Language：English   Publisher：Minimally Invasive Therapy and Allied Technologies  

Introduction: The purpose is to clarify the safety and clinical contribution of computed tomography (CT)-guided percutaneous needle-biopsy for patients with cervical spine lesion. Material and methods: Between June 2015 and August 2022, CT-guided percutaneous needle biopsies were performed for 15 cervical spine lesions of 15 patients (8 male, 7 female; 2–81 years old). The technical success, clinical contribution, and safety were evaluated. Technical success was defined as the completion of the biopsy procedure. Clinical contribution was defined as any contribution to the therapeutic strategy. Safety was assessed by the Common Terminology Criteria for Adverse Events, version 5.0. Results: The technical success rate was 100%. In all 15 patients, nontarget organs (e.g., major vessels, spinal cord) could be avoided. The post-biopsy histological diagnoses were myeloma (n = 2), metastatic adenocarcinoma (n = 2), chordoma (n = 2), Langerhans cell histiocytosis (n = 3), and one case each of malignant lymphoma, schwannoma, pyogenic spondylitis, non-pyogenic spondylitis, degenerative change, and non-pathological fracture. All of these diagnoses contributed to the therapeutic strategy decisions. One case of grade 2 pain was observed, but no complications with grade 3 or more were observed during or after the biopsies. Conclusion: CT-guided percutaneous needle biopsies for cervical spine lesions were safe and clinically beneficial.

DOI： 10.1080/13645706.2024.2311720

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Language：English   Publisher：Abdominal Radiology  

Purpose: To elucidate how precisely microvascular invasion (MVI) in hepatocellular carcinoma (HCC) can be predicted using multiparametric assessment of gadoxetic acid-enhanced MRI. Methods: In this retrospective single-center study, patients who underwent liver resection or transplantation of HCC were evaluated. Data obtained in patients who underwent liver resection were used as the training set. Nine kinds of MR findings for predicting MVI were compared between HCCs with and without MVI by univariate analysis, followed by multiple logistic regression analysis. Using significant findings, a predictive formula for diagnosing MVI was obtained. The diagnostic performance of the formula was investigated in patients who underwent liver resection (validation set 1) and in patients who underwent liver transplantation (validation set 2) using a receiver operating characteristic curve analysis. The area under the curves (AUCs) of these three groups were compared. Results: A total of 345 patients with 356 HCCs were selected for analysis. Tumor diameter (D) (P = 0.021), tumor washout (TW) (P < 0.01), and peritumoral hypointensity in the hepatobiliary phase (PHH) (P < 0.01) were significantly associated with MVI after multivariate analysis. The AUCs for predicting MVI of the predictive formula were as follows: training set, 0.88 (95% confidence interval (CI) 0.82,0.93); validation set 1, 0.81 (95% CI 0.73,0.87); validation set 2, 0.67 (95% CI 0.51,0.80). The AUCs were not significantly different among three groups (training set vs validation set 1; P = 0.15, training set vs validation set 2; P = 0.09, validation set 1 vs validation set 2; P = 0.29, respectively). Conclusion: Our multiparametric assessment of gadoxetic acid-enhanced MRI performed quite precisely and with good reproducibility for predicting MVI. Graphical abstract: (Figure presented.)

DOI： 10.1007/s00261-023-04179-3

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Language：Japanese   Publisher：(一社)日本病態栄養学会  

腹水症例は経皮内視鏡的胃瘻造設術(PEG)の相対的禁忌である。経皮経食道胃管挿入術(PTEG)での経腸栄養で、腹水消失し、PEG、経口栄養へ移行できた熱傷患者症例を経験したので報告する。70歳、男性。アルコール性肝硬変、中咽頭癌で化学放射線療法の既往。入院25日前発症の両下肢低温熱傷で搬送された。身長158cm、体重36.1kg。左下肢前面は壊死組織を伴っていた。嚥下機能低下あり、経鼻経管栄養は不快感強く中止となる。腹水貯留あり、55病日にPTEG施行し、1280Kcal/日で栄養管理した。109病日転院し、チューブ自己抜去があった。創傷処置目的に154病日再入院。体重は36.6kg、腹水は消失し、Alb2.8g/dl(100日前2.0)と上昇していた。PEG施行し、経腸栄養継続した。両下腿潰瘍、嚥下機能も改善し、8ヵ月後に胃瘻抜去できた。状態にあわせた栄養アクセスの選択が重要と考えられた。(著者抄録)

Language：English  

DOI： 10.1186/s40792-024-01856-3

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PubMed

Language：English   Publisher：Diagnostic and Interventional Radiology  

PURPOSE This retrospective study evaluates the impact of preoperative lipiodol marking on the outcomes of computed tomography (CT)-guided cryoablation for histologically diagnosed sporadic renal cell carcinoma (RCC). METHODS This study analyzed the data of 173 patients who underwent CT-guided cryoablation for histologi-cally proven sporadic RCC at a single institution between April 2014 and December 2020. The local control rate (LCR), recurrence-free survival rate (RFSR), overall survival rate (OSR), changes in renal function, and complications in patients with (n = 85) and without (n = 88) preoperative lipiodol marking were compared. RESULTS The 5-year LCR and 5-year RFSR were significantly higher in patients with lipiodol marking (97.51% and 93.84%, respectively) than in those without (72.38% and 68.10%, respectively) (P value <0.01, log-rank test). There were no significant differences between the two groups regarding the 5-year OSR (97.50% vs. 86.82%) or the deterioration in chronic kidney disease stage (12.70% vs. 16.43%). Grade ≥3 complications occurred in patients with lipiodol marking (n = 2, retroperitoneal hemato-ma and cerebral infarction in 1 patient each) and without (n = 5; urinary fistula in 2, colonic perfo-ration in 2, urinary infection in 1). CONCLUSION Lipiodol marking before CT-guided cryoablation for sporadic RCC is a feasible approach to improv-ing local control and RFS while mitigating the decline in renal function. Additionally, it may help reduce complications.

DOI： 10.4274/dir.2023.232381

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Language：English   Publisher：Journal of Hepato-Biliary-Pancreatic Sciences  

Purpose: To evaluate the prognostic impact of dynamic gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) in patients with hepatocellular carcinoma (HCC). Methods: We retrospectively reviewed the data of 206 patients with HCC who underwent preoperative Gd-EOB-DTPA-enhanced MRI and hepatectomy and quantitatively evaluated the signal intensity ratio of the tumor to the surrounding liver tissue in the portal phase (SIRPP). We verified the survival rates and assessed the prognostic factors associated with overall survival (OS) and recurrence-free survival (RFS) using SIRPP. Results: Multivariate analysis revealed that the independent predictive factors for poorly-differentiated HCC were α-fetoprotein > 20 ng/mL (hazard ratio [HR]: 3.1909, 95% confidence interval [CI]: 1.3464–7.5622, p =.0084) and SIRPP ≤ 0.85 (HR: 3.7155, 95% CI: 1.521–9.076, p =.004). The 5-year OS and RFS rates in the high and low SIRPP groups were 83.2 and 52.1%, respectively (p <.0001) and 49.7 and 18.5%, respectively (p =.0003). Multivariate analysis revealed that SIRPP ≤ 0.68 was an independent prognostic factor related to OS (HR: 4.4537, 95% CI: 1.6581–11.9626, p =.003). Conclusion: The SIRPP of preoperative Gd-EOB-DTPA-enhanced MRI might predict the histological differentiation and prognosis of HCC.

DOI： 10.1002/jhbp.1345

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Language：English   Publisher：Hepatology Research  

Aim: We aimed to evaluate the association between the intraoperative indocyanine green (ICG) fluorescence imaging (FI) pattern, preoperative magnetic resonance imaging (MRI) findings using gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA), preoperative diffusion-weighted imaging (DWI) of MRI, and histological differentiation of hepatocellular carcinoma (HCC). Methods: We retrospectively reviewed the data for 80 tumors of 64 patients. Intraoperative ICG FI patterns were classified into cancerous or rim-positive type. We evaluated the signal intensity ratio of the tumor and the surrounding liver tissue in the portal phase (SIRPP) and intensity in the hepatobiliary phase (HBP) of Gd-EOB-DTPA-enhanced MRI, the apparent diffusion coefficient (ADC) in the DWI of MRI, and clinicopathologic factors. Results: In the rim-positive group, the rate of poorly differentiated HCC and hypointensity type in HBP were significantly higher, and SIRPP and ADC were significantly lower than the rim-negative group. In the cancerous group, the rate of well or moderately differentiated HCC and hyperintensity type in HBP, SIRPP, and ADC were significantly higher than the noncancerous group. Multivariate analysis identified low SIRPP, low ADC, and hypointensity type in HBP as the significant predictive factors for rim-positive HCC and high SIRPP, high ADC, and hyperintensity type in HBP as the significant predictive factors for cancerous HCC. The positive rate of programmed cell death 1-ligand 1 and vessels that encapsulate tumor clusters status of the rim-positive HCC and HCC with low SIRPP were significantly higher than the control group. Conclusions: The intraoperative ICG FI pattern of HCC closely correlated with histological differentiation, preoperative SIRPP and intensity type in the Gd-EOB-DTPA MRI, and preoperative ADC in the DWI of MRI.

DOI： 10.1111/hepr.13902

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Publisher：金原出版  

DOI： 10.18888/rp.0000002390

CiNii Research

Language：Japanese   Publisher：金原出版(株)  

症例は気管支喘息加療中の70代女性で、腹痛、倦怠感、体重減少を主訴とした。血液検査で肝胆道系酵素上昇、好酸球増多を認め、当初は急性胆嚢炎と診断した。入院加療中に出血性ショックをきたし、腹部造影CTより肝真性動脈瘤破裂に伴う仮性動脈瘤形成を疑い血管造影・塞栓術を行った。血管造影では中動脈に多発動脈瘤を認め、既往歴や血管検査所見より好酸球性多発血管炎性肉芽腫症(EGPA)と診断した。肝動脈瘤破裂がEGPAの診断契機となった症例は極めて稀で、腹腔内破裂をきたした症例報告は本例が最初である。今までに肝動脈瘤破裂に対し血管造影・塞栓術を行った報告は無い。

Publisher：金原出版  

DOI： 10.18888/rp.0000002362

CiNii Research

Language：Japanese   Publisher：金原出版(株)  

症例は70歳代男性で、誘因なく突然の嘔吐と胸背部痛が出現したため前医を受診し、胸腹部造影CTで縦隔気腫を認めた。食道破裂が疑われ同日に救急搬送となった。搬送後の上部消化管造影検査にて、下部食道より造影剤の管腔外への漏出を認め、食道穿孔と診断した。同日に左開胸食道縫縮術、小腸瘻造設術を施行した。術後1日目に抜管し、術後経過は良好であったが、術後9日目に施行した造影CTにて偶発的に両側副腎の造影不良を認めた。搬送当日に施行された造影CTと比較して両側副腎は右側優位に腫大していた。臨床症状も乏しかったため、経過観察を行い、術後15日目に造影CTを再検した。その結果、両側副腎の造影不良は消失しサイズも縮小していた。

Language：English   Publisher：European Journal of Radiology  

Purpose: To clarify the relationship between extracellular volume (ECV) measured by dual-energy CT (DECT) and efficacy of preoperative neoadjuvant chemotherapy (NAC) in patients with pancreatic ductal adenocarcinoma (PDAC), as compared with single-energy CT (SECT). Methods: We enrolled 67 patients with PDAC who underwent dynamic contrast-enhanced CT with a dual-energy CT system prior to NAC. Attenuation values were measured on unenhanced and the equilibrium-phase 120-kVp equivalent CT images for PDAC and the aorta. ΔHU-tumor, ΔHU-tumor/ΔHU-aorta, and SECT-ECV were calculated. Iodine densities of the tumor and aorta were measured in the equilibrium phase, and DECT-ECV of the tumor was calculated. Response to NAC was evaluated and the correlation between imaging parameters and response to NAC was statistically assessed. Results: Tumor DECT-ECVs were significantly lower in the response group (n = 7) than in the non-response group (n = 60), with most significant difference (p = 0.0104). DECT-ECV showed highest diagnostic value with an Az value of 0.798. When using the optimal cut off value of DECT-ECV (<26.0 %), sensitivity, specificity, accuracy, positive predictive value, and negative value for predicting response group were 71.4 %, 85.0 %, 83.6 %, 35.7 % and 96.2 %, respectively. Conclusion: PDAC with lower DECT-ECV can potentially show better response to NAC. DECT-ECV might be a useful biomarker for predicting response to NAC in patients with PDAC.

DOI： 10.1016/j.ejrad.2023.110756

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Language：English   Publisher：(一社)日本磁気共鳴医学会  

ガドキセト酸ナトリウム造影MRI(Gd-EOB-MRI)による肝細胞造影相(HBP)に、time-reversed gradient-echoシーケンスを用いたT2-enhanced spin-echoイメージング(T2FFEイメージング)を行い、肝血管腫と転移性腫瘍の鑑別能を比較した。2013年12月～2014年12月までの期間内に、著者らの所属する医療施設で肝腫瘍疑いのためGd-EOB-MRI検査が施行された患者のうち、選定基準を満たした患者61例(男性36例、女性25例、年齢32～83歳)に伴う肝血管腫37病巣と転移性腫瘍96病巣について後向きに評価した。その結果、3D fat-suppressed T2-weighted imaging(3D FS-T2WI)とT2FFEイメージング併用時のROC曲線下面積(AUC)は、3D FS-T2WIとDWIおよび見かけの拡散係数(ADC)併用時のAUCとの有意差はみられなかったが、病変の大きさに関係なくダイナミックGd-EOB-MRIのAUCに比べ有意に大きかった。以上より、Gd-EOB-MRIのHBPにおける3D FS-T2WIとT2FFEイメージングの併用により、3D FS-T2WIとDWIおよびADC併用と同等の正確度が得られ、肝血管腫と転移性腫瘍の鑑別に有用であることが確認された。

Publisher：東京医学社  

DOI： 10.24479/endo.0000000226

CiNii Research

Language：English   Publisher：Japanese Society for Magnetic Resonance in Medicine  

<p>Purpose: To evaluate the utility of T2-enhanced spin-echo imaging using the time-reversed gradient echo sequence (T2FFE imaging) in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI (Gd-EOB-MRI) for differentiating hemangiomas from metastatic tumors.</p><p>Methods: A total of 61 patients with 133 liver lesions, including 37 hemangiomas and 96 metastatic tumors, were scanned by Gd-EOB-MRI. Four data sets were independently analyzed by two readers: (1) 3D fat-suppressed T2-weighted imaging (FS-T2WI) alone; (2) the combination of 3D FS-T2WI and T2FFE imaging in the HBP of Gd-EOB-MRI; (3) the combination of 3D FS-T2WI, diffusion-weighted imaging (DWI) with the b-value of 1000 s/mm² and the apparent diffusion coefficient (ADC); and (4) a dynamic study of Gd-EOB-MRI. After classifying the lesion sizes as ≤ 10 mm or > 10 mm, we conducted a receiver-operating characteristic analysis to compare diagnostic accuracies among the four data sets for differentiating hemangiomas from metastatic tumors.</p><p>Results: The areas under the curves (AUCs) of the four data sets of two readers were: (1) ≤ 10 mm (0.85 and 0.91) and > 10 mm (0.88 and 0.97), (2) ≤ 10 mm (0.94 and 0.94) and > 10 mm (0.96 and 0.95), (3) ≤ 10 mm (0.90 and 0.87) and > 10 mm (0.89 and 0.95), and (4) ≤ 10 mm (0.62 and 0.67) and > 10 mm (0.76 and 0.71), respectively. Data sets (2) and (3) showed no significant differences in AUCs, but both showed significantly higher AUCs compared to that of (4) regardless of the lesion size (<i>P</i> < 0.05).</p><p>Conclusion: The combination of 3D FS-T2WI and T2FFE imaging in the HBP of Gd-EOB-MRI achieved an accuracy equivalent to that of the combination of 3D FS-T2WI, DWI, and ADC and might be helpful in differentiating hemangiomas from metastatic tumors.</p>

DOI： 10.2463/mrms.mp.2020-0151

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Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.1002/jmri.24454

Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s11604-014-0324-y

Event date： 2015.3

Language：English   Presentation type：Oral presentation (general)  

Country：Austria  

Event date： 2014.10

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：神戸国際展示場・ポートピアホテル・神戸国際会議場   Country：Japan  

症例1は胃癌術後腹膜播種再発の50台男性。腹膜播種による大腸狭窄に対して回腸人工肛門が造設されていた。化学療法を継続されていたが不応となり、腹膜播種の進展に伴う人工肛門部狭窄により腸閉塞を来した。人工肛門からの造影検査にて狭窄長は約5cmであり、逆流防止弁を除去したバンパー・ボタン型の胃瘻用チューブ（24F 5cm）を人工肛門から挿入、留置した。流動食を開始したが狭窄症状再燃なく自宅退院が可能となった。その後、腹膜播種増悪による多発狭窄を来し、腸閉塞の再燃で入院となるまでの3か月間、少量の経口摂取を継続しながら自宅での生活が可能であった。
症例2は切除不能進行直腸癌の70台女性。腹膜播種による大腸イレウス発症時に回腸人工肛門が造設され、化学療法を継続中であった。腹膜播種の進展のため、人工肛門部狭窄による腸閉塞を来した。人工肛門からの造影検査にて狭窄長は約6cmであった。バンパー・チューブ型の胃瘻用チューブ（24F）を人工肛門狭窄部に挿入し、体表に出る余剰部分をストーマバッグに収納しやすく切除した。経口摂取による軽度の通過障害を認めたため、TPNサポート下での自宅退院となったが、挿入後から40日間経過した現在まで腸閉塞の再燃は認められていない。
悪性狭窄により人工肛門造設術を施術され、経過中に腹膜播種の進展に伴う人工肛門部の狭窄を来す担癌患者に稀に遭遇する。こうした悪性狭窄に対しては、再手術、減圧チューブ留置、ステント留置などの対処法があるが、確立された方法はなく、生命予後や合併症、侵襲度などの点から最適な処置を選択する必要がある。今回我々は、胃瘻用チューブを人工肛門狭窄部に挿入することで、狭窄症状とQOLの改善が得られた2例を経験した。人工肛門部の狭窄に対する治療法としての胃瘻用チューブ留置は、安価で、簡便性と低侵襲性に優れ、更にQOL改善効果も高いと思われたので報告する。

Event date： 2014.6

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：アバンセ（佐賀県立男女共同参画センター）   Country：Japan  

症例は60代女性。アルコール性肝硬変、2型糖尿病にて近医加療中。HBs-Ag(-)、HCV-Ab(-)。臍ヘルニアの手術歴あるが、術後5ヶ月で再発。食道静脈瘤破裂に対する治療歴あり。今回、2度の下血を主訴に近医受診し、精査にて腹壁瘢痕ヘルニア内に発生した小腸静脈瘤からの出血と診断された。加療目的に当科紹介となった。造影CTにて腹壁瘢痕ヘルニア内の小腸に3カ所の静脈瘤を認め、feederは空腸静脈、drainerは両側大伏在静脈へ還流する皮下静脈であった。経皮経肝的に門脈にアプローチし、空腸静脈瘤に到達した。バルーン閉塞下に50%ブドウ糖液、無水エタノール、5%EOIにて塞栓した。治療後のCTにて静脈瘤は血栓化していたが、空腸静脈に血栓を認めたため、ワーファリン内服により経過観察する方針とした。稀な小腸静脈瘤に対して経皮経肝塞栓術が奏功した1例を経験したので報告する。

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese