Koji Kamada

Long-term Prognosis of Patients Undergoing Transcatheter Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma: Comparison of Cisplatin Lipiodol Suspension and Doxorubicin Hydrochloride Emulsion

PURPOSE To evaluate long-term prognosis of transcatheter arterial chemoembolization (TACE) with use of cisplatin (CDDP) lipiodol (LPD) suspension (CDDP/LPD) compared with that with use of doxorubicin hydrochloride (ADM) LPD emulsion (ADM/LPD) in patients with unresectable hepatocellular carcinoma (HCC). MATERIALS AND METHODS One hundred eight patients were treated with use of CDDP/LPD and 26 were treated with use of ADM/LPD. Survival rates and frequency of side effects and complications in the CDDP/LPD group were compared with those in the ADM/LPD group. RESULTS CDDP/LPD was given at a dose of 15-70 mg (mean dose, 41 mg), whereas ADM/LPD was given at a dose of 20-100 mg (mean dose, 57 mg) throughout the study period. The survival rates in the CDDP/LPD group were 81% at 1 year, 41% at 3 years, 19% at 5 years, and 13% at 7 years, whereas those in the ADM/LPD group were 67% at 1 year, 18% at 3 years, and 0% at 5 years. The CDDP/LPD group showed significantly better survival than the ADM/LPD group (P <.05). In the CDDP/LPD group, there was a significant prolongation of survival in patients with monofocal HCC (P <.05) and patients with HCC assessed as an almost complete LPD accumulation (P <.05). There were no significant differences in survival rates in the ADM/LPD group according to tumor size and number of tumors. Hepatic failure was observed in 8% of all procedures and was not different between the two therapeutic groups. Renal dysfunction was observed in 2% of all treatments involving CDDP/LPD, and it resolved spontaneously with appropriate medications. CONCLUSIONS TACE with use of low-dose CDDP was efficacious for unresectable HCC and had few complications. TACE with use of CDDP may contribute to prolongation of the life span of patients with HCC versus TACE with use of ADM.

Combination of transcatheter arterial chemoembolization using cisplatin-lipiodol suspension and percutaneous ethanol injection for treatment of advanced small hepatocellular carcinoma

BACKGROUND We evaluated the long-term efficacy of the combination of transcatheter arterial chemoembolization (TACE) using cisplatin-lipiodol suspension and percutaneous ethanol injection (PEI) for treatment of advanced small hepatocellular carcinoma (HCC). PATIENTS AND METHODS Sixty-nine patients with HCC less than 3 cm in diameter and at most three lesions were enrolled in this study. HCC nodules were confirmed to be hypervascular by angiography. Thirty-two patients were treated with a combination of TACE and PEI (TACE/PEI group) and 37 patients with TACE alone (TACE group). RESULTS The 5-year survival rates were 50% for the TACE/PEI group and 22% for the TACE group. The TACE/PEI group had a slightly but not significantly better survival than the TACE group. The 5-year survival rates of patients with solitary HCC were 61% for the TACE/PEI group and 24% for the TACE group. Although the two therapeutic groups both had high rates of recurrence, the rates in the TACE/PEI group were significantly lower than those in the TACE group (P <0.05). Severe complications such as intraperitoneal bleeding and segmental hepatic infarction were observed at low incidence, and recovered with supportive treatment. CONCLUSIONS The combination of TACE and PEI appears to prolong survival, compared with TACE alone. This combination therapy can thus be a valuable form of treatment for unresectable advanced small HCC.

Impact of aging on the development of hepatocellular carcinoma in patients with hepatitis C virus infection in Japan

Background: It is difficult to study the long-term outcome of hepatitis C virus (HCV) infection because chronic infection is often asymptomatic and duration of the disease is prolonged. The clinical outcome of HCV infection remains unclear in patients of advanced age. Methods: Among 575 patients consecutively diagnosed with hepatocellular carcinoma (HCC) from 1988 to 1999 at Hiroshima University, we examined 430 with HCV. We studied the differences between males and females in the following characteristics: age at first diagnosis of HCC, Child grade, various tumour factors, history of blood transfusion, duration to development of HCC, and history of alcohol intake. Results: The incidence of HCC patients with HCV increased in elderly persons, including female patients. Background liver function was significantly better for female patients ( P r < r 0.001). In both genders, the duration between blood transfusion and diagnosis of HCC was significantly shorter when the patients received blood transfusion at an older age ( P r < r 0.001). In habitual drinkers, the average age at first diagnosis of HCC was significantly younger ( P r < r 0.001), and duration to development of HCC significantly shorter ( P r < r 0.05). The percentage of atomic bomb survivors among HCV-positive HCC patients was significantly higher than that among HCV-negative HCC patients ( P r < r 0.05). Conclusions: Patients with HCV might exhibit slow disease progression and develop HCC finally with aging regardless of gender. Patients of advanced age with HCV, even female patients, should therefore be closely followed.BACKGROUND It is difficult to study the long-term outcome of hepatitis C virus (HCV) infection because chronic infection is often asymptomatic and duration of the disease is prolonged. The clinical outcome of HCV infection remains unclear in patients of advanced age. METHODS Among 575 patients consecutively diagnosed with hepatocellular carcinoma (HCC) from 1988 to 1999 at Hiroshima University, we examined 430 with HCV. We studied the differences between males and females in the following characteristics: age at first diagnosis of HCC, Child grade, various tumour factors, history of blood transfusion, duration to development of HCC, and history of alcohol intake. RESULTS The incidence of HCC patients with HCV increased in elderly persons, including female patients. Background liver function was significantly better for female patients (P < 0.001). In both genders, the duration between blood transfusion and diagnosis of HCC was significantly shorter when the patients received blood transfusion at an older age (P < 0.001). In habitual drinkers, the average age at first diagnosis of HCC was significantly younger (P < 0.001), and duration to development of HCC significantly shorter (P < 0.05). The percentage of atomic bomb survivors among HCV-positive HCC patients was significantly higher than that among HCV-negative HCC patients (P < 0.05). CONCLUSIONS Patients with HCV might exhibit slow disease progression and develop HCC finally with aging regardless of gender. Patients of advanced age with HCV, even female patients, should therefore be closely followed.

Partial Loss of Hippocampal Striation in Medial Temporal Lobe Epilepsy: Pilot Evaluation with High-Spatial-Resolution T2-weighted MR Imaging at 3.0 T

PURPOSE To determine whether partial loss of the hippocampal striation (PLHS) at 3.0 T is more accurate than the currently accepted methods of using conventional magnetic resonance (MR) imaging to detect hippocampal sclerosis in medial temporal lobe epilepsy (MTLE). MATERIALS AND METHODS This retrospective study had institutional review board approval, and informed consent was waived. Fluid-attenuated inversion-recovery (FLAIR) MR images and T2-weighted MR images in the oblique coronal plane in 22 consecutive patients (10 men, 12 female patients; mean age, 41.0 years; range, 14-76 years) (25 hemispheres) with a clinical diagnosis of MTLE were retrospectively evaluated. Twenty-five hippocampi in 15 subjects without epilepsy were evaluated as age-matched controls. The volumes and thicknesses of the four anatomic sections of the hippocampi were quantitatively measured on the T2-weighted images. Two radiologists independently reviewed the MR imaging findings of the hippocampus regarding atrophy, abnormal signal intensity, and PLHS on each side separately, without comparing both sides. Sensitivity and specificity were calculated among the MR imaging findings. RESULTS Signal intensity abnormality on FLAIR images had a sensitivity of 36%, a specificity of 96%, and an accuracy of 66% for the diagnosis of hippocampal sclerosis. PLHS on T2-weighted MR images had a sensitivity of 76% and a specificity of 80% for the diagnosis of hippocampal sclerosis. The sensitivity for PLHS was higher than that for atrophy (44%) and abnormal signal intensity (48%) of the hippocampus on T2-weighted MR images. Although the mean volume of the hippocampus and the thickness of the hippocampal body were significantly smaller for patients with MTLE than for control subjects (P < .001 for both), there was no clear distinguishing threshold value between abnormal and normal hippocampi. CONCLUSION PLHS showed the highest sensitivity for MTLE. This MR imaging feature might improve the accuracy of the diagnosis of bilateral hippocampal sclerosis, although further research is required.

Signal Intensity of the Motor Cortex on Phase-Weighted Imaging at 3T

BACKGROUND AND PURPOSE: It is known that the motor cortex shows hypointensity on T2-weighted images in older patients. The goal of this study was to assess the signal intensity of the motor cortices on the phase-weighted imaging performed with a Windows-based software program that we developed ourselves. MATERIALS AND METHODS: All studies were performed at 3T MR imaging. First, the TE for the phase-weighted image was optimized; the best contrast between the motor and other cortices was obtained with a TE of 40 ms. The study population consisted of 45 healthy subjects (23 females, 22 males; mean age, 32.1 years). The signal intensity of the motor cortices was divided into 3 grades by 2 neuroradiologists in comparison with that of the superior frontal cortex (SFC): In grade I, the motor cortex was isointense to the SFC; in grade II, the motor cortex was slightly hypointense to the SFC; and in grade III, the motor cortex was markedly hypointense to the SFC. RESULTS: The motor cortex was classified as either grade II or III in all subjects older than 20 years of age on the phase-weighted images. Even at 10–19 years of age, the grade II or III appearance was found in 14 (88%) of 16 motor cortices (8 subjects) on the phase-weighted images. CONCLUSION: In adolescents, the motor cortex is hypointense to other cerebral cortices on phase-weighted MR imaging, which probably reflects differences in the concentration of nonheme iron and/or in the tissue architecture.

MRA of intracranial aneurysms embolized with platinum coils: a vascular phantom study at 1.5T and 3T.

To analyze the influence of matrix and echo time (TE) of three‐dimensional time‐of‐flight (3D TOF) magnetic resonance angiography (MRA) on the depiction of residual flow in aneurysms embolized with platinum coils at 1.5T and 3T.

Transcatheter chemoembolization for unresectable hepatocellular carcinoma and comparison of five staging systems

Aim:  We compared the ability of five staging system to predict survival in patients with hepatocellular carcinoma (HCC) treated with chemoembolization.

Postsurgical change in the tracheal bifurcation angle after upper lobectomy: radiographic evaluation.

RATIONALE AND OBJECTIVES The purpose of this study was to evaluate postsurgical changes in the tracheal bifurcation angle on chest radiographs after upper lobectomy and to determine whether bronchial repositioning after upper lobectomy mimics that in upper lobe collapse. MATERIALS AND METHODS The authors selected 81 patients who had undergone upper lobectomy with complete mediastinal and subcarinal lymph node dissection and in whom chest radiographs had been obtained before operation and at four postoperative intervals. The interbronchial angle and the subcarinal angle were measured on the preoperative and postoperative radiographs and compared statistically. RESULTS The average interbronchial angle and subcarinal angle during any postoperative period were significantly smaller than those before lobectomy (P < .001). These average angles decreased gradually during the postoperative periods. CONCLUSION The tracheal bifurcation angle was decreased on follow-up chest radiographs in most patients who underwent upper lobectomy with mediastinal lymph node dissection. This finding may be useful for establishing a history of this surgical procedure on the basis of chest radiographs.

Clinical evaluation of serum PIVKA-II in small hepatocellular carcinomas using a sensitive PIVKA-II assay.

腫瘍径3cm以下の小肝細胞癌82症例 (針生検例44例, 外科的切除例38例) に対し高感度PIVKA-II測定の意義について検討した. PIVKA-II陽性率は腫瘍径3.0cm以下で34%, 2.0cm以下で21%であった. 組織型別にみると中・低分化型がそれぞれ52%, 56%と比較的高率であったが, 高分化型では3%と極めて低かった (P<0.05). また切除例における検討で, 組織学的血管侵襲を有する頻度は, PIVKA-II陽性群で56%, 陰性群で18%とPIVKA-II陽性群で有意に高かった (P<0.05). また無再発生存率はPIVKA-II陽性群は陰性群に比して有意に低率であった (P<0.05). 以上のように小肝細胞癌におけるPIVKA-IIの検出率には限界があるものの, 悪性度や予後予測に有用性が認められた.

Evaluation of the relationship between hepatic encephalopathy and portosystemic shunt using noninvasive three-dimensional portography obtained by multi-slice helical computed tomography

EVALUATION OF THE RELATIONSHIP BETWEEN HEPATIC ENCEPHALOPATHY AND PORTOSYSTEMIC SHUNT USING NONINVASIVE THREE·DIMENSIONAL PORTOGRAPHY OB· TAINED BY MULTI·SLICE HELICAL COMPUTED TOMOGRAPHY. Waka Ohishi, Akiko Matsumoto, Mikiya Kitamoto, Toshio Nakanishi, Hiroshi Aikata, Michio Imamura, Yoshiiku Kawakami, Koji Kamada, Hirotaka Kono, Goro Kajiyarna, Katsuhide Ito, 1st Dept of Internal Med, Univ Sch of Medicine, Hiroshima, Japan; Hiroshima Univ Sch of Med, Hiroshima, Japan; Dept of Radiology, Univ Sch of Medicine, Hiroshima, Japan.