Katsutoshi Sugimoto

Tokyo Medical University | TMU · Department of Gastroenterology and Hepatology

This study aimed to compare systemic immune responses and metastatic effects induced by radiofrequency ablation (RFA) and irreversible electroporation (IRE) in murine tumor models. We assessed cytokine production, growth of treated and untreated metastatic tumors, and synergy with immune checkpoint inhibitors (ICIs). Hep55.1c murine hepatoma cells...

Background & Aims Radiofrequency ablation (RFA) is the standard treatment for small hepatocellular carcinoma (HCC), specifically for tumors <3 cm in size and numbering fewer than three, excluding surgical candidates. Microwave ablation (MWA) is an innovative approach believed to have theoretical benefits over RFA; however, these advantages are yet...

Purpose Immunotherapies have led to a paradigm shift in the treatment of hepatocellular carcinoma (HCC). Studies have revealed the single-cell catalogs of tumor-infiltrating immune cells and the trajectories of their differentiation. Nevertheless, the spatial distribution of these immune cells with distinct phenotypes in the tumor microenvironment...

Background Gadoxetic acid (EOB)-enhanced magnetic resonance imaging (MRI) (EOB-MRI) can be used as a one-stop examination for detecting liver tumors and evaluating liver function. Purpose The study aimed to assess the functional liver reserve (FLR) using the T1 map from the hepatobiliary phase of EOB-MRI by conducting a comparison with the results...

Purpose: The study aimed to compare the diagnostic performance of washout-parametric imaging (WOPI) with that of conventional contrast-enhanced ultrasound (cCEUS) in differentiating focal liver lesions (FLLs).Methods: A total of 181 FLLs were imaged with contrast-enhanced ultrasound using Sonazoid, and the recordings were captured for 10 minutes in...

Background Attenuation coefficient (AC) and shear-wave speed (SWS) are established US markers for assessing patients with metabolic dysfunction-associated steatotic liver disease (MASLD), while shear-wave dispersion slope (DS) is not. Purpose To assess the relationship between the multiparametric US imaging markers DS, AC, and SWS and liver histopa...

High-intensity focused ultrasound (HIFU) represents a method employing high-intensity ultrasound energy to induce thermal ablation of cancerous cells. Regarded as minimally invasive, HIFU treatment offers reduced risk of complications and abbreviated recovery periods compared to surgical interventions. Although predominantly utilized in the managem...

To investigate changes in skeletal muscle mass and fat fraction in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes mellitus (T2DM) undergoing treatment with Semaglutide for 6months. This single-arm pilot study included 21 patients with MASLD who received semaglutide for T2DM. Body weight, metabolic...

Background & Aims The predictors of progression from steatosis to more advanced stages of metabolic dysfunction–associated steatotic liver disease (MASLD) remain unclear. We evaluated the association between the quantity of hepatic steatosis and longitudinal changes in liver stiffness measurements (LSMs) using magnetic resonance elastography (MRE)...

Purpose: The effect of hepatic fibrosis stage on quantitative ultrasound based on the attenuation coefficient (AC) for liver lipid quantification is controversial. The objective of this study was to determine how the degree of fibrosis assessed by magnetic resonance (MR) elastography affects AC based on the ultrasound-guided attenuation parameter a...

Contrast-enhanced ultrasound (CEUS) shows different enhancement patterns depending on the time after administration of the contrast agent. The aim of this study was to evaluate the diagnostic performance of liver nodule characterization using our proposed deep learning model with input of nine CEUS images. A total of 181 liver lesions (48 benign, 7...

Background: As hepatic myelolipoma is rarely encountered, its radiological diagnosis using ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) is challenging. Hepatic myelolipoma is similar to fat-contained hepatic lesions seen in hepatocellular carcinoma and angiomyolipoma. Therefore, further development of techni...

Background and aim: The anti-PD-L1 antibody atezolizumab and VEGF-neutralizing antibody bevacizumab in combination (Atezo+Bev) have become the first-line therapy in advanced HCC. Distinct types of tumor immune microenvironment (TIME) and their associations with specific molecular subclasses and driver gene mutations have been identified in HCC; ho...

This review outlines several modified versions of the contrast-enhanced ultrasonography Liver Imaging Reporting and Data System (CEUS LI-RADS) that utilize Sonazoid. Furthermore, it discusses the advantages and challenges of diagnosing hepatocellular carcinoma using these guidelines, as well as the authors' expectations and opinions regarding the n...

Background: Despite the diversity of thermal ablations, such as radiofrequency ablation (RFA) and microwave ablation (MWA), and non-thermal ablation, such as irreversible electroporation (IRE) cross-comparisons of multiple ablative modalities for hepatocellular carcinoma (HCC) treatment remain scarce. Thus, we investigated the therapeutic outcomes...

An 80-year-old Japanese male with alcoholic cirrhosis and esophageal varices was scheduled for the endoscopic treatment of incidentally discovered rectal varices. Prior to his admission, bleeding in the lower gastrointestinal tract due to ruptured rectal varices was observed, and endoscopic variceal ligation (EVL) was performed to stop the bleeding...

Aim: To evaluate the usefulness and safety of a newly developed full-core biopsy needle. Methods: We selected 149 patients who underwent percutaneous liver biopsy at our institution from February 2019 to April 2021. We excluded 35 patients with hepatic fibrosis stage F3 or higher, which made it histopathologically difficult to measure the number...

Background: The detection and characterization of liver lesions are problematic in patients with bronchial asthma, renal dysfunction, or a history of allergy to gadolinium-based magnetic resonance contrast media or iodine-computed tomography contrast media because these contrast media cannot be used. Hence, the information on the lesion vascularit...

Background/purpose: Shear wave elastography (SWE) is a clinically method used to evaluate liver hardness. In this study, we assessed its applicability in assessing the pancreas and its potential for diagnosing chronic pancreatitis. Methods: We performed SWE on 59 patients who underwent abdominal ultrasound, and measured the computed tomography (...

We herein report two cases of hemorrhagic ampullary lesions in which endoscopic papillotomy was performed to control bleeding and resulted in successful treatment. Both patients were pathologically diagnosed with an underlying pathology characterized by inflammatory cell infiltration and capillary proliferation. They also had disposing factors for...

A 20-year-old man was referred to pediatrics for hyperbilirubinemia and mental retardation. Abdominal ultrasonography findings were indicative of a portosystemic shunt, and as a shunt between the left branch of the portal vein and inferior vena cava was confirmed by abdominal computed tomography, he was diagnosed with patency of the venous duct. We...

Aim: To compare the diagnostic performance based on the modified CEUS LI-RADS, which includes Kupffer-phase findings as a major imaging feature, with that of CT and MRI (CT/MRI) LI-RADS for liver nodules in patients at high risk of HCC. Methods: A total of 120 patients with 120 nodules were included in this retrospective study. The median size o...

A 68-year-old female patient with autoimmune hepatitis receiving prednisolone was referred to our institution for a mass lesion on segment VII of the liver. After undergoing contrast-enhanced ultrasonography, contrast-enhanced CT, Gd-EOB-DTPA-enhanced MRI, and ¹³¹I-adosterol scintigraphy, the mass was suspected to be a hepatic adrenal rest tumor (H...

Yamamoto et al. report a case of intraductal residual lesions after endoscopic papillectomy successfully treated with endoscopic radiofrequency ablation therapy. This report provides readers with images and videos of precise intraductal radiofrequency ablation therapy methods for safe and effective eradication of intraductal residual lesions.

The aim of this study was to compare the diagnostic performance of Contrast-Enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) version 2017, which includes portal- and late-phase washout as a major imaging feature, with that of modified CEUS LI-RADS, which includes Kupffer-phase findings as a major imaging feature. Participants at r...

Background/aim: We aimed to investigate the prognosis of patients who received radiofrequency ablation (RFA) for liver metastases of unresectable colorectal cancer (CRC). Patients and methods: We retrospectively compared 147 patients treated for CRC liver metastases, who underwent RFA (n=26), resection (n=92), and chemotherapy (n=29) between 200...

Background Nonalcoholic fatty liver disease (NAFLD) is common in the general population but identifying patients with high-risk -nonalcoholic steatohepatitis (NASH) who are candidates for pharmacologic therapy remains a challenge. Purpose To develop a score to identify patients with high-risk NASH, defined as NASH with an NAFLD activity score (NAS)...

This is the case of a 68-year-old male. On the 14th day after the introduction of atezolizumab, an immune-checkpoint inhibitor (ICI) for hepatocellular carcinoma, the patient developed difficulty in moving and had chills. Since body temperature was 39.4°C, consciousness disorder developed on the 16th day, and steroid pulse therapy was started for p...

PurposeAttenuation imaging (ATI) is a new noninvasive ultrasound technique for assessing steatosis grade (S). However, validated region-of-interest (ROI) sampling strategies are not currently available. We investigated the diagnostic performance of various ATI-ROI positions for determining histopathologic S in patients with nonalcoholic fatty liver...

Purpose: Measurement of spleen stiffness (SS) using ultrasound (US) elastography is useful for predicting portal hypertension. However, the mechanism leading to increased SS remains unclear. We jointly developed a new US elastography system (Aplio i-series, Canon Medical Systems) that can easily measure organ viscosity (dispersion slope: DS). We a...

Here, we report the case of a 30-year-old female patient who underwent coil embolization for unruptured splenic artery aneurysm without any complication at 26 weeks of pregnancy with reduction in fetal radiation exposure. The patient did not suffer from rupture of splenic artery aneurysm during or after procedure. Pregnancy is a risk factor of sple...

A 67-year-old man with a history of esophageal and gastric varices that were treated endoscopically was treated for Budd-Chiari syndrome and immunoglobulin G4-related sclerosing cholangitis in our facility. Varices in the second portion of the duodenum were revealed in follow-up upper endoscopy. The draining vein formed a venous plexus that was det...

Purpose: Shear wave elastography (SWE) has been validated in chronic hepatitis C and B; however, limited data are available in non-alcoholic fatty liver disease (NAFLD). This study aimed to evaluate the accuracy of SWE and FIB4 index for the diagnosis of fibrosis in a cohort of consecutive patients with biopsy-proven NAFLD, and to evaluate the effe...

The patient was a 67-year-old-woman, referred to our institution with prolonged slight fever and weight loss. Blood tests revealed an increased inflammatory response and hepatic disorder. Abdominal ultrasound demonstrated a mass lesion with cystic lesions in the liver. Contrast-enhanced CT showed a 10-cm in diameter mass in the right lobe of the li...

The Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) was introduced for classifying suspected hepatocellular carcinoma (HCC). However, it cannot be applied to Sonazoid. We assessed the diagnostic usefulness of a modified CEUS LI-RADS for HCC and non-HCC malignancies based on sensitivity, specificity, positive pred...

Background Nonalcoholic steatohepatitis (NASH) is diagnosed with histopathologic testing, but noninvasive surrogate markers are desirable for screening patients who are at high risk of NASH. Purpose To investigate the diagnostic performance of dispersion slope, attenuation coefficient, and shear-wave speed measurements obtained using two-dimensiona...

Irreversible electroporation (IRE) is a novel form of soft tissue ablation therapy that uses highcurrent electrical pulses to induce the formation of pores in the cell membrane, leading to cell death. Although outcome data for the ablation of hepatocellular carcinoma (HCC) by IRE are limited, early results are encouraging and may suggest equivalenc...

Background: Thrombopoietin (TPO) receptor agonist, Lusutrombopag, is recently released to treat thrombocytopenia in chronic liver disease (CLD). However, its effectiveness remains to be unclear. The purpose of this study was to clarify the efficacy of Lusutrombopag and identify the predictors associated with platelet count increase. Methods: Eighty...

Hepatic adrenal rest include ectopic adrenal tissue in the liver and adrenohepatic fusion. Long-lasting hyperstimulation of that tissue induces hyperplasia sometimes simulating true tumors. True autonomic tumors originating from ectopic adrenal tissue with or without hyperfunction are rare. Hepatic adrenal rest sometimes has similar imaging finding...

Shear wave (SW) dispersion imaging is a newly developed imaging technology for assessing the dispersion slope of SWs, which is related to tissue viscosity in diffuse liver disease. Our preclinical and preliminary clinical studies have shown that SW speed is more useful than dispersion slope for predicting the degree of fibrosis and that dispersion...

This study investigated the usefulness of shear wave (SW) speed (related to viscoelasticity), dispersion slope (related to viscosity), and attenuation value (related to steatosis) measurements obtained using a new ultrasound (US) elastography system in patients with nonalcoholic fatty liver disease (NAFLD). In multivariable analysis with histologic...

Objective: To evaluate irreversible electroporation (IRE) for locally advanced pancreatic cancer (LAPC). Materials and methods: This study was approved by our local review board. Eight patients with histologically proven LAPC≤5 cm were prospectively enrolled to undergo ultrasound-guided IRE. The primary endpoint was complications within 90 days....

To investigate the usefulness of shear-wave speed and dispersion slope measurements obtained, using an ultrasound elastography system in rat livers with various degrees of necroinflammation and fibrosis. A total of 25 male Sprague Dawley rats were randomly divided into 5 groups of 5 rats each: G0 (control), G1 (CCl4 injected twice a week for 1 wk),...

Aim: Interferon-free direct-acting antiviral (DAA) therapy is an effective treatment for chronic hepatitis C (CH(C)) patients. Activity of natural killer (NK) cells was reported to be impaired in patients with hepatitis C virus infection. The aim of this study was to examine whether DAA therapy could restore NK activity in patients with CH(C). Me...

Objective Dynamic contrast-enhanced MRI (DCE-MRI) can measure the changes in tumor blood flow, vascular permeability and interstitial and intravascular volume. The objective was to evaluate the efficacy of DCE-MRI in prediction of Barcelona Clinic Liver Cancer (BCLC) staging B or C hepatocellular carcinoma (HCC) response after treatment with transc...

A 27-year-old woman with colon cancer and liver metastasis was referred to our hospital. Colectomy and colostomy were performed to improve her ileus. Following 13 sessions of oxaliplatin-based chemotherapy (OC) with mFOLFOX6 + bevacizumab, thrombocytopenia and frequent peristomal bleeding occurred. Computed tomography showed severe ascites, splenom...

PurposeShear wave elastography (SWE) has been validated in chronic hepatitis C and B; however, limited data are available in non-alcoholic fatty liver disease (NAFLD). This study aimed to evaluate the accuracy of SWE and FIB4 index for the diagnosis of fibrosis in a cohort of consecutive patients with biopsy-proven NAFLD, and to evaluate the effect...

Background Recently, diffusion-weighted imaging (DWI) and quantitative enhancement ratio measured at the hepatobiliary phase (HBP) of Gd-EOB-DTPA–enhanced magnetic resonance imaging (MRI) has been established as an effective method for evaluating liver fibrosis. Purpose To evaluate which is a more favorable surrogate marker in predicting high-stag...

A 58-year-old man with hepatitis B cirrhosis noticed black stools and underwent an endoscopy at a community hospital. The presence of esophageal varices (EVs) was confirmed, but the bleeding point was not found. He was referred to our institution and underwent a second endoscopy. Extensive white patches of esophageal candidiasis were visible on end...

Background To evaluate the usefulness of differentiation of histological grade in hepatocellular carcinoma (HCC) using three-dimensional (3D) analysis of apparent diffusion coefficient (ADC) histograms retrospectively. Methods The subjects consisted of 53 patients with 56 HCCs. The subjects included 12 well-differentiated, 35 moderately differenti...

PurposeTo assess the diagnostic accuracy of contrast-enhanced ultrasound (CEUS), contrast-enhanced multiphase CT (CECT), and gadoxetic acid-enhanced MRI (EOB-MRI) in identifying residual tumor in the subacute follow-up of patients with malignant hepatic tumors treated by irreversible electroporation (IRE). Methods We enrolled 16 patients with 21 he...

To evaluate the association between the therapeutic outcomes of sorafenib for advanced hepatocellular carcinoma (HCC) and the parameters of intravoxel incoherent motion (IVIM). Nine patients were evaluated prospectively. All patients were Child-Pugh score A. The mean dimension of the lesion was 32 mm (range: 15–74 mm). MR images were obtained using...

Objective: To determine the optimal bolus injection rate of ultrasound (US) contrast agent in vascular imaging for focal liver lesions. Methods: Thirteen patients with 13 focal liver lesions (5 hepatocellular carcinomas (HCCs) with cirrhosis, 4 liver metastases, 2 hemangiomas, 1 intrahepatic cholangiocarcinoma, 1 focal nodular hyperplasia) recei...

Background Dual red imaging (DRI) is a new technology that can increase the visibility of deeper veins compared with narrow band imaging (NBI). As esophageal varices (EVs) are a vascular disease occurring in the submucosal layer, their visibility might be increased by DRI. We prospectively clarified whether the visibility of EVs with red color sign...

Introduction: The aim of this study to evaluate the effectiveness of enhanced diffusion-weighted imaging (DWI) for distinguishing liver haemangiomas from metastatic tumours (mets). Methods: This study included 23 patients with 27 haemangiomas and 26 patients with 46 mets. Breath-holding diffusion-weighted imaging (DWI) (b-values of 0, 50, 100, 1...

To evaluate the added value of Sonazoid-enhanced Superb Micro-vascular Imaging (SMI) in routine contrast-enhanced ultrasound (CEUS) examinations for the evaluation of focal solid hepatic lesions, CEUS was performed in 37 patients with focal hepatic lesions: 26 patients with hepatocellular carcinoma (HCC), 3 with metastasis, 4 with hemangioma, 3 wit...

Objective: Elderly gastrointestinal bleeding (GIB) patients sometimes cannot be discharged home. In some cases, they die after hemostasis, even following appropriate treatment. This study investigates the clinical backgrounds and outcomes of elderly Japanese GIB patients. Methods: The medical records of 185 patients (123 men, 62 women; mean age...

Background: Protein and energy malnutrition is a severe problem for patients with liver cirrhosis (LC) and fasting often induces starvation which is a vitally important outcome. Dietary restriction is essential for endoscopic injection sclerotherapy (EIS) to patients with risky esophageal varices, thereby creating the possible exacerbation of nutr...

Purpose: The aim of the present study was to investigate two methods of determining liver stiffness in rats with various degrees of non-alcoholic steatohepatitis induced by a methionine- and choline-deficient (MCD) diet by comparing each finding with reference to histopathological liver findings. Methods: Twenty male Wister rats were fed an MCD...

Background and aims: We are developing a computer-aided diagnosis (CAD) system for estimating the malignancy grade of hepatocellular carcinoma (HCC) using contrast-enhanced ultrasound (CEUS). In this study, observers estimated the malignancy grade of HCC with and without the cues provided by CAD. Materials and methods: Institutional review board...

Irreversible electroporation (IRE) is a promising technique for the focal treatment of soft tissue tumors. Even though the local application of an excessive electric field is a potential cause of cardiac arrhythmias, initial clinical studies have shown that IRE is generally safe when cardiac gating is employed. In this case report, we observed an e...

This clinical study was conducted to evaluate the safety and short-term outcomes of irreversible electroporation (IRE) for the treatment of patients with hepatocellular carcinoma (HCC) in Japan. The study was designed in a prospective setting. Five patients (3 men and 2 women; mean age, 66.6 ± 5.8 years) with 6 HCCs were enrolled and treated using...

To assess various ultrasound (US) findings, including B-mode, shear-wave elastography (SWE), and contrast-enhanced US, in accurately assessing ablation margins after irreversible electroporation (IRE) based on radiologic-pathologic correlation, and to compare these findings between IRE and radiofrequency (RF) ablation. IRE (n = 9) and RF ablation (...

Purpose To assess the value of shear wave elastography (SWE) for predicting the presence of hepatocellular carcinoma (HCC) and esophagogastric varices (EGV) in patients with chronic liver disease. Methods Liver tissue stiffness, as well as various other parameters potentially associated with HCC and portal hypertension, was measured by SWE in 27...

Aim: To evaluate the usefulness of three-dimensional (3D) shear-wave elastography (SWE) in assessing the liver ablation volume after radiofrequency (RF) ablation. Methods: RF ablation was performed in vivo in 10 rat livers using a 15-gauge expandable RF needle. 3D SWE as well as B-mode ultrasound (US) were performed 15 min after ablation. The ac...

Objective To evaluate the efficacy of diffusion-weighted imaging (DWI) in predicting the development of vascularization in hypovascular hepatocellular lesions (HHLs). Materials and methods Forty-two HHLs that were diagnosed by CT arteriography were evaluated retrospectively. The lesion on DWI was classified as isointense, hypointense, or hyperinte...

The aim of this study was to assess quantitatively the Kupffer-phase enhancement patterns of hepatic hemangiomas in contrast-enhanced ultrasound (CEUS) with Sonazoid. A total of 46 patients with 46 hepatic hemangiomas (17.1 ± 6.2 mm in diameter, 34 typical type and 12 high-flow type) underwent CEUS in the Kupffer phase. The lesion-to-liver contrast...

We report a woman in her late 60s with hepatocellular carcinoma in whom the tumor was successfully treated by irreversible electroporation (IRE). Vascular-phase contrast-enhanced US (CEUS) with Sonazoid and dynamic CT at 1 day after treatment showed no tumor enhancement, but the safety margin of ablation appeared to be insufficient. On the other ha...

AimThe combination therapy of pegylated-interferonαand ribavirin (PEG/Rib) is one of the effective treatment for chronic hepatitis C (CH(C)) patients. NK activity was reported to be impaired in the patients with HCV. The aim of this study was to examine whether PEG/Rib therapy could restore NK activity in CH(C) patients. Patients and Methods In nin...

Currently, micro RNA (miRNA) is considered an attractive target for therapeutic intervention. A significant obstacle to the miRNA-based treatments is the efficient delivery of miRNA to the target tissue. We have developed polyethylene glycol-modified liposomes (Bubble liposomes (BLs)) that entrap ultrasound (US) contrast gas and can serve as both p...

The 2005 Japan Gastroenterological Endoscopy Society (JGES) guidelines for the management of antithrombotic drugs focused on the increasing risks of bleeding, even from biopsy during scheduled esophagogastroduodenoscopy (EGD). The new 2012 guidelines emphasized the prevention of thromboembolic complications. To compare with the new guidelines, we i...

Objectives: Shear wave elastography is a novel noninvasive method for assessing liver fibrosis by measuring liver stiffness. This study was conducted to evaluate how pathologic changes could have an impact on measured elasticity values in both resected hepatocellular carcinomas and adjacent liver tissue. Methods: Intraoperative shear wave elasto...

Great progress has been made in the diagnosis of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) in the last few years due to the use of molecular criteria. This has allowed us to identify a new type of hepatic nodule. In this case report, we present a male patient with a hepatic nodule associated with idiopathic portal hypertensio...

Mucinous cystic neoplasms (MCNs) of the hepatobiliary system are rare tumors that usually arise within the liver. We encountered a 63-year-old woman with a surgically proven MCN of the liver. We first performed contrast-enhanced ultrasound imaging, and the mass was found to have the appearance of a solid tumor, showing peripheral nodular enhancemen...

Background and aim: Liver cirrhosis (LC) is accompanied by hepatic arterializations, intrahepatic shunts, and hyperdynamic circulations. These changes shorten the arrival time (AT) of ultrasound contrast agents to the hepatic vein (HV). Whether treatment of gastric fundal varices (GVs) by balloon-occluded transvenous obliteration (B-RTO) improves...

Balloon-occluded transarterial chemoembolization (B-TACE) is able to achieve denser accumulation of Lipiodol emulsion (LE) in hepatocellular carcinoma (HCC) than conventional TACE. However, to maximize the therapeutic effect of B-TACE, it is imperative to understand the hemodynamic changes that occur during arterial occlusion. We here present two p...

Background: Argon plasma coagulation (APC) is very useful as a consolidation treatment for reducing the recurrence of esophageal varices (EVs). However, repeated sedation in endoscopic treatment has the risk of prolonging hepatic encephalopathy and affects the respiratory state of liver cirrhosis (LC) patients, in whom pulmonary arteriovenous shun...