Seiya Sumi

Prognostic factors in the treatment of hepatocellular carcinoma with transcatheter arterial embolization and arterial infusion

From January 1986 to December 1988, a prospective trial of transcatheter arterial treatment was carried out for hepatocellular carcinoma (HCC). Two hundred seventy‐five patients were included. Okudas staging system was employed. Patients with Stage I and II HCC were treated by transcatheter arterial embolization (TAE) with a gelatin sponge containing an anti‐cancer agent (protocol 1a); a gelatin sponge and iodized oil mixed with an anti‐cancer agent (protocol 1b); or iodized oil mixed with an anti‐cancer agent (protocol 2). Patients with Stage III HCC were treated with iodized oil with anti‐cancer agent (protocol 2). As an exception, patients with an unsuccessful superselective catheterization into the proper hepatic artery by Seldinger technique or obstruction of the main trunk of the portal vein were treated with percutaneous transcatheter arterial infusion into the common hepatic artery regardless of stage (protocol 3). Tumor type and extension, area of tumor involvement, portal vein involvement, method of treatment, and presence of ascites and icterus were found to be the significant factors for an initial response to therapy. Treatment method was the most important factor. Respective survival rates at 1 and 2 years were 70.9% and 55.3% for protocol 1a; 62.3% and 43.8% for protocol 1b; 37.8% and 18.3% for protocol 2; and 16.5% and 0% for protocol 3. Many factors proved to significantly influenced prognosis; however, tumor type had the most important prognostic significance followed by AFP value, ascites, treatment protocol, and area of tumor involvement.

The effects of transjugular intrahepatic portosystemic shunt on portal hypertensive gastropathy

In addition to variceal bleeding, haematemesis may occur due to haemorrhagic gastritis in patients with portal hypertension. This has been known as portal hypertensive gastropathy (PHG). We have evaluated the effects of the transjugular intrahepatic portosystemic shunt (TIPS) on portal venous pressure (PVP) and endoscopic gastric mucosal changes observed in patients with portal hypertension. We performed TIPS in 12 patients with complications due to portal hypertension as follows: variceal bleeding in nine patients (bleeding from oesophageal varices in seven and gastric varices in two), refractory ascites in three and haemorrhage from severe PHG in one. Endoscopic examinations were performed before and after TIPS for all patients. Changes of PVP and gastric mucosal findings on endoscopy were analysed. Before TIPS, PHG was seen in 10 patients. Portal venous pressure decreased from an average of 25.1 ± 8.8 to 17.1 ± 6.2 mmHg after TIPS (P < 0.005). On endoscopy, PHG improved in nine of 10 patients. Oesophagogastric varices improved in eight of 11 patients. In one patient with massive haematemesis, haemorrhage from severe PHG completely stopped after TIPS. Because TIPS effectively reduced PVP, this procedure appeared to be effective for the treatment of uncontrollable PHG.

Balloon-occluded retrograde transvenous embolization of a pelvic arteriovenous malformation

We successfully performed embolization therapy for a pelvic arteriovenous malformation by the retrograde transvenous approach using a liquid embolie material. This malformation was unique in that it had a single draining vein, which allowed this technique employing an occlusion balloon.

Prognostic factors in liver metastases after transcatheter arterial embolization or arterial infusion.

From January 1986 to December 1988, 85 patients (55 men and 30 women, mean age 59 years) with metastatic liver tumors were treated with hepatic artery embolization (TAE) or infusion (HAI). Sixty-eight patients with successful catheterization were treated with TAE using iodized oil (Lipiodol) mixed with anticancer agent (ACA). In 12 of 68 patients with hypervascular tumors gelatin sponge was added. Patients with unsuccessful catheterization were treated with hepatic artery infusion of ACA. Forty-three patients received oral chemotherapy following TAE or HAI. Overall, the 6-month, and 1- and 2-year survival rates were 69.5, 31.8 and 4.1 per cent, respectively (mean 233 days). A univariate analysis of prognostic factors showed that number of metastases, stage, treatment times and oral chemotherapy were all significant factors (p<0.05). Ascites, jaundice, percentage of hepatic replacement and treatment protocol also had some influence (p<0.1). Sex, age, primary site, elevation of tumor markers, other metastatic lesions, portal vein involvement and difference in anticancer agent had no prognostic significance. A multivariate analysis using Coxs proportional hazard model revealed that the number of treatments had the most important prognostic significance, followed by oral chemotherapy, stage and percentage of hepatic replacement.

Chemical shift GRE MRI of renal angiomyolipoma

The renal angiomyolipoma is a fairly common benign renal tumor composed of various proportions of smooth muscle, blood vessels, and fat. Because fat is present in virtually every case, the CT findings in angiomyolipomas are so distinctive that a histologic diagnosis may be suggested. In angiomyomas composed mainly of vascular tissue and muscle or in those in which recent hemorrhage has occurred, the majority of tumors may have soft tissue CT density values without apparent fatty component (1,2). In such cases, preoperative diagnosis is extremely difficult. In this case report, we detected a small amount of fatty tissue with a chemical shift GRE MRI technique, although CT failed to detect the fatty tissue.

Spiral CT of the pancreas: The value of small field-of-view targeted reconstruction

Purpose: to compare the value of a retrospective targeted high-resolution spiral CT to the standard reconstruction technique in the assessment of pancreatic diseases Material and Methods: Spiral CT pancreatic images of a standard-size reconstruction protocol were compared prospectively with those of a retrospective targeted high-spatial-resolution reconstruction protocol in 30 patients. Prior to clinical evaluation, a phantom study was performed to evaluate the spatial resolution and signal-to-noise ratio of both protocols Results: the high-resolution protocol achieved a good signal-to-noise ratio with acceptable spatial resolution. Phantom studies revealed increased image noise (+17%) with an increase in spatial resolution (+100%). in patients studied with the high-resolution protocol, the increase in noise was not significant but there was a marked improvement in the definition of small details Conclusion: Images obtained with a targeted high-spatial-resolution reconstruction protocol showed superior lesion definition and vascular opacification compared with those obtained with a standard-size reconstruction protocol. This technique may have potential in the evaluation of small pancreatic abnormalities

Pitfalls in image reconstruction of helical CT angiography: an experimental study.

This study was undertaken to evaluate the effects of the object related factors: background tissue and the direction of vessels on the morphological reproducibility of helical CT angiography. Cylindrical tubes filled with a diluted contrast medium were prepared to obtain vascular phantoms. The scan was performed within various background tissues. For the evaluation of the direction of the vessels, two types of vascular phantoms were prepared. The phantoms were scanned by varying beam collimations and scan pitches. Reconstructed CT images were markedly affected by the background tissue. The reconstructed images were also affected by the direction of vessels.

Spiral CT of the pancreas

Purpose: to compare the value of a retrospective targeted high-resolution spiral CT to the standard reconstruction technique in the assessment of pancreatic diseasesMaterial and Methods: Spiral CT pancreatic images of a standard-size reconstruction protocol were compared prospectively with those of a retrospective targeted high-spatial-resolution reconstruction protocol in 30 patients. Prior to clinical evaluation, a phantom study was performed to evaluate the spatial resolution and signal-to-noise ratio of both protocolsResults: the high-resolution protocol achieved a good signal-to-noise ratio with acceptable spatial resolution. Phantom studies revealed increased image noise (+17%) with an increase in spatial resolution (+100%). in patients studied with the high-resolution protocol, the increase in noise was not significant but there was a marked improvement in the definition of small detailsConclusion: Images obtained with a targeted high-spatial-resolution reconstruction protocol showed superior lesio...