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ABSTRACT: PURPOSE: This study was designed to evaluate retrospectively the safety and efficacy of the percutaneous management of duodenal stump leakage with a Foley catheter after subtotal gastrectomy. METHODS: Ten consecutive patients (M:F = 9:1, median age: 64 years) were included in this retrospective study. The duodenal stump leakages were diagnosed in all the patients within a median of 10 days (range, 6-20). At first, the patients underwent percutaneous drainage on the day of or the day after confirmation of the presence of duodenal stump leakage, and then the Foley catheters were replaced at a median of 9 days (range, 6-38) after the percutaneous drainage. RESULTS: Foley catheters were placed successfully in the duodenal lumen of all the patients under a fluoroscopic guide. No complication was observed during and after the procedures in all the patients. All of the patients started a regular diet 1 day after the Foley catheter placement. The patients were discharged at a median of 7 days (range, 5-14) after the Foley catheter placement. The catheters were removed in an outpatient clinic 10-58 days (median, 28) after the Foley catheter placement. CONCLUSIONS: Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites.
CardioVascular and Interventional Radiology 03/2013; · 2.09 Impact Factor
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ABSTRACT: This study is a retrospective evaluation of an alternative technique for angioplasty of thrombosed loop hemodialysis grafts through a single vascular access. This technique can provide balloon angioplasty to the puncture site without any additional vascular accesses by using a T-shaped balloon catheter and can simplify thrombectomy procedures.
Journal of vascular and interventional radiology: JVIR 03/2013; 24(3):406-9. · 1.81 Impact Factor
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ABSTRACT: PURPOSE: To evaluate the predictability of the short-term tumor response and the clinical usefulness of cone-beam computed tomography (CT) performed immediately after drug-eluting bead (DEB) transarterial chemoembolization in patients with unresectable hepatocellular carcinoma (HCC). MATERIALS AND METHODS: This retrospective study comprised 90 patients (male-to-female ratio = 66:24; mean age, 60.4 y) with 119 tumors (mean size, 3.2 cm). All patients underwent DEB transarterial chemoembolization and received cone-beam CT after embolization. The marginal contrast saturation was defined as a contrast stasis that was observed along the margin of the tumor on the cone-beam CT images. The degree of marginal contrast saturation was calculated as a percentage and was classified into five grades in 25% increments. The degree of marginal contrast saturation and the tumor response were correlated based on follow-up imaging. RESULTS: There was a complete response in 63.8% (n = 76) of all tumors. Partial response, stable disease, and progressive disease were identified in 21.8% (n = 26), 13.4% (n = 16), and 0.8% (n = 1) of tumors. Marginal contrast saturation by cone-beam CT was 86%±16.3, 73.2%±28.8, 16.9%±27.2, and 0% for complete response, partial response, stable disease, and progressive disease, which indicated a significant correlation of a higher contrast saturation with a better response (P<.001) by follow-up imaging criteria. The positive predictive value of the G5 group showing a complete response was 98.1%. CONCLUSIONS: Marginal contrast saturation showed a high positive predictive value for short-term tumor response. This technique may improve the success rates of DEB transarterial chemoembolization procedures and may reduce technical difficulties and shorten procedural time.
Journal of vascular and interventional radiology: JVIR 02/2013; · 1.81 Impact Factor
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Myeong Jun Song,
Si Hyun Bae,
Sung Won Lee,
Do Sun Song,
Hee Yeon Kim,
Ie Ryung Yoo,
Joon-Il Choi,
Young June Lee,
Ho Jong Chun, Hae Giu Lee,
Jong Young Choi,
Seung Kew Yoon
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ABSTRACT: PURPOSE: (18)F-FDG PET monitoring of FDG uptake may be a useful tool for assessment of the biological behaviour of hepatocellular carcinoma (HCC). We evaluated the correlation between FDG uptake on (18)F-FDG PET and clinical characteristics and prognosis. METHODS: In total, 58 HCC patients undergoing (18)F-FDG PET before transarterial chemoembolization (TACE) between May 2007 and May 2010 at Seoul St. Mary's Hospital were evaluated retrospectively. The predictive value of the ratio of maximal tumour standardized uptake value (SUV) to mean liver SUV (TSUV (max)/LSUV (mean)) was tested. Primary endpoints were the clinical characteristics and treatment response according to TSUV (max)/LSUV (mean). The secondary endpoint was time to progression (TTP). RESULTS: A high SUV ratio (cutoff value 1.70) correlated significantly with tumour size (≥5 cm) and serum AFP level (≥400 ng/mL). Objective response rates were significantly different between those with a ratio above (15.7 %) and those with a ratio below (66.6 %) the cutoff value (P = 0.023). Patients in the low SUV ratio group had a median TTP of 16.8 months compared with 8.1 months in the high SUV ratio group (P = 0.011). Overall survival in the high SUV ratio group was worse than in the low SUV ratio group (median 56.5 vs. 23.3 months), although the difference was not statistically significant in a multivariate analysis. CONCLUSION: Tumour metabolic activity (TSUV (max)/LSUV (mean)), assessed by PET/CT, is an independent predictor of response to TACE in patients with intermediate-stage HCC. TSUV (max)/LSUV (mean) can be used to predict tumour progression. Thus, (18)F-FDG PET can provide valuable information for prediction of prognosis and aid in decisions regarding treatment strategy.
European Journal of Nuclear Medicine 02/2013; · 4.53 Impact Factor
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ABSTRACT: To determine if hepatocellular carcinoma refractory to conventional transarterial chemoembolization (TACE) responds to TACE with DC beads.
Between July 2008 to June 2010, 435 patients underwent TACE. Of these, 10 patients who had tumors refractory to conventional TACE and who thus were treated with TACE with DC beads were enrolled in this study. The treatment response after TACE with DC beads was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) and the Response Evaluation Criteria in Cancer of the Liver (RECICL).
Ten tumors were treated in 10 patients. Using the mRECIST and the RECICL, a complete response was observed in four (40%) of the tumors, and six tumors (60%) showed a partial response. Eight (80%) out of 10 HCCs showed delayed enhancement patterns upon angiography, and better responses were observed in these cases following DC bead treatment. The adverse effects of treatment with DC beads became tolerable.
TACE with DC beads was effective for HCCs refractory to conventional TACE, and this treatment elicited a better response, especially when the tumors were small and showed a delayed enhancement pattern upon angiography.
Gut and liver 01/2013; 7(1):89-95. · 0.83 Impact Factor
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Myeong Jun Song,
Ho Jong Chun,
Do Seon Song,
Hee Yeon Kim,
Sun Hong Yoo,
Chung-Hwa Park,
Si Hyun Bae,
Jong Young Choi,
U Im Chang,
Jin Mo Yang, Hae Giu Lee,
Seung Kew Yoon
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ABSTRACT: BACKGROUND & AIMS: Transarterial chemoembolization (TACE) is a widely used treatment for hepatocellular carcinoma. In order to maximize its therapeutic efficacy, doxorubicin-loaded drug-eluting beads have been developed to deliver higher doses of the chemotherapeutic agent and to prolong contact time with the tumor. The purpose of this study was to evaluate the efficacy and safety of drug-eluting bead (DC bead®) TACE in comparison with conventional TACE (cTACE). METHODS: A total of 129 patients who underwent TACE between August 2008 and February 2011 were enrolled. We compared HCC patients who underwent TACE with DC bead® (n=60) to controls who received cTACE (n=69). The primary end points were treatment response and treatment-related adverse events. The secondary end point was time to progression. RESULTS: The treatment response in the DC bead® group was significantly higher than that of the cTACE group (p<0.001). The time to progression was significantly better in the DC bead® group than in the cTACE group (11.7 and 7.6months, respectively, p=0.018). Subgroup analysis showed that in intermediate-stage HCC, DC bead® treatment resulted in a significantly better treatment response and longer time to progression than cTACE (p<0.001 and 0.038, respectively). However, there was no statistically significant difference in liver toxicity between the DC bead® and cTACE group (p>0.05). CONCLUSIONS: TACE with DC bead® showed better treatment response and delayed tumor progression compared with cTACE. There was no significant difference in hepatic treatment-related toxicities. DC bead® TACE thus appears to be a feasible and promising approach to the treatment of HCC.
Journal of Hepatology 07/2012; · 9.26 Impact Factor
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ABSTRACT: To investigate the correlation of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) with clinical features and the prediction of treatment response.
A total of 83 hepatocellular carcinoma (HCC) patients undergoing ¹⁸F-FDG PET before transarterial chemolipiodolization with systemic chemo-infusion between October, 2006 and May, 2009 were retrospectively enrolled. The patients included 68 men and 15 women (mean age, 60 ± 10.7 years). The effect of (18)F-FDG-monitored PET uptake on clinical features and on the evaluated treatment response was ascertained with modified Response Evaluation Criteria in Solid Tumors. The PET parameters of maximal standardized uptake value of the tumor (Tsuv(max)), the ratio of the tumor maximal standardized uptake value (SUV) to the liver maximal SUV (Tsuv(max)/Lsuv(max)) and the ratio of tumor maximal SUV to the liver mean SUV (Tsuv(max)/Lsuv(mean)) were tested as predictive factors.
Among the 3 SUV parameters, the Tsuv(max)/Lsuv(mean) ratio (cutoff value of 1.90) was significantly associated with tumor burden including tumor size, tumor number, α-fetoprotein levels and tumor stage (P < 0.001, P = 0.008, P = 0.011, P < 0.001, respectively). The objective response rates in patients with a high SUV ratio (≥ 1.90) were significantly better than those with a low SUV ratio (< 1.90) (P = 0.020). The overall survival rates of patients exhibiting a low Tsuv(max)/Lsuv(mean) ratio (< 1.90) and those with a high SUV ratio (≥ 1.90) was 38.2 and 10.3 mo, respectively (P < 0.01). However, the time to progression showed no significant difference between the groups (P = 0.15).
¹⁸F-FDG PET can be an important predictor of HCC treatment. In particular, the Tsuv(max)/Lsuv(mean) ratio (cutoff value of 1.90) can provide useful information in treatment prognosis for HCC patients treated with locoregional therapy.
World Journal of Gastroenterology 07/2012; 18(25):3215-22. · 2.47 Impact Factor
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ABSTRACT: Lipiodol transcatheter arterial chemoembolization (TACE) is widely used to treat hepatocellular carcinoma (HCC). Recently, a drug-eluting bead (DEB) has been developed to enhance drug delivery to the tumor and reduce its systemic availability. The purpose of this study was to compare the efficacy and safety of intra-arterial injection of DEB loaded with doxorubicin versus conventional, Lipiodol-based TACE regimens in Asian patients with HCC.
The study was designed as a case-control, single-institution clinical trial. Twenty patients with HCC who received DEB loaded with 50 mg doxorubicin ('cases') were matched with 20 patients who had undergone conventional TACE ('controls'). The primary efficacy endpoint was tumor response at 1 month according to modified Response Evaluation Criteria in Solid Tumors. The primary safety endpoint was liver toxicity.
The rate of objective response by modified Response Evaluation Criteria in Solid Tumors was 85% (17 of 20 patients) in the DEB arm versus 30% (six of 20 patients) in the conventional TACE arm (P=0.001). Subgroup analyses conducted in patients with large (>5 cm) or multinodular tumor confirmed significantly higher objective response rates in patients receiving DEB as compared with those treated with conventional TACE (P=0.003 and P=0.005, respectively). At the dose of 50 mg doxorubicin, there was no statistically significant difference in liver toxicity between DEB and conventional TACE (P>0.05).
In Asian patients with HCC, transcatheter treatment with DEB loaded with doxorubicin offers a distinct advantage in objective tumor response rate as compared with conventional, Lipiodol-based TACE regimens.
European journal of gastroenterology & hepatology 06/2011; 23(6):521-7. · 1.66 Impact Factor
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ABSTRACT: Arteriovenous (AV) shunts are relatively uncommon in the liver and usually associated with advanced hepatocellular carcinoma (HCC). In patients with massive AV shunts complicating advanced HCC, transarterial chemoinfusion therapy is not effective because chemotherapeutic agents go through the shunts and may cause systemic toxicity as well as decrease the chemotherapeutic effects against the tumor. We report two cases of successful transcatheter venous embolization of massive AV shunts complicating advanced HCC using the Amplatzer Vascular Plug for transarterial chemoinfusion therapy.
Japanese journal of radiology 02/2011; 29(2):156-60. · 0.65 Impact Factor
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ABSTRACT: In the present study, the signs of airflow obstruction on inspiratory and expiratory CT scans in 45 patients with rheumatoid arthritis were investigated. Radiologic findings were evaluated and correlated with the clinical data, which included rheumatoid factors and pulmonary function tests results. A lung biopsy was performed in five patients. The pattern of CT findings was as follows: infiltrative (n=15), obstructive (n=12), mixed (infiltrative and obstructive; n=10), other complicating diseases (n=7), and normal (n=1). The rheumatologic factor between patients with bronchial wall thickenings and patients without thickenings was significantly different (p=0.009). The forced expiratory flow rate between 25% and 75% of the vital capacity (FEF(25-75%)) was significantly more reduced in patients with interlobular septal thickenings than in patients without these thickenings. The patients with mosaic attenuation had significantly lower mean values of FEF(25-75% ) (p=0.001) and a lower peak expiratory flow (p=0.003) than patients without mosaic attenuation. On expiratory scans, the mean air-trapping score was 21%. These air-trapping scores were found to be well correlated with FEV1/FVC (r=0.230, p=0.0452), and FEF25-75% (r=-0.63, p= 0.05). It is widely known that a relatively higher percentage of mosaic attenuation with air-trapping and a good correlation between these and functional values contribute to the detection of early airway obstruction in patients with rheumatoid arthritis, and even in patients with infiltrative lung disease only.
Yonsei Medical Journal 07/2004; 45(3):443-52. · 1.14 Impact Factor
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American Journal of Roentgenology 12/2003; 181(5):1369-74. · 2.78 Impact Factor
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ABSTRACT: A 20-year-old man with rapid refractory pulmonary infiltrates, fever, and chill was admitted to our hospital. Microscopic examination showed focal necrosis of the lung tissue, arterial thromboembolism, and alveolar hemorrhage. He tested positive for anticardiolipin IgG antibodies. Because of the absence of underlying diseases, the possibility of secondary antiphospholipid antibody syndrome was excluded. Follow-up chest CT after 2 years revealed pulmonary arterial aneurysms with diffuse ground-glass opacities. The aneurysms were occluded by coil embolization.
Journal of Computer Assisted Tomography 26(4):608-12. · 1.22 Impact Factor
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ABSTRACT: There is a broad spectrum of neurogenic tumors that involve the abdomen. These tumors can be classified as those of (a) ganglion cell origin (ganglioneuromas, ganglioneuroblastomas, neuroblastomas), (b) paraganglionic system origin (pheochromocytomas, paragangliomas), and (c) nerve sheath origin (neurilemmomas, neurofibromas, neurofibromatosis, malignant nerve sheath tumors). Abdominal neurogenic tumors are most commonly located in the retroperitoneum, especially in the paraspinal areas and adrenal glands. All of these tumors except neuroblastomas and ganglioneuroblastomas are seen in adult patients. Abdominal neurogenic tumor commonly manifests radiologically as a well-defined, smooth or lobulated mass. Calcification may be seen in all types of neurogenic tumors. The diagnosis of abdominal neurogenic tumor is suggested by the imaging appearance of the lesion, including its location, shape, and internal architecture. Benign and malignant neurogenic tumors are difficult to differentiate unless distant metastatic foci are seen. For malignant tumors, imaging modalities other than computed tomography (CT) and magnetic resonance (MR) imaging may be necessary for staging. However, because most neurogenic tumors in adults are benign, CT and MR imaging can be used to develop a differential diagnosis and help determine the immediate local extent of tumor.
Radiographics 23(1):29-43. · 2.85 Impact Factor
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ABSTRACT: Malignant mesenchymoma is an interesting but very rare tumor in which malignant differentiation has occurred twice or more. We report a case of retroperitoneal malignant mesenchymoma consisting of osteosarcoma, leiomyosarcoma, liposarcoma and fibrosarcoma. Abdominal CT showed a large retroperitoneal mass with two separate and distinct parts, namely an area of prominent calcification and one of clearly enhancing solid components. The mass contained histologically distinct tumorous components with no histologic admixure at the interfaces. The densely calcified nodule corresponded to osteosarcoma, and the noncalcified clearly enhancing nodules to leiomyosarcoma, liposarcoma and fibrosarcoma.
Korean Journal of Radiology 3(4):264-6. · 1.54 Impact Factor
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ABSTRACT: To assess the feasibility and safety of polyvinyl alcohol (PVA) embolization adjuvant to transarterial oily chemoembolization (P-TACE) in advanced hepatocellular carcinoma (HCC) with arterioportal shunts (APS).
Nineteen patients who underwent PVA embolization for APS before a routine chemoembolization (TACE) procedure were retrospectively reviewed. 10 of these 19 patients underwent follow-up TACE or P-TACE after P-TACE (Group A), but nine patients underwent only initial P-TACE because of progression of HCC and/or underlying liver cirrhosis (Group B). Hepatic function tests, APS grades, and portal flow directions were evaluated before and after P-TACE sessions. Complications after procedures and survival days were also evaluated.
In group A, APS grade was improved in eight patients and five of six patients with hepatofugal flow showed restored hepatopetal flow postoperatively. No immediate complication was developed in either group. Transient hepatic insufficiency developed in eight (42.1%) of 19 patients after P-TACE, and seven (87.5%) of these eight recovered within two weeks under conservative care. The mean and median survival time all study subjects was 280 days and 162 days.
P-TACE is feasible and safe in advanced HCC patients with APS.
Korean Journal of Radiology 8(4):311-9. · 1.54 Impact Factor
