Yoko Saito

Detection and characterization of focal liver lesions: a Japanese phase III, multicenter comparison between gadoxetic acid disodium-enhanced magnetic resonance imaging and contrast-enhanced computed tomography predominantly in patients with hepatocellular carcinoma and chronic liver disease.

Objectives:To prospectively evaluate the safety and efficacy of combined unenhanced and gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging compared with unenhanced MR imaging and triphasic contrast-enhanced spiral computed tomography (CT) for the detection and characterization of focal liver lesions. Materials and Methods:The study was reviewed and approved by the institutional review board at each of the 15 centers involved in the study, and informed written consent was given by all patients. In total, 178 patients with suspected focal hepatic lesions (based, in most patients, on CT, tumor marker and ultrasound examinations) underwent combined MR imaging with a single, rapid injection of Gd-EOB-DTPA 0.025 mmol/kg, including T1-weighted dynamic and delayed MR images 20 to 40 minutes postinjection. Triphasic contrast-enhanced CT, the comparator examination, was performed within 4 weeks of MR imaging. Standard of references (SOR) were resection histopathology and intraoperative ultrasonography, or combined CT during arterial portography and CT hepatic arteriography; in cases where, although the major lesions were treated, some lesion(s) were not treated, follow-up superparamagnetic iron oxide-enhanced MR imaging was additionally performed. All images were assessed for differences in lesion detection and characterization (specific lesion type) by on-site readers and 3, blinded (off-site) reviewers. All adverse events (AEs) occurring within 72 hours after Gd-EOB-DTPA administration were reported. Results:Overall, 9.6% of patients who received Gd-EOB-DTPA reported 21 drug-related AEs. A total of 151 patients were included in the efficacy analysis. Combined MR imaging showed statistically higher sensitivity in lesion detection (67.5%–79.5%) than unenhanced MR imaging (46.5%–59.1%; P < 0.05 for all). Combined MR imaging also showed higher sensitivity in lesion detection than CT (61.1%–73.0%), with the results being statistically significant (P < 0.05) for on-site readers and 2 of 3 blinded readers. Higher sensitivity in lesion detection with combined MR imaging compared with CT was also clearly demonstrated in the following subgroups: lesions with a diameter ≤20 mm (lesions ≤10 mm: 38.0%–55.4% vs. 26.1%–47.3%, respectively; lesions 10–20 mm: 71.1%–87.3% vs. 65.7%–78.4%, respectively); in cirrhotic patients (64.5%–75.4% vs. 54.5%–70.3%, respectively); and in patients with hepatocellular carcinoma (66.6%–78.6% vs. 59.1%–71.6%, respectively). Combined MR imaging demonstrated a higher proportion of correctly characterized lesions (50.5%–72.1%) than unenhanced MR imaging (30.2%–50.0%; P < 0.05 for all), whereas there were no significant differences compared with CT (49.0%–68.1%), except for one blinded reader (P < 0.05). Conclusion:In this study, hepatocyte-specific Gd-EOB-DTPA was shown to be safe and to improve the detection and characterization of focal hepatic lesions compared with unenhanced MR imaging. When compared with spiral CT, Gd-EOB-DTPA enhanced MRI seems to be beneficial especially for the detection for smaller lesions or hepatocellular carcinoma underlying cirrhotic liver.

Combination chemoembolization therapy for hepatocellular carcinoma: mainly, using cisplatin (CDDP).

SummaryChemoembolization therapy, using the arterial injection of mixtures of various anticancer agents and lipiodol along with gelfoam particles, was carried out on 77 cases of hepatocellular carcinoma between January 1985 and March 1987, and an assessment was made on the anticancer effects of this treatment method. For the patients receiving lipiodol, the value of the longitudinal dimension multiplied by the vertical length of the tumor was calculated using a computerized tomograph before and after chemoembolization to determine the rate of tumor regression. (a) Of the 30 patients receiving chemoembolization therapy using a simple mixture of 100 mg cisplatin (CDDP) and lipiodol, the tumor regression rate was 50% or more in 10 cases (31%). (b) Of the 14 patients receiving chemoembolization therapy with a suspension of 100 mg of cisplatin, adriamycin (10–30 mg) and lipiodol, the tumor regression rate was 50% or more in four cases (29%). (c) Of the 31 cases receiving chemoembolization therapy using a suspension of adriamycin (10–40 mg), mitomycin C (10–20 mg) and lipiodol, the tumor regression rate was 50% or more in four cases (13%). (d) From these results, it can be concluded that the antitumor effect of chemoembolization using cisplatin is more significant than with other drugs.

Arterial infusion chemotherapy for advanced hepatocellular carcinoma using EPF and EAP therapies.

SummaryArterial infusion chemotherapy of EPF (etoposide, cisplatin, and 5-fluorouracil) or EAP (etoposide, Adriamycin, and cisplatin) was carried out in 28 cases of advanced hepatocellular carcinoma (HCC) between January 1988 and December 1990, and assessment was made of the anticancer efficacy of each treatment method. In all, 13 patients were treated with EPF therapy and 15 received EAP therapy. The anticancer agents were infused through a catheter inserted into the proper or common hepatic artery. The catheter was inserted via the axillary artery or common femoral artery using Seldingers method or the cut-down method. The results of each therapy were analyzed in relation to the tumor regression rate and the side effects encountered. The tumor regression rate was determined on the basis of two-dimensional evidence obtained by computed tomography performed before and after treatment. The treatment results were also compared with the results of chemoembolization therapy using a mixture of cisplatin (CDDP), Adriamycin (ADM) and lipiodol. Of the 28 patients treated with arterial infusion chemotherapy, 14 (50%) attained a regression rate of 50% (PR). In all, 46% of the EPF group and 53% of the EAP group achieved a PR. These results were superior to those obtained using chemoembolization therapy. In general, the side effects were relatively mild and transient.

Case of pachydermoperiostosis with solute carrier organic anion transporter family, member 2A1 (SLCO2A1) mutations

1 Kere J, Srivastava AK, Montonen O et al. X-linked anhidrotic (hypohidrotic) ectodermal dysplasia is caused by mutation in a novel transmembrane protein. Nat Genet 1996; 13: 409–416. 2 Gunadi , Miura K, Ohta M et al. Two novel mutations in the ED1 gene in Japanese families with X-linked hypohidrotic ectodermal dysplasia. Pediatr Res 2009; 65: 453–457. 3 Koguchi-Yoshioka H, Wataya-Kaneda M, Yutani M et al. Atopic diathesis in hypohidrotic/anhidrotic ectodermal dysplasia. Acta Derm Venereol 2015; 95: 476–479. 4 Dietz J, Kaercher T, Schneider AT et al. Early respiratory and ocular involvement in X-linked hypohidrotic ectodermal dysplasia. Eur J Pediatr 2013; 172: 1023–1031.

Combination therapy consisting of arterial infusion chemotherapy (EPF, EAP) and transcatheter arterial embolization (TAE)

From January 1988 to January 1993, 45 patients with unresectable advanced hepatocellular carcinoma (HCC) were treated with a new combination therapy consisting of arterial infusion chemotherapy and TAE. The combination therapy was performed according to our treatment schedule as follows: two courses of arterial infusion chemotherapy were given first, and then transcatheter arterial embolization (TAE) using a mixture of Lipiodol and cisplatin powder was performed. Two arterial infusion chemotherapeutic regimens were employed: EPF (etoposide, cisplatin, and 5-fluorouracil) and EAP (etoposide, Adriamycin or Epi-adriamycin, and cisplatin). The anticancer drugs were infused through a catheter inserted into the proper or common hepatic artery. Assessment was made of the anticancer effect and survival rate of each treatment method. The response to each therapy was evaluated on the basis of CT performed prior to and after the treatment. In the EPF·TAE group, the response rate was about 46%, whereas in the EAP·TAE group it was 48%. Overall, 21 of 45 patients attained a regression rate of 50% or more. Furthermore, daughter nodules decreased in size or disappeared in about 67% of 15 patients. Additionally, tumor thrombi tended to show a similar response. In all of the cases, the average duration of survival was 30.3 months, and the 1-year survival value was 68%, the 2-year survival value was 44%, and the 3-year survival value was 35%. These results were superior to those obtained with TAE therapy alone.

Arterial visualization by contrast-enhanced moving-table MR angiography: crossover comparison of 0.1 and 0.2 mmol/kg doses of meglumine gadopentetate in normal volunteers.

To determine the appropriate dose of contrast medium for moving‐table MR angiography (MT‐MRA) from the abdominal aorta to the ankle by comparing visualization with different doses of meglumine gadopentetate (Gd‐DTPA) administered in crossover fashion to normal volunteers.

Technical Note. Labral-ligamentous complex of the shoulder: Evaluation with double oblique axial MR arthrography

Purpose: To assess the ability of double oblique axial (DOA) MR arthrography in evaluating labral-ligamentous complex compared with conventional axial (CA) MR arthrography. Material and Methods: MR arthrography of 51 shoulders, subsequently examined with arthroscopy, were retrospectively reviewed. DOA imaging was performed in all 51 shoulders and both DOA and CA imaging in 37 using a 1.5 T unit with gradient recalled-echo T2*-weighted sequences. DOA imaging was performed using perpendicular planes to the long axis of the glenoid fossa obtained by an oblique sagittal scout image. We compared the ability of DOA with that of CA MR arthrography to assess labral injuries and to demonstrate the whole length of the anterior band of the inferior glenohumeral ligament (AIGHL), which were shown to be intact by arthroscopy. Results: For anterior labral injuries, sensitivity and specificity were 87% and 93% with CA, and 94% and 100% with DOA imaging, respectively. For posterior labral injuries, sensitivity and specificity were 47% and 100% with CA, and 79% and 96% with DOA imaging, respectively. There were no statistically significant differences between CA and DOA images, except for the ability to diagnose posterior labral injuries, where DOA imaging had a significant superior sensitivity (p = 0.0327). DOA images also demonstrated the whole length of the intact AIGHL in 10 of 11 shoulders, while CA imaging showed this in only 3 of 11. Conclusion: DOA imaging was equal or better than CA imaging for evaluating the labral-ligamentous complex.

First Experience of Uterine Fibroid Embolization Using DC Bead® in Japan

Background: We performed uterine fibroid embolization (UFE) in four patients to assess the safety and efficacy of bland embolization using DC Bead®. They were the first patients in the world who underwent UFE procedure by using DC Bead®. Methods: Four patients with uterine fibroids were enrolled and super selective embolization with DC Bead® was performed in a Japanese clinical trial. Efficacy, success rate of embolization in the target vessel (embolic performance) and operability were evaluated. To evaluate the safety, adverse events and device deficiency occurring within 30 days after the embolization were collected. Results: Patient’s age range was 34 to 48 years old, Uterine fibroid size range was 40 to 108 mm (maximum length of diameter). Multiple tumors were found in all cases. DC Bead® size range was 100-300 μm to 500-700 μm. In the evaluation of embolic performance, three cases were completely embolized (100% disappearance of target vessel and staining on DSA) and one case was highly embolized (80% or more disappearance of target vessel, stained on DSA). In the evaluation of operability, all cases were evaluated as very easy to use. At 3,6,12 months after embolization, shrinkage in all uterine fibroids could be seen. The largest reduction rate was 59% in size (the mean was 43%). Post embolization syndrome was observed in all patients. However, the degree of these was mild or moderate (grade 1 or 2 of CTCAE version 4.0). There was no serious adverse event. Conclusions: Uterine fibroid embolization using DC Bead® was safely and successfully performed. DC Bead® will be a useful embolic material for uterine fibroid embolization.