Kyu Bo Sung

Preoperative evaluation of hilar cholangiocarcinoma with contrast-enhanced three-dimensional fast imaging with steady-state precession magnetic resonance angiography: comparison with intraarterial digital subtraction angiography.

We sought to evaluate the image quality of double-dose, contrast-enhanced 3D fast imaging with steady-state precession (FISP) magnetic resonance (MR) angiography in patients with hilar cholangiocarcinoma, and to compare its efficacy with intraarterial digital subtraction angiography (DSA). Thirty-six patients were studied to determine the visibility of the hepatic artery and portal vein with contrast-enhanced MR angiography. Determination of hepatic arterial and/or portal invasion from cholangiocarcinoma was compared between MR angiography and DSA as well. 0.2 mmol/kg gadolinium chelates were administrated at a rate of 4ml/s. The hepatic artery was diagnostically visible in 28 patients (78%); the portal vein, in 34 patients (94%). The sensitivities, specificities, and accuracies in distinguishing arterial invasion, were 58%, 93%, and 89%, respectively, with MR angiography; 75%, 99%, and 96%, respectively, with DSA. In distinguishing portal venous invasion, these were 78%, 91%, and 89%, respectively, with MR angiography; 78%, 92%, and 90%, respectively, with DSA. There were no significant differences between imaging methods (p > .05); however, DSA was superior in specificity regarding hepatic arterial invasion (p = .0143). The data presented here indicate that noninvasive contrast-enhanced 3D FISP MR angiography has the potential to replace DSA in the preoperative evaluation of hilar cholangiocarcinoma.

Bile leak following living donor liver transplantation: Clinical efficacy of percutaneous transhepatic treatment

Percutaneous transhepatic treatment may be effective in patients with bile leaks after living donor liver transplantation (LDLT). We therefore evaluated the clinical efficacy of percutaneous transhepatic treatment for biliary leaks in adult‐to‐adult LDLT recipients. Twenty‐three LDLT recipients underwent percutaneous transhepatic treatment to manage bile leaks. The treatment included percutaneous transhepatic biliary drainage (PTBD) and drainage of perihepatic biloma. In patients with combined biliary strictures, balloon dilation was usually performed. Indications for PTBD included patients who had a Roux‐en‐Y hepaticojejunostomy (n = 9), failed endoscopic cannulation of bile ducts (n = 6), a bile leak refractory to endoscopic management (n = 5), and a poor general condition for endoscopic management (n = 3). Clinical success was achieved in 16 of 23 (70%) patients. PTBD catheters were removed from 14 of the 16 patients with clinical success at a median of 8 months (range, 3‐42 months) after initial PTBD. Aside from 1 patient with intrahepatic pseudoaneurysms, there were no major complications. During a median follow‐up period of 42 months (range, 3.0‐84 months), 6 (43%) of the 14 patients who underwent PTBD catheter removal experienced jaundice or cholangitis due to biliary anastomotic stricture at a median of 26 months (range, 22‐49 months) after PTBD catheter removal. In conclusion, percutaneous transhepatic treatment for biliary leaks in adult‐to‐adult LDLT recipients is clinically effective. This approach is a valuable alternative for treating bile leaks resistant to or inaccessible by endoscopic methods. However, further investigations are needed to minimize the duration of treatment and biliary strictures following PTBD catheter removal. Liver Transpl 14:1142–1149, 2008.

A Benign Colorectal Stricture: Treatment with a Retrievable Expandable Nitinol Stent

Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1, Pungnap-dong, Songpa-gu, Seoul, 138-736, South Korea Department of Radiology, Gachon Medical School, Gil Medical Center, 1198, Guwol-dong, Namdong-gu, Incheon, 405-760, South Korea Department of General Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1, Pungnap-dong, Songpa-gu, Seoul, 138-736, South Korea

Preoperative transcatheter arterial embolization of hypervascular metastatic tumors of long bones

Background: Complete resection of hypervascular metastatic tumors is often complicated by massive intraoperative blood loss. Purpose: To assess the technical success and clinical effectiveness of transcatheter arterial embolization (TAE) of hypervascular metastatic tumors of long bones to reduce blood loss during orthopedic surgery. Material and Methods: From January 2000 to September 2009, 25 patients (M:F=13:12; mean age 58.3 years) were treated with TAE of metastatic bone tumors before elective, orthopedic surgery. In all cases, the indication for TAE was preoperative devascularization. Technical success, defined as obliteration of tumor staining to 70% or more, requirement for red blood cell transfusion within 24 h following surgery, and hematologic parameters, i.e. the hemoglobin, hematocrit, and erythrocyte counts before and after surgery, were obtained. Results: The technical success rate was 96% (24/25 patients). Gelatin sponge particles (n=21) or polyvinyl alcohol particles (n=4) were used as embolic materials. The mean amount of red blood cell transfusion within the 24 h following surgery was 1.91 units (range 0–6) in the 23 patients with technically successful TAE and who underwent surgery within 3 days after TAE. In 22 patients with technically successful TAE and available hematologic data, the mean gaps in the hemoglobin, hematocrit, and erythrocyte counts before and after operation were 1.22 g/dl, 4.07%, and 0.45×106/mm3, respectively. Conclusion: Preoperative TAE is technically successful and clinically effective to minimize intraoperative and postoperative bleeding in patients with hypervascular metastasis to long bones.

Expandable Metallic Stents: in the Benign Strictures of Intrahepatic Ducts in Patients with Primary Intrahepatic Stones

Abstract: In Korea there is a prevalence for primary intrahepatic stones. Patients with primary intrahepatic stones and oriental cholangiohepatitis ofen have accompanying intrahepatic strictures. Despite complete removal of the intrahepatic stones, sustained intrahepatic strictures will evoke bile stasis and impairment of liver function. So the correction of intrahepatic strictures in addition to the removal of the stones is important in the management of primary intrahepatic stones.