Publications (42)41.64 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Objective: The aim of this study was to evaluate the prevention of liver ischemic injury by preoperative coil embolization in patients with a replaced hepatic artery scheduled for pancreatectomy with splanchnic artery resection. Methods: Between July 2009 and May 2012, 4 patients with replaced hepatic artery underwent pancreatectomy plus splanchnic artery resection. The replaced right hepatic artery was preoperatively embolized in 2 patients. In the other 2 patients, the common hepatic artery was embolized preoperatively. We evaluated the complications encountered in the perioperative period. Results: There were no embolization-related complications. Although 2 patients presented with small liver infarcts, the aspartate aminotransferase and alanine aminotransferase levels did not exceed 1000 IU/L in any of the patients, and none experienced severe liver injury. Conclusions: Coil embolization before pancreatectomy with splanchnic artery resection in patients with a replaced hepatic artery may help to prevent severe ischemic liver injury in the perioperative period.
- [Show abstract] [Hide abstract] ABSTRACT: To evaluate the characteristics of hepatocellular carcinomas (HCCs) fed by the right renal capsular artery and to assess the tumor response and complications in patients treated with transarterial therapy via the renal capsular arteries with or without other extrahepatic arteries and/or intrahepatic arteries. Between March 2006 and May 2012, 24 lesions in 19 patients were treated by transcatheter arterial chemoembolization (23 sessions), transcatheter arterial embolization (two sessions), or transcatheter arterial infusion (one session), with HCCs fed by the right renal capsular artery with or without intrahepatic arteries and/or other collateral arteries. Other intrahepatic lesions were concurrently treated if needed. Tumor size ranged from 10 mm to 107 mm (mean, 30.5 mm). Of the 24 tumors, 12 were located in segment VI, 10 in segment VII, one in the posterior segment, and one in the anterior segment after posterior segment resection. Severe complication occurred in four patients: liver abscess (n = 2), pleural effusion (n = 1), and duodenal ulcer (n = 1). Pleural effusion might be related to chemoembolization via the right renal capsular artery. A complete response was obtained in six sessions and a partial response in eight; 10 sessions were associated with stable disease and two with progressive disease. Precise renal capsular artery knowledge would facilitate successful and safe transarterial therapy for HCCs fed by the renal capsular arteries.
- [Show abstract] [Hide abstract] ABSTRACT: The purpose of this study was to evaluate the diagnostic capability of gadoxetate disodium (Gd-EOB)-MRI for the detection of hepatocellular carcinoma (HCC) compared with multidetector CT (MDCT). Fifty patients with 57 surgically proven HCCs who underwent Gd-EOB-MRI and MDCT from March 2008 to June 2011 were evaluated. Two observers evaluated MR and CT on a lesion-by-lesion basis. We analyzed sensitivity by grading on a 5-point scale, the degree of arterial enhancement and the differences in histological grades in the diffusion-weighted images (DWI). The results showed that the sensitivity of Gd-EOB-MRI was higher than that of MDCT especially for HCCs that were 1 cm in diameter or smaller. The hepatobiliary phase was useful for the detecting of small HCC. We had few cases in which it was difficult to judge HCC in the arterial enhancement between MRI and MDCT. In the diffusion-weighted image, well differentiated HCC tended to show a low signal intensity, and poorly differentiated HCC tended to show a high signal intensity. In moderately differentiated HCC's, the mean diameter of the high signal intensity group was larger than that of the low signal intensity group (24.5 mm vs. 15.8 mm). In conclusion, Gd-EOB-MRI tended to show higher sensitivity compared to MDCT in the detection of HCC.
- [Show abstract] [Hide abstract] ABSTRACT: We report the case of a woman in her 70s with a mesocaval shunt and liver cirrhosis due to autoimmune hepatitis. Percutaneous transcatheter embolization of the shunt was performed via a portal vein using coils and 50% glucose solution. Blood ammonia level decreased to the normal level and clinical symptoms of hepatic encephalopathy disappeared. Transcatheter embolization is minimally invasive and may be an effective treatment for hepatic encephalopathy with mesocaval shunt.
- [Show abstract] [Hide abstract] ABSTRACT: Intestinal tuberculosis (TB) is sometimes hard to diagnose because of mimicking the images of inflammatory bowel disease or malignant lymphoma (ML). We report a case of intestinal TB with high level of sIL-2R and ileocecal wall thickening with abnormal uptake of FDG. The case indicates that high sIL-2R suggests not only ML but also intestinal TB when a patient shows ileocecal wall thickening.
- [Show abstract] [Hide abstract] ABSTRACT: Placental polyp is one of the cause of hemorrhage after parturition or elective pregnancy termination. Uterine arterial embolization for placental polyp has been reported as less invasive treatment than hysterectomy. We report two cases who desire preserving uterus successfully treated by arterial embolization without major complication. One patient treated by additional transcervical resection was able to achieve pregnancy and resulted in term delivery. Arterial embolization seems to be an effective and safe treatment.
- [Show abstract] [Hide abstract] ABSTRACT: The purpose of this study is to evaluate the feasibility of hepatic arterial port implantation using a 2.9-Fr coaxial microcatheter for hepatic arterial infusion chemotherapy (HAIC) in patients with unresectable hepatocellular carcinoma (HCC) in the long-term follow-up period. Our study subjects were 176 patients with unresectable HCC who underwent hepatic arterial port implantation using a 2.9-Fr coaxial microcatheter via the femoral approach. A 2.9-Fr microcatheter with a side hole was introduced into the hepatic artery through a 5-Fr catheter. We determined the possible length of HAIC, starting with hepatic arterial port implantation and ending with the manifestation of technical difficulties or patient death. We also recorded the technical success rate, the time required for the procedure, and the complications encountered. The median duration of HAIC was 4.3 months (range 0.4-51.6 months) and the predictable cumulative rate of hepatic arterial port functioning at 6-, 12-, and 24 months was 75.1%, 60.9%, and 44.6%, respectively. Our technical success rate was 99.4% (175/176), and the mean time required for the procedure was 121 min. Complications were migration of the infusion hole (8.6%, 15/175), hepatic artery damage (5.7%, 10/175), port-catheter system occlusion (5.7%, 10/175), and problems involving the port or the puncture site (8.0%, 14/175). Our study demonstrates that the technical success rate of hepatic arterial port implantation using a coaxial microcatheter was high but that the incidence of port-catheter system occlusion and catheter dislocation was higher than in conventional methods. Our technique is another option to treat patients with HCC for whom conventional techniques cannot be used.
- [Show abstract] [Hide abstract] ABSTRACT: A 70-year-old male with advanced pancreatic cancer went into shock after sustaining a traumatic abdominal injury. Computed tomography (CT) showed a hematoma with extravasation around the pancreas and hemorrhagic ascites. After direct catheterization failed due to angiospasm, the ruptured splenic artery was successfully occluded by transcatheter arterial embolization (TAE) using an N-butyl cyanoacrylate (NBCA)-lipiodol mixture and the patient recovered from shock without complications. A follow-up CT obtained 20 days later showed a recurrent splenic artery pseudoaneurysm without extravasation. A repeat angiogram demonstrated recanalization of the splenic artery and pseudoaneurysm via antegrade. We embolized the recanalized pseudoaneurysm using metallic coils for isolation. Our experience indicates that adequate concentration and volume of the NBCA-lipiodol mixture should be considered depending on the vascular spasm in a patient with hypovolemic shock.
- [Show abstract] [Hide abstract] ABSTRACT: To lower the rate of cutaneous complications after transcatheter arterial treatment for hepatocellular carcinoma (HCC) via the internal mammary artery (IMA) we retrospectively assessed the complications. We reviewed cutaneous complications in 14 patients with 18 HCCs who had undergone 17 treatment procedures via the IMA, including selective transcatheter arterial infusion chemotherapy with Lipiodol (Lip-TAI) (n = 3), selective Lip-TAI + transcatheter arterial embolization (TAE) (n = 3), nonselective Lip-TAI (n = 1), nonselective Lip-TAI + TAE (n = 5), and nonselective TAE (n = 5). The filling and nonfilling of subcutaneous vessels with Lipiodol was examined on postoperative computed tomography (CT) scans. Skin rash (n = 3) and ulceration (n = 1) occurred after 4 of 17 (24%) procedures: two of three selective Lip-TAI procedures and two of five nonselective Lip-TAI + TAE procedures. The doses of chemotherapeutic agents for tumor sizes in selective Lip-TAI procedures were higher than those in selective Lip-TAI + TAE procedures. Cutaneous complications were encountered after two of three procedures with filling but not after any of eight procedures without filling. A lower dose of chemotherapeutic agents may be less risky when undertaking a selective procedure via the IMA for HCC. If nonselective, TAE alone may be less risky. Postoperative CT may be helpful for predicting cutaneous complications.
- [Show abstract] [Hide abstract] ABSTRACT: Langerhans cell histiocytosis (LCH) is the most frequent disease showing vertebral body collapse in children. In pediatric patients with LCH, open biopsy is preferred for definitive diagnosis although percutaneous needle biopsy is established in adult patients with bone tumors. We report a case of a solitary LCH of a sacral spine in 3-years old boy, in which definitive diagnosis was made based on histological findings in CT-guided percutaneous bone biopsy.
- [Show abstract] [Hide abstract] ABSTRACT: A large shunt between the inferior mesenteric vein (IMV) and the inferior vena cava (IVC) is a rare type of portosystemic shunt in patients with hepatic encephalopathy. We report a patient with hepatic encephalopathy due to a large IMV-IVC shunt who was successfully treated by balloon-occluded retrograde transvenous obliteration. The procedure involved a combination of 11 metallic coils and 5 ml of 5% ethanolamine oleate with iopamidol as the sclerosing agent. After complete obliteration of the shunt, his symptoms disappeared. At 2-years follow-up he was free of clinical symptoms, the size of his liver had slightly increased, and his liver function was preserved.
- [Show abstract] [Hide abstract] ABSTRACT: PURPOSE The implantation of coaxial catheter reservoir systems (ICCRS) without a fixed catheter tip (FCT) for hepatic arterial infusion chemotherapy is simple. This retrospective study investigated the success rate and complications of and the time required for this procedure. METHOD AND MATERIALS We retrospectively analyzed 220 sessions in 172 men and 46 women (mean age 65 years) with unresectable liver neoplasm who underwent percutaneous ICCRS without FCT and assessed the success rate, time required for, and complications of the procedure. The catheter tip was placed in the common hepatic artery (protocol A, 102 sessions), the distal portion of the left or right hepatic artery (protocol C, 64 sessions), or at a point between those sites (protocol B, 54 sessions). RESULTS All 220 sessions were successful and without major complications, the total time required for the procedure was 120 ± 27 min (mean ± SD). The median term for catheter patency was 133.5 days (range, 7-1260). Complications during follow-up were hematoma and/or infection around the port and/or puncture site (17 sessions), catheter dislocation (n=15), reservoir dysfunction (n=13), hepatic artery damage (n=11), catheter infection (n=4), side effects from chemotherapy (n=5), and others (n=3). The incidence of hepatic artery damage in protocols A, B, and C was 2.9, 9.3, and 4.7%, respectively; of catheter dislocation it was 7.8, 9.3, and 3.1%, respectively. The frequency of hepatic artery damage was significantly higher in patients whose arterial diameter at the side hole was 4 mm or less than in patients with an arterial diameter exceeding 4 mm (p=0.037). CONCLUSION ICCRS without FCT yielded a high technical success rate; the incidence of hepatic artery damage and catheter dislocation was relatively low. There were fewer instances of catheter dislocation under protocol C than the other protocols. CLINICAL RELEVANCE/APPLICATION ICCRS without FCT yielded a high success rate and a low incidence of hepatic artery damage and catheter dislocation. It may become a routine procedure for hepatic arterial infusion chemotherapy.
- [Show abstract] [Hide abstract] ABSTRACT: PURPOSE In patients with a replaced right hepatic artery (RHA), indwelling catheters of a reservoir system using a 5-Fr catheter for hepatic arterial infusion chemotherapy (HAIC) are not indicated because of frequent RHA occlusion. We delivered HAIC using a coaxial catheter reservoir system (CCRS) and a 2.5-Fr microcatheter without a fixed catheter tip (FCT) to avoid arterial occlusion in patients with a replaced RHA. In our retrospective study we analyzed the success rate, patency duration of the catheter, and complications of this treatment method. METHOD AND MATERIALS In 26 sessions (19 male, mean age 62.5 years), underwent the insertion of 25 CCRS into the replaced RHA in 26 sessions. The replaced RHAs originated from the SMA (20 sessions), the celiac artery (n=4), and the abdominal aorta (n=2). Catheter dislocation was categorized as unacceptable, resulting in discontinuation of HAIC, or as acceptable with continuation of HAIC. We retrospectively analyzed the technical success rate, the patency duration of the catheter, and complications attributable to CCRS. RESULTS CCRSs were successfully implanted in 25 of 26 sessions with no major complications during the procedure. One failure was due to severe stenosis at the origin of the replaced RHA; a reservoir system using a 5-Fr catheter had been implanted earlier into the replaced RHA. The median catheter patency was 65.5 days (range 13-1344). Complications included hemorrhage around the port (2 sessions), CCRS occlusion (n=1), and occlusion of the replaced RHA (n=1). In 5 sessions (5 systems) we encountered acceptable catheter dislocation; there were no instances of unacceptable dislocation requiring repositioning. CONCLUSION Implantation with CCRS using a 2.5-Fr microcatheter without FCT achieved a high success rate and low frequency of occlusion of RHA, and did not elicit unacceptable dislocation of the catheter system in patients with replaced RHA. CLINICAL RELEVANCE/APPLICATION Implantation of CCRS using a 2.5-Fr microcatheter without FCT is useful for HAIC in patients with a replaced RHA.
- [Show abstract] [Hide abstract] ABSTRACT: The purpose of this study is to evaluate the risk factors for the severity of pneumothorax after computed tomography (CT)-guided percutaneous lung biopsy using the single-needle method. We reviewed 91 biopsy procedures for 90 intrapulmonary lesions in 89 patients. Patient factors were age, sex, history of ipsilateral lung surgery and grade of emphysema. Lesion factors were size, location and pleural contact. Procedure factors were position, needle type, needle size, number of pleural punctures, pleural angle, length of needle passes in the aerated lung and number of harvesting samples. The severity of pneumothorax after biopsy was classified into 4 groups: "none", "mild", "moderate" and "severe". The risk factors for the severity of pneumothorax were determined by multivariate analyzing of the factors derived from univariate analysis. Pneumothorax occurred in 39 (43%) of the 91 procedures. Mild, moderate, and severe pneumothorax occurred in 24 (26%), 8 (9%) and 7 (8%) of all procedures, respectively. Multivariate analysis showed that location, pleural contact, number of pleural punctures and number of harvesting samples were significantly associated with the severity of pneumothorax (p < 0.05). In conclusion, lower locations and non-pleural contact lesions, increased number of pleural punctures and increased number of harvesting samples presented a higher severity of pneumothorax.
- [Show abstract] [Hide abstract] ABSTRACT: Aim: We compared the ability of five staging system to predict survival in patients with hepatocellular carcinoma (HCC) treated with chemoembolization. Methods: The study subjects were 214 patients with HCC treated with repeated chemoembolization alone using cisplatin and lipiodol. Predictors of survival were assessed by multivariate analysis. Before chemoembolization was carried out, the modified Japan Integrated Staging (m-JIS), Japan Integrated Staging (JIS score), Barcelona (BCLC) stage, Liver Cancer Study Group of Japan/Tumor–Node–Metastasis (LCSGJ/TNM) and Italian score (CLIP score) were checked. To validate the prognostic value of these staging systems, the survival curve was obtained and analyzed by the Kaplan–Meier method. Discriminatory ability and predictive power were compared using Akaike's information criterion (AIC) score and the likelihood ratio (LR) χ2. Results: Overall survival was 1 year in 82.9%, 3 years in 39.9% and 5 years in 15.1%. Multivariate analysis identified more than 90% lipiodol accumulation (grade I) after the first chemoembolization (P = 0.001), absence of portal vein tumor thrombosis (PVTT) (P < 0.001) and liver damage A (P = 0.012) as independent determinants of survival. AIC score and the LR χ2 showed superior predictive power of the m-JIS system in 95 patients with grade I accumulation of lipiodol after first chemoembolization. Conclusion: The discriminate ability of the m-JIS score is substantially better than those of other staging systems and has better prognostic predictive power in patients with grade I accumulation of lipiodol after first chemoembolization.
- [Show abstract] [Hide abstract] ABSTRACT: To assess the predictors of hypersensitivity reaction to chemoembolization procedures with cisplatin and Lipiodol suspension for the treatment of hepatocellular carcinoma (HCC). Between February 2005 and December 2008, 434 patients with HCC were treated with chemoembolization with a cisplatin and Lipiodol suspension. This retrospective cohort study analyzed the incidence of hypersensitivity reactions as an adverse effect and their predictors by multivariate logistic regression analyses. In total, 847 chemoembolization procedures were carried out in 434 patients. The median number of procedures per patient was 2 (range, 1-12). Mean dose of cisplatin per chemoembolization session was 27 mg (range, 15.0-80.0 mg), and the median total dose of cisplatin per patient was 55 mg (range, 5.0-560.0 mg). Hypersensitivity reactions occurred in 14 patients (1.7%). The median number of chemoembolization procedures in these patients was 7 (range, 3-10). Mean dose of cisplatin per session was 22 mg (range, 9.2-35.7 mg), and the median total dose of cisplatin was 134 mg (range, 37-286 mg). On multivariate analysis, the only parameter that showed an independent association with hypersensitivity reactions was the performance of 3 or more than three chemoembolization procedures. Performance of more than three chemoembolization procedures with a cisplatin and Lipiodol suspension was found to be independently associated with hypersensitivity reactions. Patients undergoing repeated chemoembolization procedures with cisplatin and Lipiodol suspension may experience hypersensitivity reactions as an adverse effect.
- [Show abstract] [Hide abstract] ABSTRACT: We investigated the efficacy of intra-arterial 5-fluorouracil (5-FU) and systemic interferon (IFN)-alpha (5-FU-IFN) in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis in the first branch or trunk (Vp3/4) and extrahepatic metastases. We examined 17 HCC patients with Vp3/4 and extrahepatic metastases (meta group) and 31 HCC patients with Vp3/4 (non-meta group). Baseline intrahepatic tumor factors and the hepatic reserve were similar between groups. The extrahepatic metastases of the meta group were not considered prognostic factors. Following the administration of 5-FU/IFN to all patients, we compared the survival rates, response, time to progression (TTP), and safety between groups. For intrahepatic HCC, complete response, partial response, stable disease, progressive disease, and drop out were observed in no (0%), one (6%), seven (41%), nine (53%), and no (0%) patients of the meta group, and in five (16%), seven (23%), 13 (42%), five (16%) and one (3%) patient of the non-meta group, respectively. The response rate was significantly lower in the meta group (6% vs 39%, P = 0.018). The median TTP of intrahepatic HCC and the median survival time were significantly shorter in the meta group than in the non-meta group (1.6 vs 6.3 months, P = 0.0001, and 3.9 months vs 10.5 months, P < 0.0001, respectively). The multivariate analysis showed that the absence of extrahepatic metastases was a significant and independent determinant of both TTP of intrahepatic HCC (P < 0.001) and overall survival (P < 0.001). No patient died of extrahepatic HCC-related disease. The efficacy of 5-FU/IFN for advanced HCC with Vp3/4 and extrahepatic metastases was markedly limited.
- [Show abstract] [Hide abstract] ABSTRACT: We report a case of an intractable skin ulcer at abdominal wall after transcatheter arterial chemoembolization (TACE) via the right internal mammary artery. We performed TACE for the treatment of the hepatocelluar carcinoma (HCC) with located on the ventral potion of segment III in a 80s old man. TACE was performed with 20mg of cisplatin 2ml of iodized oil and gelatin sponge particles from the main right internal mammary artery.
- [Show abstract] [Hide abstract] ABSTRACT: We evaluate the long-term prognosis and prognostic factors in patients treated with transarterial infusion chemotherapy using cisplatin-lipiodol (CDDP/LPD) suspension with or without embolization for unresectable hepatocellular carcinoma (HCC). Study subjects were 107 patients with HCC treated with repeated transarterial infusion chemotherapy alone using CDDP/LPD (adjusted as CDDP 10 mg/LPD 1 ml). The median number of transarterial infusion procedures was two (range, one to nine), the mean dose of CDDP per transarterial infusion chemotherapy session was 30 mg (range, 5.0-67.5 mg), and the median total dose of transarterial infusion chemotherapy per patient was 60 mg (range, 10-390 mg). Survival rates were 86% at 1 year, 40% at 3 years, 20% at 5 years, and 16% at 7 years. For patients with >90% LPD accumulation after the first transarterial infusion chemotherapy, rates were 98% at 1 year, 60% at 3 years, and 22% at 5 years. Multivariate analysis identified >90% LPD accumulation after the first transarterial infusion chemotherapy (p = 0.001), absence of portal vein tumor thrombosis (PVTT; p < 0.001), and Child-Pugh class A (p = 0.012) as independent determinants of survival. Anaphylactic shock was observed in two patients, at the fifth transarterial infusion chemotherapy session in one and the ninth in the other. In conclusion, transarterial infusion chemotherapy with CDDP/LPD appears to be a useful treatment option for patients with unresectable HCC without PVTT and in Child-Pugh class A. LPD accumulation after the first transarterial infusion chemotherapy is an important prognostic factor. Careful consideration should be given to the possibility of anaphylactic shock upon repeat infusion with CDDP/LPD.
Hiroshima-shi, Hiroshima-ken, Japan
- • Department of Diagnostic Radiology
- • Department of Radiology
Kure Medical CentreKure, Hiroshima, Japan