: 1.14–62.89, p = 0.044) also correlated. Multivariate analysis of OS showed that pretreatment PLR (HR:1.01 (95%CI:1.−1.03), p = 0.02) and post-treatment NLR (HR:0.33 (95%CI:0.14–0.76), p = 0.009), PLR (HR:0.98 (95%CI:0.97–1), p = 0.046), SII (HR:1.04 (95%CI:1.01–1.08), p = 0.014), and lymphocyte count (HR:0.07 (95%CI:0.01–0.16), p = 0.003) were significantly associated. Conclusion: Inflammatory markers may be associated with OS and PFS in mCRC patients undergoing TARE.
• Young, S., Torkian, P., Flanagan, S., D'Souza, D., Sanghvi, T., & Golzarian, J. (2023). Intrahepatic cholangiocarcinoma: a dose threshold evaluation in those undergoing transarterial radioembolization. Journal of gastrointestinal oncology, 14(5), 2202-2211.
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  Intrahepatic cholangiocarcinoma (ICC) is a rare primary hepatic malignancy. One of the treatment strategies which has shown some promise is transarterial radioembolization (TARE). However, data on dose thresholds, arguably the most important aspect of the procedure itself, is still limited. The study aims to evaluate the relationship between dose to tumor and radiologic response in intrahepatic cholangiocarcinoma patients undergoing transarterial radioembolization.
• İnce, O., Önder, H., Gençtürk, M., Cebeci, H., Golzarian, J., & Young, S. (2023). Machine Learning Models in Prediction of Treatment Response After Chemoembolization with MRI Clinicoradiomics Features. Cardiovascular and interventional radiology, 46(12), 1732-1742.
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  To evaluate machine learning models, created with radiomics and clinicoradiomics features, ability to predict local response after TACE.
• Abdallah, M., Vantanasiri, K., Young, S., Azeem, N., Amateau, S. K., Mallery, S., Freeman, M. L., & Trikudanathan, G. (2022). Visceral artery pseudoaneurysms in necrotizing pancreatitis: risk of early bleeding with lumen-apposing metal stents. Gastrointestinal endoscopy, 95(6), 1150-1157.
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  Visceral artery pseudoaneurysm (PSA) in necrotizing pancreatitis (NP) is associated with significant morbidity and mortality. This study aimed to evaluate the incidence, clinical presentation, management, and outcomes of PSA in NP.
• Franco, J. V., Jung, J. H., Imamura, M., Borofsky, M., Omar, M. I., Escobar Liquitay, C. M., Young, S., Golzarian, J., Veroniki, A. A., Garegnani, L., & Dahm, P. (2022). Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta-analysis. BJU international, 130(2), 142-156.
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  To assess the comparative effectiveness and ranking of minimally invasive treatments (MITs) for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH).
• Jung, J. H., McCutcheon, K. A., Borofsky, M., Young, S., Golzarian, J., Kim, M. H., Narayan, V. M., & Dahm, P. (2022). Prostatic arterial embolization for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. The Cochrane database of systematic reviews, 3(3), CD012867.
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  A variety of minimally invasive surgical approaches are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Prostatic arterial embolization (PAE) is a relatively new, minimally invasive treatment approach.
• Jung, J. H., McCutcheon, K. A., Borofsky, M., Young, S., Golzarian, J., Kim, M. H., Narayan, V., & Dahm, P. (2022). Prostatic arterial embolisation for men with benign prostatic hyperplasia: a Cochrane review. BJU international.
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  To assess the effects of prostatic arterial embolisation (PAE) compared to other procedures for treatment of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH).
• Torkian, P., Ragulojan, R., J Woodhead, G., D'Souza, D., Flanagan, S., Golzarian, J., & Young, S. (2022). Lung shunt fraction quantification methods in radioembolization: What you need to know. The British journal of radiology, 95(1139), 20220470.
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  In some patients undergoing radioembolization, lung toxicity is a limiting factor when calculating their dose. At the same time, it is known that the lung shunt fraction (LSF) is overestimated by the mapping exam. Furthermore, there are multiple methods to measure LSF. Planar measurement is both the most commonly utilized and easiest to perform, however new dosimetry software provides the ability to use more advanced 3D techniques. This paper reviews the different LSF calculation methods and elucidates the available data comparing the techniques, clinical relevance, and dose calculation.
• Wongjarupong, N., Young, S., Huynh, R. K., Lake, J., & Lim, N. (2022). Long-Term Improvement in Liver Function Following Transjugular Intrahepatic Portosystemic Shunt in Patients With Budd-Chiari Syndrome. Journal of clinical and experimental hepatology, 12(6), 1474-1479.
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  Transjugular intrahepatic portosystemic shunt (TIPS) relieves hepatic venous obstruction in Budd-Chiari syndrome (BCS), but the effect on liver function is unclear, particularly outside the immediate post-treatment period. This study aims to evaluate the long-term impact of TIPS on liver function and outcomes in BCS patients.
• Young, S. (2022).

  Editorial Comment: Echocardiography—Should It Be Routine Before Elective TIPS?

  . American Journal of Roentgenology, 219(1), 119-119. doi:10.2214/ajr.22.27580
• Young, S. (2022). Editorial Comment: Echocardiography-Should It Be Routine Before Elective TIPS?. AJR. American journal of roentgenology, 219(1), 119.
• Young, S., Chen, T., Flanagan, S., Golzarian, J., & Sanghvi, T. (2022). Realized tumor to normal ratios in hepatocellular carcinoma patients undergoing transarterial radioembolization: a retrospective evaluation. European radiology, 32(6), 4160-4167.
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  To determine the realized tumor to normal ratios (TNRs) in patients undergoing radiation segmentectomies (RS); determine the relationship between TNRs and particle load in transarterial radioembolization (TARE).
• Young, S., J. Woodhead, G., Torkian, P., Ragulojan, R., D'Souza, D., Flanagan, S., & Golzarian, J. (2022).

  Lung shunt fraction quantification methods in radioembolization: What you need to know

  . The British Journal of Radiology, 95(1139). doi:10.1259/bjr.20220470
• Young, S., Moran, P., & Golzarian, J. (2022). Ejaculatory dysfunction following prostate artery embolization: A retrospective study utilizing the male sexual health questionnaire-ejaculation dysfunction questionnaire. Diagnostic and interventional imaging, 103(6), 310-315.
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  The purpose of this study was to determine the rate of ejaculatory dysfunction that develops following prostate artery embolization (PAE) and identify predictive factors.
• Young, S., Ragulojan, R., Chen, T., Owen, J., D'souza, D., Sanghvi, T., Golzarian, J., & Flanagan, S. (2022). Dynamic Lymphocyte Changes Following Transarterial Radioembolization: Association with Normal Liver Dose and Effect on Overall Survival. Journal of hepatocellular carcinoma, 9, 29-39.
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  To evaluate the dynamic changes of lymphocytes following transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC) and their relationship to normal liver dose (NLD).
• Young, S., Ragulojan, R., Todatry, S., D'Souza, D., Golzarian, J., Flanagan, S., & Sanghvi, T. (2022). Evaluation of Inflammatory Scores in Metastatic Colorectal Cancer Patients Undergoing Transarterial Radioembolization. Cardiovascular and interventional radiology.
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  To evaluate the correlation of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), aspartate aminotransferase-to-lymphocyte ratio (ALRI), systemic inflammation index (SII), and lymphocyte count to oncologic outcomes in metastatic colorectal cancer (mCRC) patients undergoing transarterial radioembolization (TARE).
• Young, S., Rubin, N., D'Souza, D., Sharma, P., Pontolillo, J., Flanagan, S., Golzarian, J., & Sanghvi, T. (2022). Inflammatory Scores: Correlation with Clinical Outcomes in Hepatocellular Carcinoma Patients Undergoing Transarterial Radioembolization. Cardiovascular and interventional radiology, 45(4), 461-475.
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  To evaluate the ability of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), aspartate aminotransferase-to-lymphocyte ratio (ALRI) and systemic-inflammation index (SII) to predict clinical outcomes in hepatocellular carcinoma (HCC) patients undergoing transarterial radioembolization (TARE).
• Young, S., Sharma, S., Rubin, N., Hall, D., & Anderson, J. K. (2022). Ablation zone considerations in cryoablation of RCC: accuracy of manufacturer provided model and change from first to second freeze cycle. Clinical imaging, 89, 10-15.
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  To determine the accuracy of manufacturer models and difference in ice ball dimensions from the first to second freeze cycles during cryoablation of renal cell carcinoma (RCC).
• İnce, O., Önder, H., Gençtürk, M., Cebeci, H., Golzarian, J., & Young, S. (2022). Prediction of Response of Hepatocellular Carcinoma to Radioembolization: Machine Learning using Preprocedural Clinical Factors and Magnetic Resonance Imaging Radiomics. Journal of vascular and interventional radiology : JVIR.
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  To create and evaluate the ability of machine learning-based models with clinicoradiomics features to predict radiologic response after transarterial radioembolization(TARE).
• Cam, I., Gencturk, M., Lim, N., Sharma, S., Wong, J., Yang, M., Golzarian, J., Flanagan, S., & Young, S. (2021). Alcohol Recidivism Following Transjugular Intrahepatic Portosystemic Shunt Placement: Frequency and Predictive Factors. Cardiovascular and interventional radiology, 44(5), 758-765.
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  To determine the frequency and predictive factors for alcohol recidivism following transjugular intrahepatic portosystemic shunts (TIPS) placed in patients with alcoholic cirrhosis.
• Franco, J. V., Jung, J. H., Imamura, M., Borofsky, M., Omar, M. I., Escobar Liquitay, C. M., Young, S., Golzarian, J., Veroniki, A. A., Garegnani, L., & Dahm, P. (2021). Minimally invasive treatments for lower urinary tract symptoms in men with benign prostatic hyperplasia: a network meta-analysis. The Cochrane database of systematic reviews, 7(7), CD013656.
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  A variety of minimally invasive treatments are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). However, it is unclear which treatments provide better results.
• Merickel, J. L., Lawrence, J., Young, S. J., & Thomson, C. B. (2021). Cutaneous seeding of transitional cell carcinoma of the urinary bladder after placement of a subcutaneous ureteral bypass device in a dog with bilateral ureteral obstruction. Journal of the American Veterinary Medical Association, 258(8), 877-882.
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  A 12-year-old spayed female Jack Russell Terrier was presented with pollakiuria and stranguria.
• Young, S. (2021). Prostate artery embolization for benign prostatic hyperplasia: The hunt for the ideal patient population. Diagnostic and interventional imaging, 102(3), 119-120.
• Young, S., Cam, I., Gencturk, M., Rubin, N., D'souza, D., Flanagan, S., Golzarian, J., & Sanghvi, T. (2021). Inflammatory Scores: Comparison and Utility in HCC Patients Undergoing Transarterial Chemoembolization in a North American Cohort. Journal of hepatocellular carcinoma, 8, 1513-1524.
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  The purpose of this study is to determine and compare the ability of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), aspartate-aminotransferase-to-lymphocyte ratio (ALRI), systemic-inflammation index (SII) and lymphocyte count to predict oncologic outcomes in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE).
• Young, S., Larson, L., Bermudez, J., Mohei, H., Rostambeigi, N., Golzarian, J., & Mahgoub, A. (2021). Evaluation of the frequency and factors predictive of hernia incarceration following transjugular intrahepatic portosystemic shunt placement. Clinical Radiology, 76(4). doi:10.1016/j.crad.2020.12.014
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  AIM: To examine the frequency and predictive factors for bowel incarceration following transjugular intrahepatic portosystemic shunts (TIPS) placement to treat refractory cirrhosis-induced ascites. MATERIALS AND METHODS: Ninety-nine patients with known hernias at the time of TIPS placement were identified. Their electronic medical records were reviewed and pertinent pre-procedural, procedural, and outcome variables were recorded. Patients were divided between those that suffered incarceration (study group) and a control group of those with a hernia who did not suffer incarceration. RESULTS: Twelve of the 99 patients (12.1%) suffered hernia incarceration, of which seven (7.1%) suffered incarceration in the first 90 days. One patient who suffered incarceration ultimately died from complications of the incarceration. When comparing all patients who suffered incarceration to controls, incarceration patients were found to have significantly higher albumin levels (mean 3.13 versus 2.73, p=0.02). When just considering those who had incarcerations in the first 90 days to controls, incarceration patients were less likely to have improvement in their ascites (p=0.04). CONCLUSIONS: Incarcerated hernias occur frequently after TIPS placement and can lead to significant morbidity and mortality. Clinicians should be aware of this complication and counsel patients on presenting symptoms prior to placement.
• Young, S., Rostambeigi, N., & Golzarian, J. (2021). The Common but Complicated Tool: Review of Embolic Materials for the Interventional Radiologist. Seminars in interventional radiology, 38(5), 535-541.
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  Embolization is an important and widely utilized technique in interventional radiology. There are a variety of different categories and individual products which can be utilized to perform embolization. Understanding the different classes of embolic agents, the important features of each of these classes including strengths and limitations, and the variation in individual products within the classes is critical for interventional radiologist to practice safely and effectively. This article reviews the different kinds of embolics and relays some of the pertinent physical and chemical properties of individual products which should be considered when determining which embolic to select for a given purpose.
• Young, S., Young, S., Cam, I., Cam, I., Gencturk, M., & Gencturk, M. (2021). Reply to "TIPS Placement Guided by Ultrasound: Different Techniques to Achieve the Same Goal". AJR. American journal of roentgenology, 217(5), 1251-1252.
• Young, S., Young, S., Cam, I., Cam, I., Gencturk, M., & Gencturk, M. (2021). Reply to "Utility of Ultrasound Guidance During Direct Intrahepatic Portal Shunt Placement in Pediatric Patients With Budd-Chiari Syndrome". AJR. American journal of roentgenology, 216(5), W16.
• Cam, I., Gencturk, M., & Young, S. (2020). Cryoablation of a Large Metastatic Chest Wall Mass. Journal of Vascular and Interventional Radiology, 31(11). doi:10.1016/j.jvir.2020.06.023
• Cam, I., Gencturk, M., Golzarian, J., & Young, S. (2020). Early Presentation of Septic Shock Secondary to Infection of the Treatment Zone Following Radioembolization for Hepatocellular Carcinoma. CardioVascular and Interventional Radiology, 43(7). doi:10.1007/s00270-020-02466-w
• Chmelovski, R., Granick, J., Ober, C., Young, S., & Thomson, C. (2020). Percutaneous transhepatic cholecystostomy drainage in a dog with extrahepatic biliary obstruction secondary to pancreatitis. Journal of the American Veterinary Medical Association, 257(5). doi:10.2460/javma.257.5.531
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  CASE DESCRIPTION An 8-year-old 36.3-kg (79.9-lb) spayed female Rottweiler was evaluated because of anorexia and vomiting. CLINICAL FINDINGS Extrahepatic biliary obstruction (EHBO) secondary to pancreatitis was suspected on the basis of results from serum biochemical analyses, CT, and cytologic examination. TREATMENT AND OUTCOME Only marginal improvement was observed after 24 hours of traditional medical management; therefore, novel continual biliary drainage was achieved with ultrasonographically and fluoroscopically guided placement of a percutaneous transhepatic cholecystostomy drainage (PCD) catheter. Within 24 hours after PCD catheter placement, the dog was eating regularly, had increased intestinal peristaltic sounds on abdominal auscultation, no longer required nasogastric tube feeding, and had decreased serum total bilirubin concentration (7.7 mg/dL, compared with 23.1 mg/dL preoperatively). Bile recycling was performed by administering the drained bile back to the patient through a nasogastric tube. The PCD remained in place for 5 weeks and was successfully removed after follow-up cholangiography confirmed bile duct patency. CLINICAL RELEVANCE Transhepatic PCD catheter placement provided fast resolution of EHBO secondary to pancreatitis in the dog of the present report. We believe that this minimally invasive, interventional procedure has the potential to decrease morbidity and death in select patients, compared with traditional surgical options, and that additional research is warranted regarding clinical use, safety, and long-term results of this procedure in veterinary patients, particularly those that have transient causes of EHBO, are too unstable to undergo more invasive biliary diversion techniques, or have biliary diseases that could benefit from palliation alone.
• Jung, J. H., McCutcheon, K. A., Borofsky, M., Young, S., Golzarian, J., Reddy, B., Shin, T. Y., Kim, M. H., Narayan, V., & Dahm, P. (2020). Prostatic arterial embolization for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. The Cochrane database of systematic reviews, 12(12), CD012867.
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  A variety of minimally invasive surgical approaches are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Prostatic arterial embolization (PAE) is a relatively new, minimally invasive treatment approach.
• Rostambeigi, N., Farsad, K., Young, S., Shrestha, P., Jahangiri, Y., Liang, K., Cretcher, M., & Golzarian, J. (2020). Lower-extremity edema is common after transjugular intrahepatic portosystemic shunt creation and is associated with lower survival: A two-institution study. Radiology, 298(1). doi:10.1148/RADIOL.2020201690
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  Background: Transjugular intrahepatic portosystemic shunt (TIPS) creation is an accepted treatment of portal hypertension. Lower-extremity edema (LEE) is an underreported complication of TIPS creation. Purpose: To assess the epidemiologic findings of LEE after TIPS creation and their association with patient survival. Materials and Methods: The medical records of patients who underwent TIPS creation between January 2003 and April 2019 at Oregon Health and Science University and patients who underwent TIPS creation between January 2006 and December 2016 at University of Minnesota were retrospectively reviewed. Clinical, laboratory, and technical parameters, development and outcome of edema, and survival data were collected. LEE was defined as new-onset or worsened edema up to 1 year after TIPS creation. Cardiac ventricular function was evaluated with transthoracic echocardiography. Risk factors for LEE were evaluated with logistic regression analysis, and critical P values were additionally assessed by using the false discovery rate. Survival curves were compared by using the log-rank test. Results: Three hundred thirty-four patients were included (mean age, 55 years 6 11 [standard deviation]; 208 men). TIPS creation was primarily performed for ascites (159 of 334 patients, 48%), gastrointestinal bleeding (127 of 334 patients, 38%), or a combination of bleeding and ascites (38 of 334 patients, 11%). One hundred seventy of the 334 patients (51%) developed LEE (new onset, 120; worsened edema, 50). Three of 170 patients (2%) had abnormal left ventricular ejection fraction. Multivariable analysis showed TIPS creation for ascites (odds ratio, 1.7; 95% CI: 1.04, 2.7; P = .03) and hepatic hydrothorax (odds ratio, 2.2; 95% CI: 1.1, 4.2; P = .02) was likely associated with LEE; however, it did not reach significance at a critical P value of .009. Among 164 patients with data on the outcome of LEE, LEE eventually improved in 94 (57%). The median survival of patients with LEE was lower than that of patients without LEE (38 months vs 71 months, respectively; P = .02). Conclusion: Lower-extremity edema developed in more than 50% of study patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) creation, regardless of left ventricular function. There was suggestion that TIPS creation for ascites might be an underlying risk factor. Lower-extremity edema portends worse survival.
• Young, S., & Golzarian, J. (2020). Prostate Artery Embolization: State of the Evidence and Societal Guidelines. Techniques in vascular and interventional radiology, 23(3), 100695.
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  Medically refractory benign prostatic hyperplasia induced lower urinary tract symptoms is an extremely prevalent issue in older men. The current gold standard therapy transurethral resection of the prostate does produce urologic improvements but is also associated with higher than desired morbidity. This has led to the need to develop new minimally invasive means to treat this disease; prostate artery embolization (PAE) has emerged as one minimally invasive treatment option for these patients. The body of evidence which supports the use of PAE has grown quickly and substantially over the last decade. The goal of this review is to introduce and summarize the published urologic outcomes for PAE when utilized to treat benign prostatic hyperplasia induced lower urinary tract symptoms as well as document the established complication profile. Finally, the paper reviews current societal recommendations as they relate to PAE.
• Young, S., & Golzarian, J. (2020). Re: Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Amendment 2019: H. E. Foster, P. Dahm, T. S. Kohler, L. B. Lerner, J. K. Parsons, T. J. Wilt and K. T. McVary J Urol 2019; 202: 592-598.. Journal of Urology, 203(6). doi:10.1097/JU.0000000000000801
• Young, S., Rivard, M., Kimyon, R., & Sanghvi, T. (2020). Accuracy of liver ablation zone prediction in a single 2450 MHz 100 Watt generator model microwave ablation system: An in human study. Diagnostic and Interventional Imaging, 101(4). doi:10.1016/j.diii.2019.10.007
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  Purpose: To compare manufacturer provided predictions and realized ablation dimensions in the liver using one 2450 MHz 100 Watt generator model microwave ablation (MWA) system. Materials and method: Between 1/1/2015 and 2/1/2018, MWAs were performed in 86 patients who underwent a total of 103 MWAs with a single MWA system. There were 64 men and 22 women with a mean age of 63.9 ± 9.9 (SD) years (range: 30–88 years). Demographic, procedural, and outcomes data was recorded. The manufacturer predicted ablation zone sizes in three dimensions (anterior-posterior [AP], transverse [TR], and cranial caudal [CC]) were recorded and then compared to the actual ablation zone sizes at one month follow-up imaging. Results: MWAs were most commonly performed to treat hepatocellular carcinoma (92/103, 89.3%). Dividing the actual ablation size by the manufacturer prediction in the AP, TR, and CC directions resulted in a mean of 88.3 ± 20.6 (SD) % (range: 33.3–156.4%), 80.2 ± 26.5 (SD) % (range: 29.6–182.9%), and 86.7 ± 25.1 (SD) % (range: 37–186.1%), respectively. The realized AP direction was statistically closer to the manufacturer prediction than the TR (P < 0.01). Ablation Watt setting of 100 Watts resulted in more accurate predictions than the 75 or 45 Watt settings in the AP direction (P = 0.03). Conclusions: This 2450 MHz 100 Watt generator MWA system manufacturer provided model fairly accurately predicts ablation zone dimensions, but tends to over predict realized dimensions in this mainly hepatocellular carcinoma, and therefore cirrhotic, cohort. The TR is the most inaccurately predicted dimension and manufacturer predictions appear to be best in the 100 W setting, important aspects for interventionalists to consider during ablation planning and execution.
• Young, S., Rostambeigi, N., Golzarian, J., & Lim, N. (2020). MELD or sodium MELD: A comparison of the ability of two scoring systems to predict outcomes after transjugular intrahepatic portosystemic shunt placement. American Journal of Roentgenology, 215(1). doi:10.2214/AJR.19.21726
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  OBJECTIVE. The purpose of this study was to compare the ability of the model for end-stage liver disease (MELD) and sodium MELD (MELD-Na) scoring systems to predict outcomes after transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS. Two hundred and nineteen consecutive patients who underwent TIPS placement were retrospectively reviewed. The primary outcomes were death within 30 days and 90 days after TIPS placement (30- and 90-day mortality, respectively), and secondary outcomes included death within 365 days after TIPS placement (365-day mortality), length of hospital stay, and readmission to the hospital within 30 days of TIPS placement. RESULTS. Mortality rates within 30, 90, and 365 days after TIPS placement were 2.3% (5/219), 8.2% (17/207), and 21.7% (41/189), respectively. Logistic regression showed that the MELD score predicted 30-day mortality (odds ratio [OR], 1.13; 95% CI, 1.00–1.27; p = 0.04) and trended toward predicting 90-day mortality (OR, 1.09; 95% CI, 1.00–1.18; p = 0.06), whereas the MELD-Na score did not predict 30-day mortality (OR, 1.02; 95% CI, 0.97–1.06; p = 0.51) or 90-day mortality (OR, 1.01; 95% CI, 0.98–1.15; p = 0.44). In a comparison of the ROC AUCs for MELD and MELD-Na, MELD showed improved prediction of 30-day mortality (p = 0.06) but did not significantly vary in prediction of 90- and 365-day mortality (p = 0.80 and p = 0.76, respectively). When the maximal inflection point for MELD and MELD-Na was analyzed on the basis of 90-day mortality, a score of 23 was found to be most significant for both MELD (OR, 6.6; 95% CI, 1.5–29.1; p = 0.01) and MELD-Na (OR, 3.3; 95% CI, 1.1–9.6; p = 0.03). MELD and MELD-Na both accurately predicted the length of hospital stay after TIPS placement (p = 0.005 and p = 0.01, respectively). CONCLUSION. MELD is superior to MELD-Na for predicting 30-day and, perhaps, 90-day mortality after TIPS placement. At present, decisions regarding patient selection for TIPS placement should be made on the basis of the MELD score rather than the MELD-Na score.
• Young, S., Sanghvi, T., Lake, J., Rubin, N., & Golzarian, J. (2020). Predicting post-transarterial chemoembolization outcomes: A comparison of direct and total bilirubin serums levels. Diagnostic and Interventional Imaging, 101(6). doi:10.1016/j.diii.2019.12.006
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  Purpose: To retrospectively review the ability of direct bilirubin serum level to predict mortality and complications in patients undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) and compare it to the predictive value of the currently utilized total bilirubin serum level. Materials and methods: A total of 219 patients who underwent TACE for 353 hepatocelluar carcinomas (HCC) at a single institution were included. There were 165 men and 54 women, with a mean age of 61.4 ± 7.6 (SD) [range: 27–86 years]. The patients’ electronic medical records were evaluated and they were divided into cohorts based on total bilirubin (< 2, 2–3, and > 3 mg/dL) as well as direct bilirubin (< 1 and 1–2 mg/dL). Results: Direct bilirubin serum level was significantly greater in the cohort of patients who did not survive as compared to those who survived 6 months ([0.58 ± 0.46 (SD) mg/dL; range: < 0.1–1.8 mg/dL] vs. [0.40 ± 0.31 (SD) mg/dL; range: < 0.1–1.6 mg/dL], respectively) (P = 0.04) and 12 months ([0.49 ± 0.38 (SD) mg/dL; range: < 0.1–1.8 mg/dL] vs. [0.38 ± 0.32 (SD) mg/dL; range: < 0.1–1.6 mg/dL], respectively) (P = 0.03). While total bilirubin serum level was not significantly different in those who did not and did survive 6 months ([1.54 ± 0.99 (SD) mg/dL; range: 0.3–3.9 mg/dL] vs. [1.27 ± 0.70 (SD) mg/dL; range: 0.3–3.75 mg/dL], respectively) (P = 0.16), it was significantly different when evaluating 12 months survival ([1.46 ± 0.87 (SD) mg/dL; range: 0.3–3.9 mg/dL] vs. [1.22 ± 0.65 (SD) mg/dL; range: 0.3–3.9 mg/dL]) (P = 0.03). Akaike information criterion (AIC) analysis revealed that direct bilirubin level more accurately predicted overall survival (AIC = 941.19 vs. 1000.51) and complications (AIC = 352.22 vs. 357.42) than total bilirubin serum levels. Conclusion: Direct bilirubin serum level appears to outperform total bilirubin concentration for predicting complications and overall survival in patients undergoing TACE. Patients with relatively maintained direct bilirubin levels should be considered for TACE, particularly in the setting of bridging to transplant.
• Young, S., Sanghvi, T., Rubin, N., Hall, D., Roller, L., Charaf, Y., & Golzarian, J. (2020). Transarterial Chemoembolization of Hepatocellular Carcinoma: Propensity Score Matching Study Comparing Survival and Complications in Patients with Nonalcoholic Steatohepatitis Versus Other Causes Cirrhosis. CardioVascular and Interventional Radiology, 43(1). doi:10.1007/s00270-019-02363-x
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  Purpose: To evaluate the oncologic outcomes and complication profile in nonalcoholic steatohepatitis (NASH)-induced cirrhosis leading to hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). Materials and Methods: Two hundred and twenty patients who underwent treatment of 353 HCCs were retrospectively reviewed, including 30 NASH patients who received TACE for 46 HCCs. Patient charts were evaluated for time to progression (TTP), complications and overall survival (OS). The group was split into NASH and non-NASH cohorts for comparison and additional analyses were done using propensity score matching (PSM). Results: Patients in the NASH cohort presented with significantly larger lesions (4.9 ± 5.8 cm vs 3.1 ± 2.4 cm, p = 0.05). There was no significant difference in TTP overall [Median NASH 396 days (95% CI 308–526 days) vs non-NASH cohort 307 days (95% CI 272–364), p = 0.25) or after PSM [259 days non-NASH (95% CI 215–490) vs 396 days NASH (95% CI (349–not reached), p = 0.43]. There was a non-significant increased OS in the non-NASH [median 1078 days (95% CI 668–1594)] as compared to the NASH cohort [median 706 days (95% CI 314–not reached)] (p = 0.08) which decreased following PSM [853 days (95% CI 526–1511) non-NASH vs 706 days (95% CI 314–not reached) NASH, p = 0.48]. The number of complications did not differ significantly between the two groups (p = 0.23). Conclusion: The oncologic outcomes and complication profile of TACE for HCC induced by NASH cirrhosis appear to be similar to that of other etiologies of cirrhosis. NASH patients presented with larger tumors emphasizing the need for early surveillance.
• Craig, P., Young, S., & Golzarian, J. (2019). Current Trends in the Treatment of Hepatocellular Carcinoma with Transarterial Embolization: Variability in Technical Aspects. CardioVascular and Interventional Radiology, 42(9). doi:10.1007/s00270-019-02232-7
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  Purpose: While transarterial chemoembolization (TACE) is a mainstay of treatment for unresectable hepatocellular carcinomas (HCCs), technical aspects have varied considerably in the literature. These variations lead to heterogeneity and make meaningful comparisons between articles difficult. The goal of this survey was to report international embolization practices for the treatment of HCC in an effort to understand current treatment strategies as a first step toward technique standardization. Materials and Methods: An anonymous 18 question online survey, evaluating technical aspects of TACE, was distributed via e-mail to practicing members of the five largest interventional radiology societies in Chinese and English. A total of 1160 responses were obtained from 62 countries. Results: Between regions, there were significant statistical differences in nearly all responses, including the amount of ethiodol oil used for cTACE (p = < 0.001). Practitioners most commonly used greater than 7.5 ml of ethiodol oil (240/506, 47.4%) and most did not utilize a specific mixing method (249/505, 49.3%). Particles utilized varied by geographical region (p = < 0.001), spherical embolic particles were slightly favored (363/757, 47.9%), followed closely by gelatin-based or sponge particles (279/680, 36.8%). Gelfoam was used almost exclusively in Japan and Korea (79/82 responses). LC/DC beads were the most commonly used drug-eluting bead (DEB) (450/742, 60.6%), with the most common size of DEB being 100–300 μm (354/690, 51.3%, p = 0.07). Conclusion: Technical aspects of transarterial embolization for HCC vary significantly by geographical location.
• Young, S., Bermudez, J., Zhang, L., Rostambeigi, N., & Golzarian, J. (2019). Transjugular intrahepatic portosystemic shunt (TIPS) placement: A comparison of outcomes between patients with hepatic hydrothorax and patients with refractory ascites. Diagnostic and Interventional Imaging, 100(5). doi:10.1016/j.diii.2018.10.006
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  Purpose: To compare the outcomes in patients who had transjugular intrahepatic portosystemic shunts (TIPS) placed for hepatic hydrothorax with those who had it placed for refractory ascites. Materials and methods: One hundred and forty-seven patients who underwent TIPS placement for refractory fluid accumulation were included. There were 97 men and 50 women with a mean age of 56.1 ± 9.7 (SD) years (range: 25–81 years). Of those, 32 patients (32/147; 21.8%) had refractory hepatic hydrothorax and 115 (115/147; 78.2%) had refractory ascites. Electronic medical records were reviewed for all patients to determine demographic, procedural related, and outcomes data. Both traditional analysis and a propensity score matching analysis were performed, to account for differences in baseline laboratory values, etiology of cirrhosis, age, and average number of paracenteses/thoracenteses per week. Survival analysis was also performed to compare post-TIPS survival by indication. Results: Differences in response rates, in terms of fluid accumulation reductions, at 1, 3, and 6 months were not significant (P = 0.19, P = 0.33, and P = 0.28, respectively). A successful propensity score matching was made between 24 hepatic hydrothorax and 46 ascites patients. After propensity score matching the response rates at 1, 3, and 6 months remained non-significant (P = 0.3, P = 0.71, and P = 0.78 respectively). No differences in mean overall survival were found between hepatic hydrothorax patients (672 days) and ascites patients (1224 days) (P = 0.15). Conclusion: The clinically relevant outcomes of improvement in fluid accumulation and overall survival do not appear to be significantly different in patients who have TIPS placed for refractory hepatic hydrothorax or and those who have TIPS placed for ascites.
• Young, S., Craig, P., & Golzarian, J. (2019). Current trends in the treatment of hepatocellular carcinoma with transarterial embolization: a cross-sectional survey of techniques. European Radiology, 29(6). doi:10.1007/s00330-018-5782-7
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  Purpose: Despite being accepted as a mainstay of treatment for hepatocellular carcinoma (HCC), technical aspects of transarterial chemoembolization (TACE) continue to vary by reporting author, leading to heterogeneity in the literature and making meaningful comparisons between treatments difficult. The goal of this survey was to report international chemoembolization practices for the treatment of HCC in an effort to understand current treatment strategies as a first step towards technique standardization. Materials and methods: An anonymous 18-question online survey, evaluating technical aspects of their TACE practice, was distributed via email to practicing members of the five largest interventional radiology societies in Chinese and English. A total of 1160 responses were obtained from 62 countries. Responses were categorized according to region of practice and analyzed using Fisher’s exact test and chi-square test with Bonferroni correction as needed. Results: There were significant statistical differences between regions for nearly all questions. Doxorubicin was more commonly used among respondents from North America, Europe, and South Korea than Japan and China (p = 0.0001). For single and multiple HCCs, drug-eluting bead TACE was most popular in North America and Europe (p = 0.0001), while conventional TACE was most popular in Japan, Korea, and China (p = 0.0001). CT was the most commonly used modality for follow-up among all respondents, although MR was used more commonly in North America and in academic centers (p = 0.0001). Conclusion: This survey provides comprehensive information on and confirms the heterogeneous nature of current practice patterns in regard to TA(C)E for HCC. Key Points: • There is a lack of information regarding current practice patterns in the area of technical considerations when performing transarterial chemoembolization. • Type of transarterial chemoembolization utilized to treat hepatocellular carcinoma varies widely across geographical area. • Chemotherapeutic agents and embolic agents used to perform transarterial chemoembolization for the treatment of hepatocellular carcinoma vary widely across geographical areas.
• Young, S., Golzarian, J., & Anderson, J. (2019). Thermal Ablation of T1a Renal Cell Carcinoma: The Clinical Evidence. Seminars in Interventional Radiology, 36(5). doi:10.1055/s-0039-1696650
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  Renal cell carcinoma (RCC) is most commonly diagnosed at an early (T1a) stage and is typically amenable to several effective treatments. The current gold standard therapy is partial nephrectomy, given its decreased morbidity and similar oncologic outcomes when compared with radical nephrectomy. Thermal ablation is an evolving definitive therapy for T1a RCC which is even less invasive than partial nephrectomy. This article reviews the evidence for thermal ablation in the treatment of T1a RCC and compares outcomes of existing ablation modalities with surgical management.
• Young, S., Taylor, A., Golzarian, J., Flanagan, S., D'Souza, D., & Sanghvi, T. (2019). Clinical utility of one month imaging following selective internal radiation therapy. Diagnostic and Interventional Imaging, 100(1). doi:10.1016/j.diii.2018.07.005
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  Purpose: The goal of this retrospective review was to determine the clinical relevance of one-month post-treatment imaging in the selective internal radiation therapy (SIRT) patient population by reporting the incidence of change in clinical management. Materials and methods: Between January 2012 and January 2016, 85 patients underwent 109 SIRT treatments for either primary or secondary hepatic malignancies. There were 59 men and 26 women with a mean age of 62.4 years (range: 39–89 years). Patients’ medical records were retrospectively reviewed for procedural, historical, laboratory and imaging information. The imaging study was considered to have changed patients’ clinical management if it resulted in the addition of a new procedure, canceling of a planned procedure or change in systemic therapy. Results: The one-month post-treatment imaging findings led to management changes in 10 of 109 (9.2%) of treatments. When evaluated by cancer type, 2/61 (3.3%) hepatocellular carcinoma (HCC) treatments had management changed while 8/48 (16.7%) non-HCC treatments underwent management change (P = 0.03). This difference was also significant at multivariate analysis (P = 0.03; odds ratio: 0.17 [0.03–082]). Conclusion: Management is rarely changed by one-month post-SIRT imaging in patients with HCC and thus is likely unwarranted. Conversely, in non-HCC patients, one month post-SIRT imaging led to a significant percentage of clinical management changes suggesting that one month imaging in this setting is likely warranted.
• Young, S., & Rosenberg, M. (2018). Percutaneous Removal of an Infected Renal Artery Stent Graft. Journal of Vascular and Interventional Radiology, 29(5). doi:10.1016/j.jvir.2017.11.020
• Young, S., Bergren, L., Dunn, T., Shrestha, P., Yadav, K., Frank, N., Kandaswamy, R., & Golzarian, J. (2018). Outcomes of endovascular management of late vascular hemorrhage after pancreatic transplant. American Journal of Roentgenology, 210(1). doi:10.2214/AJR.17.18171
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  OBJECTIVE. The aim of this retrospective study is to evaluate the endovascular treatment of hemorrhage in the nonperioperative setting in pancreas transplant recipients. MATERIALS AND METHODS. All angiograms performed between January 1, 1999, and June 1, 2016, to treat hemorrhage after pancreatic transplant at a single large-volume transplant center were reviewed. Fourteen patients who underwent 21 angiograms were identified. The patients' charts were reviewed for clinical indications, technical aspects of the endovascular interventions, outcomes, and complications. RESULTS. The mean number of angiograms was 1.5 per patient. The primary and primary assisted clinical success rates were 64.3% (9/14 patients) and 71.4% (10/14 patients), respectively. Five patients (35.7%) experienced complications. At presentation, eight patients had functioning grafts and seven of these eight patients (87.5%) maintained graft function. CONCLUSION. It is critical to recognize transplant-related hemorrhage after pancreas transplant. Endovascular management is associated with high clinical success and rarely results in loss of graft function, suggesting that it should be a consideration for first-line therapy in this patient population.
• Young, S., Wong, J., Rosenberg, M., Golzarian, J., & Frank, N. (2018). Treatment of peristomal hemorrhage: A review of outcomes and comparison of two minimally invasive techniques. Diagnostic and Interventional Imaging, 99(12). doi:10.1016/j.diii.2018.08.017
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  Purpose: The purpose of this study was to review and compare outcomes between percutaneous sclerotherapy and transjugular intrahepatic portosystemic shunt (TIPS) treatments in patients with peristomal variceal bleeding. Materials and methods: Ten patients who underwent sclerotherapy (n = 3 patients), TIPS placement (n = 5 patients) or both (n= 2 patients) for peristomal variceal bleeding were retrospectively reviewed. There were 6 women and 4 men, with a mean age of 62.6 years (range: 44–84 years). Data pertaining to the technical aspects of the procedure, demographics, and information regarding the underlying cause of ostomy and portal hypertension were collected. Treatment was considered a primary success if no further hemorrhage occurred. Results: No differences in primary success were found between TIPS cohort (100%) and sclerotherapy cohort (40%) (P = 0.4). Sclerotherapy patients had a poorer nutritional status (mean albumin serum level of 2.04 g/dL in the sclerotherapy group and 2.95 g/dL in theTIPS group; P = 0.04) and worse liver function (mean total bilirubin serum level of 4.9 mg/dL in the sclerotherapy group and 1.6 mg/dL in the TIPS group; P = 0.07). Conclusion: While further investigation is needed, TIPS may be more effective than sclerotherapy in treating peristomal variceal bleeding. However, sclerotherapy may serve as an effective bridging mechanism in critically ill patients.
• Jung, J., Shin, T., Mccutcheon, K., Borofsky, M., Narayan, V., Young, S., Golzarian, J., Kim, M., Reddy, B., & Dahm, P. (2017). Prostatic arterial embolization for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database of Systematic Reviews, 2017(11). doi:10.1002/14651858.CD012867
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  This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of PAE for the treatment of LUTS in men with BPH.
• Smith, C., Craig, P., Taleb, S., Young, S., & Golzarian, J. (2017). Comparison of Traditional and Emerging Surgical Therapies for Lower Urinary Tract Symptoms in Men: A Review. CardioVascular and Interventional Radiology, 40(8). doi:10.1007/s00270-017-1575-7
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  Lower urinary tract symptoms (LUTS) are one of the most common health issues in men and pose a significant economic challenge in healthcare. Transurethral resection of the prostate (TURP) remains the gold standard surgical treatment for medically refractive LUTS secondary to benign prostatic hyperplasia. The institution of medical therapy and the development of several minimally invasive surgical therapies (MISTs) began in the 1980’s and 1990’s. Together, these therapies brought about a change in the natural course of the disease, stimulating investigation into the economic consequences of various management approaches. TURP has been observed to have higher complication rates, but better efficacy and lower retreatment rates compared to MISTs. Staying abreast of the evolving understanding of LUTS and the alternative treatment options is imperative for radiologists.
• Yadav, K., Young, S., Finger, E., Kandaswamy, R., Sutherland, D., Golzarian, J., & Dunn, T. (2017). Significant arterial complications after pancreas transplantation—A single-center experience and review of literature. Clinical Transplantation, 31(10). doi:10.1111/ctr.13070
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  Arterial fistulas and pseudoaneurysms are rarely described significant arterial complications associated with pancreas transplantation that sometimes present with herald or catastrophic bleeding. We herein describe our institutional case series with a focus on management and outcomes. Of 2256 pancreas transplants, 24 arterial complications were identified in 23 recipients. Chart review was performed to describe the clinical characteristics, treatments, and outcomes of the complications (pseudoaneurysm, arterial enteric/cystic/ureteric fistula, or arteriovenous fistula). Of these 23 patients, 57% had a failed allograft at the time of the complication. Nine patients underwent primary surgical repair of 10 complications, 13 were treated by endovascular methods, and one patient by medical management. In total, 3 embolized patients rebled, 2 of which had failed allografts prior to treatment. Of those with graft function that were treated by embolization alone, all retained graft function. Diagnosis of arterial complications requires a high degree of suspicion and should involve early systemic angiography to evaluate the pancreatic vasculature. Management can be endovascular or surgical and should be individualized. We report our center's evolution from a predominantly surgical to endovascular approach as a definitive vs stabilizing therapy, with selective coiling mostly reserved for well-defined peripheral lesions in patients with a functioning allograft.
• Young, S., & Golzarian, J. (2017). Prostate Arterial Embolization is a Viable Option for Treating Symptoms of Benign Prostatic Hyperplasia: Pro. Journal of Urology, 198(1). doi:10.1016/j.juro.2017.04.073
• Young, S., & Golzarian, J. (2017). Regarding: Y90 Radioembolization Significantly Prolongs Time to Progression Compared With Chemoembolization in Patients With Hepatocellular Carcinoma. Gastroenterology, 152(6). doi:10.1053/j.gastro.2016.09.070
• Young, S., Flanagan, S., Golzarian, J., & D’Souza, D. (2017). Review of the Clinical Evidence for the Use of DEBIRI in the Treatment of Colorectal Metastatic Disease. CardioVascular and Interventional Radiology, 40(4). doi:10.1007/s00270-016-1537-5
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  Colorectal cancer is a common malignancy that most commonly metastasizes to the liver. There has been considerable effort in developing new treatment options for these patients. One method that has been developed for the treatment of colorectal metastases to the liver is irinotecan-loaded drug-eluting bead (DEBIRI) embolization. This article reviews the current literature on DEBIRI and discusses the state of current knowledge and possible areas of future investigation.
• Young, S., Scanlon, P., Sherestha, P., Golzarian, J., & Sanghvi, T. (2017). Duplex Ultrasound Versus Clinical Surveillance in the Prediction of TIPS Malfunction Placed for Refractory Ascites: Is Ultrasound Surveillance Useful?. CardioVascular and Interventional Radiology, 40(12). doi:10.1007/s00270-017-1706-1
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  Purpose: Since the advent of expanded polytetrafluoroethylene-covered stents and the improved patency they confer for transjugular intrahepatic portosystemic shunt (TIPS), the need to perform ultrasound surveillance has been debated. Prior reports have failed to separately evaluate patients who had TIPS placed for refractory ascites and variceal bleeding. The difference in morbidity from TIPS malfunction between these cohorts argues for distinction between the two. This retrospective review aims to determine whether Duplex ultrasound or return of symptoms more accurately predicts TIPS dysfunction. Materials and Methods: Seventy-eight consecutive venograms in forty patients were retrospectively reviewed. TIPS venograms were used as the gold standard for TIPS dysfunction and considered abnormal if a pressure gradient >12 mmHg was discovered. Patients’ charts were reviewed to assess for a return/worsening of ascites. Lastly, the two ultrasounds prior to TIPS revision were evaluated. Results: The sensitivities of symptom relapse and ultrasound were 83 and 80.0%, respectively, while the specificities were 38.7 and 4.0%, respectively. The sensitivities were not found to be statistically different (p > 0.05); however, symptom relapse was found to be statistically more specific (p < 0.05). Conclusion: Symptom relapse is as sensitive and perhaps more specific than ultrasound in patients who had TIPS placed for refractory ascites.
• Young, S., Pritzker, M., & Rosenberg, M. (2016). Vacuum-Assisted Thrombectomy of Massive Pulmonary Embolism. Journal of Vascular and Interventional Radiology, 27(7). doi:10.1016/j.jvir.2016.01.145
• Young, S., Young, L., Vogel, J., Sutkowski, R., & Venkataperumal, S. (2016). Accessing totally implantable venous access systems on the day of placement does not significantly increase the risk of infection. Journal of Vascular Access, 17(3). doi:10.5301/jva.5000505
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  Purpose: Totally implantable venous access systems (ports) are commonly placed and have a low complication rate. The most common complication is infection, which can have very negative effects on patients resulting in hospitalization and/or treatment delay in the setting of neoplasm. While a number of variables have been studied in relation to diminishing infectious rates, one remaining question is the effect of accessing the port on day of placement, which is the aim of this retrospective study. Materials and methods: After internal review board approval the electronic medical records of 2, 006 patients who underwent port placement between 10/1/2008 and 9/30/2013 were reviewed. Of these patients 628 were excluded as they did not have complete placement and removal data available, leaving 1378 patients in our cohort. Results: There was a significantly longer number of infection-free catheter days in the out-patient cohort as compared to the in-patient cohort (p = 0.027). In-patients mean day after placement when the port was first accessed (DAP) (0.5) was statistically earlier (closer to placement) than the out-patients DAP (7.2) (p
• Young, S., Toskich, B., & Zendejas, I. (2014). Combined laparoscopic placement of a PTBD demonstrating multidisciplinary problem-solving in a complex patient. Radiology Case Reports, 9(4). doi:10.2484/rcr.v9i4.1022
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  In rare cases, biliary drainage is prevented by colonic position. When these situations arise within a critically ill patient who is not a good surgical candidate, unique solutions must be found. In this case, the solution was to use laparoscopic assistance to displace the colon while the interventional radiology team successfully accessed the biliary system.
• Young, S., Vogel, J., Wiley, S., & Caridi, J. (2013). Transarterial fiducial marker placement: A novel technique. Journal of Vascular and Interventional Radiology, 24(5). doi:10.1016/j.jvir.2013.01.011
• Young, S., Abbitt, P., & Hughes, S. (2012). Port-Site Recurrence of Pancreatic Adenocarcinoma Following Laparoscopic Pancreaticoduodenectomy. Journal of Gastrointestinal Surgery, 16(12). doi:10.1007/s11605-012-2050-z
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  Introduction: Minimally invasive surgical approaches have only recently been applied to pancreatic adenocarcinoma. Discussion: Significant apprehension exists that minimally invasive pancreatic surgery will not lead to equivalent or superior oncologic outcomes compared to traditional surgical approaches. This is the first case report of a port-site recurrence following laparoscopic pancreaticoduodenectomy. © 2012 The Society for Surgery of the Alimentary Tract.
• Zahodne, L., Young, S., Kirsch-Darrow, L., Nisenzon, A., Fernandez, H., Okun, M., & Bowers, D. (2009). Examination of the Lille Apathy Rating Scale in Parkinson disease. Movement Disorders, 24(5). doi:10.1002/mds.22441
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  Apathy is a unique, multidimensional syndrome commonly encountered in patients with Parkinson disease (PD). Recently, the Lille Apathy Rating Scale (LARS), a semistructured interview yielding a global score, and composite subscores for different domains of apathy (i.e., cognitive, behavioral, affective, self awareness), was developed and given to a sample of patients with PD in France. This study is the first outside of its original developers to examine the English language version of the LARS in PD. We found the LARS to be a coherent instrument demonstrating both convergent and divergent validity, as compared to the Apathy Scale (AS) and Beck Depression Inventory (BDI-II). Using a receiver operating characteristic (ROC) analysis comparing the LARS to the AS, a validated and widely-used measure, we identified a cut-off score (sensitivity = 64%, specificity = 92%, PPV = 88%, NPV = 75%) that was higher than that proposed by the original authors, who derived their cutoff by comparing LARS global scores to clinical judgments of apathy. Although the present study does not compare the LARS to a diagnostic gold standard or promote its utility for diagnosing apathy, it provides further support for the LARS as a promising instrument to examine apathy in PD. © 2009 Movement Disorder Society.

Reviews

• Caplin, D. M., Young, S., Kassin, M., Dowell, J. D., Makary, M. S., Metwalli, Z. A., Charalel, R. A., Halin, N. J., Kleedehn, M., Lewis, P. B., Ward, T. J., & Shah, R. P. (2023. A History and Modern Framework for Quality Improvement in Interventional Radiology(pp 2012-2019).
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  Quality improvement (QI) initiatives have benefited patients as well as the broader practice of medicine. Large-scale QI has been facilitated by multi-institutional data registries, many of which were formed out of national or international medical society initiatives. With broad participation, QI registries have provided benefits that include but are not limited to establishing treatment guidelines, facilitating research related to uncommon procedures and conditions, and demonstrating the fiscal and clinical value of procedures for both medical providers and health systems. Because of the benefits offered by these databases, Society of Interventional Radiology (SIR) and SIR Foundation have committed to the development of an interventional radiology (IR) clinical data registry known as VIRTEX. A large IR database with participation from a multitude of practice environments has the potential to have a significant positive impact on the specialty through data-driven advances in patient safety and outcomes, clinical research, and reimbursement. This article reviews the current landscape of societal QI programs, presents a vision for a large-scale IR clinical data registry supported by SIR, and discusses the anticipated results that such a framework can produce.