Junta Harada

Percutaneous cryoablation of renal cell carcinoma guided by horizontal open magnetic resonance imaging

Background:  Cryoablation is a treatment option for some patients with small exophytic lesions of the kidney. The purpose of this study is to determine the feasibility, safety, and intermediate‐term treatment outcome of percutaneous cryoablation of renal cell carcinoma guided by horizontal open magnetic resonance imaging (MRI).

Importance of Preoperative Imaging with 64-Row Three-Dimensional Multidetector Computed Tomography for Safer Video-Assisted Thoracic Surgery in Lung Cancer

PurposeVideo-assisted thoracic surgery (VATS) has recently been adopted for complicated anatomical lung resections. During these thoracoscopic procedures, surgeons view the operative field on a two-dimensional (2-D) video monitor and cannot palpate the organ directly, thus frequently encountering anatomical difficulties. This study aimed to estimate the usefulness of preoperative three-dimensional (3-D) imaging of thoracic organs.MethodsWe compared the preoperative 64-row three-dimensional multidetector computed tomography (3DMDCT) findings of lung cancer-affected thoracic organs to the operative findings.ResultsIn comparison to the operative findings, the branches of pulmonary arteries, veins, and bronchi were well defined in the 3D-MDCT images of 27 patients.Conclusion3D-MDCT imaging is useful for preoperatively understanding the individual thoracic anatomy in lung cancer surgery. This modality can therefore contribute to safer anatomical pulmonary operations, especially in VATS.

Pulmonary vein analysis using three-dimensional computed tomography angiography for thoracic surgery

ObjectiveLittle information is available regarding the variations in pulmonary vein anatomy for the purpose of thoracic or video-assisted thoracoscopic surgery (VATS). To learn about the types and frequency of pulmonary vein variations for VATS, we reviewed a “tailor-made virtual lung” of patients that was constructed using three-dimensional multidetector computed tomography (3D-MDCT) angiography.MethodsWe reviewed routine 64-row 3D-MDCT pulmonary angiography of 140 patients before surgery between June 2006 and February 2009.ResultsWe observed that most patients had the expected anatomy (98%) on the left side and on the right side (86%). On the right side, 10% of patients had three branches, and 4% patients had four or five branches. Independent drainage of the middle lobe vein directly into the left atrium was observed in 8% patients. Common ostia were observed on the left side in 33% and on the right side in 13% of the patients. The right inferior pulmonary veins branched immediately in 23% of the patients. Right isolated superior posterior branches were observed occasionally (2%).ConclusionsWe observed common ostia more frequently on the left side than on the right. The middle lobe variations were frequent, and the right inferior pulmonary vein often divided at the root. Preoperative 3D-MDCT presented correct pulmonary vein anatomy of the patients.

Anomalous pulmonary vein detected using three-dimensional computed tomography in a patient with lung cancer undergoing thoracoscopic lobectomy

Few clinicians are familiar with the anatomy of anomalous pulmonary veins, and studies reporting patients who required right lower lobectomy for lung cancer and who had anomalies of the middle and lower pulmonary veins are even rarer. This report describes the case of a lung cancer patient who had an anomalous lateral part of the middle lobe vein (V4) draining into the right inferior pulmonary vein, which was confirmed by three-dimensional 64-row multidetector computed axial tomography (3D-MDCT) angiography. She was then successfully treated with video-assisted thoracic surgery. The preoperative 3D imaging of the pulmonary vein and artery allowed us to comprehend fully the patient’s vascular anatomy before the operation. Thus, we recommend preoperative 3D-MDCT angiography for patients with lung cancer undergoing thoracic surgery, especially video-assisted thoracic surgery.

Preoperative evaluation of a tracheal bronchus by three-dimensional 64-row multidetector-row computed tomography (MDCT) bronchography and angiography: report of a case.

We performed successful surgery for lung cancer after confirming the anatomical abnormality of a tracheal bronchus by three-dimensional multidetector-row computed tomography (3D-MDCT) bronchography and angiography. Tracheal bronchus is unusual, and right upper lobectomy for lung cancer would rarely be performed in a patient with a tracheal bronchus. Most clinicians are unfamiliar with the anatomy of a right upper lobe that includes a tracheal bronchus. Preoperative 3D imaging of the tracheal bronchus and its related vessels familiarized us with the anatomy of this patient before the operation. Thus, we recommend preoperative 3DMDCT bronchography and angiography, especially for patients with a possible bronchial anomaly.

Ultrasound virtual endoscopic imaging

Volume data acquisition, three dimensional (3D) imaging, and multiplanar reformatting have become widely used for computed tomography (CT) and magnetic resonance imaging (MRI). As an extension of this technology, virtual endoscopic visualization of hollow organs has become a reality that is now finding its way into clinical CT practice. The same methods of computer processing as are used for CT and MRI can be applied to an ultrasound (US) volume image data set with the same potential output; namely, 3D, multiplanar, and virtual endoscopic images. The use of this image processing technology for US applications has lagged behind the CT and MRI applications, but considerable progress in applying these methods to US has occurred in recent years. As a result, US virtual endoscopic imaging now can be performed on a clinical basis by using standard US instruments and commercially available computer software. The use of newer US imaging methods, such as tissue harmonic and power Doppler imaging, has enhanced the potential for US virtual endoscopy. This article reviews the technology of US virtual endoscopy. In addition, our preliminary experience of using this method for abdominal and vascular diagnosis is described. Finally, we speculate on technical improvements and potential applications that are likely in the future.

Percutaneous MR-guided cryoablation for malignancies, with a focus on renal cell carcinoma

Cryosurgery is the oldest thermal ablation method, and was first performed in the mid-nineteenth century. Since the development of cryosurgical systems capable of delivering liquid nitrogen, organs in various regions have been treated with cryosurgery. However, the lack of an adequate monitoring modality during the freezing process did not allow the precise and complete destruction of lesions deep inside the parenchyma. This led to local recurrences caused by unsatisfactory results of treatment. Recently, a magnetic resonance (MR)-compatible argon-based cryoablation sytem has been developed, and a combination of this cryoablation system and MR imaging has been shown to be an effective method for treating malignant tumors. In this article, we describe our clinical experience of percutaneous MR-guided cryoablation for malignancies, focusing on renal cell carcinoma.

Bone scintigraphy in polyostotic fibrous dysplasia

The authors describe a patient with polyostotic fibrous dysplasia. A 21-year-old woman with a history of left coxodynia had exacerbation of her symptoms. Bone scintigraphy showed multiple areas of increased accumulation in the left side of the limbs. Plain radiographs showed multifocal bony lesions with some bone expansion and mixed osteolytic and ground-glass opacities. The findings are those of polyostotic fibrous dysplasia, which tends to involve one side of the bodv.

Labelled gelfoam in transcatheter arterial embolization of renal cell carcinoma.

Six patients with renal cell carcinoma underwent transcatheter arterial embolization with Gelfoam labelled by metallic clips. The embolization procedure was more easily monitored by fluoroscopy, and the complication of peripheral embolization was prevented. Tumor regression can be evaluated by changes in the distribution of the metallic clips on plain films.

PC reporting system for radiologists: practical use under PACS environment

To evaluate the practical usefulness of several types of the reporting system especially for radiologists, we have developed and employed several reporting systems. We categorized those reporting systems as follows (1) stand alone PC reporting system; (2) linked reporting system with PACS environment; (3) integrated three-dimensional (3D) imaging workstation (WS) with the intranet. We have evaluated the advantages and disadvantages of those three systems, and compared between the reporting system without PACS and network reporting system with PACS. Using linked reporting system with PACS, radiologists could easily reference both previous reports and archived diagnostic images, and also make their teaching files quickly. In conclusion, the reporting system under PACS environment is found to be practical and helpful for Japanese radiologists.