Subaru Hashimoto

Intraarterial digital subtraction angiography with carbon dioxide: superior detectability of arteriovenous shunting.

Intraarterial digital subtraction angiography (IADSA) with carbon dioxide (CO2) was performed on 41 patients with liver or renal diseases. CO2 produced no hypersensitivity reactions, and the pain or feeling of warmth was relatively mild compared with iodinated contrast media. Although the image quality of the arterial or capillary phase was inferior to that with iodinated contrast media, the detectability of arteriovenous shunting was excellent. IADSA with CO2 may become an effective method for detecting arteriovenous shunting which cannot be demonstrated with conventional angiography or DSA with iodinated contrast medium.

Expanding role of emergency embolization in the management of severe blunt hepatic trauma

Emergency embolization using Gelfoam particles alone, or in combination with stainless steel coils or epinephrine, was attempted in 4 patients with severe blunt hepatic trauma complicated by hypovolemic shock to control exsanguinating hemorrhage. Angiography prior to embolization revealed extravasation in all cases. None of the patients rebled or required further intervention. Postembolization course was uneventful in each case. Embolization could become the treatment of choice for more unstable and complicated patients than previously considered.

Quantitative image reconstruction using position-dependent scatter correction in single photon emission CT

Elimination of scattered photons from acquired counts is necessary for reconstructing a quantitative SPECT (single photon emission computed tomography) image. To perform correction of the scattered photons, the authors have developed a novel scatter correction method considering the local scatter fraction at each pixel in a planar image and evaluated its validity by simulations using numerical phantoms. In the present work, they evaluate the parameters used in the correction method, i.e., the width of a main window and subwindows, and the location of the subwindows. They show the results of experiments using a myocardial phantom and preliminary clinical studies using a commercially available gamma-camera system equipped with special hardware. In the clinical studies, a new Tc-99m myocardial perfusion imaging agent (P-53) was used. These results show that quantitative measurement of activity in clinical study is possible without adding data acquisition/processing time.<<ETX>>

Transileocolic venous balloon dilatation for the management of primary and recurrent portal venous stenosis after living donor liver transplantation in children

Portal venous stenosis is relatively a rare complication after liver transplantation in children and it sometimes leads to life threatening event due to gastrointestinal bleeding or graft failure. Recently, balloon dilatation has been widely accepted as a treatment of choice for the management of portal venous stenosis. The purpose of this study was to evaluate the feasibility of transileocolic venous balloon dilatation for the management of primary and recurrent portal venous stenosis after living donor liver transplantation (LDLT) in children. The records of 57 pediatric liver transplants were retrospectively reviewed. Nine patients (15.8%) with portal venous stenosis were identified. Seven symptomatic children with portal venous stenosis underwent balloon dilatation. Two approaches were employed for balloon dilatation; the transileocolic venous approach and the percutaneous transhepatic approach. In patients with recurrent stenosis, careful follow-up was carried out while they were asymptomatic. Twelve balloon dilatations were performed in seven children with primary or recurrent portal venous stenoses. The initial technical success rate was 91.7% (11/12), while 6 out of 12 (50.0%) procedures resulted in recurrent stenosis. Five out of six recurrent stenoses required repeated balloon dilatation. The clinical success rate of balloon dilatation in our study was 85.7% (6/7). Other than recurrent stenosis, two procedure-related complications occurred. In conclusion, transileocolic venous balloon dilatation was a safe and effective procedure for portal venous stenosis after LDLT in children.

Transcatheter hepatic arterial chemoembolization using epirubicin-lipiodol: experimental and pharmacological evaluation.

SummaryThe experimental and pharmacological characteristics of various formulations of an anticancer agent (epirubicin, EPI) and lipiodol were evaluated in vitro and in vivo. Three forms of EPI-lipiodol, i.e., an oil-in-water type of emulsion (O/W type), a water-in-oil type of emulsion (W/O type), and a suspension (S type), were prepared and investigated for their stability. An O/W-type emulsion using a stock solution of Iopamidol as the solvent for EPI was the most stable form in the stationary state in vitro. In 16 patients with malignant liver tumors (14 hepatocellular carcinomas and 2 liver metastases), the three forms of EPI-lipiodol were injected into the proper hepatic artery. The plasma EPI level was monitored periodically and analyzed pharmacokinetically. No significant difference in the pharmacokinetics of EPI was detected among the O/W, W/O, and S types.

INTRA-ARTERIAL CT-ANGIOGRAPHY FOR CEREBRAL ARTERIOVENOUS MALFORMATION—INITIAL EXPERIENCES FOR TREATMENT PLANNING OF RADIOSURGERY

PURPOSE To clarify the feasibility and effectiveness of intra-arterial CT angiography (IACTA) for treatment planning of arteriovenous malformation radiosurgery. METHODS AND MATERIALS A CT scanner installed in an angiographic examination room was used. Helical IACTA was performed in 22 patients during continuous intra-arterial infusion of contrast medium via the internal carotid or vertebral artery, and dynamic IACTA was performed in 20 of these patients with reconstruction at 0.2-s intervals. The dynamic IACTA was repeated for each 3- or 5-mm increment to encompass the nidus. Subtractions were performed in postembolization cases. A retrospective review of IACTA was performed to assess the effectiveness of dynamic scans. RESULTS No complications related to the angiographic procedure or CT imaging were detected. High contrast enhancement was obtained for both helical and dynamic IACTA. In 18 of the 20 cases (90%), draining veins were separated from the nidus by using the enhancement patterns, and in 13 cases (65%), feeding arteries were separated. CONCLUSION Dynamic IACTA added important information for target-volume determinations. Conventional CT and MRI could be omitted from the protocol, and the period that patients wore the frame was substantially shortened. We conclude that IACTA is a practical and useful method for radiosurgical treatment planning of arteriovenous malformations.

Successful percutaneous coil embolization of coronary–pulmonary, –carotid, and –internal mammary artery fistulas

We herein describe a 57-year-old man with coronary–pulmonary artery fistulas that had abnormal connections between the left common carotid artery and the left internal mammary artery. The patient was treated with percutaneous coil embolization using antegrade (via the coronary artery) and retrograde (via the pulmonary artery) approaches. Coronary artery fistulas have diverse anatomical variations, and it is important to thoroughly evaluate the anatomy before beginning any mode of treatment, surgical or endovascular. In the case reported herein, multislice computed tomography played a pivotal role in the preprocedure evaluation.

Large renal arteriovenous fistula with left-sided inferior vena cava

Idiopathic renal arteriovenous fistulas (RAVFs) are uncommon, and a left-sided inferior vena cava (IVC) is also rare. We report a large idiopathic RAVF in a 36-year-old woman who had progressive congestive heart failure. An abdominal computed tomographic scan revealed an enlarged IVC on the left side and a 5.0-×4.5-cm RAVF with a single communication between the left renal artery and vein. Transcatheter embolization was not performed because complete flow control by a balloon catheter could not be achieved. Because of the size of the RAVF and the left-sided position of the IVC, nephrectomy was performed.

A Case of Severe Rectal Hemorrhage Possibly Caused by Radiation Recall after Administration of Gemcitabine

Radiation recall is an acute inflammatory reaction that can be triggered when systemic agents are administered long time after radiotherapy. Because radiotherapy is now indicated for many types of cancer, care should be taken regarding possible toxic events relating to radiotherapy in combination with radio-sensitizing agents. Gemcitabine, one such anti-cancer agent, is widely used, especially for urologic cancers. We report an intriguing case of possible radiation recall in the rectum caused by gemcitabine administration 37 years after radiation therapy. From a review of the literature, it appears that there have been no reported cases of radiation recall in the rectum with such a long interval between radiation therapy and chemotherapy. Here, we describe the case and provide a literature review.

CT during arteriography to visualize the right adrenal vein for adrenal venous sampling

The present report describes 6 cases of adrenal venous sampling (AVS) in patients who underwent computed tomography (CT) during arteriography because cannulation of right adrenal veins was otherwise difficult. CT was performed during arteriography to obtain information on the location and direction of the right adrenal vein. Two right adrenal veins were visualized in 1 case. The right central adrenal vein was not visualized in 1 case owing to an injury from a previous unsuccessful AVS procedure, but the right renal capsular vein was well visualized. CT during arteriography could contribute to a high AVS success rate.