Kazuyuki Kinoshita

Yamanouchi Magnetic Compression Anastomosis for Bilioenteric Anastomotic Stricture after Living-donor Liver Transplantation

Yamanouchi magnetic compression anastomosis (YMCA) is a novel interventional method that creates an anastomosis between the bile duct and small intestine. The method uses two magnets to compress the stricture transmurally, causing gradual ischemic necrosis of the stricture. This ischemic necrosis creates an anastomosis between the two magnets. The present report describes two cases in which YMCA was successfully applied to treat bilioenteric anastomotic stricture after living-donor liver transplantation. These two patients exhibited good long-term clinical courses.

Covered Coronary Stent Graft in the Treatment of Hepatic Artery Pseudoaneurysm after Liver Transplantation

bacteremia, presumably from the colon. Mycotic suprarenal aortic aneurysms caused by B fragilis are very rare. We have found two case reports of patients treated surgically for B fragilis mycotic suprarenal aneurysms (4,5). Complicating this patient’s presentation is a history of lepromatous leprosy. Leprosy has well-documented effects on small arteries, veins, and nerves. We have not found literature describing the effects of leprosy on the aorta or its vasa vasorum. Although it is conceivable that lepromatous involvement of the aorta may have played a role in the development of this patient’s aneurysm, that role must remain speculative given endovascular treatment with no pathologic specimen obtainable. Aortic mycotic aneurysm is a fulminant infectious disease and may potentially progress to rupture and death unless appropriate treatment is instituted. The conventional strategy for the treatment of mycotic aneurysm is surgical intervention followed by long-term antibiotic therapy, which is essential to control systemic sepsis and to achieve cardiovascular stability (3). The surgical procedures are associated with substantial mortality rates associated with the risk of recurrent infection. Stanley et al (6) have reported endovascular stent treatment of four patients with mycotic aneurysms of the thoracic aorta. Semba et al (7) reported efficacy with endovascular treatment of a ruptured thoracic aortic aneurysm, which is known to be associated with high operative mortality and morbidity. The same group also successfully treated three patients with mycotic aortic aneurysm, including one patient with ruptured aneurysm, with stent-graft placement (8). There were no perioperative deaths or life-threatening complications during follow-up in their series. Successful outcomes in these small series, as well as the excellent outcome of our patient, suggest that endovascular stent-graft repair can play a role in definitive therapy for patients with mycotic thoracic aneurysms. The role of acute bacteremic infection in the development of mycotic aneurysms is well-known. The combined effect of underlying chronic lepromatous infection, an entity with documented vascular sequelae, is unknown and may warrant further study.

Detection of preclinically latent hyperperfusion due to stroke-like episodes by arterial spin-labeling perfusion MRI in MELAS patients.

In stroke-like episodes (SEs) of patients with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS), the detection of preclinically latent lesions is a challenge. We report regional cerebral hyperperfusion observed on arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) in the preclinical phase more than 3 months before the clinical onset of SEs in 3 MELAS patients. These hyperperfused areas were not detected by conventional MRI in the preclinical phase and developed into acute lesions at the clinical onset of SEs, suggesting that ASL imaging has the potential for predicting the emergence of SEs.

Assessment of tumor blood flow and its correlation with histopathologic features in skull base meningiomas and schwannomas by using pseudo-continuous arterial spin labeling images

OBJECTIVE We aimed to investigate whether pseudo-continuous arterial spin labeling (pcASL)-MRI can adequately evaluate tumor perfusion even if the tumors are located in the skull base region and evaluate the correlation between tumor blood flow (TBF) and the histopathologic features of skull base meningiomas and schwannomas. MATERIALS AND METHODS We enrolled 31 patients with skull base meningioma (n=14) and schwannoma (n=17) who underwent surgical resection. TBF was calculated from pcASL. Tissue sections were stained with CD34 to evaluate microvessel area (MVA). TBF and MVA ratio were compared between meningiomas and schwannomas using Mann-Whitney U-test. The correlations between MVA ratio and TBF were evaluated in each tumor by using single linear regression analysis and Spearmans rank correlation coefficients (rs). RESULTS MVA ratio and TBF were significantly higher in meningioma than in schwannoma (both p<0.01). Correlation analyses revealed significant positive correlations between MVA ratio and both mean and max TBF for meningiomas (rs=0.89, 0.81, both p<0.01). There was a weak positive correlation between MVA ratio and mean TBF for schwannomas (rs=0.43, p=0.04). However, no significant correlation was found between MVA ratio and max TBF for schwannoma. CONCLUSIONS pcASL-MRI is useful for evaluating tumor perfusion even if the tumors are located in the skull base region. Moreover, pcASL-TBF was significantly higher in most meningiomas compared to schwannomas, which can help in the differential diagnosis of the 2 tumor types even without the use of contrast material.

Feasibility of liver weight estimation by postmortem computed tomography images: An autopsy study

Although organ weight gives pathologists information about the pathogenesis of diseases at autopsy, the knowledge is rarely helpful in postmortem virtual autopsy by computed tomography (CT). To investigate the feasibility of liver weight estimation based on liver volume estimated from three‐dimensional CT images and the specific gravity of liver, thirty cadavers who died in the University of Fukui Hospital and whose family members agreed to postmortem CT and autopsy were prospectively enrolled. Mean specific gravity of liver was 1.054 ± 0.009 g/mL (95% confidence interval: 1.0507–1.0573 g/mL). The specific gravity was positively correlated to Hounsfield unit (HU) values of less than 40 (cases with moderate to severe fatty deposition) and remained stable between 1.05 to 1.065 g/mL for HU values greater than 40 (cases with mild or no fatty change). The liver weight estimated by our formula corresponded well to the actual liver weight, and the correlation coefficient was 0.96 (P < 1 × 10−13). The estimated liver weight calculated from estimated liver volume and the specific gravity of 1.055 g/mL was highly accurate, whereas the specific gravity should be reduced by 2%–3% in patients with an HU value less than 40 due to fatty deposition.

Monitoring of extra-axial brain tumor response to radiotherapy using pseudo-continuous arterial spin labeling images: Preliminary results

INTRODUCTION Technological developments have increased the ease of performing perfusion MRI by arterial spin labeling (ASL) in clinical settings. The objective of this study was to evaluate the effects of radiotherapy on extra-axial brain tumors by using MR perfusion images obtained using the pseudo-continuous arterial spin labeling (pcASL) method. MATERIALS AND METHODS Six consecutive patients (nine lesions) with extra-axial brain tumors treated only with radiotherapy were enrolled in this study. MR examinations, including pcASL imaging, were performed before and after radiotherapy. Cerebral blood flow, maximum tumor blood flow (mTBF), tumor volume and the ratio of signal enhancement by contrast material (enhancement ratio) were evaluated in serial examinations during the course of radiotherapy. Both the percentage change in mTBF (mTBF ratio) and the percentage change in volume (volume ratio) were calculated using values obtained before and after radiotherapy. The correlation between the volume ratio and the mTBF ratio was assessed using linear regression analysis and Spearmans rank correlation coefficient (rs). RESULTS A strong correlation was demonstrated between the tumor volume ratio and the mTBF ratio before and after radiotherapy (rs=0.93, P<.01). However, no significant correlation was identified between changes in enhancement and volume ratio (rs=0.20) or between changes in enhancement and mTBF ratio (rs=0.30) before and after radiotherapy. CONCLUSION The mTBF measured using pcASL may serve as an additive index for tumor volume when determining tumor response to radiotherapy even in the absence of contrast material.

Rate of liver volume increase: can it predict recipient prognosis after left lobe transplantation from living related donors?

PURPOSE The purpose of this study was to determine whether liver volume increase can predict recipient outcome. MATERIALS AND METHODS Size-matched left lobe transplantation was performed for 16 patients. Computed tomography was performed in Week 1 after transplantation. Rate of liver volume increase was compared between survivors and deceased subjects. RESULTS Mean rate of liver volume increase was significantly higher for survivors than for fatalities. CONCLUSION Rate of liver volume increase might be useful for predicting outcome of living donor liver transplantation.

Postmortem Intravascular Gas Caused by Antemortem Bacterial Sepsis

In diabetic patients, septicemia with intravascular gas and liver abscess with intrahepatic gas occur at rates of 4% and 16%, respectively, being mainly induced by E. coli, Clostridium, and Klebsiella (1). We herein report the gas images of postmortem computed tomography [autopsy imaging (Ai)] due to antemortem bacterial sepsis. A 69-year-old diabetic man with advanced gastric cancer had developed a high fever for several days prior to death. No resuscitation was performed. Ai performed two hours after death revealed the accumulation of gas in the liver (Picture A), right atrium (Picture B), and arteries (Picture C). All bacterial cultures from the liver abscess and blood samples in the right atrium

A rare congenital anomaly, bridge-like appendiceal fistula to the terminal ileum, demonstrated by MDCT

Although appendiceal anatomical anomalies are very rare, understanding of the anatomical details of these anomalies is important for surgery. In this case report, we present images from multi-detector row computed tomography (MDCT) and histological findings of a rare anatomical appendiceal anomaly originating from the cecum and opening into the terminal ileum like a bridge. These anatomical details were clearly depicted on MDCT with multi-planar reconstruction. MDCT demonstrated a communication between the appendix and terminal ileum. Histological analysis revealed that a normal mucosal layer was maintained from the appendix to the connected ileum, without any evidence of inflammatory or neoplastic changes, and only thickening of the muscular layer of the appendix was identified. Based on these histological findings, the appendix was considered to represent an anatomical anomaly rather than secondary fistula caused by inflammation or neoplasm, which has not yet been reported.

Original contributionMonitoring of extra-axial brain tumor response to radiotherapy using pseudo-continuous arterial spin labeling images: Preliminary results

INTRODUCTION Technological developments have increased the ease of performing perfusion MRI by arterial spin labeling (ASL) in clinical settings. The objective of this study was to evaluate the effects of radiotherapy on extra-axial brain tumors by using MR perfusion images obtained using the pseudo-continuous arterial spin labeling (pcASL) method. MATERIALS AND METHODS Six consecutive patients (nine lesions) with extra-axial brain tumors treated only with radiotherapy were enrolled in this study. MR examinations, including pcASL imaging, were performed before and after radiotherapy. Cerebral blood flow, maximum tumor blood flow (mTBF), tumor volume and the ratio of signal enhancement by contrast material (enhancement ratio) were evaluated in serial examinations during the course of radiotherapy. Both the percentage change in mTBF (mTBF ratio) and the percentage change in volume (volume ratio) were calculated using values obtained before and after radiotherapy. The correlation between the volume ratio and the mTBF ratio was assessed using linear regression analysis and Spearmans rank correlation coefficient (rs). RESULTS A strong correlation was demonstrated between the tumor volume ratio and the mTBF ratio before and after radiotherapy (rs=0.93, P<.01). However, no significant correlation was identified between changes in enhancement and volume ratio (rs=0.20) or between changes in enhancement and mTBF ratio (rs=0.30) before and after radiotherapy. CONCLUSION The mTBF measured using pcASL may serve as an additive index for tumor volume when determining tumor response to radiotherapy even in the absence of contrast material.