Fumie Ametani

Transcatheter Microcoil Embolotherapy for Ruptured Pseudoaneurysm Following Pancreatic and Biliary Surgery

Purpose: To evaluate the outcome of transcatheter microcoil embolotherapy for bleeding pseudoaneurysms complicating major pancreatic and biliary surgery. Materials and Methods: Over an 8-year period, 8 patients were encountered who developed massive bleeding from pseudoaneurysms 15–64 days (mean 31 days) following major pancreatic and biliary surgery. Urgent transcatheter microcoil embolotherapy was performed in all 8 patients. Results: Transcatheter embolotherapy was successful in 7 of 8 patients (88%) but failed in one due to development of disseminated intravascular coagulation. One patient developed recurrent bleeding 36 days after the first embolotherapy from a newly developed pseudoaneurysm, which was again treated successfully with embolization. Two patients subsequently underwent additional surgery for residual pathology. Three of the 7 patients with successful embolotherapy were alive at 10–96 months, 4 patients died of associated malignancies 4–20 months after embolotherapy. Conclusion: Transcatheter microcoil embolotherapy is effective for bleeding pseudoaneurysms complicating pancreatic and biliary surgery, and should be considered the first treatment of choice.

Malignant hepatic tumor detection with ferumoxides-enhanced MR imaging with a 1.5-T system: comparison of four imaging pulse sequences.

The purpose of our study was to compare observer performance in the detection of malignant hepatic tumors with ferumoxides‐enhanced magnetic resonance (MR) images obtained with proton density‐weighted spin‐echo (SE), T2‐weighted fast SE, T2*‐weighted gradient‐recalled‐echo (GRE), and proton density‐weighted echo‐planar (EP) sequences. Ferumoxides‐enhanced MR images obtained with the four sequences in 50 patients with 92 solid malignant and 64 nonsolid benign lesions were retrospectively analyzed. Image review was conducted on a segment‐by‐segment basis; a total of 397 liver segments was reviewed separately for solid and nonsolid lesions by three independent readers. Observer performance was evaluated with receiver operating characteristic analysis. Lesion‐to‐liver contrast‐to‐noise ratio was higher with SE and EP than with GRE and fast SE images for solid lesions (P < 0.05), and higher with fast SE and SE than with GRE images for nonsolid lesions (P < 0.01). Proton density‐weighted SE and T2‐weighted fast‐SE images were superior to T2*‐weighted GRE and proton density‐weighted EP images for detection of malignant hepatic tumors. T2‐weighted fast SE images were the best for detection of nonsolid lesions. T2‐weighted fast SE images that were comparable to proton density‐weighted SE images for solid tumor detection, that were the best for nonsolid lesion detection, and that had an acquisition time of one third to half of that of SE imaging may be able to replace SE images for ferumoxides‐enhanced liver imaging. J. Magn. Reson. Imaging 2001;13:249–257.

Efficacy of Nonsurgical Treatments for Hepatocellular Carcinoma in the Caudate Lobe

Purpose: To evaluate the efficacy of nonsurgical treatments for caudate hepatocellular carcinoma (HCC). Methods: Between January 1994 and February 2001, 25 patients were treated for HCCs with percutaneous ethanol injection (PEI), and/or transcatheter arterial embolization (TAE). PEI was performed for 19 caudate HCCs, combined treatment with PEI and TAE for 4 nodules, and TAE for 2 nodules. Results: During follow-up periods ranging from 3 to 60 months (mean 21.3 months), 18 patients had no local recurrence. Local recurrence was seen in 7 patients, and recurrence in the other segments of the liver in 15 patients. Thirteen patients were alive, ranging from 6 to 60 months, and 12 patients died of multiple HCCs, hepatic failure, or rupture of esophageal varix. The 1-, 2-, 3-, and 5-year survival rates of the 25 patients were 70.6%, 60.2%, 48.1%, and 16.0%, respectively. Conclusion: PEI, PEI and TAE, or TAE would be an effective alternative treatment for HCC in the caudate lobe.