Shigeru Furui

Cystic islet cell tumors: Radiologic findings in three cases

We report three cases of cystic islet cell tumors, two caused by gastrinomas and the other by an islet cell carcinoma. All three patients underwent computed tomography (CT) and angiography and two also had magnetic resonance (MR) imaging. Several common radiographic findings were present as follows: thickening of the cyst wall and irregularity of the inner surface on postcontrast CT and MR images, neovascularity and a densely staining hypervascular rim on angiography, and moderately increased signal intensity of the cyst content on T1-weighted MR images, which indicated fluid containing blood and/or necrotic tissue. These findings are helpful in defining the nature of these lesions and strongly suggest that cystic islet cell tumor should be included in the differential diagnosis.

Clinical application of an ultra-thin pancreatoscope using a sequential video converter

The main pancreatic duct was studied endoscopically by inserting an ultra-thin pancreatoscope into the normal papilla of Vater. Recently, we developed a new pancreatoscope system and improved the image, the durability, and the ease of use. A special video converter was connected to the head of the pancreatoscope. The sequential electronic endoscope images were observed on a TV monitor. We performed examinations with this new system in 52 cases (8 with pancreatic cancer, 19 with chronic pancreatitis and 25 normal cases). We studied the brightness, color and quality of the images on 35-mm film and on videotape. As a result, it has become clear that the images obtained with this system are much better than those obtained by the conventional method. Although further improvement in the ability to angulate the endoscope is necessary, this new pancreatoscope system should help diagnose diseases of the pancreas.

Emergent embolotherapy of small intestine hemorrhage.

The efficacy of emergent embolotherapy was evaluated in six patients suffering hemorrhage from the small intestine. Hemorrhage was from the jejunum in four patients, from the ileum in one, and from Meckels diverticulum in one. Superselective embolization of the arcade of the small intestine artery branch was performed in all patients with a coaxial catheter. Embolic materials used were Gelfoam particles alone or Gelfoam particles plus coils in earlier cases and microcoils in recent cases. Complete hemostasis was immediately achieved in all patients, but one patient died of disseminated intravascular coagulation. After stabilization of the patients condition by hemostasis, elective surgery was performed on three patients suffering small intestine ulcer. Histopathologically, no bowel infarction was noted but mild mucosal inflammation with submucosal edema was found in the jejunum of two patients. We recommend embolization for life-threatening small intestine hemorrhage, preferentially in situations where the blood vessel involved can be superselectively occluded at the nearest level of the arcade of the vasa recta, lest the vasa recta should be occluded.

MRI appearances of calcified regions within intracranial tumours

The MRI appearances of calcification within intracranial tumours was assessed by reviewing MR images of 11 calcified tumours documented by CT. The signal intensity of the calcified regions was varied and nonspecific on both T1-and T2-weighted images. They were seen as signal void exclusively on T2-weighted images in only 2 patients. Gadolinium enhancement of the calcified portion occurred in 7 of 10 patients. These findings reflect the presence of tumour parenchyma within the calcified region, as proved in 5 lesions examined histologically.

Treatment of Tuberculous Bronchial Stenosis with Expandable Metallic Stents

Gianturco expandable metallic stents were placed in 5 patients with dyspnea on exercise due to tuberculous bronchial stenosis. The stents were placed after dilatation with a 10-mm diameter high pressure balloon catheter. In all 5 patients, obstructive changes disappeared following the procedure, and dyspnea on exercise improved markedly. No complications related to the procedure were encountered. At follow-up during a period of up to 38 months, 2 patients showed bronchial restenosis at 11 and 17 months, respectively, after stent placement. Restenosis by granulomatous tissue was successfully treated by laser ablation. One patient showed slight one-day hemoptysis 26 months after stent placement.

Moyamoya disease: diagnosis with three-dimensional CT angiography

Our purpose was to assess the value of threedimensional (3D) CT angiography in the diagnosis of moyamoya disease. We studied seven patients with moyamoya disease proved by conventional angiography. Three-dimensional (3D) CT angiography was performed using rapid sequence or helical (spiral) scanning in conjunction with a bolus injection of intravenous contrast medium. All seven patients could be diagnosed as having moyamoya disease on the basis of the following 3D CT angiographic findings: poor visualisation of the main trunks and/or major branches of anterior and middle cerebral arteries (7 patients); dilated leptomeningeal anastomotic channels from the posterior cerebral arteries (4); and demonstration of “moyamoya vessels” in the basal ganglia (2). Although conventional angiography remains the principal imaging technique for demonstrating anatomical changes in detail, less invasive 3D CT angiography provides a solid means of diagnosing moyamoya disease when it is suspected on CT, MRI, or clinical grounds.

Contrast-enhanced magnetic resonance imaging of sub- and epidural empyemas

SummaryContrast-enhanced magnetic resonance images (MRI) of three patients with subdural (SDE) and two with epidural empyemas (EDE) were reviewed. In each case, the capsule of the lesion demonstrated enhancement, and distinction between capsule and contents was obvious on contrast-enhanced images. In SDE, contrast-enhanced images clearly depicted thickening of the neighbouring dura mater and a co-existent brain abscess. In EDE, part of the displaced dura mater did not enhance, which facilitated differentiation from SDE. Contrast-enhanced MRI was thus of value in diagnosis.

Outcome of localized hepatocellular carcinoma treated with segmental arterioportal chemoembolization

SummaryWhen lipiodol is injected into the hepatic artery at a dose exceeding a certain level, it flows into the portal vein. On the basis of this feature, an emulsion of Adriamycin with lipiodol was injected into a segmental or subsegmental artery such that it was delivered to the portal vein of the same segment, and the artery was then embolized with Gelfoam. This segmental arterioportal chemoembolization (cement therapy) was performed in 50 patients with localized hepatocellular carcinoma. A posttreatment CT scan showed that almost 100% of the lesions were occupied by lipiodol. The cumulative survival values determined for the 50 patients were very high: 83.4% after 1 year and 62.7% after 2 years.

Prevention of Gastric Complications in Hepatic Arterial Chemoembolization

Gastric complications may be a problem in transcatheter arterial chemoembolization, if the right gastric artery branches distally from the proper hepatic artery or its branch, or the accessory left gastric artery arises from the left hepatic artery. We occluded the proper hepatic artery with a balloon catheter to redirect blood flow in these gastric branches toward the liver. This procedure prevented chemoembolic agents from flowing into the gastric branches, and accordingly protected against gastric complications even when chemoembolization was performed by injecting the agents proximally to the gastric branches.

Massive intestinal bleeding caused by an ileal arteriovenous malformation: report of a case.

We report herein the case of a 43-year-old man in whom gastrointestinal bleeding was found to be caused by a large arteriovenous malformation (AVM) in the ileum. Emergency angiography proved invaluable in disclosing the AVM as the bleeding source, after which the patient was successfully treated by surgery. Although the number of reports of AVM has recently been increasing, ileal AVMs are still relatively rare. Moreover, according to the Japanese literature, no other patient has had such marked and large feeding arteries and draining veins as those in the patient described in this report.