[Show abstract][Hide abstract]ABSTRACT: A patient who had previously undergone endovascular abdominal aortic repair (EVAR) of an abdominal aortic aneurysm was found to have aneurysmal growth 5 years after the initial EVAR and endovascular rein-tervention was considered. However, the patient was deemed unsuitable for an ordinary bifurcated stent graft. Re-EVAR was successfully conducted with a back table modification of the Endurant bifurcated stent graft to an aorto-uni-iliac (AUI) stent graft in a setting where a manufactured AUI stent graft was not available; this procedure was followed by a crossover femoro-femoral bypass. The patient's one-year follow-up exam revealed a marked regression of the aneurysm without any related complications. This modified technique may extend the limits of abdominal endovascular treatment for patients who are not suitable for a bifurcated stent graft and may be applicable in situations where adequate AUI devices are not available.
[Show abstract][Hide abstract]ABSTRACT: Rationale and objectives:
Nocardiosis is difficult to diagnose, and the diagnosis is thus frequently delayed. High-resolution computed tomography (HRCT) findings of patients with pulmonary nocardiosis have been documented in few reports. Our study objective was to assess HRCT findings of patients with pulmonary nocardiosis.
Materials and methods:
This was a retrospective study of 20 consecutive patients with pulmonary Nocardia infections who underwent HRCT of the chest at our institutions from January 2011 to August 2014. After the exclusion of two patients with concurrent infections, the study group comprised 18 patients (11 men, 7 women; age range, 39-83 years; mean, 67.9 years) with pulmonary Nocardia infections. Parenchymal abnormalities, enlarged lymph nodes, and pleural effusion were evaluated on HRCT.
Underlying conditions included respiratory disease (n = 6, 33.3%), collagen diseases (n = 5, 27.8%), and diabetes mellitus (n = 4, 22.2%). All patients showed abnormal HRCT findings, including the presence of a nodule/mass (n = 17, 94.4%), ground-glass opacity (n = 14, 77.8%), interlobular septal thickening (n = 14, 77.8%), and cavitation (n = 12, 66.7%). Pleural effusion was seen in two patients. There were no cases of lymph node enlargement.
Among the HRCT findings in patients with pneumonia, a nodule/mass with interlobular septal thickening and/or cavitation are suggestive of pulmonary nocardiosis.
[Show abstract][Hide abstract]ABSTRACT: Balloon-occluded retrograde transvenous obliteration (BRTO) is an effective and minimally invasive treatment for isolated gastric varices (GVs) that is usually performed through a gastrorenal shunt (GRS) or gastrocaval shunt (GCS). However, there are some cases in which GVs drain mainly into the left pericardiophrenic vein without an accessible GRS or GCS. This brief report presents four cases of GVs without a GRS/GCS treated by BRTO through the pericardiophrenic vein. BRTO was successfully performed with the use of flexible balloon catheters without any complications in all four patients, and the GVs were completely obliterated.
Full-text Article · Dec 2015 · Journal of vascular and interventional radiology: JVIR
[Show abstract][Hide abstract]ABSTRACT: The aims of this study were to evaluate the angioarchitecture of cavernous sinus dural arteriovenous fistulas (CSdAVFs), including the number and location of shunted pouches (SPs), and to evaluate whether the location and number of the SPs affect the outcomes of transvenous embolization of CSdAVFs.
Nineteen consecutive cases of CSdAVFs that underwent rotational angiography and transvenous embolization were reviewed. Multiplanar reconstruction images of rotational angiography and selective angiography were reviewed with particular interest in the SPs. Relationships of the locations and number of SPs with the results of transvenous embolization were statistically analyzed.
All cases showed SPs, with numbers ranging from 1 to 4 (mean, 2.2). The location of the SPs was "posteromedial" in 16, "posterolateral" in 13, "lateral" in 6, and "medial" in 3 patients. Six cases showed posteromedial SPs alone, and three cases showed posterolateral SPs alone. The other 10 cases showed multiple locations of SPs. All cases were treated by transvenous embolization with sinus packing (n = 11) or selective embolization of the SP (n = 8). Complete occlusion of dAVF was obtained in 16 cases immediately after embolization. Locations of SPs and drainage types were significantly associated with the immediate angiographic results (p < 0.01).
The SP of CSdAVFs is often multiple and is located posteriorly to the CS. The number and location of SPs affect immediate angiographic results of transvenous embolization.
[Show abstract][Hide abstract]ABSTRACT: Currently, Computer Aided Diagnosis (CAD) have become very advanced that radiologist can provide very high quality diagnosis. This progressive technology brings radiologists big burden to investigate large amount of high-definition medical images for one patient. It is strongly required to reduce their burden without debasing the quality of imaging diagnosis. We propose a method to generate sounds to support diagnosis in this paper. If sound effects can represent invisible medical image features, it can reduce the diagnosis fatigue.
[Show abstract][Hide abstract]ABSTRACT: Purpose
We describe the clinical utility of an imaging technique that combines 3D subtracted and unsubtracted rotational angiography for evaluation of the angioarchitecture of dural arteriovenous fistulas (DAVFs).
From May 2010 to June 2013, 21 consecutive patients with intracranial DAVFs (22 lesions) underwent 3D angiography for pretherapeutic evaluation. 3D fusion angiography (3DFA) images were semiautomatically obtained from a dataset of unsubtracted and subtracted rotational angiographs. Multiplanar reformatted images and partial MIP images from unsubtracted rotational angiography and fusion images were evaluated by two radiologists, with particular focus on visualization of feeding arteries, shunted pouches, and drainage veins of DAVFs by use of a 3-point scale. The referring neuroradiologists were asked whether the information provided by 3DFA was helpful for treatment decisions.
For 21 of 22 lesions, all evaluated items were well depicted on the 3DFA. The visualization rating score for feeding arteries and shunted pouches on 3DFA were significantly higher than those of 3D digital angiography (p
Full-text Article · Aug 2014 · Japanese journal of radiology
[Show abstract][Hide abstract]ABSTRACT: Introduction
The aim of the study was to investigate the variations in the uncal vein (UV) termination and its clinical implication in cavernous sinus dural arteriovenous fistulas (CSDAVFs).
Biplane cerebral angiography in 80 patients (160 sides) with normal cerebral venous return (normal group) was reviewed with special interest in the termination of the UV. Frequency and types of uncal venous drainage from CSDAVFs in consecutive 26 patients were also analyzed.
In the normal group, the UV was identified in 118 sides (74 %). The UV terminated into cavernous sinus (CS) in 41 sides (34 %), the superficial middle cerebral vein (SMCV) in 58 sides (48 %), the laterocavernous sinus (LCS) in 15 sides (13 %), and the paracavernous sinus (PCS) in 4 sides (3 %). Cerebral venous blood via the UV draining into the CS directly (n = 41) or through the SMCV and/or the LCS (n = 45) was observed in 86 sides (54 %). Uncal venous drainage from CSDAVFs was found in 13 patients (50 %). The CSDAVFs drained directly into the UV in two patients, drained via LCS into the UV in two patients, and drained through the SMCV into the UV in the remaining nine patients. All cases were successfully treated by transvenous embolization with special attention given to uncal venous drainage.
There are several variations in UV termination according to the embryological development of the primitive tentorial sinus and the deep telencephalic vein. Careful attention should be paid to uncal venous drainage for the treatment of CSDAVFs.
[Show abstract][Hide abstract]ABSTRACT: Purpose
To evaluate the feasibility and efficacy of transarterial sac embolization with a mixture of N-butyl cyanoacrylate and ethiodized oil (Lipiodol; Guerbet Japan, Tokyo, Japan) (NBCA-LPD) for type II endoleaks after endovascular aortic repair (EVAR) using a double coaxial microcatheter technique.
Materials and Methods
A retrospective review was performed of 20 consecutive cases of type II endoleaks treated by transarterial embolization using the technique from August 2010 to June 2013. The treatment indication was persistent type II endoleak over 6 months after EVAR associated with aneurysm expansion ≥ 5 mm in maximum diameter. A 1.9-F nontapered microcatheter was advanced to the aneurysmal sac through a 2.7-F microcatheter, which was coaxially introduced through a catheter. The endpoint of the procedure was intrasaccular filling with NBCA-LPD and occlusion of the feeder of the type II endoleak. The technical success rate was defined as success in transarterial intrasaccular approach followed by embolization of the intrasaccular channel and inflow arteries. Clinical success was defined as aneurysmal sac shrinkage or stabilization (freedom from sac expansion > 5 mm in maximum diameter).
Technical success was achieved in 18 of 20 cases. During a mean follow-up period of 18.5 months, complete sac occlusion was observed in 13 cases (65%). Clinical success was achieved in 16 cases (80%). No serious complications were observed.
The transarterial intrasaccular approach with a double coaxial microcatheter technique can be successfully performed in most cases, and transarterial aneurysm sac embolization using NBCA-LPD has been proven to be feasible.
Full-text Article · May 2014 · Journal of vascular and interventional radiology: JVIR
[Show abstract][Hide abstract]ABSTRACT: The maxillary artery is a terminal branch of the external carotid artery. Although the main maxillary artery trunk and most of its branches course within the extracranial space and supply the organs and muscles of the head and neck, other surrounding soft tissues, and the oral and rhinosinusal cavities, other branches supply the dura mater and cranial nerve and can anastomose to the internal carotid artery (ICA). Various pathologic conditions of the intracranial, head, and neck regions can involve the branches of the maxillary artery. Many of these diseases can be treated with endovascular approaches; however, there is a potential risk of complications in the brain parenchyma and cranial nerves related to the meningoneuronal arterial supply and anastomoses to the ICA. Therefore, familiarity with the functional and imaging anatomy of the maxillary artery is essential. In the past, conventional angiography has been the standard imaging technique for depicting the maxillary artery anatomy and related pathologic findings. However, recent advances in computed tomographic, magnetic resonance, and rotational angiography have further elucidated the maxillary artery anatomy by means of three-dimensional representations. Understanding the functional and imaging anatomy of the maxillary artery allows safe and successful transcatheter treatment of pathologic conditions in the maxillary artery territories.
[Show abstract][Hide abstract]ABSTRACT: Computer Aided Diagnosis (CAD) has become one of the most important medical activities. Because of development of image processing, large amount of high-definition images are provided to investigate. Radiologists have to cost so much times and efforts to investigate these medical images. It is strongly required to reduce their burden without debasing the quality of imaging diagnosis. In this paper, we propose a method to generate sound information based on the image features and discuss about their effects of sounds for diagnosis. Sonification technique helps for attention rousing and the fatigue reduction for medical imaging diagnosis.
[Show abstract][Hide abstract]ABSTRACT: Computer Aided Diagnosis (CAD) has become one of the most important for medical activity. While various CAD image become more exact, the larger amount of high-definition images are provided. Radiologists have to cost their time and efforts to investigate these medical images. It is strongly required to reduce their burden without debasing the quality of imaging diagnosis. In this paper, we propose a method to generate sound information based on the image features and discuss their sounds for diagnosis. Sonification technique helps for attention rousing and the fatigue reduction for medical imaging diagnosis.
[Show abstract][Hide abstract]ABSTRACT: BACKGROUND AND PURPOSE:Recognition of shunted pouches dural arteriovenous fistula allows us to treat the disease effectively by selective embolization of the pouches at first. However, the shunted pouches in transverse-sigmoid sinus dural arteriovenous fistulas have not been well-documented. Our aim was to evaluate the angioarchitecture of transverse-sigmoid sinus dural arteriovenous fistulas, including the frequency and location of shunted pouches and their feeding arteries.MATERIALS AND METHODS
Twenty-five consecutive cases of TSS-DAVFs that underwent rotational angiography and transvenous embolization between 2008 and 2011 were reviewed. Multiplanar reformatted images of rotational angiography and selective angiography were reviewed with a particular focus on the shunted pouches.RESULTS:All 25 cases showed SPs, with numbers ranging from 1 to 4 pouches (mean, 2.35). The SPs were located at the transverse-sigmoid junction in 16, close to the vein of Labbé in 9, at the dorsal-to-sigmoid sinus in 9, inferior to the sigmoid sinus in 6, at the sigmoid-jugular junction in 5, and inferior to the transverse sinus or the sinus confluence in 14. The SP at the sigmoid sinus was frequently fed by the jugular branch of the ascending pharyngeal artery and the stylomastoid artery. The SP at the transverse-sigmoid junction and the vein of Labbé was fed by the petrosal/petrosquamous and posterior branches of the middle meningeal artery and the transosseous branches of the occipital artery. The SP inferior to the transverse sinus and the sinus confluence was fed by the transosseous branches of the occipital artery and the posterior meningeal artery. All cases were successfully treated by transvenous embolization with sinus packing (n = 13) or selective embolization of the SP (n = 12).CONCLUSIONS:The presence of SP is a common angioarchitecture of TSS-DAVFs. Identification of the SPs would be useful for their treatment.
Full-text Article · Mar 2013 · American Journal of Neuroradiology
[Show abstract][Hide abstract]ABSTRACT: Introduction:
Comprehensive reports concerning selective embolization for arterial bleeding from third molar removal have not been published. We analyzed cases of arterial bleeding from third molar extraction that required transarterial embolization, and we demonstrate representative cases.
Five consecutive patients (three men and two women, aged 24 to 37 years) who underwent transarterial embolization at our institution were included in this study. Four of them showed postoperative bleeding after lower third molar removal, and one suffered bleeding after upper third molar extraction. The period of time from extraction to embolization varied from 5 h to 5 weeks.
Angiography revealed pseudoaneurysms at the inferior alveolar artery in four cases and at the superior alveolar artery in one case. The pseudoaneurysms were selectively embolized using 25-33 % n-butyl-2-cyanoacrylate (NBCA)-lipiodol. All of the cases showed good results angiographically and clinically. Transit hypoesthesia at the region of the mental nerve was observed in one patient.
Selective transarterial embolization is an effective technique for arterial bleeding from third molar removal when it is difficult to obtain hemostasis by dental procedures. Injection of NBCA can be useful when the alveolar artery is too small to embolize with coils.
[Show abstract][Hide abstract]ABSTRACT: The aim of this brief report is to compare unenhanced magnetic resonance (MR) angiography with time-spatial labeling inversion pulse (Time-SLIP) with conventional digital subtraction angiography (DSA) in assessing degree of saccular visceral artery aneurysm (VAA) occlusion after endosaccular packing with detachable coils. Eight patients with VAAs (five renal and three splenic artery aneurysms) were enrolled in this study. VAA occlusion rates based on Time-SLIP MR angiography were complete occlusion in four patients, neck remnants in three patients, and body filling in one patient. These findings corresponded with the DSA findings.
Article · Feb 2013 · Journal of vascular and interventional radiology: JVIR
[Show abstract][Hide abstract]ABSTRACT: Most gastric varices arise at hepatofugal collateral pathways and drain into the systemic vein through one or both of two different types of portosystemic collateral drainage systems: the gastroesophageal (azygous) venous system and the gastrophrenic venous system. The gastroesophageal venous system consists of gastric varices contiguous with esophageal varices, paraesophageal varices, and the azygos vein, which terminates into the superior vena cava. Gastric varices draining through the gastroesophageal venous system can be treated with endoscopic techniques or creation of a transjugular intrahepatic portosystemic shunt. The gastrophrenic venous system consists of the gastric varices and the left inferior phrenic vein (IPV), which terminates into the left renal vein or the inferior vena cava. The left IPV has abundant anastomoses with peridiaphragmatic and retroperitoneal veins, and these anastomoses can function as drainage pathways from gastric varices. Balloon-occluded retrograde transvenous obliteration is a preferred treatment option for this type of gastric varix. Occasionally, gastric varices can form at the hepatopetal collateral pathway that develops secondary to localized portal hypertension caused by splenic vein occlusion. Splenectomy is often required for the treatment of this type of gastric varix. Multidetector computed tomography permits comprehensive evaluation of these venous drainage systems. Familiarity with and assessment of these draining routes of gastric varices are important for selecting treatment options and interventional techniques.
[Show abstract][Hide abstract]ABSTRACT: Introduction
Spinal ventral epidural arteriovenous fistulas (EDAVFs) are relatively rare spinal vascular lesions. We investigated the angioarchitecture of spinal ventral EDAVFs and show the results of endovascular treatment.
We reviewed six consecutive patients (four males and two females; mean age, 67.3 years) with spinal ventral EDAVFs treated at our institutions from May 2011 to October 2012. All patients presented with progressive myelopathy. The findings of angiography, including 3D/2D reformatted images, treatments, and outcomes, were investigated. A literature review focused on the angioarchitecture and treatment of spinal ventral EDAVFs is also presented.
The EDAVFs were located in the ventral epidural space at the L1–L5 levels. All EDAVFs were supplied by the dorsal somatic branches from multiple segmental arteries. The ventral somatic branches and the radiculomeningeal arteries also supplied the AVFs in two patients. The AVFs drained via an epidural venous pouch into the perimedullary vein in four patients and into both the perimedullary vein and paravertebral veins in two patients. Four cases without paravertebral drainage were treated by transarterial embolization with diluted glue, and two cases with perimedullary and paravertebral drainages were treated by transvenous embolization alone or in combination with transarterial embolization. An angiographic cure was obtained in all patients. Clinical symptoms resolved in two patients, markedly improved in three patients, and minimally improved in one patient.
In our limited experience, spinal ventral EDAVFs were primarily fed by somatic branches. EDAVFs can be successfully treated by endovascular techniques selected based on the drainage type of the AVF.
[Show abstract][Hide abstract]ABSTRACT: PURPOSE
To evaluate the safety and efficacy of additional use of n-butyl 2-cyanoacrylate (NBCA) in balloon-occluded retrograde transvenous obliteration (BRTO) for the treatment of complicated cases of gastroduodenal varices difficultly to treat by standard B-RTO technique.
METHOD AND MATERIALS
From June 2007 to December 2010, nine patients (4 males and 5 females; mean age 61 years)with gastroduodenal varices (gastric varices in 6 and duodenal varices in 3) were treated by BRTO with using NBCA alternative to ethanolamine oelate-iopamidole (EOI) due to insufficient stagnation of EOI in the varices . All BRTO procedures were using double coaxial balloon catheter system with a femoral venous approach. After placement of a microcatheter close to or into the varices, 5% EOI was injected into the varices under balloon occlusion of the drainage vein. ,When EOI could not be sufficiently filled or stagnated in the varices, we injected 20-30% NBCA-Lipiodol mixture liquid alternative to EOI. Following injection of NBCA, several microcoils were placed in the drainage veins to prevent potential risk of further migration of NBCA into the systemic veins. Technical success, degree of obliteration of varices on CT, follow-up endoscopic findings, and complications were analyzed.
Technical success was obtained in all patients. Amount of NBCA-Lipiodol mixture used was 1 to 2.5ml. CT performed 1 week after BRTO showed complete obliteration of the varices in 8 patients and partial obliteration in one. Follow-up gastroduodenoscopy was performed in 8 patients 1-24 months after B-RTO, and it showed disappearance of the varices in 3 and marked regression in 5 cases. No variceal bleeding was observed in all patients after BRTO. No major complication was observed in any of the patients.
Additional use of n-butyl 2-cyanoacrylate (NBCA) in balloon-occluded retrograde transvenous obliteration (BRTO), is safe and effective technique for the treatment of complicated cases of gastroduodenal varices.
This study shows the efficacy of BRTO using NBCA. In the cases that microcatheter can be advanced into the varices, this technique is safe and may be useful for shortening of balloon-occluded time.
[Show abstract][Hide abstract]ABSTRACT: PurposeTo evaluate techniques and efficacy of retrograde transvenous obliteration for the treatment of duodenal varices associated with mesocaval collateral pathway.Materials and Methods
Six consecutive cases of large/growing or ruptured duodenal varices treated by retrograde transvenous obliteration were retrospectively reviewed. Selective balloon-occluded retrograde transvenous obliteration (B-RTO) with 5% ethanolamine oleate (EO) was performed in all cases. When EO could not be sufficiently stagnated in the varices, additional/alternative techniques were performed, including coil embolization of afferent vein or intravariceal injection of n-butyl-2-cyanoacrylate (NBCA). Clinical findings, anatomic features of duodenal varices, obliteration techniques, complications, posttherapeutic computed tomography (CT) findings, and follow-up endoscopic findings were investigated.ResultsAll duodenal varices were located at the second/third junction of the duodenum and were fed by single (n = 1) or multiple (n = 5) pancreaticoduodenal veins. One varix fed by a single afferent vein was successfully treated by simple selective B-RTO technique alone. The other five cases required coil embolization of afferent vein (n = 1) or intravariceal injection of NBCA (n = 4) because sclerosant was not sufficiently stagnated in the varices. CT 1 week after the procedure showed complete occlusion of the varices in all cases. A duodenal ulcer at the variceal site developed in one patient and was successfully treated by medication. Follow-up endoscopy showed disappearance of varices in all cases, and no recurrence was observed during follow-up.Conclusions
Retrograde transvenous obliteration is an effective technique for the treatment of duodenal varices. However, additional/alternative techniques are required for successful treatment because of the complex anatomic features of duodenal varices.
Article · Oct 2012 · Journal of vascular and interventional radiology: JVIR