Motomasa Kimura

Myometrial invasion of endometrial carcinoma: Assessment with dynamic MR and contrast-enhanced T1-weighted images

AIM To evaluate the usefulness of dynamic magnetic resonance (MR) imaging in assessing the depth of myometrial invasion, compared with conventional T2-weighted and contrast-enhanced T1-weighted imaging. PATIENTS AND METHODS Forty patients with endometrial carcinoma were examined with T2-weighted images, dynamic studies and contrast-enhanced T1-weighted images, preoperatively. We evaluated enhancement patterns of myometrium and tumour, and compared MR findings with histological results concerning the depth of myometrial invasion. RESULTS In assessing the depth of myometrial invasion, the accuracy of T2-weighted images, dynamic studies and contrast-enhanced T1-weighted images was 58%, 85% and 68%, respectively. The tumour-myometrial contrast of dynamic studies was higher than that of other images. In addition, subendometrial enhancement (SEE) was frequently observed in dynamic studies in post-menopausal women, which was an important landmark in detecting myometrial invasion. CONCLUSION We consider that dynamic MR imaging has greater advantage in assessing myometrial invasion than T2-weighted or contrast-enhanced T1-weighted imaging.

Hepatic arterial infusion chemotherapy using percutaneous catheter placement with an implantable port: Assessment of factors affecting patency of the hepatic artery

OBJECTIVE To assess the factors affecting patency of the hepatic artery during hepatic arterial infusion chemotherapy (HAIC) with an implantable port system inserted percutaneously. PATIENTS AND METHODS Ninety patients with malignant hepatic tumours were given HAIC using percutaneous catheter placement. An end-hole catheter was inserted into the hepatic artery (conventional method) in 41 patients. An end-closed and side-hole catheter was used in 49 patients, in which the catheter tip was fixed in the gastroduodenal artery and the side hole was placed in the common hepatic artery (fixed catheter-tip method). The patency of the hepatic artery was evaluated with computed tomography (CT) arteriography using the implantable port system and angiography. Then, the factors affecting hepatic arterial patency were analysed. RESULTS Hepatic arterial occlusion was observed in 15 patients (17%). The overall patency of the hepatic artery was 86.9%, 78.4% and 51.5% at 6 months, 1 year and 2 years, respectively. The patency rate of the hepatic artery was significantly higher in patients with catheter placement using fixed catheter-tip method than those using conventional method (P = 0.01), and in patients without transcatheter arterial chemoembolization (TACE) prior to catheter placement than those with prior TACE (P = 0.01). When the variables affecting patency of the hepatic artery were studied together by multivariate analyses, the important factors were the method of catheter placement and the presence or absence of prior TACE. CONCLUSION We consider that it is important for long-term patency of the hepatic artery during HAIC to use fixed catheter-tip method for percutaneous catheter placement instead of conventional method, and to select patients without prior TACE.

Hepatic perfusion abnormalities during treatment with hepatic arterial infusion chemotherapy: Value of CT arteriography using an implantable port system

PURPOSE The purpose of this study was to evaluate CT arteriography (CTA) using an implantable port system in the detection of perfusion abnormalities occurring during hepatic arterial infusion chemotherapy (HAIC). METHOD In 51 patients with unresectable primary and metastatic liver tumors, who had implanted port systems for HAIC, CTA examinations through the infusion pump were performed. When perfusion abnormalities were found, selective angiography and/or digital subtraction angiography using the implantable port system were performed to determine the etiology. RESULTS Forty-nine perfusion abnormalities were detected in 32 patients. Intrahepatic hypoperfusion was found in 24 cases. Of 11 patients in whom correction of the hypoperfusion was attempted, it was successful in 10. Of 13 patients in whom correction was not attempted, 6 patients showed progressive disease in nonperfused areas. Intrahepatic hyperperfusion was found in 14 cases, which showed no subsequent complication. Extrahepatic perfusion was found in 11 cases. CONCLUSION We consider CTA to be useful in detecting perfusion abnormalities that may compromise HAIC.

Development of extrahepatic arterial blood supply to the liver during hepatic arterial infusion chemotherapy.

Abstract. The aim of this study was to evaluate the correlation of development of the collateral circulation to the liver during hepatic arterial infusion chemotherapy (HAIC) with the presence of hepatic tumours adjacent to the hepatic surface, and with pretreatment occlusion of aberrant hepatic arteries. In 102 patients with unresectable malignant hepatic tumours treated with HAIC using an implantable port system, development of collaterals to the liver was assessed with CT arteriography using the implantable port and pre- and postoperative angiography. Aberrant hepatic arteries, if present, were occluded prior to treatment for hepatic arterial redistribution. Collaterals to the liver were seen in 29 patients, who had 35 areas with collateral perfusion: 22 areas were in the right posterosuperior area, 6 in the left peripheral area and 7 in the right or left lobar area. Collaterals were revealed more frequently in patients with hepatic tumours adjacent to the hepatic surface than in those without hepatic tumours in peripheral areas in the liver (p < 0.0001). In addition, collaterals developed more frequently in patients with an aberrant hepatic arterial anatomy compared with those with conventional anatomy (p = 0.0007). Our results indicated that patients with hepatic tumours adjacent to the hepatic surface and with pretreatment occlusion of aberrant hepatic arteries had the potential to develop collaterals to the liver during HAIC.

Small hypervascular hepatocellular carcinoma versus hypervascular pseudolesions: differential diagnosis on MRI

AbstractBackground: We wanted to differentiate small hypervascular hepatocellular carcinoma (HCC) from hypervascular pseudolesion (HPL) on magnetic resonance imaging (MRI). Methods: We reviewed small hypervascular foci (≤2 cm in diameter) on dynamic MRI in patients with chronic liver disease, which were followed-up with serial MRI examinations. Results: Twenty of 34 hypervascular foci were larger at follow-up; 19 of 20 foci had characteristics suggesting HCC; and 14 foci did not grow or disappeared and were judged to be HPLs. There were no differences in the initial sizes and follow-up periods between HCCs and HPLs. On initial MRI, nine of 19 HCCs (47%) and one of 14 HPLs (7%) appeared hyperintense on T2-weighted images. The difference between HCCs and HPLs on T2-weighted images was statistically significant (p= 0.039). Conclusion: HPLs are seen frequently as small hypervascular foci on dynamic MRI in patients with chronic liver disease. Hyperintensity of the foci on T2-weighted images differentiates HCCs from HPLs.

Evaluation of upper urinary tract dynamics by diuresis renography in patients receiving urinary reservoir operation : comparison of full and empty reservoir

Upper urinary tract dynamics was evaluated using diuresis renography during full and empty reservoir in 14 patients (11 men, 3 women, 13-70 years old) with intestinal urinary reservoir or intestinal bladder augmentation. Types of operation were Mainz pouch urinary diversion 5, Mainz neobladder to urethra, 5, Kock pouch urinary diversion 2, and Mainz bladder augmentation 2. Diuresis renography was performed using 99mTc-DTPA and furosemide during full and empty reservoir, and several parameters (Tmax, T75, T50, GFR) in addition to the patterns of renogram were evaluated. In the normal control, none of the parameters of the diuresis renogram with full bladder differed from those with empty bladder. In 5 of 14 patients, abnormal waves on cystometry (CMG) were found, and in 4 of these 5 patients, the patterns of diuresis renogram of full reservoir were worse than those of empty reservoir. However, the patterns of diuresis renogram of full reservoir were not different from those of empty reservoir in 9 patients without abnormal waves on CMG. In conclusion, renal injury may easily occur in patients with intestinal reservoir and abnormal waves on CMG.

Hepatic arterial infusion chemotherapy with 5-fluorouracil-based regimens in the management of liver metastases of colorectal carcinoma

BackgroundWe assessed the efficacy and safety of hepatic arterial infusion chemotherapy, using 5-fluorouracil-based regimens, in the treatment of unresectable liver metastases of colorectal carcinoma.Patients and MethodsThirty patients with liver metastases of colorectal carcinoma were given hepatic arterial infusion chemotherapy using 5-fluorouracil-based regimens, through an implantable port system, inserted into the hepatic artety by percutaneous procedures. Weekly 5-fluorouracil infusions were given to 17 patients, daily 5-fluorouracil infusions were given to 2, the MF (5-fluorouracil-mitomycin) regimen was given to 8, and the FEM (5-fluorouracil-epirubicin-mitomycin) regimen was given to 3.ResultsThe median survival time was 11.6 months, with an overall response rate of 64%. These results were similar to those in previous reports on hepatic arterial infusion chemotherapy using floxuridine. Hematologic and hepatic toxicity was minimal Grade 3 thrombocytopenia occurred in 2 patients (7%), and a grade 2 elevation of alkaline phosphatase, in 1 (4%). Biliary sclerosis was not observed. The major toxicity was nausea and vomiting, grade 2 or 3, most of which was controllable, in 5 patients (18%). The occurrence of hepatic failure resulting in death was significantly (P=0.0015) lower in responsive cases than in nonresponsive cases.ConclusionWe consider that 5-fluorouracil-based regimens can be used safely for hepatic arterial infusion chemotherapy with minimal toxicity, and that they are useful in preventing hepatic failure, because of their high response rate.

Urokinase Lysis for Acute Left Subclavian Artery Thrombosis after Placement of Infusion Catheter: Report of Two Cases

We present two cases of acute subclavian and/or axillary arterial occlusion after transaxillary catheterization with an implantable port for hepatic arterial infusion chemotherapy. They were successfully treated with thrombolytic therapy using intraarterial administration of urokinase without removal of the infusion catheter system. We consider that this treatment is suitable for managing acute thrombosis of the conduit artery after catheterization for hepatic arterial infusion chemotherapy.

SURGICAL IMPLICATION OF AORTIC DISSECTION ON LONG-TERM OUTCOME IN MARFAN PATIENTS

We herein review our 17-year surgical experience for the treatment of ascending aortic aneurysm in patients with Marfan syndrome to clarify the risks of increased mortality and reoperation. The subjects consisted of 15 patients who had all undergone surgery for the aortic root and ascending aorta at Niigata University Hospital between July 1978 and January 1995. Aortic valve replacement and ascending aortic wrapping were performed in 5 patients, Bentall or Cabrol operation in 6, and combined aortic arch reconstruction and Carbrol operation in 2, as the initial surgery. Patients who had an aortic dissection (Stanford type A) at initial surgery were assigned to group I (n=7), while those with an aortic root aneurysm were assigned to group II (n=8). In group I, 3 patients required a second operation for the remaining aortic arch aneurysm, and 1 died due to a late rupture of the distal aneurysm. In group II, no patient needed a reoperation; however, 1 died due to an intracranial hemorrhage and another due to composite valve graft failure and distal dissection. The results thus indicate that aortic dissection seems to affect long-term outcome, and therefore the combined repair of the aortic root and transverse arch is recommended in Marfan patients with aortic dissection involving the transverse aortic arch.

MR arteriography using an implantable port system: a new method in assessing perfusion abnormalities during hepatic arterial infusion chemotherapy.

We present a case in which MR arteriography (MRA) with an indwelling catheter was used in a perfusion study of intrahepatic arterial chemotherapy for liver metastases. After embolization of collateral vessels using platinum coils, CT imaging was disturbed by strong artifact. However, platinum coils produced no MR artifact. In addition, MRA had greater advantages in depicting perfusion defects than perfusion scintigraphy. We consider MRA useful in assessing perfusion abnormalities during intrahepatic arterial chemotherapy.