Suvranu Ganguli's research while affiliated with Boston Medical Center and other places

Publications (187)

Article
The liver is the most common site of metastatic disease in colorectal cancer, and, in the setting of liver-dominant disease, a chief contributor to mortality. Chemotherapy is the backbone of treatment for metastatic colorectal cancer; however, the duration of response is limited and resistance to therapy inevitably develops. Radioembolization repre...
Article
Nontraumatic aortic disease can be caused by a wide variety of disorders including congenital, inflammatory, infectious, metabolic, neoplastic, and degenerative processes. Imaging examinations such as radiography, ultrasound, echocardiography, catheter-based angiography, CT, MRI, and nuclear medicine examinations are essential for diagnosis, treatm...
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Purpose The American College of Radiology (ACR), American Brachytherapy Society (ABS), American College of Nuclear Medicine (ACNM), American Society for Radiation Oncology (ASTRO), Society of Interventional Radiology (SIR), and Society of Nuclear Medicine and Molecular Imaging (SNMMI) have jointly developed a practice parameter on selective interna...
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BACKGROUND: Primary colon cancer location in metastatic colorectal cancer (mCRC) affects survival. Outcomes based on primary tumor location after salvage hepatic radioembolization with Yttrium-90 resin microspheres (Y90) are not well studied. OBJECTIVE: To assess survival outcomes in patients with advanced chemorefractory mCRC treated with Y90 radi...
Chapter
The role of endovascular therapy in venous thoracic outlet syndrome (VTOS) is critical but complex, particularly with regard to the role of stent placement. The borders of the venous thoracic outlet are rigid, potentially limiting the utility of stents in the pre-surgical setting and creating significant long-term problems if the thoracic outlet is...
Chapter
Performing interventional procedures requires a different skillset not traditionally associated with nephrology training. It involves developing cognitive skills and understanding the indications of different interventional procedures, their limitations and potential complications, mastering fluoroscopic eye-hand coordination, understanding the beh...
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Purpose To describe interventional oncology therapies combined with immune checkpoint inhibitor (ICI) therapy targeting the programmed death 1 pathway in patients with different neoplasms. Materials and Methods This was a retrospective cohort study of patients who underwent tumor-directed thermal ablation, embolization, or selective internal radia...
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Purpose: Maximally decreasing portal pressures with transjugular intrahepatic portosystemic shunt (TIPS) is associated with improved ascites control but also increased encephalopathy incidence. Since splenic venous flow contributes to portal hypertension, we assessed if combining small-diameter TIPS with splenic artery embolization could improve a...
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Modern systemic therapies provide a significant survival benefit in metastatic colorectal cancer. Despite these advances, the durability of response remains limited and nearly all patients progress on systemic treatment. Colorectal liver metastases (CLM) develop in approximately half of patients with metastatic disease and contribute to mortality i...
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Purpose To evaluate whether the recalculation of lung shunt fraction (LSF) is necessary prior to next-stage or same lobe repeat radioembolization. Materials and Methods Retrospective chart review was performed for patients who underwent radioembolization between February 2008 and December 2018. Eighty of 312 patients had repeat mapping angiograms...
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Aims The efficacy of somatostatin in altering splanchnic hemodynamics in cirrhotic portal hypertension is still controversial. We aimed to establish the dynamic effect of somatostatin on portal pressure in cirrhotic patients and compared its effect with Partial Splenic Embolization (PSE). Methods Eighteen patients with cirrhotic portal hypertensio...
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Introduction. Hepatic encephalopathy (HE) following transjugular intrahepatic portosystemic shunt (TIPS) placement remains a leading adverse event. Controversy remains regarding the optimal stent diameter given that smaller stents may decrease the amount of shunted blood and decrease the risk of HE, but stent patency and/or clinical adequacy of por...
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OBJECTIVE. The purpose of this article was to investigate the medical condition of patients who received substantial cumulative effective dose (CED) in fluoroscopically guided interventional (FGI) procedures. MATERIALS AND METHODS. We examined 25,253 patients (mean age, 58.2 years; 50.6% male) who underwent 46,491 FGI procedures at a tertiary care...
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e16119 Background: Assessment of the clinical outcomes and prognostic value of genomic mutations in colorectal liver metastases treated with Y90 radioembolization. Methods: Multi-institution retrospective study of patients who underwent Y-90 radioembolization treatment after tumor genotyping was completed for CRLM. Patients treated between 2008 and...
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Thoracic outlet syndrome (TOS) is the clinical entity that occurs with compression of the brachial plexus, subclavian artery, and/or subclavian vein at the superior thoracic outlet. Compression of each of these structures results in characteristic symptoms divided into three variants: neurogenic TOS, venous TOS, and arterial TOS, each arising from...
Article
239 Background: Assessment of the clinical outcome and prognostic factors of patients receiving Y90 radioembolization to treat colorectal liver metastases. Methods: Multi-institution retrospective study of patients with CRLM who received Y-90 radioembolization after undergoing molecular testing was performed. Patients treated between 2008 and 2019...
Article
Vascular malformations of the extremities represent a wide spectrum of lesions, broadly divided into high-flow and low-flow categories. High-flow lesions include arteriovenous malformations and arteriovenous fistulas, while the more common low-flow lesions consist of venous and lymphatic malformations. The clinical presentation of vascular malforma...
Article
Objectives: Most localized hepatocellular carcinoma (HCC) patients are not surgically operable or transplantation candidates, increasing the role for nonsurgical therapies. Ablative external beam radiotherapy (XRT) and transarterial radioembolization (TARE) are emerging radiotherapeutic treatments for localized HCC. We sought to evaluate their uti...
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Background/Aims The MELD score was developed to predict survival after transjugular intrahepatic portosystemic shunt (TIPS) placement. Given changes in practice patterns and development of new prognostic tools in cirrhosis, we aimed to evaluate common models to predict mortality after TIPS placement. Methods Analysis of consecutive patients who un...
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A broad range of nonatherosclerotic diseases affect the peripheral arteries. The appropriate initial diagnostic imaging studies vary, depending upon the clinical presentation and suspicion of disease. Accurate vascular imaging relies upon visualization of the vessel lumen, vessel wall, and surrounding soft-tissue structures, with some modalities al...
Article
Abdominal aortic aneurysm (AAA) is defined as aneurysmal dilation of the abdominal aorta to 3 cm or greater. A high degree of morbidity and mortality is associated with AAA rupture, and imaging surveillance plays an essential role in mitigating the risk of rupture. Aneurysm size and growth rate are factors associated with the risk of rupture, thus...
Article
Purpose To evaluate the feasibility of a same-day yttrium-90 (⁹⁰Y) radioembolization protocol with resin microspheres (including pretreatment angiography, lung shunt fraction [LSF] determination, and radioembolization) for the treatment of hepatocellular carcinoma (HCC) and liver metastases. Materials and Methods All same-day radioembolization pro...
Article
329 Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality worldwide. Most patients with localized HCC are not surgically operable or transplantation candidates, thus there is an increasing role for nonsurgical locoregional therapies. Ablative external beam radiotherapy (XRT) and transarterial radioembolization (TARE) are...
Article
Y90 radioembolization is an alternative to transarterial chemoembolization for the intra-arterial treatment of hepatocellular carcinoma (HCC). However, the optimal treatment of HCC varies by tumor stage, underlying liver function and functional status, and local expertise. Therefore, the appropriate selection of patients for Y90 radioembolization i...
Article
Objective: The objective of this study was to assess the safety, feasibility, and effectiveness of endobronchial forceps-assisted retrieval of inferior vena cava (IVC) filters when standard retrieval techniques fail. Methods: An Institutional Review Board-approved single-center retrospective review during a 6-year period identified 60 consecutiv...
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Purpose To present procedure-specific radiation dose metric distributions and define quantitative CT utilization factors for CT-guided interventional procedures. Materials and Methods This single-center, retrospective study collected dictation reports and radiation dose data from 9143 consecutive CT-guided interventional procedures in adult patient...
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Purpose To assess the safety of drug-eluting beads transarterial chemoembolization (DEB-TACE) for unresectable hepatocellular carcinoma (HCC) in patients with transjugular intrahepatic portosystemic shunt (TIPS). Materials and Methods Records of patients with a patent TIPS who underwent DEB-TACE for inoperable HCC from 2005 to 2014 at two instituti...
Article
Seventy-five percent of abdominal aortic aneurysms are now treated by endovascular aneurysm repair (EVAR) rather than open repair, given the decreased periprocedural mortality, complications, and length of hospital stay for EVAR compared to the surgical counterpart. An endoleak is a potential complication after EVAR, characterized by continued perf...
Article
Nivolumab has recently received approval by the Food and Drug Administration for treatment of advanced hepatocellular carcinoma (HCC) in patients previously treated with sorafenib. Nivolumabs’ overall response rate of 20% (El-Khoueiry et al. in Lancet 389:2492–2502, 2017) is a step forward for these patients, but there is significant room for impro...
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Dialysis associated steal syndrome (DASS) is a relatively rare but debilitating complication of arteriovenous fistulas. While mild symptoms can be observed, if severe symptoms are left untreated, DASS can result in ulcerations and limb threatening ischemia. High-flow with resultant heart failure is another documented complication following dialysis...
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Peripheral arterial disease (PAD) affects millions across the world and in the United States between 9% to 23% of all patients older than 55 years. The refinement of surgical techniques and evolution of endovascular approaches have improved the success rates of revascularization in patients afflicted by lower extremity PAD. However, restenosis or o...
Article
Endoleaks are a common complication of endovascular aortic repair (EVAR). As a result, patients require lifelong imaging surveillance following EVAR. In current clinical practice evaluation for endoleaks is predominantly performed with computed tomography angiography (CTA). Due to the significant cumulative radiation burden associated with repetiti...
Article
Aorto-enteric fistula (AEF) is a rare life-threatening condition. Early recognition and diagnosis are of paramount importance to improve outcome. In this article four cases of AEF with relevant pre- and post-procedural images are presented to demonstrate the utility of cross-sectional imaging in the work-up of AEF. The literature is reviewed to des...
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Elective abdominal aortic aneurysm (AAA) repair is recommended for aneurysms greater than 5.5 cm, symptomatic, or rapidly expanding more than 0.5 cm in 6 months. Seventy-five percent of AAAs today are treated with endovascular aneurysm repair (EVAR) rather than open repair. This is fostered by the lower periprocedural mortality, complications, and...
Article
The anatomy of aortic aneurysms from the proximal neck to the access vessels may create technical challenges for endovascular repair. Upwards of 30% of patients with abdominal aortic aneurysms (AAA) have unsuitable proximal neck morphology for endovascular repair. Anatomies considered unsuitable for conventional infrarenal stent grafting include sh...
Article
Bleeding is a common and often challenging complication of malignancy. Etiologies of hemorrhage in this patient population vary, and bleeding may present as an acute, life-threatening emergency or a chronic, low-volume blood loss. For patients with advanced malignancies, interventions to manage bleeding must be balanced by the patient's life expect...
Article
Objective: The purpose of this study is to evaluate the role of endovascular therapy in the management of venous thoracic outlet syndrome (TOS), with an emphasis on its role after surgical decompression. Materials and methods: This single-center retrospective review identified all patients who underwent conventional contrast-enhanced venography...
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Background: Tumoral macrovascular invasion (MVI) of hepatic and/or portal vein branches is a common phenomenon in hepatocellular carcinoma (HCC) and is associated with poorer prognosis when compared to HCC without MVI. Summary: Current international guidelines for the management of HCC recommend sorafenib as the only treatment option in case of...
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Spontaneous isolated celiac or superior mesenteric artery (SMA) dissection (SICMAD) is a rare clinical entity. Not much is known about the natural history and appropriate treatment. We retrospectively queried a prospectively collected institutional radiology database for all patients diagnosed with SICMAD from 1990 to 2017. We identified 42 arterie...
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Viral oncolysis broadly refers to the use of modified viruses to infect and subsequently lyse tumor cells. This concept arises from the observation that viral replication is itself effective in destroying tumor cells. This effect is then amplified by reinfection of adjacent tumor cells by the progeny virion released from lysed tumor cells. Herpes s...
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Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC) are primary liver cancers where all or most of the tumor burden is usually confined to the liver. Therefore, locoregional liver-directed therapies can provide an opportunity to control intrahepatic disease with minimal systemic side effects. The English medical literature and...
Article
Chylothorax is an uncommon but serious medical condition, which arises when intestinal lymphatic fluid leaks into the pleural space. Treatment strategies depend on the daily output and underlying etiology, which may be due to direct injury to lymphatic vessels or a nontraumatic disorder. Chest radiographs confirm the presence of pleural fluid and l...
Article
Clinical palpation of a pulsating abdominal mass alerts the clinician to the presence of a possible abdominal aortic aneurysm (AAA). Imaging studies are important in diagnosing and categorizing the extent of the aneurysm and may aid in treatment planning. The consensus of the literature supports the use of ultrasound as the initial screening test i...
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Background and Aim Endovascular embolization is a well-established option in the management of acute gastrointestinal bleeding (GIB) after failed therapeutic endoscopy; however, questions remain concerning the outcomes and the various predictors of clinical and technical success of this therapy. The authors aimed to assess the effectiveness of endo...
Article
Background: The long term efficacy of endovascular recanalization for chronic iliocaval occlusion secondary to inferior vena cava (IVC) filters is unknown. The purpose of this study was to evaluate the effectiveness of endovascular recanalization and stent placement across the filter in patients with filter-associated chronic iliocaval occlusion....
Article
Venous disease, particularly venous thromboembolism, is associated with significant mortality and morbidity. Over 200,000 first lifetime cases of venous thromboembolism occur every year in the United States. If the disease remains undetected, long-term morbidity can be significant. Up to 40% of patients with symptomatic deep vein thrombosis (DVT) d...
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Venous incompetence in the lower extremity is a common clinical problem. Basic understanding of venous anatomy, pathophysiologic mechanisms of venous reflux is essential for choosing the appropriate treatment strategy. The complex interplay of venous pressure, abdominal pressure, venous valvular function and gravitational force determine the venous...
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Deep venous thrombosis (DVT) affecting the extremities is a common clinical problem. Prompt imaging aids in rapid diagnosis and adequate treatment. While ultrasound (US) remains the workhorse of detection of extremity venous thrombosis, CT and MRI are commonly used as the problem-solving tools either to visualize the thrombosis in central veins lik...
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Incompetent superficial veins are the most common cause of lower extremity superficial venous reflux and varicose veins; however, incompetent or insufficient perforator veins are the most common cause of recurrent varicose veins after treatment, often unrecognized. Perforator vein insufficiency can result in pain, skin changes, and skin ulcers, and...
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Imaging of the venous system plays a vital role in the diagnosis and management of a wide range of clinically significant disorders. There have been great advances in venous imaging techniques, culminating in the use of magnetic resonance venography (MRV). Although MRV has distinct advantages in anatomic and quantitative cross sectional imaging wit...
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Venous compression syndromes are a unique group of disorders characterized by anatomical extrinsic venous compression, typically in young and otherwise healthy individuals. While uncommon, they may cause serious complications including pain, swelling, deep venous thrombosis (DVT), pulmonary embolism, and post-thrombotic syndrome. The major disease...
Article
Objectives: To compare utilization, procedural outcomes, complications and long-term patient outcomes associated with bedside placement of inferior vena cava filters (IVCF) using intravascular ultrasound (IVUS) and fluoroscopic placement of IVCF. Background: IVCF are usually placed under fluoroscopic-guidance in dedicated angiography suites. Bed...
Article
Purpose: To evaluate intraarterial catheter-directed thrombolysis for prediction and prevention of delayed surgical amputation as part of multidisciplinary management of frostbite injury. Materials and methods: A retrospective review was performed of 13 patients (11 men, 2 women; median age, 33.4 y; range, 8-62 y) at risk of tissue loss secondar...