Terumitsu Hasebe

Balloon-occluded transarterial chemoembolization using a 1.8-French tip coaxial microballoon catheter for hepatocellular carcinoma: technical and safety considerations.

Abstract Objective: To evaluate the technical feasibility and safety considerations of balloon-occluded transarterial chemoembolization (B-TACE) using a newly developed 1.8-French (Fr) tip microballoon catheter for hepatocellular carcinoma (HCC). Material and methods: Between February 2013 and May 2013, 31 patients (20 males, 11 females; age range 56–85 years) underwent B-TACE using a 1.8-Fr tip microballoon catheter for unresectable HCC. The technical success rate, procedural complications, and adverse events of B-TACE were retrospectively investigated. Results: A total of 31 patients were subjected to 70 sessions of B-TACE using a 1.8-Fr tip microballoon catheter. The level of B-TACE was sub-subsegmental in 11, subsegmental in 35, segmental in 14, lobar in five, and right inferior phrenic artery in five sessions. The overall technical success rate was 99% (69 out of 70 sessions). As procedural complications, rupturing of the microballoon (n = 3) and aneurysmal dilatation at the site of balloon occlusion (n = 2) were encountered. There were no significant differences in any parameters between blood biochemical examination before and between two to four weeks after the procedure. Conclusion: A 1.8-Fr tip microballoon catheter enables selective catheterization in patients with HCC and B-TACE using the 1.8-Fr tip microballoon catheter is a safe procedure.

Simple Fabrication of Gd(III)-DTPA-Nanodiamond Particles by Chemical Modification for Use as Magnetic Resonance Imaging (MRI) Contrast Agent

We have developed a simple and useful process for fabricating nanodiamond (ND) particles modified with an organogadolinium moiety by chemical modification for their use as a magnetic resonance imaging (MRI) contrast agent. The introduction of the organogadolinium moiety on the surface of the ND particles was performed by the condensation of ND and diethylenetriaminepentaacetic acid (DTPA) followed by treatment with GdCl3. The modified surfaces were evaluated by X-ray photoelectron spectroscopy, diffuse reflectance Fourier transform infrared spectroscopy, mass spectroscopy, and inductively coupled plasma atomic emission spectroscopy analyses. MRI experiments on the Gd-DTPA-ND particles indicated their high signal intensity on T1-weighted images.

Ultrastructural characterization of surface-induced platelet activation on artificial materials by transmission electron microscopy

Platelet adhesion is one of the most pivotal events of blood clotting for artificial surfaces. However, the mechanisms of surface‐induced platelet activation have not been fully been elucidated or visualized so far. In this study, we attempted to observe the internal structures and adhesion interfaces of human platelets attached to artificial surfaces by transmission electron microscopy (TEM) during the platelet activation process. We prepared observation samples by a conventional embedding method using EPON 812 resin. The sectioning was sliced perpendicular to the a‐platelet/material interface. Observation by TEM indicates that internal granules coalesce in the center of the platelet accompanied by pseudopodial growth in the early stage of platelet activation. Pseudopodia from a platelet attach to the material interface not along a plane but at a point. In addition, along with the process of platelet activation, the gap between the platelet membrane and the material surface at the interface disappeared and a‐platelet/material adhesion became much tighter. In the fully activated platelet stage, the platelet becomes thinner and tightly adheres to the substrate. As a result of comparative observation of an adherent platelet on polycarbonate (PC) and on amorphous carbon (a‐C:H), it was found that internal granules release was inhibited more remarkably on a‐C:H coating rather than on PC. Despite numerous technical difficulties in preparing sectional samples, such a study might prove the essential mechanism of biomaterial‐related thrombosis, and it might become possible to modify the surfaces of materials to minimize material‐related thrombosis. Microsc. Res. Tech. 76:342–349, 2013.

Development of a Portable Training Tool for Simulating Visceral Angiographic Procedures for Beginners

The purpose of this study was to evaluate the usefulness of a tool that we developed to simulate performance of visceral angiography to train beginners in the field of splanchnic angiography. Seven residents and two fellows who were rotating within the Division of Interventional Radiology at our institution between June and August 2008 participated in the evaluation of this tool. They had no experience in performing visceral angiography as an operator. Time for selection of arterial branches arising from the celiac axis on the model was measured before and after training. After such training, the participants performed actual visceral angiography as an operator with instructors beside them. Success of the trainees in selecting visceral arterial branches was evaluated in these real-life cases. In the first test using the model, seven of nine trainees (77.8%) succeeded in selecting all required arteries, while the remaining two failed to select all required arteries. After training using the model, all trainees succeeded in selecting all required arteries just before the actual angiographic study. In the actual angiography, the catheter was successfully inserted from the femoral artery and advanced to the superior mesenteric, celiac, splenic, common hepatic, gastroduodenal, and right and left hepatic arteries by all trainees with only two exceptions. In conclusion, this tool is helpful for training beginners in visceral angiographic procedures.

Balloon-occluded arterial stump pressure before balloon-occluded transarterial chemoembolization

Abstract Objective To evaluate balloon-occluded arterial stump pressure (BOASP), which is responsible for effective balloon-occluded transarterial chemoembolization (B-TACE), at each hepatic arterial level before B-TACE using a 1.8-French tip microballoon catheter for unresectable hepatocellular carcinoma (HCC). Material and methods The BOASP at various embolization portions was retrospectively investigated. “Selective” and “non-targeted” BOASP was defined as the BOASP at the subsegmental or segmental artery and the lobar artery, respectively. Results The measurement of the BOASP was carried out in 87 arteries in 47 patients. BOASP > 64 mmHg was revealed in the caudate lobe artery (A1) and the left medial segmental (A4), right anterior superior segmental (A8), anterior segmental, right and left hepatic arteries. Significant difference was noted in the incidence of BOASP above 64 mmHg between “non-targeted” and “selective” BOASP (p = 0.01). “Non-targeted” BOASP was significantly greater than “selective” BOASP (p = 0.0147). In addition, the BOASP in A1, 4, 8 and the anterior segmental arteries were significantly greater than in the other subsegmental and segmental arteries (p = 0.0007). Conclusion “Non-targeted” B-TACE should be avoided to perform effective B-TACE and “selective” B-TACE at A1, 4, 8 and the anterior segmental arteries may become less effective than at the other segmental or subsegmental arteries.

Accuracy of real-time magnetic resonance imaging-transrectal ultrasound fusion image-guided transperineal target biopsy with needle tracking with a mechanical position-encoded stepper in detecting significant prostate cancer in biopsy-naïve men

To evaluate the accuracy of real‐time elastic fusion image‐guided transperineal prostate biopsy with needle tracking involving a mechanical position‐encoded stepper in detecting clinically significant prostate cancer for biopsy‐naïve men.

Hepatic Arterial Infusion Chemotherapy by the Fixed-Catheter-Tip Method: Retrospective Comparison of Percutaneous Left Subclavian and Femoral Port-Catheter System Implantation

OBJECTIVE The purpose of this study was to retrospectively compare the subclavian and femoral approaches to a fixed-catheter-tip method of implantation of a port-catheter system for hepatic arterial infusion chemotherapy with respect to complications and dysfunctions. MATERIALS AND METHODS Between April 2006 and April 2012, 153 patients (104 men, 49 women; age range, 23-82 years; mean, 65 years) with unresectable malignant liver tumors underwent percutaneous implantation of indwelling port-catheter systems by the fixed-catheter-tip method via the left subclavian or femoral artery. The success of implantation and outcome of complications were investigated and compared between these approach routes. RESULTS The overall technical success rate of port-catheter system implantation with the fixed-catheter-tip method was 99% (152 of 153 patients). Seventy-five patients underwent implantation with a port-catheter system via the left subclavian artery, and 77 patients via the femoral artery. Catheter dislocation occurred in 3.9% of the patients; hepatic artery obstruction, 2.6%; catheter occlusion, 3.9%; bleeding at the puncture site, 3.9%; cerebral infarction, 1.3%; and infection related to port-catheter implantation, 2.6%. No significant differences in complications and port-catheter system dysfunction between the left subclavian and femoral approaches to port-catheter system implantation with the fixed-catheter-tip method were seen in any of the parameters. In addition, cerebral infarction occurred exclusively with the left subclavian approach, whereas infection occurred exclusively with the femoral approach. CONCLUSION Implantation of the port-catheter system with the fixed-catheter-tip method is equally feasible via both the left subclavian and the femoral approaches.

Hepatic encephalopathy due to intrahepatic portosystemic venous shunt successfully treated by balloon occluded retrograde transvenous embolization with GDCs.

We report a 65-year-old man with hepatic encephalopathy due to an intrahepatic portosystemic venous shunt that was successfully occluded by balloon occluded retrograde transvenous embolization with Guglielmi and interlocking detachable coils as performed percutaneously.

Perirenal lymphatic systems: Evaluation using spectral presaturation with inversion recovery T2 -weighted MR images with 3D volume isotropic turbo spin-echo acquisition at 3.0T.

To evaluate the normal anatomy of the perirenal lymphatics using spectral presaturation with inversion recovery (SPIR) T2‐weighted magnetic resonance imaging (MRI) with 3D volume isotropic turbo spin‐echo acquisition (VISTA) at 3.0T.

The Role of Divided Injections of a Sclerotic Agent over Two Days in Balloon-Occluded Retrograde Transvenous Obliteration for Large Gastric Varices

Objective To determine the safety and usefulness of a two-tiered approach to balloon-occluded retrograde transvenous obliteration (B-RTO) as a treatment for large gastric varices after portal hypertension. Materials and Methods 50 patients were studied who underwent B-RTO for gastric varices between October 2004 and October 2011 in our institution. The B-RTO procedure was performed from the right femoral vein and the B-RTO catheter was retained until the following morning. Distribution of sclerotic agents in the gastric varices on fluoroscopy was evaluated in all patients on days 1 and 2. When distribution of sclerotic agents in the gastric varices on day 1 had been none or very scanty even though the volume of the sclerotic agent infused was above the acceptable level, a second infusion was administered on day 2. When distribution was satisfactory, the B-RTO catheter was removed. Results In 8 (16%) patients, little or no sclerotic agent infused on day 1 was distributed in the gastric varices. However, on day 2, sclerotic agents were distributed in all gastric varices. Mean volume of ethanolamine oleate-iopamidol infused on day 1 was 24.6 mL and was 19.4 mL on day 2. Gastric varices were well obliterated with no recurrence. Complications caused by the sclerotic agent such as pulmonary edema or renal insufficiencies were not seen. Conclusion When gastric varices are very large, a strategy involving thrombosis of only the drainage vein on the first day followed by infusing the sclerotic agent on the following day might be effective and feasible.