[Show abstract][Hide abstract] ABSTRACT: Purpose:
As stereotactic radiotherapy (SRT) becomes widespread, precise information including number, location, and margin of lesions is required when magnetic resonance (MR) imaging of brain metastasis is performed. We compare methods using 2 separate injections and a single injection for the administration of a double dose of contrast medium for contrastenhanced MR imaging.
Materials and methods:
We divided 40 patients with brain metastasis into 2 groups of 20 patients. Group A received 2 separate injections (0.2 + 0.2 mL/kg) of contrast medium (gadoteridol); Group B received a single injection of the same total dose (0.4 mL/kg). Group A underwent spin echo (SE) T1-weighted imaging (T1WI) and magnetization prepared rapid acquisition with gradient echo sequence (MPRAGE) after each injection, and Group B underwent the same MR studies at the same timing as Group A. We evaluated the number, signal-to-noise ratio (SNR), diameter, margin delineation, and volume of lesions and compared them between early and delayed studies by the 2 methods.
The number of detected lesions was largest in delayed studies of MPRAGE in both groups. The SNR of the lesions was statistically lower in early studies of Group A than other studies. Delayed studies of Group B showed statistically better margin delineation than other studies on both SE-T1WI and MPRAGE studies. Diameter and enhanced volume were statistically significantly larger on delayed phase than early phase in both groups.
Use of a single injection of double-dose contrast medium and longer delay time may improve margin delineation of lesions for the study of brain metastasis. Enhanced volume was larger on delayed phase, and it may influence selection of therapeutic strategy.
Magnetic Resonance in Medical Sciences 08/2014; 13(4). DOI:10.2463/mrms.2013-0068 · 1.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hybrid CT/angiography (angio) system and C-arm cone-beam CT provide cross-sectional imaging as an adjunct to angiography. Current interventional oncologic procedures can be conducted precisely using these two technologies. In this article, several cases using a hybrid CT/angio system are shown first, and then the advantages and disadvantages of the hybrid CT/angio and C-arm cone-beam CT are discussed with literature reviews.
British Journal of Radiology 06/2014; 87(1041):20140126. DOI:10.1259/bjr.20140126 · 2.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Transcatheter embolization is considered to be less effective for early-stage hepatocellular carcinomas (HCCs) without a hypervascular arterial supply. In the present case report, a 65-year-old male with hepatitis type C and non-hypervascular HCC located in the hepatic hilum was successfully treated by bland transarterial embolization (TAE). After the temporary protective embolization of normal liver tissue using large gelatin particles, diluted 40-μm microspheres were injected via the tumor-feeding artery. The tumor shrank, and the patient has survived for 25 months without recurrence.
Anticancer research 04/2014; 34(4):1947-51. · 1.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose
To compare the efficacy, complications, and inflammatory levels in partial splenic embolization (PSE) with coils or gelatin sponge (GS) particles with or without intraarterial antibiotic agents.
Materials and Methods
Forty-four patients with hypersplenism treated by PSE were assessed. GS particles were used in 31 patients, and coils were used in 13 patients. In 17 of the 31 patients who received GS, GS suspended in antibiotic solution was injected via the splenic artery. In the other 14 patients, antibiotic agents were not used. In all 13 coil group patients, an antibiotic solution was intraarterially injected before embolization. Platelet counts were compared between the GS and coil groups. Complications and serum C-reactive protein (CRP) levels were compared among the three groups.
There were no significant differences in platelet counts and platelet increased ratios at 6 months (10.0 × 104/µL and 193% in the GS group vs 9.0 × 104/µL and 221% in the coil group), and no significant differences in frequencies of complications. However, one splenic abscess occurred in a patient treated with GS without antibiotics, resulting in death. The mean serum CRP level in the GS with antibiotic group at 2 weeks was significantly lower than in the other two groups.
The efficacy of PSE is similar with the use of coils versus GS particles. Prophylactic intraarterial antibiotic treatment could be useful in preventing inflammatory reactions after PSE.
Journal of vascular and interventional radiology: JVIR 03/2014; 25(6). DOI:10.1016/j.jvir.2013.12.563 · 2.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Single-incision laparoscopic surgery has recently received more attention. We developed a novel simple technique of gasless transumbilical single-incisional laparoscopic-assisted appendectomy (TUSILAA) and retrospectively analyzed our initial experience.
TUSILAA has been attempted in 50 consecutive patients with acute appendicitis. The vertical incision through the umbilicus was used for laparoscopic access and the abdominal wall was lifted by a Kent retractor set system.
Our technique was successful in 45 out of 50 (90 %) patients. The median operating time was 59 min (range 35-140). The median length of postoperative hospital stay was 4 days (range 2-12). None of the cases were converted to open appendectomy. There were no perioperative surgical complications.
Our novel technique, gasless TUSILAA, is safe and feasible with acceptable operative time and excellent cosmetic result. Furthermore, this procedure has the advantage of cost-effectiveness since any disposable instruments including trocars, staplers, or expensive devices are not required. Therefore, this could be used as the first-choice surgical procedure for selected patients with uncomplicated acute appendicitis.
Langenbeck s Archives of Surgery 01/2014; 399(3). DOI:10.1007/s00423-014-1164-z · 2.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
Our previous report presented at RSNA 2012 demonstrated the importance of the 3-dimmensional embolization margin (3D-safety margin) in superselective transcatheter arterial chemoembolization (TACE), which could significantly prolong disease free survival. We developed novel navigation TACE using hybrid CT/Angio with a workstation to obtain 3D-safety margin, and prospectively evaluated the feasibility of this technique.
METHOD AND MATERIALS
Fifteen patients with small HCC (size: 1.2-2.9cm, mean 1.8cm) and good liver function (Child-Pugh score: 5-7, mean 5.5) were enrolled in this pilot study. Firstly, a maximum intensity projection (MIP) imaging of the hepatic arteriography was created using CT during hepatic arteriography (CTHA) via the common hepatic artery (CHA). Secondly, a catheter was superselectively inserted into the tumor feeding artery, and presence or absence of the 3D-safety margin was evaluated by the 3D-fusion images reconstructed using whole liver CTHA via CHA and superselective CTHA via the targeted artery. Thirdly, in the cases without 3D-safety margins, the regions, which lacked safety margins, were marked by a workstation (ZIOSTATIONR). These markings automatically appeared on the MIP images, which showed the arterial branches supplying the tumor surrounding areas.
In 13 of 15 patients, 3D-safety margins were absent in the initial fusion images. In all 13 cases, the MIP images of the hepatic arteriography clearly showed the supplying branches into the marginal areas. Superselective TACE using lipiodol (mean volume 2.7ml) mixed with epirubicin (mean volume 23mg) were conducted via both the tumor feeding arteries and the marginal branches. 3D-safety margins were obtained in all 15 patients. No severe complications including liver dysfunction were observed. The mean Child-Pugh score after TACE was 5.5, and no local recurrence was seen during follow-up periods (mean 233 days, range: 171-344 days).
Superselective TACE using this novel navigation technique can achieve 3D-safety margin for HCC patients. Currently, a phase II study using this technique is ongoing to evaluate the local tumor recurrence rate for long term period.
Superselective TACE using this navigation technique can achieve 3D-safety margin, which could prevent local recurrence.
Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
[Show abstract][Hide abstract] ABSTRACT: The purpose of this pilot study was to assess the effectiveness of repeated bland-TAE using small-size microspheres for liver metastases. To date, there have been no publications as to whether bland-TAE could be effective for nonhypervascular liver tumors.
Bland-TAE with 100-μm, calibrated microspheres was performed in two chemoresistant patients: one with colorectal metastases and the other with gastric metastases. Both patients had multiple tumors in the entire liver. An implantable port-catheter system was placed in the hepatic artery to conduct repeated embolizations, thereby achieving enough efficacies. Microspheres were injected via the port until the disappearance of the tumor stains. Angiographies via the port were conducted 1, 3, 7, and 14 days after bland-TAE to evaluate the patency of the hepatic artery.
The hepatic artery started to recanalize 1 day after TAE and tumor stains appeared again during the 14 days. In both patients, bland-TAE was repeated four times in intervals of 14-21 days. The enhanced CTs showed necrotic changes and the decrease in size of the tumors. The serum CEA level decreased from 2,989 to 70 ng/ml and from 174 to 48 ng/ml, respectively. Bilomas and a liver abscess developed as complications.
Repeated bland-TAE using 100-μm microspheres injected via an implantable port-catheter system could be effective for liver metastases, although the caution of biliary injury is needed.
[Show abstract][Hide abstract] ABSTRACT: : The aim of this study was to evaluate the safety and feasibility for single-incision laparoscopic cholecystectomy (SILC) by retrospective comparison with conventional laparoscopic cholecystectomy (CLC) in a local community hospital.
: SILC was introduced and performed in 57 patients for benign gallbladder diseases. Their clinical data were compared with those of 62 patients treated with CLC. They included patient demographic data and operative outcomes.
: SILC was attempted in 57 patients and 52 cases (91.2%) were successfully completed. There were no statistical differences between the 2 groups in terms of operative time, blood loss, and postoperative complications. The length of hospital stay in the SILC group was significantly shorter compared with CLC (P<0.0001).
: SILC has been successfully introduced in a local community hospital. The safety and feasibility was also confirmed. The SILC procedure may become 1 standard option for the treatment of benign gallbladder diseases.
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
The purpose of this study is to identify the importance of the 3-dimmensional embolization margin (3D-safety margin) in superselective transcatheter arterial chemoembolization (TACE) and to evaluate the usefulness of fusion imaging by CT during hepaticarteriography (CTHA).
METHOD AND MATERIALS
In 209 consecutive patients underwent TACE for hepatocellular carcinoma (HCC) between March 2006 and August 2008, 44 patients with solitary small HCC (1.0- 3.0cm in diameter, mean 1.9) who underwent superselective TACE were retrospectively analyzed. Superselective TACE was performed using lipiodol mixed with anticancer agents followed by the injection of gelatin sponge particles. Before TACE, the 3D-safety margin was accessed by the fusion images reconstructed using whole liver CTHA via the common hepatic artery and superselective CTHA via the targeted arterial branch. Local disease-free survival (DFS) and overall survival (OS) were calculated by Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to assess the prognostic factors.
In all patients, the fusion images using CTHA clearly showed the relationship between the tumor and the embolization area. The qualitative assessment of fusion images was satisfied. The mean follow-up duration was 36 months (range 5- 56). The 2-year local DFS rate was 59%. The 1-, 2-, 3-year OS was 95.5%, 86.4% and 67.3%, respectively. 3D-safety margins were achieved in 28 patients. Multivariate analysis revealed 3D-safety margin as the independent prognostic factor of DSF (hazard ratio; 0.134, 95% CI; 0.037-0.483, p=0.002). The 2-year local DFS rate in the patients with 3D-safety margin was 82.1% (versus without of that; 18.7%, p<0.001).
Superselective TACE with the 3D-safety margin could enhance a treatment efficacy for HCC. CT fusion imaging using CTHA is useful to access the 3D-safety margin during the superselective TACE procedure.
To achieve 3D-safety margin is important of in superselective TACE to prolong disease free survival, and the fusion imaging using CTHA is useful to evaluate 3D-safety margin.
Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
To retrospectively assess the feasibility and efficacy of hepatic arterial infusion chemotherapy (HAIC) using a fine powder formulation of cisplatin (cisplatin powder) as a salvage treatment for advanced hepatocellular carcinoma (HCC) failed to transcatheter arterial chemoembolization (TACE) and to identify the prognostic factors.
METHOD AND MATERIALS
In 463 consecutive patients underwent TACE for hepatocellular carcinoma (HCC) between December 2006 and March 2011, 52 HCC patients (median age, 70 years; range, 51- 85; Child-Pugh A 26, B 22, C 4) failed or contraindicated to TACE underwent HAIC using cisplatin powder. Cisplatin solution (65mg/m2) was administered every 4-6 weeks and repeated up to 6 times. The overall survival (OS) was evaluated using the Kaplan–Meier method and prognostic factors were accessed by univariate and multivariate Cox regression analyses.
The mean follow-up period was 10.6 months (range, 1.0– 35.9). The response rate evaluated by RECIST was 9.6%. The overall median OS was 12.1 months. On multivariate analysis, Child-Pugh A and portal vein tumor thrombosis (Vp) of <3 were independent favorable prognostic factors. The median OS were 15.8 months in Child-Pugh A (vs 7.2 months in Child-Pugh B/C, p=0.035) and 14.2 months in Vp0-2 (vs 4.9 months in Vp3/4, p=0.001). The following major Grade3/4 toxicities were observed: thrombocytopenia (28.8%), aspartate transaminase elevation (13.5%) and bilirubin elevation (11.5%).
HAIC using cisplatin powder was well-tolerated and effective in prolonging the survival of patients with HCC failed to TACE. The patients with Child-Pugh A and Vp0-2 are considered to be optimal candidates for this therapy.
HAIC using cisplatin powder is a promising salvage therapy for patients with advanced HCC failed to TACE. The patients with Child-Pugh A and Vp0-2 could be optimal candidates for this therapy.
Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
[Show abstract][Hide abstract] ABSTRACT: A 70-year-old man with liver cirrhosis due to hepatitis C viral infection had a single well-differentiated hepatocellular carcinoma(HCC) of 5-cm diameter in the right superior anterior segment of the liver. Surgery could not be performed because of his poor liver function. Furthermore, it was difficult to treat this tumor with transcatheter arterial chemoembolization because the tumor exhibited hypovascularity. Radiofrequency ablation (RFA) alone was also not an option because the tumor was too large to manage with a simple RFA procedure. This solitary tumor was adjacent to the right and middle hepatic veins. Finally, we planned to treat this tumor with RFA and temporary vessel occlusion as follows: RFA was performed with a 5-cm expandable type RITA model 90 electrode under temporary occlusions of the right anterior hepatic artery with degradable starch microspheres, and of the right and middle hepatic veins by balloon catheters, to reduce the heat sink effect and obtain a larger coagulation size. We successfully treated this HCC with RFA combined with temporary vessel occlusion, and the patient has not obtained local recurrence at 18 months of the procedure.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):1822-4.
[Show abstract][Hide abstract] ABSTRACT: Objective:
Miriplatin(MP) is a promising newly developed anticancer agent for transcatheter arterial chemoinfusion in patients with hepatocellular carcinoma(HCC), particularly those previously not treated with chemotherapy. The aim of this study was to assess the efficacy and safety of transarterial chemolipiodolization with MP for recurrent HCC in patients previously treated with chemotherapy.
Materials and methods:
From January 2010 to March 2011, 17 patients with recurrent HCC were treated with MP via a transcatheter arterial approach. The dose of MP per treatment session was up to 140 mg. We repeated this treatment protocol until tumor progression occurred. We assessed the therapeutic results and the adverse events.
MP was infused at a dose of 60-140 mg in the initial treatment session; the mean treatment session number was 1.8; and the total dose of MP was 60-400 mg (median, 120 mg). Response rate and disease control rate after the initial treatment were 17.6% and 47.1%,respectively. Response rate and disease control rate after the total treatment session were 17.6% and 29.4%,respectively. Median tumor-free survival was 86 days. We encountered a severe adverse event in 1 patient who died due to his concomitant disease( diabetic nephropathy and radiation hepatitis) 38 days after this protocol.
The therapeutic result of MP was unsatisfactory, but adverse events due to MP infusion, including renal and/or liver damage, were minor.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):1840-2.
[Show abstract][Hide abstract] ABSTRACT: Response rates to systemic chemotherapy for unresectable pancreatic cancer are low. The purposes of this phases 1 and 2 study of intraarterial therapy were to ascertain the recommended dose of intraarterial chemoinfusion and to evaluate the efficacy and safety of this therapy.
Pancreatic arteries originating from the superior mesenteric artery (the anterior and posterior inferior pancreaticoduodenal and the dorsal pancreatic) were embolized to achieve a single blood supply from the celiac artery to manage pancreatic cancer, and a catheter-port system was placed. Intraarterial 5-fluorouracil (5-FU) and IV gemcitabine (fixed dose of 1000 mg/m(2)) were administered. In phase 1, doses of 5-FU were increased from 750 to 1000 mg/m(2). In phase 2, tumor response, toxicity, and survival time were assessed.
A total of 20 patients were enrolled. In 19 patients (95%), the technique to unify the pancreatic blood supply was successful. No severe toxicity was observed with escalation of the 5-FU dose. The tumor response rate was 68.8%. The median overall survival time was 9.8 months and the progression-free survival time, 6.0 months. The grade 3 toxicities neutropenia (15.8%) and thrombocytopenia (5.3%) occurred.
In intraarterial administration of 5-FU at a dose of 1000 mg/m(2) combined with full-dose systemic gemcitabine for unresectable pancreatic cancer, the toxicity rate was acceptable, and response rate and survival time improved over those for treatment with gemcitabine alone.
American Journal of Roentgenology 06/2012; 198(6):1445-52. DOI:10.2214/AJR.11.8008 · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although chemoradiotherapy with full-dose gemcitabine as a strategy for locally advanced pancreatic cancer was expected to optimize local tumor control and prevent distant metastasis, the volume of the radiation field is the critical factor related to toxicities. We are currently developing a novel therapeutic technique to conduct neoadjuvant treatments of intra-arterial chemoinfusion prior to chemoradiotherapy with the aim of tumor volume reduction. Case
In two patients with locally invasive pancreatic cancer, the pancreatic blood supply was altered under angiographic guidance, and an intra-arterial catheter with a subcutaneous port was left in place for the administration of 5-fluorouracil (5-FU) 1,000 mg/m(2). After shrinkage of the tumor, chemoradiotherapy with gemcitabine 1,000 mg/m(2) was delivered. In both patients, the full-dose gemcitabine was administered concurrently with radiation therapy without severe complications. The patients responded to the treatment with survival times of 42 and 38 months.
Intra-arterial chemoinfusion followed by chemoradiation with full-dose systemic gemcitabine might prove to be a promising therapeutic approach for locally advanced pancreatic cancer. Large prospective Phase II trials of this combination regimen are warranted.
Anticancer research 11/2011; 31(11):3909-12. · 1.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Brain abscess associated with an arteriovenous fistula (AVF) is sometimes difficult to diagnose and tends to recur. We report a case of recurrent brain abscess due to a pulmonary AVF (PAVF). A 69-year-old woman with a mass in the left cerebral peduncle had taken a progressively worse and shown decorticate rigidity. After an intravenous antibiotic for fever of unknown origin was changed, her condition gradually improved. She was discharged with the help of a cane. Thirty-one months later, she suffered left hemiparesis. Magnetic resonance imaging revealed a cystic mass in the right lateral frontal lobe. At surgery, we confirmed pus in the cyst. A PAVF was detected and was treated with coil embolization. The left hemiparesis improved and the postoperative course was uneventful. Exhaustive study is absolutely necessary to detect the etiology of recurrent brain abscess and to achieve a cure.
Journal of Infection and Chemotherapy 08/2011; 17(4):552-4. DOI:10.1007/s10156-011-0210-9 · 1.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To clarify the efficacy of transcatheter hepatic sub-subsegmental, subsegmental, and segmental arterial chemoembolization using lipiodol (subseg/seg lip-TACE) for hepatocellular carcinoma (HCC), long-term outcomes of patients who had been treated using subseg/seg lip-TACE alone were retrospectively examined.
Subjects comprised 199 patients with HCC (T1/2/≥3=30/108/61; Child-Pugh A/B/C=115/52/32; Japan Integrated Staging [JIS] score≤1/2/≥3=88/64/47) who underwent subseg/seg lip-TACE using lipiodol mixed with an anticancer drug followed by injection of gelatin sponge particles. Each patient was followed-up every 3 months, and repeat subseg/seg lip-TACE and/or conventional lip-TACE was performed in cases showing recurrence. One-, 3-, 5-, 7-, and 10-year cumulative survival rates were calculated. Subgroup analyses were performed by stratifying the population according to T-factor, Child-Pugh classification, and JIS score.
Median duration of follow-up was 3.8 years (range 0.2 to 16.4). Median overall survival was 3.8 years. One-, 3-, 5-, 7- and 10-year survival rates were 91.5, 66.1, 38.8, 20.3, and 9.4% for all patients, and 95.5, 76.9, 51.9, 27.9 and 20.4% for patients with JIS≤1, respectively. Significant survival differences were found across two subgroups of staging systems (T2 vs. T3≤[P=0.0012] and JIS score≤1 vs. 2 [P=0.0036]).
This study demonstrated that subseg/seg lip-TACE is a feasible treatment for obtaining prolonged survival in patients with localized HCC showing rich vasculature. Outcomes are influenced by both tumor stage and liver function, as seen in the best prolonged survival in patients with JIS score≤1.
[Show abstract][Hide abstract] ABSTRACT: This study was designed to clarify the advantages of biodegradable stents in terms of mucosal reaction and biodegradation after placement. We designed a biodegradable stent and assessed stent degradation and changes in the normal bile ducts of dogs.
The biodegradable stent is a balloon-expandable Z stent consisting of poly-L-lactic acid (PLLA) with a diameter of 6 mm and a length of 15 mm. We assessed four groups of three beagle dogs each at 1, 3, 6, and 9 months of follow-up. After evaluating stent migration by radiography and stent and bile duct patency by cholangiography, the dogs were sacrificed to remove the bile duct together with the stent. The bile duct lumen was examined macroscopically and histologically, and the stent degradation was examined macroscopically and by scanning electron microscopy (SEM).
Bile duct obstruction was absent and none of the stents migrated. Macroscopic evaluation showed moderate endothelial proliferation in the bile ducts at the implant sites at 3 and 6 months and a slight change at 9 months. Slight mononuclear cell infiltration was histologically identified at all time points and epithelial hyperplasia that was moderate at 3 months was reduced to slight at 6 and 9 months. Stent degradation was macroscopically evident in all animals at 9 months and was proven by SEM in two dogs at 6 months and in all of them at 9 months.
Our results suggest that PLLA bioabsorbable stents seems to be useful for implantation in the biliary system with further investigation.
[Show abstract][Hide abstract] ABSTRACT: We report a 60-year-old female with locally advanced pancreatic cancer successfully treated with stereotactic radiotherapy after arterial chemoinfusion. Using the indwelling catheter-port system with the unification of the pancreatic blood supply, we initially conducted an arterial infusion of weekly high-dose 5-FU (1,000 mg/m2/qw) combined with systemic gemcitabine (1,000 mg/m2/qw). As a result, the tumor was remarkably decreased. However, a part of the tumor where the drug had not been distributed remained in no reduction. Therefore, we added the stereotactic radiotherapy (50 Gy) targeted on the limited residual tumor and combined with concurrent systemic gemcitabine (1,000 mg/m2/qw). The residual tumors have been controlled well without distant metastases, and the patient is alive today 36 months after our initial treatment.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2315-8.