Tsuyoshi Tajima

Enhanced computed tomography after partial nephrectomy in early postoperative period to detect asymptomatic renal artery pseudoaneurysm

We systematically examined the incidence and potential implications of renal artery pseudoaneurysm occurring after partial nephrectomy detected by computed tomography screening in the early postoperative period.

Early Postoperative Screening by Contrast-Enhanced CT and Prophylactic Embolization of Detected Pseudoaneurysms Prevents Delayed Hemorrhage after Partial Nephrectomy

PURPOSE To evaluate retrospectively whether prophylactic embolization of pseudoaneurysms detected on early postoperative screening with computed tomography (CT) after partial nephrectomy can prevent delayed hemorrhage. MATERIALS AND METHODS Between January 2012 and May 2014, early postoperative contrast-enhanced CT was performed 3-5 days after partial nephrectomy in 312 patients (group A); CT was not performed in 65 patients (group B) because of renal insufficiency or contrast medium allergy. If pseudoaneurysms were detected on CT in group A, prophylactic embolization was performed. The frequency of delayed hemorrhage occurring more than 3 days after surgery in group A was compared with group B and with 212 patients (group C) who underwent partial nephrectomy between January 2010 and December 2011 without early postoperative CT. Changes in estimated glomerular filtration rate at discharge were compared among the groups. RESULTS Prophylactic embolization of pseudoaneurysms was performed in 26 patients (8%) in group A. Frequency of delayed hemorrhage in group A (0.6%) was significantly lower than in groups B (4.6%; P = .038) and C (4.7%; P = .005). No major complications attributable to prophylactic embolization were observed. The decrease in estimated glomerular filtration rate in group A (-2% ± 13%) was smaller than that in group B (-8% ± 13%; P < .001) and not worse than that in group C (-4% ± 14%; P = .108). CONCLUSIONS Prophylactic embolization of pseudoaneurysms detected on early postoperative CT can prevent delayed hemorrhage after partial nephrectomy, without major complications.

Safety and Feasibility of CT-Guided Core Biopsy for Gynecologic Lesions: Case Series

We performed CT-guided percutaneous uterine biopsy in three females for whom diagnosis by endometrial brushing cytology and endometrial biopsy had proved difficult. In each case, a percutaneous tumor biopsy was performed using CT fluoroscopy with reference to the MR images obtained beforehand. The sampling of multiple biopsy specimens was successful by the coaxial method using a 16/18G Quick-Core biopsy needle in all the cases, and definitive histopathologic diagnoses were achieved. The final pathological diagnoses were one benign lesion (pseudowidening of adenomyosis) and two malignant lesions (small cell carcinoma and adenocarcinoma of Mullerian origin of ovaries). There were no associated complications. The treatment strategy was formulated according to the results of the pathological diagnosis in each case, and consisted of either hormonal therapy or systemic chemotherapy.

[Evaluation of the right internal iliac artery which is anastomosed to transplant renal artery using non-contrast enhanced MR angiography with electrocardiography-gated and 3D True SSFP time-spatial labeling inversion pulse sequence].

To evaluate whether electrocardiography-gated is useful in non-contrast-enhanced MRA with time-spatial labeling inversion pulse (Time-SLIP) in renal transplantation patients compared with respiration-triggered free-breathing. Simulation-based analyses of black blood time interval (BBTI) values for spatial selective inversion-recovery pulse and electrocardiography rates were performed, and confirmed on human subjects using a three-dimensional (3D) coherent steady-state free precession (SSFP) sequence on a 1.5 tesla Toshiba MRI scanner. Signal acquisition interval and BBTI values in which signal of a water tissue becomes the null point showed a strong correlation, and successfully suppressed signals from the background and provided better contrast between the arteries and the background. Because electrocardiography-gated non-contrast MRA does not depend on the respiration interval, providing a contrast stable, it was suggested to be an effective screening tool for evaluation of pelvic arteries.