Background and Aims Advances in cancer treatment have improved survival; however, local recurrence and metastatic disease—the principal causes of cancer mortality—have limited the ability to achieve durable remissions. Local recurrences arise from latent tumor cells that survive therapy and are often not detectable by conventional clinical imaging techniques. Local recurrence after transarterial embolization (TAE) of hepatocellular carcinoma (HCC) provides a compelling clinical correlate of this phenomenon. In response to TAE‐induced ischemia, HCC cells adapt their growth program to effect a latent phenotype that precedes local recurrence. Approach and Results In this study, we characterized and leveraged the metabolic reprogramming demonstrated by latent HCC cells in response to TAE‐induced ischemia to enable their detection in vivo using dynamic nuclear polarization (DNP) magnetic resonance spectroscopic imaging (MRSI) of 13carbon‐labeled substrates. Under TAE‐induced ischemia, latent HCC cells demonstrated reduced metabolism and developed a dependence on glycolytic flux to lactate. Despite the hypometabolic state of these cells, DNP‐MRSI of 1‐13C‐pyruvate and its downstream metabolites, 1‐13C‐lactate and 1‐13C‐alanine, predicted histological viability. Conclusions These studies provide a paradigm for imaging latent, treatment‐refractory cancer cells, suggesting that DNP‐MRSI provides a technology for this application.

Hepatocellular carcinoma (HCC), the most common primary liver cancer, of which ~800,000 new cases will be diagnosed worldwide this year, portends a five-year survival rate of merely 17% in patients...

For patients with renal masses and non-diagnostic imaging studies, image-guided percutaneous biopsy is found to be highly accurate and useful in directing patient management. Once the diagnosis of AML has been made based on either imaging or biopsy, arterial embolization of tumors that are symptomatic or >4 cm has been demonstrated to reduce the risk of hemorrhage as well as tumor size. Percutaneous ablation devices have been proposed as alternative strategies but remain investigational. The utility of interventional radiology techniques including percutaneous core needle biopsy and prophylactic super-selective arterial embolization is safe and effective management strategies for patients presenting with AML tumors.

In response to the COVID-19 pandemic reducing medical student presence on clinical services and in classrooms, academic institutions are utilizing a virtual format to continue medical student education. We describe a successful initial experience implementing a virtual elective in interventional radiology (IR) and provide the course framework, student feedback, and potential improvements. Materials and methods: A 2-week virtual IR elective curriculum was created utilizing a combination of synchronous and asynchronous learning and the "flipped" classroom educational model. Students virtually participated in daily IR resident education conferences, resident-led case review sessions, and dedicated lectures. Asynchronous prelearning material consisted of text and video correlating to lecture topics. Anonymous precourse and postcourse surveys were sent to all participating students (n = 10). Results: Ten students (100%) completed precourse and seven (70%) completed postcourse surveys. Enrolled students were considering residencies in surgery (50%), internal medicine (40%), interventional radiology (30%), and/or diagnostic radiology (30%). Students' understanding of what IRs do and the procedures they perform (p < 0.001), when to consult IR for assistance in patient management (p = 0.005), and the number of IR procedures students could recall (p = 0.015) improved after the course. Case-review sessions and virtual lectures ranked as having the highest education value. Students recommended additional small-group case workshops. Conclusion: This successful virtual IR elective provides a framework for others to continue IR medical student education during the pandemic and grow the specialty's presence within an increasingly virtual medical school curriculum. The described model may be modified to improve IR education beyond the COVID-19 era.

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Purpose To test the hypotheses that greater initial body weight is associated with a relative improvement in survival with diminished fibrosis in a diethylnitrosamine (DEN)-induced rat model of HCC and that TAE (TAE) via femoral artery access decreases procedure times compared to carotid artery access. Materials and Methods 138 male Wistar rats were administered 0.01% DEN in water ad libitum for 12 weeks. Rats received weekly T2-MRI to detect HCC. Upon development of ≥5mm tumors, rats underwent selective TAE via carotid or femoral artery catheterization under fluoroscopic guidance. Rats were retrospectively categorized into 3 groups (<300g, 300-400g, >400g) based on initial weight for analyses of survival, tumor latency, and fibrosis. Site of access was compared relative to procedural outcomes of success, mortality, and time. Results No significant differences in tumor latency were related to weight group (p=0.310). Rats weighing <300g had shorter survival time than both larger groups (mean=88d vs. 108d, p<0.0001) and more severe fibrosis (<300g median=4.0, 300-400g median=1.5, >400g median=1.0; p=0.015). No significant difference was found in peri-procedural mortality based on access site; however, procedure times were shorter via a femoral approach (mean=71+/-23min vs. 127+/-24min; p<0.0001). Conclusion Greater initial body weight resulted in improved survival without prolonging tumor latency for rats with DEN-induced HCCs and was associated with less severe fibrosis. A femoral approach for TAE in this model resulted in decreased procedure time. These modifications provide a translational animal model of HCC and TAE that may be suited for short-term survival studies.