Takeshi Hayashida

Vascular Complications of Hepatic Artery After Transcatheter Arterial Chemoembolization in Patients With Hepatocellular Carcinoma

OBJECTIVE The purpose of this article is to review the angiographic changes, development of collaterals, and possible complications after transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC). CONCLUSION Extrahepatic collateral arteries can supply the tumor after repeated TACE. Knowledge of hepatic artery changes can help in repeated TACE procedures and reduce TACE time. Appreciation of the complications and collaterals may improve the outcome of patients with HCC.

Quantification of lung perfusion blood volume (lung PBV) by dual-energy CT in patients with and without pulmonary embolism: preliminary results.

OBJECTIVES Recently, software has been used for quantification of lung PBV, which can be evaluated objectively; however, this technique is yet to be validated. The purpose was to investigate the clinical feasibility of the quantification of lung perfusion blood volume (lung PBV) by dual-energy CT in patients with pulmonary embolism (PE). MATERIALS AND METHODS One hundred thirteen patients with clinical suspicion of PE underwent dual-energy CT angiography with a standard injection protocol. Patients were divided into each two groups with and without PE based on the presence of endoluminal clots on transverse diagnostic scans. We evaluated the quantification of lung PBV using a workstation. Associations between lung PVB and the numbers of pulmonary segments with PE were also evaluated. RESULTS Thirty three of 113 (29%) patients were found to have endoluminal clots in the right and/or left lungs. The remaining 80 patients did not have endoluminal clots. In 33 patients, the mean number of segments with endoluminal clots was 5.2±3.3. For patient (whole lung)-based analysis, in patients with and without PE, mean lung PBVs were 20.8±2.3 and 28.7±6.8 Hounsfield Unit (HU), respectively, with a significant difference between the two groups (p<0.0001). In patients with PE, there was a significant correlation between lung PBV and the numbers of pulmonary segments with PE (R=0.57, p=0.0005). CONCLUSION The findings of this preliminary study suggest that quantification of lung PBV may reflect the pulmonary artery perfusion, which is useful to evaluate pulmonary blood flow in patients with PE.

PET features of aortic diseases.

OBJECTIVE Recently, several reports have highlighted the potential role of (18)F-FDG PET for the assessment of various aortic diseases based on FDG accumulation. In this article, we divided various aortic diseases into the following three groups on the basis of the mechanism of FDG accumulation: atherosclerosis, aortitis or periaortitis, and thrombus. Elucidating the mechanisms and patterns of FDG uptake in various aortic diseases provides valuable information for clinical management. CONCLUSION PET findings can provide additional information for the diagnosis of aortic diseases and valuable information for clinical management. It is essential to understand the characteristics of FDG uptake in various aortic diseases for proper appreciation of PET findings.

Comparison of Outcome in Aortic Dissection with Single False Lumen versus Multiple False Lumens: CT Assessment

PURPOSE To investigate the clinical features and outcomes of type B multibarreled (multiple false lumens) aortic dissection (AD) compared with those of double-barreled (single false lumen) AD by using computed tomography (CT). MATERIALS AND METHODS The ethics committee approved this study. Informed consent was waived. A total of 221 consecutive patients (127 men; median age, 62 years) with acute type B AD were evaluated by using CT. The clinical outcome, including AD-related events, AD-related deaths, and long-term survival, was retrospectively reviewed and compared with that of patients with double-barreled AD during the follow-up period (median, 60 months). Survival analysis was performed by using Kaplan-Meier analysis with the log-rank test within 10 years after onset. The Cox proportional hazards model was used to estimate the risk for AD-related events and death. RESULTS In 201 of 221 patients (91.0%), double-barreled AD was identified at initial CT. In 20 of 221 patients (9%), multibarreled AD was identified at initial CT (n = 16) and follow-up CT (n = 4). In 15 of 20 patients (75%) with multibarreled AD, AD-related events occurred, and nine patients (45%) died of AD-related complications. Patients with multibarreled AD showed significantly poorer survival rates than patients with double-barreled AD (P = .0002). The presence of a multibarreled false lumen was the most powerful risk factor for AD-related deaths according to multivariate analysis (hazard ratio, 5.61; 95% confidence interval: 2.44, 12.90; P < .0001). CONCLUSION Multibarreled AD occurs in 9% of acute type B dissections. The presence of multibarreled AD is a powerful predictor of AD-related deaths.

Quantification of lung perfusion blood volume (lung PBV) by dual-energy CT in pulmonary embolism before and after treatment: preliminary results

The purpose was to investigate the quantification of lung perfusion blood volume (PBV) by dual-energy computed tomography (CT) in patients with pulmonary embolism (PE) before and after treatment. Twenty-five patients with PE underwent dual-energy CT angiography before and after treatment. In all 25 patients, pulmonary CT confirmed that there was no PE after treatment. This preliminary study demonstrated the possibility that quantification of lung PBV may reflect parenchymal arterial perfusion before and after treatment, including the compensatory increase of lung perfusion.

Serum amyloid A is a useful marker to evaluate the disease activity of Takayasu's arteritis.

Takayasu’s arteritis (TA) is a rare large vessel vasculitis that is difficult to diagnose in the early stages. Therefore, it is also very difficult to manage and prevent irreversible vascular damage in TA. A 19-year-old female patient with back pain was examined using [18F]-FDG-PET to detect the source of inflammation. Specific accumulation of [18F]-FDG was observed in the thoracic and abdominal aorta, leading to the diagnosis of TA. Corticosteroid treatment resulted in clinical remission. However, the serum amyloid A (SAA) levels remained elevated. A follow-up scan showed residual uptake of [18F]-FDG in the thoracic aorta suggesting subclinical vascular inflammation. Methotrexate was combined with the corticosteroid, and the elevated levels of SAA became normalized. The present case suggests that monitoring serum levels of SAA and [18F]-FDG-PET could help clinicians to make adequate treatment adjustments in TA patients.

Cardiac Involvement of Adult T-Cell Leukemia/Lymphoma

Cardiac Involvement of Adult T-Cell Leukemia/Lymphoma Hiroki Nagayama, MD, Eijun Sueyoshi, MD, Takeshi Hayashida, MD, Ichiro Sakamoto, MD, Jun Taguchi, MD, Takashi Kudo, MD, and Masataka Uetani, MD, a Department of Radiology, Nagasaki University School of Medicine, Sakamoto, Nagasaki, Japan b Department of Hematology and Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan

Quantification of enhancement of left ventricular myocardium in patients with dilated cardiomyopathy using delayed enhanced MR imaging

The purpose is to evaluate delayed enhancement (DE) of the myocardium in patients with dilated cardiomyopathy (DCM), compared with control subjects. We also evaluated the interrelationships of DE and contractile function. DCM patients (n = 42) and 14 control subjects were evaluated by DE MR imaging, acquired using a two-dimensional segmented inversion-recovery prepared gradient-echo sequence (TI = 250 ms), 15 min after intravenous administration of 0.2 mmol/kg gadolinium. For the myocardium of left ventricle (LV), we traced epicardial and endocardial borders, and regions of interest (ROIs) were placed in each slice. For analysis of DE images, the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) of the LV myocardium were calculated. The averaged SNR (aSNR) and averaged CNR (aCNR) per slice of the LV myocardium were calculated. In the DCM group, we also evaluated the interrelationship of DE and the contractile function of the LV. Mean aSNR was not significantly different between the studied groups; however, mean aCNR was significantly higher in the DCM group (3.5+/-3.1) than in control subjects (-4.1+/-2.1). In the DCM group, aCNR was moderately related to LV ejection fraction (LVEF) (r = 0.52, P<.0001). Mean aCNR was significantly higher in the DCM group with low LVEF (<25%) (6.0+/-2.8) than in the DCM group with high LVEF (>or=25%) (2.0+/-2.3). In DE MR imaging, the LV myocardium of DCM usually has high aCNR, which may suggest fibrosis. Quantification of aCNR may contribute to the diagnosis of DCM. The level of aCNR seems to correlate with LVEF. Using this technique, quantification of aCNR is objective and very useful for the diagnosis of DCM and contractile function of LV.