Shiro Miyayama

Kanazawa University, Kanazawa, Ishikawa, Japan

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Publications (102)227.04 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: We evaluated the performance of automated tumor-feeder detection (AFD) software using cone-beam computed tomography technology in identifying tumor-feeders of extrahepatic collaterals. AFD was prospectively used in superselective transarterial chemoembolization (TACE) or embolization (TAE) of extrahepatic collaterals for 29 hepatocellular carcinomas and one liver metastasis (mean tumor diameter ± standard deviation, 28 ± 15.6 mm) in 25 patients. The detectability of extrahepatic tumor-feeders with non-selective digital subtraction angiography (DSA) and AFD was evaluated and compared using a χ(2)-test. Tumor response of target lesions in each patient at 2-3 months after treatment was evaluated using the modified Response Evaluation Criteria in Solid Tumors. Complications were also evaluated. Of 46 tumor-feeders, non-selective DSA and AFD could identify 26 and 44, respectively (P < 0.001). Regarding the origin of tumor-feeders, both non-selective DSA and AFD could identify 14 of 15, six of seven and two of two tumor-feeders of the right inferior phrenic, omental and right renal capsular artery, respectively. In the cystic and left gastric or right colic artery, AFD could identify 13 of 13 and nine of nine tumor-feeders but non-selective DSA could identify only three of 13 and one of nine, respectively (P < 0.001). Complete response was obtained in 15 patients, partial response in six, stable disease in three and progressive disease in one. No severe complications developed except for right pleural effusion after embolization of the right inferior phrenic artery. AFD has a sufficient ability to identify extrahepatic tumor-feeders and may improve the safety and local effects of TACE/TAE of extrahepatic collaterals. © 2015 The Japan Society of Hepatology.
    Hepatology Research 07/2015; DOI:10.1111/hepr.12556 · 2.74 Impact Factor
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    Shiro Miyayama · Takuro Terada · Masato Tamaki ·
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    ABSTRACT: A 51-year-old man with a ruptured pancreaticoduodenal artery (PDA) aneurysm caused by compression of the celiac artery by the median arcuate ligament and aortic dissection involving the celiac axis was transferred to our hospital for endovascular treatment. A 4-F catheter was advanced into the superior mesenteric artery through the narrow true lumen via the left brachial artery, and coil embolization of the aneurysm was successfully performed. In this case, rapid increase of blood flow in the superior mesenteric artery, which compensated for the decreased celiac blood flow by aortic dissection, increased hemodynamic stress on the PDA, leading to aneurysmal rupture.
    Annals of Vascular Diseases 04/2015; 8(1):40-2. DOI:10.3400/
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    ABSTRACT: The mortality rate of patients with ruptured pancreaticoduodenal artery aneurysms is high; therefore, it is recommended to treat pancreaticoduodenal artery aneurysms regardless of their size. In small pancreaticoduodenal artery aneurysms, however, identification of the access route on two-dimensional arteriography is sometimes difficult because of the superimposition of many hypertrophied branches of pancreaticoduodenal arteries on the aneurysm. We report two cases of ruptured pancreaticoduodenal artery aneurysm embolized successfully with metallic coils, assisted by automated feeder-detection software using cone-beam computed tomography data. This new technology may reduce physicians' workload during the procedure. © The Author(s) 2015 Reprints and permissions:
    Vascular 01/2015; DOI:10.1177/1708538114567186 · 0.80 Impact Factor
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    ABSTRACT: In the 2010 version of the Japan Society of Hepatology (JSH) consensus-based treatment algorithm for the management of hepatocellular carcinoma (HCC), transarterial chemoembolization (TACE) failure/refractoriness was defined assuming the use of superselective lipiodol TACE, which has been widely used worldwide and particularly in Japan, and areas with lipiodol deposition were considered to be necrotic. However, this concept is not well accepted internationally. Furthermore, following the approval of microspheres, an embolic material that does not use lipiodol, in February 2014 in Japan, the phrase 'lipiodol deposition' needed to be changed to 'necrotic lesion or viable lesion'. Accordingly, the respective section in the JSH guidelines was revised to define TACE failure as an insufficient response after ≥2 consecutive TACE procedures that is evident on response evaluation computed tomography or magnetic resonance imaging after 1-3 months, even after chemotherapeutic agents have been changed and/or the feeding artery has been reanalyzed. In addition, the appearance of a higher number of lesions in the liver than that recorded at the previous TACE procedure (other than the nodule being treated) was added to the definition of TACE failure/refractoriness. Following the discussion of other issues concerning the continuous elevation of tumor markers, vascular invasion, and extrahepatic spread, descriptions similar to those in the previous version were approved. The revision of these TACE failure definitions was approved by over 85% of HCC experts. © 2014 S. Karger AG, Basel.
    Oncology 11/2014; 87 Suppl 1(s1):22-31. DOI:10.1159/000368142 · 2.42 Impact Factor
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    ABSTRACT: The Clinical Practice Guidelines for the Management of Hepatocellular Carcinoma proposed by the Japan Society of Hepatology was updated in June 2014 at a consensus meeting of the Liver Cancer Study Group of Japan. Three important items have been updated: the surveillance and diagnostic algorithm, the treatment algorithm, and the definition of transarterial chemoembolization (TACE) failure/refractoriness. The most important update to the diagnostic algorithm is the inclusion of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging as a first line surveillance/diagnostic tool. Another significant update concerns removal of the term "lipiodol" from the definition of TACE failure/refractoriness.
    10/2014; 3(3-4):458-68. DOI:10.1159/000343875
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    ABSTRACT: Purpose Retrospective evaluation of intermediate-stage hepatocellular carcinoma (HCC) patient survival after undergoing chemoembolization based on the Child-Pugh score. Materials and methods Data of intermediate-stage HCC patients undergoing chemoembolization were gathered from 43 centers in Japan. Overall survival rates were compared with Child-Pugh scores. Results Of the 329 patients examined in this study, Child-Pugh scores were 5 (CP-5) in 136 patients (41.3 %), 6 (CP-6) in 101 patients (30.7 %), 7 (CP-7) in 58 (17.7 %), 8 (CP-8) in 22 (6.7 %), and 9 (CP-9) in 12 (3.6 %). Two-year survival rates were 77.5 % in CP-5 patients (p = 0.047 vs. CP-6), 65.1 % in CP-6 patients (p = 0.038 vs. CP-7), 51.3 % in CP-7 patients (p = 0.30 vs. CP-8, p = 0.034 vs. CP-9), 50.3 % in CP-8 patients (p = 0.0065 vs. CP-9), and 16.7 % in CP-9 patients. Two-year survival rates were 77.2 % in 139 patients meeting the 4 tumors of 7 cm criterion with Child-Pugh class A (B1) (p
    Japanese journal of radiology 09/2014; 32(11). DOI:10.1007/s11604-014-0358-1 · 0.84 Impact Factor
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    ABSTRACT: Objectives: The aim of this study was to assess the relationship between the pericardial fat volume (PFV) and the characteristics of coronary plaques in patients with ischemic heart disease (IHD). Background: It has been suggested that pericardial adipose tissue promotes plaque development in coronary artery disease (CAD). Methods: We analyzed the cardiac computed tomography scans in consecutive patients suspected of CAD. PFV was quantified using validated software and indexed to body surface area, and the severity of coronary stenosis was evaluated in the patients who underwent coronary angiography. A total of 105 subjects (mean age, 68 10 years) with IHD were categorized into tertiles of body surface area-indexed PFV values (PFVi, cm(3)/m(2)): low-tertile, PFVi <= 81.2 cm(3)/m(2); mid-tertile, 81.2 cm(3)/m(2) <= PFVi <= 114 cm(3)/m(2); high-tertile, PFVi > 114 cm(3)/m(2). Their body mass index (BMI), waist circumference, Gensini score (GS), and coronary plaque component were evaluated. Results: The GS was significantly different between the high-tertile and the low-tertile groups, indicating a stepwise decrease in GS from high-tertile to mid-tertile and to low-tertile. PFVi had a significant positive correlation with BMI (p = 0.0001) and GS (p < 0.0001). However, no significant association was found between GS and BMI. On the multivariate analysis, high PFVi remained an independent predictor for the coronary artery disease severity (p <0.001), while BMI and waist circumference were not independent predictors. Conclusions: Obese patients were found to have more PFVi, and the characteristics of their coronary lesions were more severe. Pericardial adipose tissue as unique ectopic fat might be more highly associated with IHD progression.
    Journal of Cardiology 05/2014; 65(1). DOI:10.1016/j.jjcc.2014.03.015 · 2.78 Impact Factor
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    ABSTRACT: To find a subgroup that benefits most from transarterial chemoembolization (TACE) in terms of tumor number and size and liver profile in patients with intermediate-stage hepatocellular carcinoma (HCC). Data of 325 intermediate-stage HCC patients who received TACE as the initial treatment were gathered. Four tumor numbers (3-6 tumors) and five maximum tumor diameters (3-7 cm) as well as all of their combinations but one (3 tumors and 3 cm) and Child-Pugh grade were used as variables to ascertain prognostic factors. The respective 1-, 3-, and 5-year overall survival rates in all patients were 86.5, 47.0, and 23.7 %, respectively. Tumor numbers of 4 (P = 0.00145) and 5 (P = 0.036), and tumor size of 7 cm (P = 0.015), and 12 other combinations of tumor number and size, and Child-Pugh grade (P = 0.0015) were identified as significant prognostic factors in univariate analysis, and 4 tumors of 7 cm (P = 0.0008) and Child-Pugh grade (P = 0.0036) remained significant in the stepwise Cox proportional hazard model. The overall survival was significantly better in a patient subgroup having two factors other than patient subgroups having one or no prognostic factors. A patient subgroup having two prognostic factors benefited most from TACE in intermediate-stage HCC patients.
    Japanese journal of radiology 03/2014; 32(5). DOI:10.1007/s11604-014-0298-9 · 0.84 Impact Factor
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    ABSTRACT: To analyze the technical success and tumor response of ultraselective transcatheter arterial chemoembolization (TACE) for small hepatocellular carcinoma (HCC) using automated tumor-feeders detection (AFD) software. Prototype AFD software was prospectively applied to cone-beam computed tomography images acquired during TACE for 155 consecutive HCCs ≤50 mm in 81 patients. The detectability of tumor-feeding subsubsegmental arteries was analyzed. Technical success of TACE was classified into three grades according to 1-week CT; the tumor was embolized with a safety margin (5 mm wide for tumors <25 mm, and 10 mm wide for tumors ≥25 mm) (grade A), without a margin in parts (grade B), or the entire tumor was not embolized (grade C). Tumor response at 2-3 months after TACE was also evaluated in 71 patients using the modified Response Evaluation Criteria in Solid Tumors. One-hundred and twenty-eight (82.6%) tumors were classed as grade A, 17 (11%) as grade B, and 10 (6.5%) as grade C. AFD software could identify 211 (85.4%) of 247 tumor-feeders but not 36 (14.6%). Eighteen (7.9%) were false positive. The tumor response of target lesions in each patient was complete response (CR) in 49 (69%) patients, partial response (PR) in 19 (26.8%), and stable disease (SD) in 3 (4.2%). The overall tumor response was CR in 39 (54.9%) patients, PR in 15 (21.2%), SD in 1 (1.4%), and progressive disease in 16 (22.5%). AFD software has sufficient performance to identify tumor-feeders and contributes to the high technical success in ultraselective TACE.
    Abdominal Imaging 02/2014; 39(3). DOI:10.1007/s00261-014-0094-0 · 1.63 Impact Factor
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    ABSTRACT: Gelatin sponge (GS) is one of the most widely used embolic agents in interventional procedures. There are four commercially available GS products in Japan; however, the endovascular use of Gelfoam and Spongel is off-label, and Gelpart can only be used for hepatic artery embolization and Serescue can only be used for hemostasis of arterial bleeding. GS has been used for a variety of clinical indications, mainly tumor embolization and stopping massive arterial bleeding. The optimal size and preparation procedure of GS particles differs slightly for each clinical indication. In addition, there is a risk of ischemic and/or infectious complications associated with GS embolization in various situations. Therefore, radiologists should be familiar with not only the preparation and handling of GS particles, but also the disadvantages and potential risks, in order to perform GS embolization safely and effectively.
    Japanese journal of radiology 02/2014; 32(4). DOI:10.1007/s11604-014-0292-2 · 0.84 Impact Factor
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    ABSTRACT: To report the usefulness of percutaneous transluminal angioplasty (PTA) of a non-mainstream venous route in an occluded native hemodialysis fistula when a mainstream outflow vein could not be traversed. This cohort included seven patients with an occulted hemodialysis fistula with difficulty in traversing via a mainstream route. A non-mainstream vein near the occluded portion was traversed until it connected with a proximal large-sized vein and the route was dilated using a 4- or 5-mm balloon catheter. Metallic stent placement was performed, if necessary. Technical aspects and long-term patency was evaluated. PTA could be performed in all patients; however, stent placement was required in two because of residual stenosis and clotting. The clinical success rate of fistula restoration was 100 %. Fistula dysfunction recurred in six patients 17-668 days (mean ± standard deviation 229.3 ± 225.0) later. PTA was repeated in four patients, but not in two. The mean duration of the primary patency was 336.6 ± 417.2 days (range 17-1,190) and that of the secondary patency was 897.1 ± 801.4 days (range 17-2,230). PTA of a non-mainstream venous route is useful for restoring an occluded hemodialysis fistula when the mainstream outflow vein cannot be traversed.
    Japanese journal of radiology 01/2014; 32(2). DOI:10.1007/s11604-013-0277-6 · 0.84 Impact Factor
  • Shiro Miyayama · Tetsuya Minami · Kazuto Kozaka · Yasuyuki Ushiogi ·
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    ABSTRACT: A 75-year-old woman with hemodialysis-related right subclavian vein occlusion was referred to our hospital for retry of endovascular treatment. The occluded segment could not be crossed via either antegrade or retrograde approaches, including puncturing the obstruction with the stiff end of the guide wire. The obstruction was successfully punctured using a 75-cm long 21-G needle via the right median cubital vein and a metallic stent was placed to cover the occluded segment after balloon angioplasty. The recanalized segment was patent for 10 months until the patient's death from concomitant disease.
    11/2013; 29(3). DOI:10.1007/s12928-013-0225-5
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    ABSTRACT: Purpose: This study was designed to compare technical success and local recurrence rates of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with/without monitoring of embolized areas using cone-beam computed tomography (CBCT). Methods: A total of 207 HCCs ≤6 cm were treated with superselective TACE using digital subtraction angiography (DSA) alone (DSA group, 98 tumors of 70 patients) or plus CBCT monitoring (CBCT group, 109 tumors of 79 patients). Technical success of TACE was classified into three grades according to 1-week CT; the tumor was embolized with a safety margin (5-mm wide for tumors <25 mm, and 10-mm wide for tumors 25≥ and ≤60 mm; grade A), without a margin in parts (grade B), or the entire tumor was not embolized (grade C). Technical success and local recurrence rates in the DSA and CBCT groups were compared. Local recurrence rates of grade A and B tumors were also compared. Results: The grade A/B/C tumors in the DSA and CBCT groups were 64 (65.3%)/25 (25.5%)/9 (9.2%) and 95 (87.2%)/11 (10.1%)/3 (2.8%), respectively. Local recurrence developed in 46/158 (29.1%) grade A tumors and 24/36 (66.7%) grade B. There were significant differences in technical success between the DSA and CBCT groups (p < 0.001) and local recurrence rates between grade A and B tumors (p < 0.001). The 1-, 2-, and 3-year local recurrence rates in the DSA and CBCT groups were 33.3 and 22.3%, 41.3 and 26.8%, and 48 and 30.6%, respectively (p = 0.0217). Conclusion: Intraprocedural CBCT monitoring of embolized areas reduces the local tumor recurrence.
    CardioVascular and Interventional Radiology 06/2013; 37(2). DOI:10.1007/s00270-013-0667-2 · 2.07 Impact Factor

  • Journal of vascular and interventional radiology: JVIR 06/2013; 24(6):913-915. DOI:10.1016/j.jvir.2013.02.028 · 2.41 Impact Factor
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    ABSTRACT: Purpose: To evaluate the performance of transcatheter arterial chemoembolization guidance software that uses cone-beam computed tomography (CT) technology in identifying small hepatocellular carcinoma (HCC) tumors and feeding branches. Materials and methods: Cone-beam CT and manual feeder vessel detection (MFD) software were used in chemoembolization of 68 HCCs 30 mm or smaller (mean ± standard deviation, 15.3 mm ± 5.2). Detectability of tumors and tumor-feeding sub-subsegmental arteries was compared versus that of nonselective digital subtraction angiography (DSA). Technical success of chemoembolization was divided into three grades according to 1-week CT findings: entire tumor embolized with at least a 5-mm-wide margin (ie, complete), tumor embolized without a margin in parts (ie, adequate), or entire tumor not embolized (ie, incomplete). All cone-beam CT data were also reanalyzed with automatic feeder vessel detection (AFD) software that was developed later. Results: Cone-beam CT could depict all tumors, including eight that were first discovered during chemoembolization. Sixty-one tumors (89.7%) were detected on CT during arterial portography and during hepatic arteriography, and seven (10.3%) were detected with one or the other. Nonselective DSA depicted 49 tumors (72.1%). Among 100 tumor-feeding vessels, 81 were identified with MFD and 38 with nonselective DSA. Detectability of tumors with CT and tumor-feeding branches with MFD was significantly better than with nonselective DSA (both P<.001). Fifty-nine tumors (86.8%) were completely embolized and nine (13.2%) were adequately embolized. AFD identified 96 feeder vessels; 88 (88%) represented true-positive findings. Conclusions: Transcatheter arterial chemoembolization guidance software with cone-beam CT technology has a sufficient performance level to detect small HCCs and their feeding branches.
    Journal of vascular and interventional radiology: JVIR 02/2013; 24(4). DOI:10.1016/j.jvir.2012.12.022 · 2.41 Impact Factor
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    ABSTRACT: AimMain bile duct necrosis develops after transcatheter arterial chemoembolization (TACE) through the caudate artery (A1) and medial subsegmental artery (A4) of the hepatic artery in the treatment of hepatocellular carcinoma. The aim of this study was to evaluate the bile duct branch (BD branch) from A1 and A4. Methods We evaluated the origin and vascular territory of the BD branch in 11 patients who underwent selective A1 and/or A4 arteriography using arteriograms, cone-beam computed tomography (CBCT) and CT obtained 1 week after TACE. Follow-up CT and/or magnetic resonance imaging were also evaluated. ResultsThe BD branch arose from the first branch (n=4), the second branch (n=1), and both the first and second branches (n=1) of A1, and from the first branch of A4 (n=5). It supplied the bilateral hepatic ducts and common hepatic duct (CHD) (n=4), the right hepatic duct (RHD) and CHD (n=2), RHD, CHD and common bile duct (n=1), the left hepatic duct (LHD) and CHD (n=2), and LHD alone (n=2). Anastomosis between A1 or A4 and other branches was demonstrated in seven patients. Bile duct stricture developed in all nine patients 2-8 months after TACE of the BD branch and percutaneous transhepatic bile duct drainage and metallic stent placement was required in one because of jaundice. Conclusion The BD branch arises from the proximal portion of A1 and A4 and mainly supplies the hepatic ducts and CHD.
    Hepatology Research 01/2013; 43(11). DOI:10.1111/hepr.12071 · 2.74 Impact Factor
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    ABSTRACT: Purpose: To evaluate the clinical features of hepatocellular carcinoma (HCC) supplied by the left internal mammary artery (LIMA). Materials and methods: This cohort included 12 HCCs of 12 patients supplied by the LIMA. The clinical features of these tumors were analyzed. Results: The tumor diameters were 4.2 ± 4.4 cm (mean ± SD) located at the surface of segments 4 (n = 6), 3 (n = 3), 2 (n = 2), and 4-8 (n = 1), respectively. The tumor was supplied by the phrenic branch (n = 8) or musclophrenic artery (n = 4) entirely (n = 7) or partially (n = 5). Two patients with large tumors 10 and 16 cm in diameter, respectively, received no previous treatment. Ten patients had previously undergone 5.8 ± 3.7 TACE sessions including through extrahepatic collaterals. Selective TACE could not be completed in one. No TACE-related complications developed. Of 11 embolized tumors, six did not recur at 8.8 ± 4.6 months and five recurred 4.4 ± 2.6 months later. Conclusion: The clinical features of HCC supplied by the LIMA can be divided into two categories, untreated large tumors and small tumors receiving multiple TACE sessions at the subcapsular area of the left hepatic lobe.
    Japanese journal of radiology 09/2012; 30(10). DOI:10.1007/s11604-012-0123-2 · 0.84 Impact Factor
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    ABSTRACT: The "Guideline on the Use of New Anticancer Drugs for the Treatment of Hepatocellular Carcinoma" was prepared by the Study Group on New Liver Cancer Therapies established by the "Research Project on Emergency Measures to Overcome Hepatitis" under the auspices of the Health and Labour Sciences Research Grant. The Guideline brings together data collected by the Study Group on the use and incidence of adverse events in 264 patients with advanced hepatocellular carcinoma (HCC) treated using sorafenib and in 535 patients with advanced HCC treated using miriplatin at 16 participating institutions up until 22 December 2010, as well as referring to the published studies, academic presentations, and reports from the private sector. The aim of this Guideline is to facilitate understanding and current thinking regarding the proper usage of new anticancer drugs towards actual use in therapy. In terms of the format, the Guideline presents "clinical questions" on issues pertaining to medical care, makes "recommendations" on diagnosis and treatment in response to each of these clinical questions, and provides a rationale for these recommendations in the form of "scientific statements".
    Hepatology Research 06/2012; 42(6):523-542. DOI:10.1111/j.1872-034X.2012.00981.x · 2.74 Impact Factor
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    ABSTRACT: To evaluate retrospectively whether technical factors of hepatic arterial embolization affect the prognosis of patients with hepatocellular carcinoma (HCC). Inclusion criteria of this study were the following: (1) patients received embolization as the initial treatment during 2003-2004, (2) Child A or B liver profile, (3) five or fewer HCCs with maximum diameter of 7 cm or smaller, and (4) no extrahepatic metastasis. Patient data were gathered from 43 centers. Prognostic factors were evaluated using univariate and multivariate analyses. Eight hundred fifteen patients were enrolled. The 1-, 3-, 5-, and 7-year overall survival rates were 92.0 % (95 % CI 90.1-93.9), 62.9 % (95 % CI 59.3-66.6), 39.0 % (95 % CI 35.1-43.0), and 26.7 % (95 % CI 22.6-30.8) in all patients. Univariate analysis showed a Child-Pugh class-A, alpha-fetoprotein level lower than 100 ng/ml, tumor size of 3 cm or smaller, tumor number of 3 or fewer, one-lobe tumor distribution, nodular tumor type, within the Milan criteria, stage I or II, no portal venous invasion, use of iodized oil, and selective embolization were significantly better prognostic factors. In the multivariate Cox model, the benefit to survival of selective embolization remained significant (hazard ratio 0.68; 95 % CI 0.48-0.97; p = 0.033). Selective embolization contributes to survival in patients with HCCs.
    Japanese journal of radiology 05/2012; 30(7):560-6. DOI:10.1007/s11604-012-0088-1 · 0.84 Impact Factor
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    ABSTRACT: The left hepatic lobe is divided into three subsegments according to anatomical landmarks; however, there are several variations in the vascular territories of the left hepatic arterial branches. Hepatocellular carcinoma (HCC) located near the umbilical fissure or at the left side of the umbilical portion of the left portal vein has frequent crossover blood supply. HCC located in the caudal aspect of the lateral segment has a variety of feeding arteries, and is infrequently supplied by the caudate artery or the medial subsegmental artery (A4), and by the lateral left hepatic arteries. HCC located in the posterior aspect of segment 4 is frequently supplied by the caudate artery or a small A4 branch arising from the caudate artery. In addition, the left inferior phrenic, right and left internal mammary, right and left gastric, cystic, and omental arteries are well known extrahepatic collateral pathways supplying HCC in the left hepatic lobe, especially when the hepatic artery is attenuated by previous transcatheter arterial chemoembolization (TACE). Interventional radiologists should have sufficient knowledge of vascular territories in the left hepatic arterial branches and extrahepatic collaterals to perform effective TACE for HCC located in the left hepatic lobe.
    Japanese journal of radiology 04/2012; 30(6):471-9. DOI:10.1007/s11604-012-0075-6 · 0.84 Impact Factor

Publication Stats

2k Citations
227.04 Total Impact Points


  • 1990-2012
    • Kanazawa University
      • Department of Radiology
      Kanazawa, Ishikawa, Japan
  • 2007
    • Osaka City University
      • Department of Radiology
      Ōsaka, Ōsaka, Japan
  • 1994-1996
    • Kanazawa Medical University
      • Department of Radiology
      Kanazawa-shi, Ishikawa-ken, Japan