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ABSTRACT: The authors report on the use of a catheter with a cleft for catheterization of a branch artery arising from the aorta with an acute angle. The cleft was created on either the right or cephalad portion at the tip of a seated 4-F shepherd hook catheter in the artery origin, depending on vessel angulation during chemoembolization procedures. This catheter was used in eight arteries-seven inferior phrenic arteries and one right subcostal artery-that could not be catheterized with a conventional coaxial technique. The microcatheter was successfully introduced into all eight vessels through the cleft without complications.
Journal of vascular and interventional radiology: JVIR 11/2008; 19(12):1769-71. · 1.81 Impact Factor
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ABSTRACT: To evaluate the detectability of hepatocellular carcinoma (HCC) by computed tomography during arterial portography (CTAP) using cone-beam CT technology (CBCTAP) by comparing it with conventional CTAP.
Forty-four HCC lesions (mean diameter 1.9 +/- 1.1 cm) of 24 patients who sequentially underwent conventional CTAP and CBCTAP during the same angiography session were evaluated. CBCTAP findings of each tumor were classed into three grades as compared to conventional CTAP: optimal; suboptimal; and nondiagnostic.
All CBCTAP images had image artifacts from the catheter placed in the superior mesenteric artery and enhanced portal veins. Additionally, the contrast between HCC lesion and surrounding liver parenchyma of CBCTAP images was less than that of CTAP images. Of the 44 tumors, findings of 31 nodules (mean 2.2 +/- 1.2 cm) (70.5%) were classed as optimal. Eight nodules (mean 1.4 +/- 0.8 cm) (18.2%) were classed as suboptimal. Five nodules (mean 1.0 +/- 0.1 cm) (11.4%) including two located in the outside of field of view were classed as nondiagnostic.
CBCTAP had sufficient image quality to detect almost all small HCC lesions compared to conventional CTAP and could depict approximately 89% of HCC nodules, including eight suboptimal lesions.
Abdominal Imaging 04/2008; 34(4):502-6. · 1.73 Impact Factor
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Journal of Endovascular Therapy 03/2008; 15(1):133-4. · 2.86 Impact Factor
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ABSTRACT: We evaluated iodized oil accumulation in the hypovascular portion of early-stage hepatocellular carcinoma (HCC) after ultraselective transcatheter arterial embolization (TACE).
Forty-seven HCC lesions with hypovascular portions were treated by TACE at the distal level of the sub-subsegmental artery of the liver. Portal blood in the hypovascular portion was classed in two grades by computed tomography (CT) during arterial portography: decreased and preserved. Iodized oil accumulation was classed into three grades on CT obtained 1 week after TACE: (1) dense accumulation in the almost entire tumor, including the hypovascular portion (grade 2); (2) dense accumulation in hypervascular portions but sparse accumulation in hypovascular portion (grade 1); and (3) sparse accumulation or no accumulation (grade 0). Findings on serial follow-up CT images were also analyzed.
Portal blood in the hypovascular portion was decreased in 32 lesions, and preserved in 15 lesions. On CT 1 week after TACE, 32 tumors (68.1%)-23 with decreased portal blood and 9 with preserved portal blood-were classed as grade 2. Twelve tumors (25.5%), six with decreased portal blood and six with preserved portal blood, were classed as grade 1. Three tumors (6.4%) with decreased portal blood were classed into grade 0. In total, 25 tumors (53.2%), 22 in grade 2 and 3 in grade 1, were well controlled by ultraselective TACE during the mean follow-up of 15.8 months.
Iodized oil accumulation and retention in the hypovascular portion of early-stage HCC was frequently observed after ultraselective TACE, mainly in the hypovascular portion with decreased portal blood.
Hepatology International 01/2008; 1(4):451-9. · 2.64 Impact Factor
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ABSTRACT: To analyze visualization of hepatic lymphatic vessels during transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).
Retrospective review was conducted of 255 tumors in 161 patients treated by TACE with catheterization of the most distal portion of the tumor-feeding branches. All TACE procedures were performed with use of a mixture of iodized oil and anticancer drugs followed by gelatin sponge particles. Arteriograms and spot radiographs obtained during TACE were reviewed to determine whether hepatic lymphatic vessels appeared. Serial computed tomography (CT) images after TACE were evaluated along with clinical symptoms in cases that exhibited lymphatic vessel visualization.
Hepatic lymphatic vessels were demonstrated in eight tumors (3.1%) in eight patients during TACE. The mean tumor diameter was 1.7 cm +/- 0.7 (range, 1.0-3.3 cm), and mean volume of injected iodized oil was 1.7 mL +/- 1.0 (range, 1-4 mL). Lymphatic vessels were demonstrated followed by marked portal vein visualization (n = 5) or extravasation of a small amount of contrast material (n = 2). In the remaining patient, these were depicted during the early stage of the TACE procedure. On CT after 1 week, iodized oil in the lymphatic systems in the hepatoduodenal ligament was seen in six patients, and it was shown to have been retained in four of these patients on follow-up CT performed 2, 7, 11, and 21 months later, respectively. None of these patients presented any clinical symptom other than postembolization syndrome.
Hepatic lymphatic vessels were demonstrated in 3.1% of tumors treated by ultraselective TACE. Iodized oil in the lymphatic vessels may be retained for a relatively long time without specific symptoms.
Journal of Vascular and Interventional Radiology 10/2007; 18(9):1111-7. · 2.08 Impact Factor
