Clinical Focus


  • Interventional Radiology
  • Diagnostic Radiology

Professional Education


  • Fellowship: Stanford University Radiology Fellowships (2017) CA
  • Residency: Stanford University Radiology Residency (2016) CA
  • Board Certification: American Board of Radiology, Diagnostic Radiology (2017)
  • Internship: Santa Clara Valley Medical Center Dept of Medicine (2012) CA
  • Medical Education: Harvard Medical School (2011) MA

Graduate and Fellowship Programs


  • Vascular Interventional Radiology (Fellowship Program)

All Publications


  • Technical and Anatomic Factors Influencing the Success of Inferior Vena Caval Stent Placement for Malignant Obstruction. Journal of vascular and interventional radiology Devcic, Z., Techasith, T., Banerjee, A., Rosenberg, J. K., Sze, D. Y. 2016; 27 (9): 1350-1360 e1

    Abstract

    To evaluate the outcomes of inferior vena cava (IVC) stent placement for malignant obstruction and to identify anatomic and procedural factors influencing technical and clinical success.A total of 57 patients (37 male, 20 female; age range, 22-86 y) underwent 62 IVC stent placement procedures using 97 stents (47 Wallstents, 15 S.M.A.R.T. stents, 18 Wallflex stents, 17 others) from 2005 to 2016 for malignant IVC obstruction caused by hepatic metastases (n = 22; 39%), primary hepatic malignancy (n = 16; 28%), retroperitoneal metastases (n = 16; 28%), or other primary malignancy (n = 5; 9%). Presenting symptoms included lower-extremity edema (n = 54; 95%), ascites (n = 28; 50%), and perineal edema (n = 14; 25%). Sixteen percent (n = 10) and 10% (n = 6) of the procedures involved tumor and bland thrombus, respectively.Stent placements resulted in 100% venographic patency and significantly decreased pressure gradients (P < .0001). Lower-extremity swelling, perineal swelling, and abdominal distension improved within 7 days in 83% (35 of 42), 100% (9 of 9), and 40% (6 of 15) of patients, respectively, and at 30 days after the procedure in 86% (25 of 29), 89% (8 of 9), and 80% (4 of 5) of patients, respectively. Increased pre- and post-stent placement pressure gradients were associated with worse outcomes. A 4% stent misplacement rate (4 of 97) was related to the use of Wallstents with caudal stent tapering, asymmetric deployment superior to the obstruction, suprahepatic IVC involvement, and decreased stent adherence to the IVC wall as a result of local mechanical factors.Stent placement is reliable, rapid, and durable in improving malignant IVC syndrome. Understanding of technical and anatomic factors can improve accuracy and avoid complications of stent misplacement.

    View details for DOI 10.1016/j.jvir.2016.02.030

    View details for PubMedID 27117949

  • Emergent Salvage Direct Intrahepatic Portocaval Shunt Procedure for Acute Variceal Hemorrhage JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Ward, T. J., Techasith, T., Louie, J. D., Hwang, G. L., Hofmann, L. V., Sze, D. Y. 2015; 26 (6): 829-834

    Abstract

    To review the safety and effectiveness of direct intrahepatic portocaval shunt (DIPS) creation with variceal embolization for acute variceal hemorrhage after a failed transjugular intrahepatic portosystemic shunt (TIPS) creation attempt or in patients with prohibitive anatomy.Transjugular intrahepatic portosystemic shunt and DIPS procedures performed for variceal hemorrhage between January 2008 and July 2014 were reviewed. The default procedure was TIPS creation, with DIPS creation reserved for patients with unfavorable anatomy or who had technically unsuccessful TIPS creation. Thirteen patients underwent DIPS creation (mean age, 60 y ± 12; Child-Pugh class A/B/C, 8%/62%/30%; Model for End-stage Liver Disease score, 15 ± 5; range, 8-26) and 117 underwent TIPS creation. Four patients underwent a TIPS attempt and were converted to DIPS creation upon technical failure; 9 were treated primarily with DIPS creation because of preprocedural imaging revealing unfavorable anatomy (intrahepatic portal thrombosis, n = 2; venous distortion from prior hepatic resections, n = 2; severely angulated hepatic veins, n = 5).Direct intrahepatic portocaval shunt creation with variceal embolization (six gastric or esophageal; seven stomal, duodenal, or rectal) was successful in all patients; 11 also had concomitant variceal sclerotherapy. Mean DIPS procedure time was less than 2 hours. There was 1 major procedural complication. During a mean follow-up of 13.0 months ± 15.5, 1 patient developed DIPS thrombosis and recurrent hemorrhage; 1 patient underwent successful transplantation. Two deaths were observed within 30 days, neither associated with recurrent hemorrhage.Direct intrahepatic portocaval shunt creation appears to be a safe, expedient, and effective treatment for patients with acute variceal hemorrhage who are poor anatomic candidates for TIPS creation or who have undergone unsuccessful TIPS creation attempts.

    View details for DOI 10.1016/j.jvir.2015.03.004

    View details for PubMedID 25881512

  • The Efficacy of Hepatic 90Y Resin Radioembolization for Metastatic Neuroendocrine Tumors: A Meta-Analysis. Journal of nuclear medicine : official publication, Society of Nuclear Medicine Devcic, Z., Rosenberg, J., Braat, A. J., Techasith, T., Banerjee, A., Sze, D. Y., Lam, M. G. 2014; 55 (9): 1404-1410

    Abstract

    (90)Y resin radioembolization is an emerging treatment in patients with liver-dominant metastatic neuroendocrine tumors (mNETs), despite the absence of level I data. The aim of this study was to evaluate the efficacy of this modality in a meta-analysis of the published literature.A comprehensive review protocol screened all reports in the literature. Strict selection criteria were applied to ensure consistency among the selected studies: human subjects, complete response data with time interval, resin microspheres, more than 5 patients, not a duplicate cohort, English language, and separate and complete data for resin-based (90)Y treatment of mNET if the study included multiple tumor and microsphere types. Selected studies were critically appraised on 50 study criteria, in accordance with the research reporting standards for radioembolization. Response data (Response Evaluation Criteria in Solid Tumors) were extracted and analyzed using both fixed and random-effects meta-analyses.One hundred fifty-six studies were screened; 12 were selected, totaling 435 procedures for response assessment. Funnel plots showed no evidence of publication bias (P = 0.841). Critical appraisal revealed a median of 75% of desired criteria included in selected studies. Very high between-study heterogeneity ruled out a fixed-effects model. The random-effects weighted average objective response rate (complete and partial responses, CR and PR, respectively) was 50% (95% confidence interval, 38%-62%), and weighted average disease control rate (CR, PR, and stable disease) was 86% (95% confidence interval, 78%-92%). The percentage of patients with pancreatic mNET was marginally associated with poorer response (P = 0.030), accounting for approximately 23% of the heterogeneity among studies. The percentage of CR and PR correlated with median survival (R = 0.85; P = 0.008).This meta-analysis confirms radioembolization to be an effective treatment option for patients with hepatic mNET. The pooled data demonstrated a high response rate and improved survival for patients responding to therapy.

    View details for DOI 10.2967/jnumed.113.135855

    View details for PubMedID 25012459

  • A comparison of reconstruction and viewing parameters on image quality and accuracy of stress myocardial CT perfusion JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY Ghoshhajra, B. B., Rogers, I. S., Maurovich-Horvat, P., Techasith, T., Verdini, D., Sidhu, M. S., Drzezga, N. K., Medina, H. M., Blankstein, R., Brady, T. J., Cury, R. C. 2011; 5 (6): 459-466

    Abstract

    Myocardial stress computed tomography perfusion (CTP) has similar diagnostic accuracy for detecting perfusion defects (PDs) versus single-photon emission computed tomography (SPECT). However, the optimal diagnostic viewing and image processing parameters for CTP are unknown.We sought to compare the diagnostic accuracy of different image processing techniques, cardiac phases, slice thicknesses, and viewing parameters for detection of PDs.A stress and rest dual-source CTP protocol was performed with adenosine. Twelve subjects with severe stenosis proven by quantitative coronary angiography (QCA), with corresponding territorial defects at SPECT, were selected as well as 7 controls (subjects with similar clinical suspicion but negative QCA and SPECT). Short-axis stress images were processed with 3 techniques: minimum intensity projection (MinIP), maximum intensity projection, and average intensity multiplanar reconstruction (MPR), 3 thicknesses (1, 3, 8 mm), and 2 phases (systolic, mid-diastolic). The resulting images (n = 1026) were randomized and interpreted by independent readers.Diastolic reconstructions (8-mm MPR) showed the highest sensitivity (81%) to detect true PDs. The highest accuracy was achieved with the 8-mm (61%) and 1-mm (61%) MPR diastolic images. The most sensitive and accurate systolic reconstructions were 3-mm MinIP images. These findings related to viewing in relatively narrow window width and window level settings.Viewing parameters for optimal accuracy in detection of perfusion defects on CTP differ for systolic and diastolic images.

    View details for DOI 10.1016/j.jcct.2011.10.011

    View details for Web of Science ID 000310933700013

    View details for PubMedID 22146505