2024
Effect of Incomplete Cryoablation and Matrix Metalloproteinase Inhibition on Intratumoral CD8+ T-Cell Infiltration in Murine Hepatocellular Carcinoma.
Shewarega A, Santana J, Nam D, Berz A, Tefera J, Kahl V, Mishra S, Coman D, Duncan J, Roberts S, Wetter A, Madoff D, Chapiro J. Effect of Incomplete Cryoablation and Matrix Metalloproteinase Inhibition on Intratumoral CD8+ T-Cell Infiltration in Murine Hepatocellular Carcinoma. Radiology 2024, 310: e232365. PMID: 38349244, PMCID: PMC10902598, DOI: 10.1148/radiol.232365.Peer-Reviewed Original ResearchConceptsT cell infiltrationCD8<sup>+</sup> T cellsMatrix metalloproteinase inhibitionT cellsHepatocellular carcinomaMatrix metalloproteinase inhibitorsMatrix metalloproteinasesResidual tumorCXCR3<sup>+</sup> CD8<sup>+</sup> T cellsCytotoxic CD8<sup>+</sup> T cell infiltrationIntratumoral CD8+ T cell infiltrationCD8+ T cell infiltrationCD8<sup>+</sup> T cell infiltrationMouse model of hepatocellular carcinomaEarly-stage hepatocellular carcinomaImage-guided tumor ablationUnpaired Student's <i>t</i> testModel of hepatocellular carcinomaFirst-line therapyMurine hepatocellular carcinomaT cell subsetsTumor-associated macrophagesMurine HCC modelLocal immune responseFemale BALB/c mice
2022
Machine Learning Models for Prediction of Posttreatment Recurrence in Early-Stage Hepatocellular Carcinoma Using Pretreatment Clinical and MRI Features: A Proof-of-Concept Study.
Iseke S, Zeevi T, Kucukkaya AS, Raju R, Gross M, Haider SP, Petukhova-Greenstein A, Kuhn TN, Lin M, Nowak M, Cooper K, Thomas E, Weber MA, Madoff DC, Staib L, Batra R, Chapiro J. Machine Learning Models for Prediction of Posttreatment Recurrence in Early-Stage Hepatocellular Carcinoma Using Pretreatment Clinical and MRI Features: A Proof-of-Concept Study. American Journal Of Roentgenology 2022, 220: 245-255. PMID: 35975886, PMCID: PMC10015590, DOI: 10.2214/ajr.22.28077.Peer-Reviewed Original ResearchConceptsEarly-stage hepatocellular carcinomaLiver transplantHepatocellular carcinomaImaging featuresPosttreatment recurrenceOrgan allocationMean AUCLiver transplant eligibilityPretreatment clinical characteristicsPretreatment MRI examinationsKaplan-Meier analysisKaplan-Meier curvesClinical characteristicsImaging surveillanceTherapy allocationTransplant eligibilityUnderwent treatmentClinical parametersRetrospective studyUnpredictable complicationMRI dataConcept studyPoor survivalClinical impactPretreatment MRI
2021
Improved performance and consistency of deep learning 3D liver segmentation with heterogeneous cancer stages in magnetic resonance imaging
Gross M, Spektor M, Jaffe A, Kucukkaya AS, Iseke S, Haider SP, Strazzabosco M, Chapiro J, Onofrey JA. Improved performance and consistency of deep learning 3D liver segmentation with heterogeneous cancer stages in magnetic resonance imaging. PLOS ONE 2021, 16: e0260630. PMID: 34852007, PMCID: PMC8635384, DOI: 10.1371/journal.pone.0260630.Peer-Reviewed Original ResearchRole of 3D quantitative tumor analysis for predicting overall survival after conventional chemoembolization of intrahepatic cholangiocarcinoma
Rexha I, Laage-Gaupp F, Chapiro J, Miszczuk MA, van Breugel JMM, Lin M, Konstantinidis M, Duran R, Gebauer B, Georgiades C, Hong K, Nezami N. Role of 3D quantitative tumor analysis for predicting overall survival after conventional chemoembolization of intrahepatic cholangiocarcinoma. Scientific Reports 2021, 11: 9337. PMID: 33927226, PMCID: PMC8085245, DOI: 10.1038/s41598-021-88426-x.Peer-Reviewed Original ResearchConceptsTotal tumor volumeConventional transarterial chemoembolizationTumor diameterIntrahepatic cholangiocarcinomaOverall survivalTumor areaICC patientsTumor volumeHigh tumor burden groupTumor analysisOS of patientsHazard ratioTransarterial chemoembolizationTumor burdenBurden groupConventional chemoembolizationHTB groupRetrospective analysisPatientsSurvival curvesMultivariate analysisChemoembolizationCholangiocarcinomaETVBaseline imagesElastin-specific MRI of extracellular matrix-remodelling following hepatic radiofrequency-ablation in a VX2 liver tumor model
Collettini F, Reimann C, Brangsch J, Chapiro J, Savic LJ, Onthank DC, Robinson SP, Karst U, Buchholz R, Keller S, Hamm B, Goldberg SN, Makowski MR. Elastin-specific MRI of extracellular matrix-remodelling following hepatic radiofrequency-ablation in a VX2 liver tumor model. Scientific Reports 2021, 11: 6814. PMID: 33767303, PMCID: PMC7994448, DOI: 10.1038/s41598-021-86417-6.Peer-Reviewed Original ResearchThermal ablation alone vs thermal ablation combined with transarterial chemoembolization for patients with small (<3 cm) hepatocellular carcinoma
Chai NX, Chapiro J, Petukhova A, Gross M, Kucukkaya A, Raju R, Zeevi T, Elbanan M, Lin M, Perez-Lozada JC, Schlachter T, Strazzabosco M, Pollak JS, Madoff DC. Thermal ablation alone vs thermal ablation combined with transarterial chemoembolization for patients with small (<3 cm) hepatocellular carcinoma. Clinical Imaging 2021, 76: 123-129. PMID: 33592550, PMCID: PMC8217099, DOI: 10.1016/j.clinimag.2021.01.043.Peer-Reviewed Original ResearchConceptsOverall survivalTransarterial chemoembolizationHepatocellular carcinomaThermal ablationTA groupEarly-stage hepatocellular carcinomaMedian overall survivalTherapy-naïve patientsKaplan-Meier analysisMaximum tumor diameterStage hepatocellular carcinomaLog-rank testDrug-eluting beadsSmall hepatocellular carcinomaTerms of TTPHIPAA-compliant IRBSignificant differencesLipiodol-TACELocoregional therapyBCLC stageComplication rateTreatment cohortsTumor diameterAFP levelsPatient group
2020
Comparison of Drug-Eluting Embolics versus Conventional Transarterial Chemoembolization for the Treatment of Patients with Unresectable Hepatocellular Carcinoma: A Cost-Effectiveness Analysis
Wu X, Chapiro J, Malhotra A, Kothary N. Comparison of Drug-Eluting Embolics versus Conventional Transarterial Chemoembolization for the Treatment of Patients with Unresectable Hepatocellular Carcinoma: A Cost-Effectiveness Analysis. Journal Of Vascular And Interventional Radiology 2020, 32: 2-12.e1. PMID: 33160827, DOI: 10.1016/j.jvir.2020.09.022.Peer-Reviewed Original ResearchAdolescentAdultAgedAged, 80 and overAntibiotics, AntineoplasticCarcinoma, HepatocellularChemoembolization, TherapeuticClinical Decision-MakingCost SavingsCost-Benefit AnalysisDecision Support TechniquesDecision TreesDisease ProgressionDoxorubicinDrug CarriersDrug CostsFemaleHumansLiver NeoplasmsMaleMiddle AgedModels, EconomicQuality of LifeQuality-Adjusted Life YearsTime FactorsTreatment OutcomeYoung AdultAutomated feature quantification of Lipiodol as imaging biomarker to predict therapeutic efficacy of conventional transarterial chemoembolization of liver cancer
Stark S, Wang C, Savic LJ, Letzen B, Schobert I, Miszczuk M, Murali N, Oestmann P, Gebauer B, Lin M, Duncan J, Schlachter T, Chapiro J. Automated feature quantification of Lipiodol as imaging biomarker to predict therapeutic efficacy of conventional transarterial chemoembolization of liver cancer. Scientific Reports 2020, 10: 18026. PMID: 33093524, PMCID: PMC7582153, DOI: 10.1038/s41598-020-75120-7.Peer-Reviewed Original ResearchConceptsConventional transarterial chemoembolizationLipiodol depositionTransarterial chemoembolizationLiver cancerPeripheral depositionLipiodol depositsTherapeutic efficacyNecrotic tumor areasBaseline MRITherapy optionsTumor responseTreatment responseTumor volumeLiver lesionsLipiodolH postTumor areaH-CTHounsfield unitsBiomarkersChemoembolizationHigh rateTumorsCancerImproved responseQuantitative volumetric assessment of baseline enhancing tumor volume as an imaging biomarker predicts overall survival in patients with glioblastoma
Auer TA, Della Seta M, Collettini F, Chapiro J, Zschaeck S, Ghadjar P, Badakhshi H, Florange J, Hamm B, Budach V, Kaul D. Quantitative volumetric assessment of baseline enhancing tumor volume as an imaging biomarker predicts overall survival in patients with glioblastoma. Acta Radiologica 2020, 62: 1200-1207. PMID: 32938221, DOI: 10.1177/0284185120953796.Peer-Reviewed Original ResearchConceptsProgression-free survivalOverall survivalTumor volumeGlioblastoma multiformeMagnetic resonance imagingMultivariable analysisCommon malignant primary brain tumorIntracranial progression-free survivalKarnofsky performance status scoreCranial magnetic resonance imagingMalignant primary brain tumorMedian overall survivalPerformance status scoreOS of patientsCox regression modelSignificant prognostic rolePrimary brain tumorsContrast-enhanced MRI sequencesQuantitative volumetric assessmentResection statusPrognostic roleMethyltransferase statusWorse prognosisEntire cohortNon-invasive methodFibronodular hepatocellular carcinoma—a new variant of liver cancer: clinical, pathological and radiological correlation
Tefera J, Revzin M, Chapiro J, Savic L, Mulligan D, Batra R, Taddei T, Jain D, Zhang X. Fibronodular hepatocellular carcinoma—a new variant of liver cancer: clinical, pathological and radiological correlation. Journal Of Clinical Pathology 2020, 74: 31-35. PMID: 32430483, PMCID: PMC7674234, DOI: 10.1136/jclinpath-2020-206574.Peer-Reviewed Original ResearchConceptsAdvanced Barcelona Clinic Liver Cancer stageBarcelona Clinic Liver Cancer stageScirrhous HCCMultiple rounded nodulesNon-peripheral washoutLiver Cancer stageRadiological featuresClinical featuresRadiological correlationCarcinoma variantsCancer stageHCC casesHepatocellular carcinomaLiver cancerFibrotic liverConventional HCCHCCLower ratesHigh rateRounded nodulesProgressionDistinct patternsCarcinomaSpecific variantsLesionsNeutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictors of tumor response in hepatocellular carcinoma after DEB-TACE
Schobert IT, Savic LJ, Chapiro J, Bousabarah K, Chen E, Laage-Gaupp F, Tefera J, Nezami N, Lin M, Pollak J, Schlachter T. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictors of tumor response in hepatocellular carcinoma after DEB-TACE. European Radiology 2020, 30: 5663-5673. PMID: 32424595, PMCID: PMC7483919, DOI: 10.1007/s00330-020-06931-5.Peer-Reviewed Original ResearchMeSH KeywordsAgedBlood PlateletsCarcinoma, HepatocellularChemoembolization, TherapeuticFemaleHumansInflammationKaplan-Meier EstimateLiver NeoplasmsLymphocytesMagnetic Resonance ImagingMaleMiddle AgedMultivariate AnalysisNeutrophilsPrognosisProgression-Free SurvivalProportional Hazards ModelsRetrospective StudiesTreatment OutcomeConceptsProgression-free survivalTreatment-naïve hepatocellular carcinomaShorter progression-free survivalPoor tumor responseDEB-TACELymphocyte ratioTumor responseHepatocellular carcinomaMagnetic resonance imagingTumor growthInflammatory biomarkersDrug-eluting bead transarterial chemoembolizationContrast-enhanced magnetic resonance imagingHigher baseline NLRHigher baseline plateletsRadiomic featuresVolumetric tumor responseLoco-regional therapyAlpha-fetoprotein levelsBead transarterial chemoembolizationKaplan-Meier analysisMethodsThis retrospective studyDifferential blood countQuantitative European AssociationNodular tumor growthQuantification of contrast-uptake as imaging biomarker for disease progression of renal cell carcinoma after tumor ablation
Tegel BR, Huber S, Savic LJ, Lin M, Gebauer B, Pollak J, Chapiro J. Quantification of contrast-uptake as imaging biomarker for disease progression of renal cell carcinoma after tumor ablation. Acta Radiologica 2020, 61: 1708-1716. PMID: 32216452, PMCID: PMC7529766, DOI: 10.1177/0284185120909964.Peer-Reviewed Original ResearchMeSH KeywordsAblation TechniquesAdultAgedAged, 80 and overBiomarkers, TumorCarcinoma, Renal CellContrast MediaDisease ProgressionFemaleHumansImaging, Three-DimensionalKidney NeoplasmsMaleMiddle AgedNeoplasm StagingRadiography, InterventionalRetrospective StudiesSensitivity and SpecificityTumor BurdenUltrasonography, InterventionalConceptsProgression-free survivalTotal tumor volumeRenal cell carcinomaCell carcinomaOdds ratioTumor volumeImaging biomarkersImage-guided thermal ablationPrognosis of patientsRENAL nephrometry scoreCox regression modelLargest tumor diameterLog-rank testKaplan-Meier plotsCross-sectional imagingSensitive imaging biomarkerMetastatic diseaseSecondary outcomesPrimary outcomeDistant metastasisNephrometry scoreTumor diameterOutcome parametersLesion vascularityTNM stage
2019
Comparing HCC arterial tumour vascularisation on baseline imaging and after lipiodol cTACE: how do estimations of enhancing tumour volumes differ on contrast-enhanced MR and CT?
Luedemann WM, Geisel D, Gebauer B, Schnapauff D, Chapiro J, Wieners G, Steffen I, Kahn J. Comparing HCC arterial tumour vascularisation on baseline imaging and after lipiodol cTACE: how do estimations of enhancing tumour volumes differ on contrast-enhanced MR and CT? European Radiology 2019, 30: 1601-1608. PMID: 31811428, DOI: 10.1007/s00330-019-06430-2.Peer-Reviewed Original ResearchConceptsLipiodol depositionNative CT scansTumor volumeTumour vascularisationTechnical successHCC patientsCE-CTCT scanDifferent imaging modalitiesImaging modalitiesContrast-enhanced CTContrast-enhanced MRPearson correlation coefficientBaseline imagingSubgroup analysisRespective regression coefficientsCT groupLinear regression analysisCE-MRICE-MRVascularisationCTContrast phasesPatientsCTACEFluorodeoxyglucose PET for Monitoring Response to Embolotherapy (Transarterial Chemoembolization) in Primary and Metastatic Liver Tumors
Schobert I, Chapiro J, Pucar D, Saperstein L, Savic LJ. Fluorodeoxyglucose PET for Monitoring Response to Embolotherapy (Transarterial Chemoembolization) in Primary and Metastatic Liver Tumors. PET Clinics 2019, 14: 437-445. PMID: 31472741, DOI: 10.1016/j.cpet.2019.06.008.Peer-Reviewed Original ResearchMeSH KeywordsAgedCarcinoma, HepatocellularChemoembolization, TherapeuticFemaleFluorodeoxyglucose F18HumansInfusions, Intra-ArterialLiver NeoplasmsMagnetic Resonance ImagingMaleMiddle AgedMonitoring, PhysiologicMultimodal ImagingNeoplasm MetastasisPositron-Emission TomographyRadiopharmaceuticalsSensitivity and SpecificitySurvival AnalysisTomography, X-Ray ComputedTreatment OutcomeTumor MicroenvironmentConceptsTransarterial chemoembolizationLiver tumorsFluorine-18 fluorodeoxyglucose PETEfficacy of embolotherapyCross-sectional imaging techniquesMetastatic liver tumorsCancer cell glycolysisLocal recurrenceFluorodeoxyglucose PETTumor necrosisLiver cancerMorphologic changesCell glycolysisEmbolotherapyTumorsMonitoring responseIndividual molecular characteristicsMolecular characteristicsImaging techniquesChemoembolizationResponsePatientsRecurrencePETTherapyDeep learning for liver tumor diagnosis part II: convolutional neural network interpretation using radiologic imaging features
Wang CJ, Hamm CA, Savic LJ, Ferrante M, Schobert I, Schlachter T, Lin M, Weinreb JC, Duncan JS, Chapiro J, Letzen B. Deep learning for liver tumor diagnosis part II: convolutional neural network interpretation using radiologic imaging features. European Radiology 2019, 29: 3348-3357. PMID: 31093705, PMCID: PMC7243989, DOI: 10.1007/s00330-019-06214-8.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAlgorithmsBile Duct NeoplasmsBile Ducts, IntrahepaticCarcinoma, HepatocellularCholangiocarcinomaDeep LearningFemaleHumansImage Interpretation, Computer-AssistedLiver NeoplasmsMachine LearningMagnetic Resonance ImagingMaleMiddle AgedNeural Networks, ComputerPredictive Value of TestsProof of Concept StudyRetrospective StudiesConceptsDeep learning systemConvolutional neural networkLearning systemRelevance scoresFeature mapsPre-trained CNN modelsFeature relevance scoresMulti-phasic MRINeural network interpretationEvidence-based decision supportDeep NeuralDeep learningCNN modelLesion classifierLearning prototypeNeural networkOriginal imageSystem prototypeDecision supportLesion classificationNetwork interpretationImage voxelsIncorrect featuresLesion classesTest setDeep learning for liver tumor diagnosis part I: development of a convolutional neural network classifier for multi-phasic MRI
Hamm CA, Wang CJ, Savic LJ, Ferrante M, Schobert I, Schlachter T, Lin M, Duncan JS, Weinreb JC, Chapiro J, Letzen B. Deep learning for liver tumor diagnosis part I: development of a convolutional neural network classifier for multi-phasic MRI. European Radiology 2019, 29: 3338-3347. PMID: 31016442, PMCID: PMC7251621, DOI: 10.1007/s00330-019-06205-9.Peer-Reviewed Original ResearchAdultAgedBile Duct NeoplasmsBile Ducts, IntrahepaticCarcinoma, HepatocellularCholangiocarcinomaDeep LearningFemaleHumansImage Interpretation, Computer-AssistedLiver NeoplasmsMagnetic Resonance ImagingMaleMiddle AgedNeural Networks, ComputerReproducibility of ResultsROC CurveSensitivity and SpecificityUnited StatesA 3D quantitative imaging biomarker in pre-treatment MRI predicts overall survival after stereotactic radiation therapy of patients with a singular brain metastasis
Della Seta M, Collettini F, Chapiro J, Angelidis A, Engeling F, Hamm B, Kaul D. A 3D quantitative imaging biomarker in pre-treatment MRI predicts overall survival after stereotactic radiation therapy of patients with a singular brain metastasis. Acta Radiologica 2019, 60: 1496-1503. PMID: 30841703, DOI: 10.1177/0284185119831692.Peer-Reviewed Original ResearchConceptsIntracranial progression-free survivalSingular brain metastasisStereotactic radiation therapyPre-treatment magnetic resonance imagingMagnetic resonance imagingBrain metastasesPrognostic factorsTumor volumeRadiation therapyCranial magnetic resonance imagingContrast-enhanced MRI scansMultivariable Cox regressionProgression-free survivalIntracranial malignant tumorPrediction of survivalOverall survivalMultivariable analysisPrognostic indexCox regressionRetrospective studyMalignant tumorsQuantitative imaging biomarkersMRI scansPatientsRadiomic biomarkersQuantitative Imaging Biomarkers for 90Y Distribution on Bremsstrahlung SPECT After Resin-Based Radioembolization
Schobert I, Chapiro J, Nezami N, Hamm CA, Gebauer B, Lin M, Pollak J, Saperstein L, Schlachter T, Savic LJ. Quantitative Imaging Biomarkers for 90Y Distribution on Bremsstrahlung SPECT After Resin-Based Radioembolization. Journal Of Nuclear Medicine 2019, 60: 1066-1072. PMID: 30655331, PMCID: PMC6681698, DOI: 10.2967/jnumed.118.219691.Peer-Reviewed Original ResearchMeSH KeywordsAgedAngiographyBiomarkersCarcinoma, HepatocellularEmbolization, TherapeuticFeasibility StudiesFemaleHumansImaging, Three-DimensionalLiverLiver NeoplasmsMagnetic Resonance ImagingMaleMicrospheresMiddle AgedMultimodal ImagingPrognosisRegression AnalysisRetrospective StudiesTomography, Emission-Computed, Single-PhotonTomography, X-Ray ComputedTreatment OutcomeYttrium RadioisotopesConceptsNon-HCC patientsTransarterial radioembolizationHepatocellular carcinomaBaseline imagingTumor responseTumor volumeChild-Pugh class B patientsBaseline imaging featuresClass B patientsNormal liver ratiosTotal tumor volumeSPECT/CTContrast-enhanced MRIQuantitative European AssociationMultiphasic contrast-enhanced MRIInstitutional review boardHigh TNRPreprocedural MRIChild-PughB patientsLiver criteriaTumor burdenClinical parametersHepatic malignanciesRetrospective study
2018
Irinotecan-Eluting 75–150-μm Embolics Lobar Chemoembolization in Patients with Colorectal Cancer Liver Metastases: A Prospective Single-Center Phase I Study
Fereydooni A, Letzen B, Ghani MA, Miszczuk MA, Huber S, Chapiro J, Schlachter T, Geschwind JF, Georgiades C. Irinotecan-Eluting 75–150-μm Embolics Lobar Chemoembolization in Patients with Colorectal Cancer Liver Metastases: A Prospective Single-Center Phase I Study. Journal Of Vascular And Interventional Radiology 2018, 29: 1646-1653.e5. PMID: 30337148, DOI: 10.1016/j.jvir.2018.08.010.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overAntineoplastic AgentsBiomarkers, TumorChemoembolization, TherapeuticColorectal NeoplasmsConnecticutDrug CarriersFeasibility StudiesFemaleHumansIrinotecanLiver NeoplasmsMaleMicrospheresMiddle AgedPalliative CareProspective StudiesTime FactorsTomography, X-Ray ComputedTreatment OutcomeVascular Endothelial Growth Factor AVascular Endothelial Growth Factor Receptor-1Vascular Endothelial Growth Factor Receptor-2ConceptsVascular endothelial growth factor receptor 1Transarterial chemoembolizationAdverse eventsMetastatic diseaseObjective responseColorectal cancer liver metastasesLiver-dominant metastatic diseaseMetastatic colorectal cancer refractorySingle-center phase IColorectal cancer refractoryLines of chemotherapyMedian overall survivalPrimary end pointCancer liver metastasesResponse Evaluation CriteriaOnly grade 3Drug-eluting embolicsImaging-based criteriaGrowth factor receptor 1Factor receptor 1World Health OrganizationCancer refractoryAbdominal painSystemic chemotherapyLiver metastasesClinical Experience with Real-Time 3-D Guidance Based on C-Arm-Acquired Cone-Beam CT (CBCT) in Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS) Placement
Böning G, Lüdemann WM, Chapiro J, Jonczyk M, Hamm B, Günther RW, Gebauer B, Streitparth F. Clinical Experience with Real-Time 3-D Guidance Based on C-Arm-Acquired Cone-Beam CT (CBCT) in Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS) Placement. CardioVascular And Interventional Radiology 2018, 41: 1035-1042. PMID: 29541837, DOI: 10.1007/s00270-018-1877-4.Peer-Reviewed Original ResearchMeSH KeywordsCone-Beam Computed TomographyFeasibility StudiesFemaleFluoroscopyHepatic VeinsHumansHypertension, PortalImaging, Three-DimensionalMaleMiddle AgedPortal VeinPortasystemic Shunt, Transjugular IntrahepaticProspective StudiesPuncturesRadiography, InterventionalRetrospective StudiesStentsTreatment OutcomeUltrasonographyConceptsPuncture attemptsTIPSS placementTIPSS procedureProcedure timeTransjugular intrahepatic portosystemic stent shunt placementMean puncture timeSuccess ratePortal vein punctureSignificant differencesShunt placementPuncture timeConsecutive casesMedian numberProspective groupVein punctureUS guidanceClinical experienceControl groupCone beamStudy designCone-beam CTMean timeDoseCBCT guidancePatients