-
[show abstract]
[hide abstract]
ABSTRACT: PURPOSE: The purpose of this study was to evaluate the feasibility and potential usefulness of unenhanced magnetic resonance (MR) hepatic portal perfusion using arterial spin labeling (ASL) among healthy volunteers and hepatocellular carcinoma patients. MATERIALS AND METHODS: The five healthy volunteers underwent unenhanced MR perfusion with inversion time 2 (TI2) values at 500-ms intervals between 2,000 and 4,000 ms, and the 12 patients underwent unenhanced MR perfusion using ASL and computed tomography (CT) perfusion during superior mesenteric artery (SMA) portography. The regions of interest were placed in both the right and left lobes of the liver or both the right anterior and posterior segments of the liver and were placed over the tumor if a lesion was located within a particular perfusion study slice. RESULTS: In the healthy volunteer study, perfusion rate in hepatic parenchyma showed a peak at the TI2 value of 3,000 ms (254.3 ml/min/100 g ± 58.3). In patients, a fair correlation was observed between CT and MR perfusion (r = 0.795, P < 0.01). CONCLUSION: Our results demonstrate a significant fair correlation between unenhanced MR hepatic portal perfusion imaging using ASL and CT perfusion during SMA portography.
Japanese journal of radiology 09/2012; · 0.65 Impact Factor
-
Chizu Maeda, Masaya Tamano,
Toshimitsu Murohisa,
Toshitsugu Yamagishi,
Takashi Hashimoto,
Kazuo Kojima,
Makoto Iijima,
Takeshi Sugaya,
Masakazu Nakano,
Takashi Akima,
Shigeki Tomita,
Takahiro Fujimori,
Hideyuki Hiraishi
[show abstract]
[hide abstract]
ABSTRACT: A rare case of hepatocellular carcinoma (HCC) in a 78-year-old woman with a 10-year history of autoimmune hepatitis (AIH)
without liver cirrhosis and no history of alcohol abuse, drug injection, or blood transfusion is presented. At the time HCC
was diagnosed, based on imaging studies showing a 5-cm-diameter S6 liver tumor, she had normal liver function, positive anti-nuclear
antibodies, negative hepatitisB and C markers, and elevated alfa-fetoprotein (AFP; 169ng/ml) and protein-induced by vitaminK
absence or antagonistII (PIVKA-II; 721mAU/ml) levels. Following subsegmental S6 resection, no evidence of fibrosis or cirrhosis
was observed.
KeywordsAutoimmune hepatitis-Hepatocellular carcinoma-Non-liver-cirrhosis
Clinical Journal of Gastroenterology 04/2012; 3(2):111-115.
-
[show abstract]
[hide abstract]
ABSTRACT: IntroductionTo determine the clinical significance of tumor-cell proliferation in hepatocellular carcinoma (HCC), we investigated the
relationship between tumor-cell proliferation evaluated by Ki-67 labeling index and ultrasonographic findings and degree of
arterial vascularity evaluated by US angiography in patients with HCC.
MethodsHCC cells from 70 histologically confirmed HCC nodules obtained at biopsy of 64 patients were immunohistochemically studied
for Ki-67 labeling index. We compared such corresponding ultrasonographic findings as tumor diameter, halo, and internal echo
pattern, and the degree of arterial vascularity on US angiography. Arterial vascularity was then classified into three grades
based on the findings of digital subtraction angiography (DSA) and US angiography.
ResultsNodule diameter greater than 3 cm, presence of halo, or presence of internal echo with a mosaic pattern, alone or in combination,
indicated enhanced proliferation of tumor cells. Although enhanced proliferation of tumor cells was seen in nodules with a
stron arterial vascularity that could be detected by DSA, proliferation was not enhanced in nodules with a weak arterial vascularity
that could be detected only by US angiography.
ConclusionHCC with weak arterial vascularity detectable only by US angiography may show a lower grade of biological malignancy, suggesting
that prognosis is improved by early diagnosis and treatment of these lesions.
Journal of Medical Ultrasonics 04/2012; 28(3):117-125. · 0.33 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Aim: To investigate the value of liver stiffness in diagnosing hepatocellular carcinoma (HCC) among patients with viral hepatitis, and to prospectively investigate relationships between liver stiffness and HCC development. Methods: Liver stiffness was measured by transient elastography for 157 patients with viral hepatitis, along with various other parameters potentially associated with HCC. HCC was initially present in 41 patients and absent in 116 patients, of whom 106 patients were followed prospectively for HCC development. Diagnostic performances of liver stiffness and other clinical parameters in predicting presence of HCC were evaluated using receiver operating characteristic (ROC) curves and area under the ROC curve (AUROC). Results: Liver stiffness was significantly higher in patients with HCC (24.9 ± 19.5 kPa) than in patients without HCC (10.9 ± 8.4 kPa; P < 0.0001). Age (P < 0.0001), platelet cell count (P = 0.0001), prothrombin activity (P = 0.0009), alpha fetoprotein (P = 0.0091), and des-gamma-carboxy prothrombin (DCP) (P = 0.0099) also differed significantly between patients with and without HCC. The largest AUROC was for liver stiffness. Differences between liver stiffness and age, platelet cell count, prothrombin activity, and DCP were not significant, but the AUROC of liver stiffness was superior to that of alpha fetoprotein (P = 0.03850). Using a cut-off liver stiffness of 12.5 kPa, development of HCC was identified in 10 of the 106 patients followed. Multivariate analysis identified liver stiffness ≥12.5 kPa, age ≥60 years, and serum total bilirubin ≥1.0 mg/dL as significantly correlated with development of HCC. Conclusions: Liver stiffness as measured by transient elastography is a predictor of HCC development in viral hepatitis.
Hepatology Research 08/2011; 41(10):965-70. · 2.20 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We describe a 77-year-old woman with chronic hepatitis B who became resistant to lamivudine. She was started on adefovir (10 mg daily) while still continuing lamivudine therapy. Four mo later her liver function improved and serum Hepatitis B virus (HBV)-DNA level became undetectable. Three years after the start of additional adefovir treatment, hepatocellular carcinoma (HCC) was detected and the patient underwent a successful hepatectomy. Our findings suggest that the addition of adefovir to ongoing lamivudine therapy cannot completely suppress hepatocarcinogenesis, but is useful for improving liver function in patients with lamivudine-resistant HBV-related cirrhosis, allowing HCC surgery.
World journal of hepatology. 08/2010; 2(8):318-21.
-
Kyoko Kumagai, Masaya Tamano,
Kazuo Kojima,
Chizu Maeda,
Keiichi Tominaga,
Takashi Hashimoto,
Takashi Akima,
Masakazu Nakano,
Takeshi Sugaya,
Mitsugu Shimoda,
Keiichi Kubota,
Hideyuki Hiraishi
[show abstract]
[hide abstract]
ABSTRACT: A 16-year-old girl had been given a diagnosis of systemic lupus erythematosus (SLE) at age 4, and a diagnosis of nephrotic syndrome caused by lupus nephritis at age 9. Medical treatment began with steroids from age 4. She developed acute pancreatitis in May 2007. Abdominal computed tomography showed cystic lesions in the abdominal cavity, and surgical drainage was performed for intracystic bleeding, infection and alimentary canal perforation.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 02/2010; 107(2):278-84.
-
Kohei Tsuchida,
Michiko Yamagata,
Yasuyuki Saifuku,
Dan Ichikawa,
Kazunari Kanke,
Toshimitsu Murohisa, Masaya Tamano,
Makoto Iijima,
Yukiko Nemoto,
Wataru Shimoda,
Toshiaki Komori,
Hirokazu Fukui,
Kazuhito Ichikawa,
Hitoshi Sugaya,
Kazuhito Miyachi,
Takahiro Fujimori,
Hideyuki Hiraishi
[show abstract]
[hide abstract]
ABSTRACT: Attention has recently been focused on biliary papillary tumors as the novel disease entity intraductal papillary neoplasm of the bile duct (IPNB), which consists of papillary proliferation of dysplastic biliary epithelium. As even benign papillary tumors are considered as premalignant, some investigators recommend aggressive surgical therapy for IPNB, although no guidelines are available to manage this disease. Few reports have described long-term follow-up of patients with benign IPNB without radical resection. If patients with IPNB who are treated only with endoscopic procedures are noted, clinical profiles and alternative therapies other than resection may be recommended. We report the case of a patient who experienced repetitive cholangitis for 10 years and was finally diagnosed with IPNB. Radical resection could not be recommended because of the age of the patient, therefore, endoscopic sphincterotomy was performed. Although an endoscopic retrograde biliary drainage catheter was placed several times for repetitive cholangitis, the patient has done well during follow-up. Our case may offer insights into the natural course and management decisions for the novel disease entity of IPNB.
World Journal of Gastroenterology 02/2010; 16(7):909-13. · 2.47 Impact Factor
-
Yasuyuki Saifuku,
Michiko Yamagata,
Takero Koike,
Genyo Hitomi,
Kazunari Kanke,
Hidetaka Watanabe,
Toshimitsu Murohisa, Masaya Tamano,
Makoto Iijima,
Keiichi Kubota,
Hideyuki Hiraishi
[show abstract]
[hide abstract]
ABSTRACT: To assess the diagnostic ability of endoscopic ultrasonography (EUS) for evaluating causes of distal biliary strictures shown on endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP), even without identifiable mass on computed tomography (CT).
The diagnostic ability of EUS was retrospectively analyzed and compared with that of routine cytology (RC) and tumor markers in 34 patients with distal biliary strictures detected by ERCP or MRCP at Dokkyo Medical School Hospital from December 2005 to December 2008, without any adjacent mass or eccentric thickening of the bile duct on CT that could cause biliary strictures. Findings considered as benign strictures on EUS included preservation of the normal sonographic layers of the bile duct wall, irrespective of the presence of a mass lesion. Other strictures were considered malignant. Final diagnosis of underlying diseases was made by pathological examination in 18 cases after surgical removal of the samples, and by clinical follow-up for > 10 mo in 16 cases.
Seventeen patients (50%) were finally diagnosed with benign conditions, including 6 "normal" subjects, while 17 patients (50%) were diagnosed with malignant disease. In terms of diagnostic ability, EUS showed 94.1% sensitivity, 82.3% specificity, 84.2% positive predictive value, 93.3% negative predictive value (NPV) and 88.2% accuracy for identifying malignant and benign strictures. EUS was more sensitive than RC (94.1% vs 62.5%, P = 0.039). NPV was also better for EUS than for RC (93.3% vs 57.5%, P = 0.035). In addition, EUS provided significantly higher sensitivity than tumor markers using 100 U/mL as the cutoff level of carbohydrate antigen 19-9 (94.1% vs 53%, P = 0.017). On EUS, biliary stricture that was finally diagnosed as malignant showed as a hypoechoic, irregular mass, with obstruction of the biliary duct and invasion to surrounding tissues.
EUS can diagnose biliary strictures caused by malignant tumors that are undetectable on CT. Earlier detection by EUS would provide more therapeutic options for patients with early-stage pancreaticobiliary cancer.
World Journal of Gastroenterology 01/2010; 16(2):237-44. · 2.47 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: An 83-year old Japanese man was transferred to our hospital due to a 1-week history of melena and signs of disordered awareness. Esophagogastroduodenoscopy showed a villous tumor associated with massive white mucous discharge in the posterior wall of the gastric corpus, where pathologically identified mucin-producing epithelium with nuclear atypia had developed into a papillary form. An abdominal enhanced computed tomography scan demonstrated communication between the dilated main pancreatic duct and the gastric lumen. Based on these findings, we reached a diagnosis of gastric penetration by an intraductal papillary mucinous neoplasm (IPMN) of the main pancreatic duct. IPMN is partly characterized by expansive mucinous growth that may result in penetration into adjacent organs.
Digestive Endoscopy 01/2010; 22(1):69-70. · 1.19 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We investigated the utility and safety of contrast-enhanced ultrasonography using Sonazoid in the diagnosis of hepatic hydrothorax.
The study consisted of seven liver cirrhosis patients with hydrothorax and hydroperitoneum. After obtaining informed consent, Sonazoid was injected intraperitoneally, and enhancement in the peritoneal and pleural cavities was observed.
In all patients, the peritoneal cavity was quickly enhanced after the Sonazoid injection. The pleural cavity was enhanced in five of the seven patients, and these five patients were diagnosed with hepatic hydrothorax. Two patients without enhancement of the pleural cavity were diagnosed with inflammatory hydrothorax.
This is the first report to confirm transdiaphragmatic movement of ascitic fluid into the pleural cavity using contrast-enhanced ultrasonography with Sonazoid. This method can safely detect ascitic flow in real time, and is thus very useful for the diagnosis of hepatic hydrothorax.
Journal of Gastroenterology and Hepatology 10/2009; 25(2):383-6. · 2.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A 62-year-old Japanese woman was admitted to our hospital with dyspnea. Chest X-ray revealed massive pleural effusion on the
left side. Contrast-enhanced ultrasonography using Levovist was performed to confirm the transdiaphragmatic passage of ascitic
fluid into the pleural cavity. After injection of Levovist into the peritoneal cavity, an enhanced pulsative flow into the
pleural cavity was detected. This is the first report of hepatic hydrothorax diagnosed by contrast-enhanced ultrasonography.
This method is safe and useful for the diagnosis of hepatic hydrothorax, and it allows observation of the real-time movement
of ascitic fluid from the peritoneal cavity to the pleural space and detection of the site of the peritoneopleural communication.
Journal of Medical Ultrasonics 08/2008; 35(3):129-132. · 0.33 Impact Factor
-
Masato Yoneda,
M Yoneda,
Masashi Yoneda,
Koji Fujita,
K Fujita,
Masahiko Inamori,
M Inamori, Masaya Tamano,
M Tamano,
Hideyuki Hiriishi,
H Hiraishi,
Atsushi Nakajima,
A Nakajima
Gut 10/2007; 56(9):1330-1. · 10.11 Impact Factor
-
Nihon Naika Gakkai Zasshi 10/2005; 94(9):1711-22.
-
[show abstract]
[hide abstract]
ABSTRACT: Central neuropeptides play roles in many physiologic regulations through the autonomic nervous system. We have demonstrated that central thyrotropin-releasing hormone (TRH), one of neuropeptides, induces a stimulation of hepatic proliferation through vagal-cholinergic pathways. Since cAMP is known to play an important role in the hepatic proliferation, effect of central TRH on hepatic cAMP was investigated. Rats were intracisternally injected with either a TRH analog, RX-77368 (1-100 ng), or saline. The liver was removed 2-72 h after the TRH analog and hepatic cAMP content was determined by radioimmunoassay. In some experiments, pretreatment with hepatic vagotomy, atropine methyl nitrate, or 6-hydroxydopamine (6-OHDA) was performed. Hepatic cAMP was dose-dependently increased by intracisternal TRH analog (5-100 ng) with a peak response occurring 12 h postinjection. The central TRH-induced increase in hepatic cAMP was abolished by vagotomy, atropine and indomethacin, but not by 6-OHDA. Intravenous injection of the TRH analog (10 ng) did not affect hepatic cAMP. These results demonstrate that TRH acts in the brain to increase hepatic cAMP through vagal-cholinergic and prostaglandin-dependent pathways, suggesting that central TRH modulates hepatic functions through cAMP-mediated signaling pathways.
Peptides 10/2005; 26(9):1573-9. · 2.43 Impact Factor
-
Nihon Naika Gakkai Zasshi 09/2005; 94(8):1640-6.
-
Nippon rinsho. Japanese journal of clinical medicine 03/2005; 63 Suppl 2:338-40.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate if esophageal varices can be evaluated using external contrast-enhanced ultrasonography with Levovist and coded harmonic angio (CHA).
Subjects were six healthy adult volunteers and 23 patients with liver cirrhosis. After identification of the lower esophagus under B-mode scanning, 300 mg/mL of Levovist was intravenously injected into the cubital vein at a rate of 1 mL/s under observation by CHA-mode scanning. Approximately 30 s after intravenous administration, interval-delay scanning was performed every second to visualize the area around the lower esophageal lumen. The degree of ultrasonographic enhancement was assessed as either no enhancement (negative); linear enhancement along the esophageal wall (weak) or full enhancement of the esophageal lumen (strong). Endoscopic evaluation of esophageal varices was also performed.
The CHA enhancement around the lower esophageal lumen was identified in 21 of the 23 patients. Of these 21 patients, endoscopic assessments of varices were as follows: F0 in four patients, F1 in seven patients, F2 in three patients, and F3 in seven patients. Nine patients were red color sign (RCS)-positive. Regarding the relationship between ultrasonographic enhancement and endoscopic assessment, enhancement was identified as negative in all four F0 patients, negative in three and weak in three and strong in one of the seven F1 patients, weak in one and strong in two of the three F2 patients, and weak in two and strong in five of the seven F3 patients, respectively. Furthermore, of the nine RCS-positive patients, enhancement was recognized as strong in seven and weak in two patients. Ultrasonographic enhancement was identified as negative in all six healthy volunteers.
By performing contrast-enhanced CHA ultrasonography using Levovist, ultrasonographic enhancement was detectable in all patients with varices categorized as F2 or above. Because the present method is easy to perform and causes less pain to patients compared to endoscopy, it is useful for following and assessing esophageal varices in patients with liver cirrhosis.
Journal of Gastroenterology and Hepatology 06/2004; 19(5):572-5. · 2.87 Impact Factor
-
Masaya Tamano,
Hitoshi Sugaya,
Motoo Oguma,
Makoto Iijima,
Masashi Yoneda,
Toshimitsu Murohisa,
Kazuo Kojima,
Toru Kuniyoshi,
Yuichi Majima,
Takashi Hashimoto,
Akira Terano
[show abstract]
[hide abstract]
ABSTRACT: A sensitive method for measuring the serum level of protein-induced by vitamin K absence or antagonist II (PIVKA-II) has become so widely available that it is now used for the clinical diagnosis of small hepatocellular carcinoma (HCC). It is known that serum PIVKA-II can be a prognostic indicator for HCC, but there have been no detailed investigations concerning the tissue expression of PIVKA-II. The present study assessed the relationship between serum or tissue PIVKA-II and the biological malignant potential of HCC. The subjects were 25 patients with histologically confirmed HCC, that were solitary and 3 cm or less in diameter. Tissue PIVKA-II was detected by immunostaining using MU-3 as the primary antibody. The biological malignant potential of the tumors was evaluated on the basis of the Ki-67 labeling index of HCC cells and the tumor arterial vascularity assesed by angiography and CO(2) enhanced ultrasonography. The recurrence-free period after treatment was also evaluated. Among the 25 patients, eight were positive for tissue PIVKA-II. Serum PIVKA-II levels were significantly higher in the tissue PIVKA-II-positive patients compared with the negative patients, but serum and tissue PIVKA-II expressions were not consistently parallel. Tumor cell proliferation was closely correlated with the tissue PIVKA-II expression, while the recurrence-free period was correlated with the serum PIVKA-II level. Tumor arterial vascularity showed a strong correlation with the expression of both serum and tissue PIVKA-II. In conclusion, serum and tissue PIVKA-II expression reflect the biological malignant potential of HCC and thus may be useful indicators for the prognosis of small HCC.
Hepatology Research 05/2002; 22(4):261-269. · 2.20 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The degree of hepatic fibrosis is an important factor for prognosis and management of patients with chronic liver disease; however, liver biopsy is an invasive method of measuring fibrosis. Here, we investigated the diagnostic utility of liver stiffness, as measured by transient elastography in assessing hepatic fibrosis of viral chronic liver disease and nonalcoholic fatty liver disease (NAFLD).
Four hundred and nine eligible patients underwent transient elastography to measure liver stiffness. Liver biopsy for histopathological assessment of fibrosis (F0-F4) was performed in 71 of these patients. Serum levels of hyaluronic acid were determined in 110 patients. We assessed liver stiffness in several chronic liver diseases and compared correlations among liver stiffness, hepatic fibrosis stage and serum hyaluronic acid levels.
A steady stepwise increase in liver stiffness was observed with progressing severity of hepatic fibrosis (p<0.0001) in 71 patients who underwent liver biopsy. In 32 chronic viral hepatitis patients, measuring liver stiffness was useful for differentiating between F1, or F2, or F3 and F4, while in 32 NAFLD liver stiffness can differentiate between F0 and F1, F2, or F3, F1 and F3 or F4 and F2 and F4. There was no significant correlation between liver fibrotic stages and serum hyaluronic levels.
The present data advocates measuring liver stiffness for assessing hepatic fibrosis is more sensitive in NAFLD than viral chronic diseases, and liver stiffness is useful compared to serum hyaluronic acid level in estimating hepatic fibrosis.
Hepato-gastroenterology 59(115):826-30. · 0.66 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Des-gamma-carboxy prothrombin (DCP) is measured by an enzyme immunoassay system with the monoclonal antibody MU-3. A novel DCP antibody named 19B7 recognizes a different epitope against the Gla domain of DCP measured by the MU-3 antibody. Therefore, it is possible that DCP variants can be measured with these two antibodies. The aim of this study was to elucidate the usefulness of the DCP ratio as a new prognostic parameter for patients with hepatocellular carcinoma (HCC).
One hundred and eighty-three patients with HCC were enrolled in the current study. The DCP ratio was calculated using the formula: DCP ratio = DCP level measured by the MU-3 (mAU/mL) / DCP level measured by the 19B7 (mAU/mL).
There was no statistical correlation between DCP level measured by MU-3 antibody and DCP ratio. Clinical stage, tumor type, portal tumor thrombus and DCP were independent factors in the multivariate analysis for survival of 183 patients. In 67 patients with single nodule HCC, clinical stage and DCP ratio were independent factors in the multivariate analysis for survival rate.
The most useful prognostic tumor marker was the DCP in the 183 HCC patients and the DCP ratio in single nodule HCC.
Hepato-gastroenterology 55(81):197-201. · 0.66 Impact Factor
