Authorship：Lead author   Language：English   Publisher：Japanese Society for Magnetic Resonance in Medicine  

We evaluated the newly developed whole-brain, isotropic, 3-dimensional turbo spin-echo imaging with variable flip angle echo train (SPACE) for contrast-enhanced T₁-weighted imaging in detecting brain metastases at 3 tesla (T). Twenty-two patients with suspected brain metastases underwent postcontrast study with SPACE, magnetization-prepared rapid gradient-echo (MP-RAGE), and 2-dimensional T₁-weighted spin echo (2D-SE) imaging at 3T. We quantitatively compared SPACE, MP-RAGE, and 2D-SE images by using signal-to-noise ratios (SNRs) for gray matter (GM) and white matter (WM) and contrast-to-noise ratios (CNRs) for GM-to-WM, lesion-to-GM, and lesion-to-WM. Two blinded radiologists evaluated the detection of brain metastases by segment-by-segment analysis and continuously-distributed test. The CNR between GM and WM was significantly higher on MP-RAGE images than on SPACE images (<i>P</i><0.01). The CNRs for lesion-to-GM and lesion-to-WM were significantly higher on SPACE images than on MP-RAGE images (<i>P</i><0.01). There was no significant difference in each sequence in detection of brain metastases by segment-by-segment analysis and the continuously-distributed test. However, in some cases, the lesions were easier to detect in SPACE images than in other sequences, and also the vascular signals, which sometimes mimic lesions in MP-RAGE and 2D-SE images, were suppressed in SPACE images. In detection of brain metastases at 3T magnetic resonance (MR) imaging, SPACE imaging may provide an effective, alternative approach to MP-RAGE imaging for 3D T₁-weighted imaging.<br>

DOI： 10.2463/mrms.7.13

PubMed

CiNii Books

Other Link： http://search.jamas.or.jp/link/ui/2008264647

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

BACKGROUND: Although endovascular aneurysmal repair (EVAR) is a preferred treatment for abdominal aortic aneurysm (AAA) owing to its low invasiveness, its impact on the local hemodynamics has not been fully assessed. PURPOSE: To elucidate how EVAR affects the local hemodynamics in terms of energy loss (EL). STUDY TYPE: Prospective single-arm study. FIELD STRENGTH/SEQUENCE: A 3.0 T/4D flow MRI using a phase-contrast three-dimensional cine-gradient-echo sequence. POPULATION: A total of 13 consecutive patients (median [interquartile range] age: 77.0 [73.0, 78.8] years, 11 male) scheduled for EVAR as an initial treatment for fusiform AAA. ASSESSMENT: 4D flow MRI covering the abdominal aorta and bilateral common iliac arteries and the corresponding stent-graft (SG) lumen was performed before and after EVAR. Plasma brain natriuretic peptide (BNP) was measured within 1 week before and 1 month after EVAR. The hemodynamic data, including mean velocity and the local EL, were compared pre-/post-EVAR. EL was correlated with AAA neck angle and with BNP. Patients were subdivided into deformed (N = 5) and undeformed SG subgroups (N = 8) and pre-/post-EVAR BNP compared in each. STATISTICS: Parametric or nonparametric methods. Spearman's rank correlation coefficients (r). The interobserver/intraobserver variabilities with Bland-Altman plots. A P value < 0.05 is considered significant. RESULTS: The mean velocity (cm/sec) at the AAA was five times greater after EVAR: 4.79 ± 0.32 vs. 0.91 ± 0.02. The total EL (mW) increased by 1.7 times after EVAR: 0.487 (0.420, 0.706) vs. 0.292 (0.192, 0.420). The total EL was proportional to the AAA neck angle pre-EVAR (r = 0.691) and post-EVAR (r = 0.718). BNP (pg/mL) was proportional to the total EL post-EVAR (r = 0.773). In the deformed SG group, EL (0.349 [0.261, 0.416]) increased 2.4-fold to 0.848 (0.597, 1.13), and the BNP 90.3 (53.6, 105) to 100 (67.2, 123) post-EVAR. CONCLUSION: The local EL showed a 1.7-fold increase after EVAR. The larger increase in the EL in the deformed SG group might be a potential concern for frail patients. EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 2.

DOI： 10.1002/jmri.28359

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PubMed

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

Endoscopic injection sclerotherapy (EIS) for esophagogastric varices (EGV) was attempted for a 29-year-old man with extrahepatic portal vein obstruction. However, pipeline varices characterized by a large blood flow volume were present, and the sclerosant did not accumulate sufficiently in them. Transileocolic obliteration (TIO) using coils was performed, but some EGVs and palisading veins remained. Thus, EIS was performed once again immediately after TIO. Since a reduction in the intravariceal blood flow was achieved by preceding TIO, effective injection of sclerosant into the vessels was possible. For pipeline varices difficult to treat endoscopically, combination therapy with TIO may be effective.

DOI： 10.2169/internalmedicine.9404-22

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PubMed

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

OBJECTIVE. The purpose of this study was to clarify the natural history of unruptured visceral artery aneurysms due to segmental arterial mediolysis and the efficacy of transcatheter arterial embolization. MATERIALS AND METHODS. Patients with a pathologic or clinical diagnosis of visceral artery aneurysms due to segmental arterial mediolysis between 2005 and 2015 were enrolled. For patients with clinical diagnoses, images were collected and assessed by central radiologic review. To clarify the natural history of unruptured aneurysms, the morphologic changes were assessed. The efficacy and safety of transcatheter arterial embolization for aneurysms due to segmental arterial mediolysis were evaluated. RESULTS. Forty-five patients with 123 aneurysms due to segmental arterial mediolysis were enrolled. Among the 123 aneurysms, 70 unruptured aneurysms were evaluated for natural history. Forty-five of the 70 (64%) aneurysms had no change in morphology. Among the other 25 aneurysms, nine (13% of the 70) were reduced in size, 13 (19%) disappeared, and three (4%) were newly found at follow-up. Aneurysms of the middle colic artery were ruptured in 10 of 11 (91%) cases. Transcatheter arterial embolization was performed on 45 aneurysms and was successful in all cases but caused slight arterial injury in three cases (6.7%). CONCLUSION. At initial diagnosis, unruptured aneurysms due to segmental arterial mediolysis are likely to be stable or to resolve, but the risk of rupture of aneurysms of the middle colic artery appears high. Transcatheter arterial embolization is a useful treatment, but careful manipulation is necessary.

DOI： 10.2214/AJR.19.22547

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PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

PURPOSE: This study aimed to evaluate the usefulness of a coaxial double balloon catheter for simplification of the balloon-occluded retrograde transcatheter obliteration (BRTO) procedure compared with a single-balloon catheter. MATERIALS AND METHODS: Thirty-three patients who underwent BRTO with a single-balloon catheter (Single-balloon group, n = 15) or a coaxial double balloon catheter (Coaxial group, n = 18) were included, retrospectively. The frequency of additional procedures for stagnation of sclerosant including ethanol injection, coil embolization, and additional balloon occlusion for collateral draining veins; the dose of ethanolamine oleate (EO); and the complication rate and the success rate of sclerosant stagnation were evaluated. RESULTS: Additional procedures were needed in four patients in the Coaxial group, which was significantly lower than that in the Single-balloon group (nine patients, P = 0.038). The dose of EO in the Coaxial group (11.2 ± 6.6 g) was lower, but not significantly different than that in the Single-balloon group (14.4 g ± 6.1 g, P = 0.184). The complication rate and the success rate of sclerosant stagnation were not different between the two groups. CONCLUSION: The use of a coaxial double balloon catheter can simplify the BRTO procedure compared with a single-balloon catheter.

DOI： 10.1007/s11604-020-01060-x

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PubMed

Other Link： http://link.springer.com/article/10.1007/s11604-020-01060-x/fulltext.html

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

In patients with a reconstructed gastric tube, the right gastroepiploic artery is a very important feeding artery of the tube, which must be preserved when performing a pancreaticoduodenectomy. A 76-year-old man with a reconstructed gastric tube underwent pancreaticoduodenectomy for distal bile duct carcinoma. On postoperative day 8, he had an arterial hemorrhage from a drain, apparently from a ligation of the anterior superior duodenal artery. He, therefore, underwent stent-graft placement in the gastroduodenal artery. The stent-grafts were temporarily occluded, and the gastric tube was necrotizing. However, thrombolytic therapy allowed the stent-grafts to reopen and prevented gastric tube necrosis. We believe our case of stent-graft implantation in the gastroduodenal artery is the first of this kind to successfully prevent lethal necrosis of the gastric tube.

DOI： 10.1016/j.radcr.2020.10.021

PubMed

Language：Japanese   Publisher：(一社)日本インターベンショナルラジオロジー学会  

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Language：English  

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

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER IRELAND LTD  

Purpose: To evaluate dynamic contrast-enhanced computed tomography (CT) features of pancreatic neuroendocrine tumors (PNETs) containing areas of iso- or hypoattenuation and the relationship with pathological grading.
Materials and Methods: Between June 2006 and March 2014,61 PNETs in 58 consecutive patients (29 male, 29 female; median-age 55 years), which were surgically diagnosed, underwent preoperative dynamic contrast-enhanced CT. PNETs were classified based on contrast enhancement patterns in the pancreatic phase: iso/hypo-PNETs were defined as tumors containing areas of iso- or hypoattenuation except for cystic components, and hyper-PNETs were tumors showing hyperattenuation over the whole area. CT findings and contrast-enhancement patterns of the tumors were evaluated retrospectively by two radiologists and compared with the pathological grading.
Results: Iso/hypo-PNETs comprised 26 tumors, and hyper-PNETs comprised 35 tumors. Not only hyperPNETs but also most iso/hypo-PNETs showed peak enhancement in the pancreatic phase and a washout from the portal venous phase to the delayed phase. Iso/hypo-PNETs showed larger tumor size than the hyper-PNETs (mean, 3.7 cm vs. 1.6 cm; P&lt; 0.001), and were significantly correlated with unclear tumor margins (n= 4 vs. n= 0; P = 0.029), the existence of cystic components (n=10 vs. n= 3; P = 0.006), intratumoral blood vessels in the early arterial phase (n= 13 vs. n= 3; P&lt; 0.001), and a smooth rim enhancement in the delayed phase (n= 12 vs. n= 6; P= 0.019). Iso/hypo-PNETs also showed significantly higher pathological grading (WHO 2010 classification; iso/hypo, G1 = 14, G2 = 11, G3 = 1; hyper, G1 =34, G2 = 1; P&lt; 0.001).
Conclusion: PNETs containing iso/hypo-areas showed a rapid enhancement pattern as well as hyperPNETs, various radiological features and higher malignant potential. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.ejrad.2015.08.014

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

DOI： 10.1177/2058460115589338

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PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

Background The aim of the present study was to assess the clinical efficiency of portal vein (PV) stenting when performed with preoperative percutaneous transhepatic portal vein embolization (PTPVE) in patients with severe PV stenosis due to tumor invasion.
Methods Between 2007 and 2013, four consecutive patients (one male, three females; mean age, 52 years; age range, 25-73 years) with perihilar cholangiocarcinoma and PV stenosis underwent PTPVE and PV stenting. Patients were analyzed with regard to the procedure, hypertrophy of the future remnant liver (FRL), and plasma clearance rate of indocyanine green by the FRL (ICGK-F). Further, the %FRL volume increase in PTPVE was compared between the stenting group and the usual PTPVE group who have perihilar cholangiocarcinomas without PV stenosis.
Results Preoperative PTPVE with PV stenting was successfully performed and portal flow to the FRL improved after stenting in all four patients. The % FRL volume increase was 18-60% (mean, 34%) in the stenting group and was 12-51% (mean, 21%) in the usual PTPVE group. The ICGK-F value after PTPVE exceeded 0.05 in all four patients. All patients achieved R0 resection.
Conclusions Preoperative PTPVE with PV stenting appears to be feasible in cases of severe PV tumor invasion and stenosis. This procedure may allow a broader indication for surgery.

DOI： 10.1002/jhbp.200

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PubMed

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

PubMed

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

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

We report two cases of intraperitoneal bleeding from superior mesenteric artery (SMA) pseudoaneurysm after pancreaticoduodenectomy for pancreatic head carcinoma. In both cases, a stent-graft was deployed on the main SMA to exclude pseudoaneurysm and to preserve blood flow to the bowel. Bleeding stopped after the procedure. One patient was able to be discharged but died from carcinoma recurrence 4 months later. The other patient died of sepsis and stent-graft infection 5 months later. These patients remained free of intraperitoneal rebleeding during the follow-up period.

DOI： 10.1007/s00270-009-9502-1

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PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

The purpose of this study was to assess the efficacy of transcatheter arterial embolization for ruptured pancreaticoduodenal artery (PDA) aneurysms associated with celiac axis stenosis (CS). Seven patients (four men and three women; mean age, 64; range, 43-84) were treated with transcatheter arterial embolization between 2002 and 2007. They were analyzed with regard to the clinical presentation, radiological finding, procedure, and outcome. All patients presented with sudden epigastric pain or abdominal discomfort. Contrast-enhanced CT showed a small aneurysm and retroperitoneal hematoma around the pancreatic head in all patients. The aneurysms ranged from 0.3 to 0.9 cm in size. In one patient, two aneurysms were detected. The aneurysms were located in the pancreaticoduodenal artery (n = 5) and the dorsal pancreatic artery (n = 3). Embolization was performed with microcoils in all aneurysms (n = 8). N-Butyl 2-cyanoacrylate (n = 1) and gelatine particle (n = 1) were also used. Complete occlusion was achieved in four patients. In the other three patients, a significantly reduced flow to the aneurysm remained at final angiography. However, these aneurysms were thrombosed on follow-up CT within 2 weeks. And there was no recurrence of the symptoms and bleeding during follow-up (mean, 28 months; range, 5-65 months) in all patients. In conclusion, transcatheter arterial embolization for PDA aneurysms associated with CS is effective. Significant reduction of the flow to the aneurysm at final angiography may be predictive of future thrombosis.

DOI： 10.1007/s00270-008-9343-3

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DOI： 10.1007/s00330-007-0741-8

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PubMed