Yoshimi Hatanaka

Prognostic factors in the treatment of hepatocellular carcinoma with transcatheter arterial embolization and arterial infusion

From January 1986 to December 1988, a prospective trial of transcatheter arterial treatment was carried out for hepatocellular carcinoma (HCC). Two hundred seventy‐five patients were included. Okudas staging system was employed. Patients with Stage I and II HCC were treated by transcatheter arterial embolization (TAE) with a gelatin sponge containing an anti‐cancer agent (protocol 1a); a gelatin sponge and iodized oil mixed with an anti‐cancer agent (protocol 1b); or iodized oil mixed with an anti‐cancer agent (protocol 2). Patients with Stage III HCC were treated with iodized oil with anti‐cancer agent (protocol 2). As an exception, patients with an unsuccessful superselective catheterization into the proper hepatic artery by Seldinger technique or obstruction of the main trunk of the portal vein were treated with percutaneous transcatheter arterial infusion into the common hepatic artery regardless of stage (protocol 3). Tumor type and extension, area of tumor involvement, portal vein involvement, method of treatment, and presence of ascites and icterus were found to be the significant factors for an initial response to therapy. Treatment method was the most important factor. Respective survival rates at 1 and 2 years were 70.9% and 55.3% for protocol 1a; 62.3% and 43.8% for protocol 1b; 37.8% and 18.3% for protocol 2; and 16.5% and 0% for protocol 3. Many factors proved to significantly influenced prognosis; however, tumor type had the most important prognostic significance followed by AFP value, ascites, treatment protocol, and area of tumor involvement.

The effects of transjugular intrahepatic portosystemic shunt on portal hypertensive gastropathy

In addition to variceal bleeding, haematemesis may occur due to haemorrhagic gastritis in patients with portal hypertension. This has been known as portal hypertensive gastropathy (PHG). We have evaluated the effects of the transjugular intrahepatic portosystemic shunt (TIPS) on portal venous pressure (PVP) and endoscopic gastric mucosal changes observed in patients with portal hypertension. We performed TIPS in 12 patients with complications due to portal hypertension as follows: variceal bleeding in nine patients (bleeding from oesophageal varices in seven and gastric varices in two), refractory ascites in three and haemorrhage from severe PHG in one. Endoscopic examinations were performed before and after TIPS for all patients. Changes of PVP and gastric mucosal findings on endoscopy were analysed. Before TIPS, PHG was seen in 10 patients. Portal venous pressure decreased from an average of 25.1 ± 8.8 to 17.1 ± 6.2 mmHg after TIPS (P < 0.005). On endoscopy, PHG improved in nine of 10 patients. Oesophagogastric varices improved in eight of 11 patients. In one patient with massive haematemesis, haemorrhage from severe PHG completely stopped after TIPS. Because TIPS effectively reduced PVP, this procedure appeared to be effective for the treatment of uncontrollable PHG.

Dynamic MRI of small renal cell carcinoma

Objective To evaluate the appearance of contrast-enhanced dynamic MRI of small renal cell carcinoma (RCC) (<3 cm diameter). Materials and Methods Twenty-seven patients with 28 small RCCs were studied by both conventional spin echo and contrast-enhanced dynamic MRI for tumor detection and characterization. All tumors were detected by contrast-enhanced CT and confirmed by operation. Dynamic MRI was performed using a breath-hold fast low angle shot technique after rapid injection of gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA). Characterization of a renal mass was done by the visual analysis of tumor vascularity as well as quantitative assessment of the contrast noise ratio (CNR) and degree of enhancement. Results With conventional spin echo MR and dynamic MR, 18 and 26 of 28 small RCCs were detected, respectively. In the dynamic study the tumor/renal medulla contrast was marked at 90–120 s after administration of Gd-DTPA (CNR: 15.1). The tumor/renal medulla contrast in the dynamic study was more marked than that of postcontrast T1-weighted imaging (CNR, −0.25); T2-weighted imaging (CNR, 3.1); and T1-weighted imaging (CNR, −0.76). Conclusion Contrast-enhanced dynamic MRI is a useful technique for the diagnosis of small RCC especially in a patient with renal insufficiency or allergy to iodinated contrast material.

Characterization of Sonographically Indeterminate Ovarian Tumors with MR Imaging A logistic regression analysis

Purpose: The goal of this study was to maximize the discrimination between benign and malignant masses in patients with sonographically indeterminate ovarian lesions by means of unenhanced and contrast-enhanced MR imaging, and to develop a computer-assisted diagnosis system. Material and Methods: Findings in precontrast and Gd-DTPA contrast-enhanced MR images of 104 patients with 115 sonographically indeterminate ovarian masses were analyzed, and the results were correlated with histopathological findings. of 115 lesions, 65 were benign (23 cystadenomas, 13 complex cysts, 11 teratomas, 6 fibro-thecomas, 12 others) and 50 were malignant (32 ovarian carcinomas, 7 metastatic tumors of the ovary, 4 carcinomas of the fallopian tubes, 7 others). A logistic regression analysis was performed to discriminate between benign and malignant lesions, and a model of a computer-assisted diagnosis was developed. This model was pro-spectively tested in 75 cases of ovarian tumors found at other institutions. Results: From the univariate analysis, the following parameters were selected as significant for predicting malignancy (p<0.05): a solid or cystic mass with a large solid component or wall thickness greater than 3 mm; complex internal architecture; ascites; and bilaterality. Based on these parameters, a model of a computer-assisted diagnosis system was developed with the logistic regression analysis. To distinguish benign from malignant lesions, the maximum cut-off point was obtained between 0.47 and 0.51. In a prospective application of this model, 87% of the lesions were accurately identified as benign or malignant. Conclusion: Benign and malignant ovarian lesions can be distinguished in most sonographically indeterminate lesions by means of parameters obtained from contrast-enhanced MR imaging.

Struma ovarii : MR appearances

Abstract.Background: Analysis of unenhanced and contrast-enhanced magnetic resonance (MR) images of struma ovarii, a rare benign neoplasm of the ovary, is the aim of this study. Methods: T2-weighted and Gd-DTPA-enhanced T1-weighted MR images of five histologically proven struma ovarii were evaluated retrospectively. Results: In all patients, unenhanced and contrast-enhanced T1-weighted MR images showed complex cystic masses composed of multiple cysts and a solid component, indicating the presence of large and small thyroid follicles. In four patients, the cyst fluid was hypointense on T1-weighted images and hyperintense on T2-weighted images. In one patient, the fluid was hyperintense on T1-weighted images and hypointense on T2-weighted images due to hemorrhage. Conclusion: A complex mass composed of multiple cysts and a solid component, indicating the presence of large and small thyroid follicles, appeared to be a characteristic MR finding of struma ovarii.

Short communication: The value of embolization therapy in painful osseous metastases from hepatocellular carcinomas; Comparative study with radiation therapy

We evaluated the therapeutic effect of transcatheter arterial embolization therapy (TAE) for painful osseous metastases from hepatocellular carcinoma (HCC) in comparison with radiation therapy (RT). TAE using gelatin sponge particles was performed for seven lesions in seven patients. Selective catheterization and embolization were successfully performed in all lesions. Within 10 days after TAE, complete pain relief (CR), partial relief (PR) and no relief (NR) were attained in 57%, 29% and 14%, respectively. RT was used to treat 34 lesions in 22 patients. The dose fractionation schedules were in the range 28.0-50.4 Gy, with 1.8-4.0 Gy per fraction. CR, PR and NR were attained in 47%, 47% and 6%, respectively. There were no serious complications related to these treatments. Both TAE and RT are effective and the treatment of choice should be selected on an individual basis.

MR imaging of atypical polypoid adenomyoma

The magnetic resonance (MR) appearances of three cases of atypical polypoid adenomyoma are reported. The signal intensity of the tumor was similar to that of adenomyosis on T2-weighted MR Imaging (MRI). On contrast-enhanced study, irregular enhancement was seen in hyperintense areas on T2-weighted images. Atypical polypoid adenomyoma can be characterized as a hypointense polypoid mass with hyperintense foci on T2-weighted MR images, resembling the appearance of adenomyosis.

Magnetic resonance characteristics of intrapelvic haematomas

Although haematomas in the female pelvis are not rare, their magnetic resonance (MR) appearance has not been well characterized. Accordingly, we analysed the MR appearances of various stages of haematomas in the female pelvis. A retrospective analysis of 35 haematomas in 28 patients sequentially imaged with a 1.5 T MR unit was performed. The time interval between the insult and MR imaging was determined and the appearances of the haematoma were evaluated. The results were compared with those in the central nervous system. The evolution of haematomas in the pelvis appeared similar to that of haematomas in the brain, and four stages (acute, early subacute, late subacute and chronic) were identified according to the signal intensity pattern on T1 and T2 weighted images. Pelvic haematomas differed from intracranial haematomas in the following features: (1) The speed of evolving pelvic haematomas was gradual. (2) In the centre of acute haematomas, slightly hyperintense areas were seen on both sequences, suggesting residual oxyhaemoglobin. (3) Haematomas evaluated in the early subacute stage had complex appearances. (4) In older haematomas, central intermediate signal intensity areas, presumably due to diamagnetic hemichromes, became predominant on T1 weighted images. In conclusion, although the evolution of a pelvic haematoma is similar to that of a brain haematoma, its speed is gradual and MR appearances are somewhat different due to environmental differences.

Prognostic factors in liver metastases after transcatheter arterial embolization or arterial infusion.

From January 1986 to December 1988, 85 patients (55 men and 30 women, mean age 59 years) with metastatic liver tumors were treated with hepatic artery embolization (TAE) or infusion (HAI). Sixty-eight patients with successful catheterization were treated with TAE using iodized oil (Lipiodol) mixed with anticancer agent (ACA). In 12 of 68 patients with hypervascular tumors gelatin sponge was added. Patients with unsuccessful catheterization were treated with hepatic artery infusion of ACA. Forty-three patients received oral chemotherapy following TAE or HAI. Overall, the 6-month, and 1- and 2-year survival rates were 69.5, 31.8 and 4.1 per cent, respectively (mean 233 days). A univariate analysis of prognostic factors showed that number of metastases, stage, treatment times and oral chemotherapy were all significant factors (p<0.05). Ascites, jaundice, percentage of hepatic replacement and treatment protocol also had some influence (p<0.1). Sex, age, primary site, elevation of tumor markers, other metastatic lesions, portal vein involvement and difference in anticancer agent had no prognostic significance. A multivariate analysis using Coxs proportional hazard model revealed that the number of treatments had the most important prognostic significance, followed by oral chemotherapy, stage and percentage of hepatic replacement.

Radiotherapy of spontaneous carotid-cavernous sinus fistulas

Between 1984 and 1986, 7 patients with spontaneous carotid-cavernous fistulas (CCF) were treated by radiotherapy delivering 3,000 cGy (200 cGy, 5 times per week) to the sellar region. Improvements of clinical signs and symptoms were seen in all patients within 6 months of treatment. During a follow-up period of 7 to 35 months, 6 patients remained in good clinical condition and only one patient developed a recurrence. As an adverse effect, one patient developed early menopause, but no other side-effects or complications were seen. Radiotherapy should be considered in patients with spontaneous CCF, when CCF are seen in middle-high aged patients and progressive without relief of symptoms.