Shunsuke Sugawara

Patterns of Soft-Tissue Tumor Extension in and out of the Pelvis

OBJECTIVE The purpose of this article is to present the route of extension in nine soft-tissue tumors and tumorlike lesions of the pelvic wall. CONCLUSION Soft-tissue tumors of the pelvis, particularly malignant ones, extend into other compartments through specific pathways that are bordered by bones, ligaments, and fasciae. Such pathways include the greater sciatic foramen, the obturator foramen, the femoral canal, the muscular lacuna, the pelvic outlet, and the inguinal canal.

Hand and wrist arthritis of Behçet disease: Imaging features

Background: Reports on arthritis in Behçet disease are relatively scarce, and imaging features vary. Purpose: To document the various imaging features of articular disorders of the hand and wrist in Behçet disease. Material and Methods: Four patients, four women aged 26 to 65 years, fulfilling the diagnostic criteria of Behçet disease, with imaging findings of hand and wrist arthritis, were seen in two institutions. Radiography and magnetic resonance (MR) imaging were studied to elucidate the pattern and distribution. Results: Both non-erosive arthritis and erosive arthritis of different features were noted: one with non-erosive synovitis of the wrist, one with wrist synovitis with minimal erosion, and two with erosive arthritis of the distal interphalangeal joint. Conclusion: Imaging manifestations of arthritis of Behçet disease vary, and may be similar to other seronegative arthritides.

Antireflux Metal Stent for Initial Treatment of Malignant Distal Biliary Obstruction

Objectives To compare the use of an antireflux metal stent (ARMS) with that of a conventional covered self-expandable metal stent (c-CSEMS) for initial stenting of malignant distal biliary obstruction (MDBO). Materials and Methods We retrospectively investigated 59 consecutive patients with unresectable MDBO undergoing initial endoscopic biliary drainage. ARMS was used in 32 patients and c-CSEMS in 27. Technical success, functional success, complications, causes of recurrent biliary obstruction (RBO), time to RBO (TRBO), and reintervention were compared between the groups. Results Stent placement was technically successful in all patients. There were no significant intergroup differences in functional success (ARMS [96.9%] versus c-CSEMS [96.2%]), complications (6.2 versus 7.4%), and RBO (48.4 versus 42.3%). Food impaction was significantly less frequent for ARMS than for c-CSEMS (P = 0.037), but TRBO did not differ significantly between the groups (log-rank test, P = 0.967). The median TRBO was 180.0 [interquartile range (IQR), 114.0–349.0] days for ARMS and 137.0 [IQR, 87.0–442.0] days for c-CSEMS. In both groups, reintervention for RBO was successfully completed in all patients thus treated. Conclusion ARMS offers no advantage for initial stent placement, but food impaction is significantly prevented by the antireflux valve.

Angio-CT–Assisted Balloon Dissection: Protection of the Adjacent Intestine during Cryoablation for Patients with Renal Cancer

The present study describes the technical feasibility of a combined-modality angiography/computed tomography (angio-CT)-assisted balloon dissection technique for bowel protection during renal cryoablation in six procedures in five patients. A retrospective review was performed to evaluate balloon dissection using the angio-CT system. Mean bowel-to-tumor distances before and after balloon dissection were 0.9 mm (range, 0-3 mm) and 13.0 mm (range, 11-17 mm), respectively. No bowel injury was observed during the mean follow-up period of 19 months (range, 7-44 mo). Our preliminary experience suggests that balloon dissection using the angio-CT system for bowel protection during renal cryoablation may be feasible and effective.

Percutaneous Creation of an Extraanatomic Splenoportal Shunt in a Patient with Bleeding Ectopic Varices

Editor: We report percutaneous creation of an extraanatomic splenoportal shunt in combination with a transjugular intrahepatic portosystemic shunt (TIPS) and variceal embolization to treat a patient with bleeding ectopic varices at the site of a previous choledochojejunostomy. Our hospital’s institutional review board did not require approval for this case report. A 74-year-old man with a history of chronic pancreatitis presented with melena and anemia requiring multiple transfusions, resulting in impaired performance status. Computed tomography (CT) and double-balloon endoscopy performed at the referring hospital revealed variceal bleeding in the jejunum, adjacent to the anastomotic site of previous choledochojejunostomy for occlusion of the bile duct caused by pancreatitis. Endoscopy could not control the bleeding, and surgery was deemed unsafe as a result of postsurgical adhesions. The patient was referred to our hospital to seek possible treatment. On admission, hematologic tests revealed a decrease in hemoglobin level (8.0 g/dL) and platelet count (133,000/ μL). Liver function test and coagulation profile results were normal except for decreased albumin level (2.5 g/ dL). Contrast-enhanced CT demonstrated occlusion of the portal venous system, involving the intrahepatic bilateral main portal trunks, extrahepatic portal vein, and the confluence of the superior mesenteric and splenic veins. Collateral vessels were identified around the choledochojejunostomy site (Fig 1). On the basis of these findings, recanalization of the portal vein was planned. An angiography/CT system (INFX-8000C/ Aquilion 16; Toshiba, Ohtawara, Japan) with a c-arm

Percutaneous Catheter and Port Placement for Hepatic Arterial Infusion Chemotherapy: Catheter Placement from Subclavian Artery

Abstract Hepatic arterial infusion chemotherapy (HAIC) has been performed for patients with life-threatening liver tumors resistant to standard therapies for more than 30 years. Placement of the port and catheter system for HAIC is performed by surgeons or interventional radiologists. Surgical placement requires laparotomy, whereas the interventional radiologic approach places a port and a catheter percutaneously. The interventional radiologic technique of implanting a port and catheter was originally developed in Japan in the 1980s. The procedure consists of arterial redistribution, catheter and port placement, and evaluation and management of the drug distribution. For the catheter and port placement, the subclavian artery, femoral artery, or inferior epigastric artery is used as an access route. We have used a subclavian artery for HAIC to have the stability of the system at the anterior chest wall and the ease to advance a catheter into hepatic arteries at the time of the placement; however, there are some risks, such as cerebral infarction, and the specific skills of a cutdown procedure are required to access the subclavian artery. No procedure can be perfectly appropriate for all patients, and we should consider what we choose on a case-by-case basis. With this video (available online at www.jvir.org), we hope many interventional radiologists will be aware that this could be within their scope of practice with training.

Bridging stent placement through the superior vena cava to the inferior vena cava in a patient with malignant superior vena cava syndrome and an iodinated contrast material allergy

Positioning is critical during the placement of superior vena cava (SVC) stents in patients with malignant SVC syndrome. Although SVC stents effectively relieve various symptoms of SVC syndrome, improper stent positioning may cause life-threatening complications such as migration that result in fatal cardiac failure. Here we describe a patient with an allergy to iodinated contrast material (ICM) who presented with SVC syndrome owing to mediastinal lymph node metastases from hepatocellular carcinoma, which was successfully treated with an SVC stent. Secure stent placement was achieved by bridging the stent through the SVC to the inferior vena cava with venography using carbon dioxide instead of ICM.