著者

Kohei Tokuyama Hiro Kiyosue Yuzo Hori Mika Okahara Hirofumi Nagatomi Yoshiki Asayama

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2023-0012, (Released:2023-06-13)

参考文献数

5

被引用文献数

1

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Objective: Selective transvenous embolization (sTVE) is an effective technique for treating dural arteriovenous fistulas (DAVFs); however, selective catheterization into the shunted pouch is often difficult due to the acute angle of the access route between the target pouch and dural sinus. We present our initial experience using a steerable microcatheter (SM) to manually control the tip angle for selective catheterization and sTVE of DAVFs.Methods: Thirteen consecutive cases of DAVFs and 16 procedures that involved sTVE using SM between October 2016 and October 2018 were reviewed. SMs were used for selective catheterization of shunted venous pouches and/or the affected sinus and coil embolization. We evaluated the maneuverability of the SM, the success of selective catheterization into the target lesions, and the results of endovascular treatments.Results: Endovascular procedures were performed in a single session in 10 cases and in two staged sessions in 3 cases. There was no difficulty in maneuverability of the SM. Successful selective catheterization was achieved in 26 of 27 target lesions. Immediately after embolization, angiography showed complete occlusion in 10 cases and marked reduction in 3 cases. During 40.9 months of mean follow-up, 12 cases showed complete occlusion and one case showed a small residual shunt on MRI. Procedure-related complications of spontaneous thrombosis of the affected sinus were observed in one case. There were no cases of recurrence or exacerbation during follow-up.Conclusion: SM is useful for selective catheterization for target lesions during sTVE of DAVFs.

著者

Nobuhiro FUJITA Akihiro NISHIE Yoshiki ASAYAMA Kousei ISHIGAMI Yasuhiro USHIJIMA Yukihisa TAKAYAMA Daisuke OKAMOTO Koichiro MORITA Ken SHIRABE Kazuhiro KOTO Yuichiro KUBO Yoshinao ODA Hiroshi HONDA

出版者

Japanese Society for Magnetic Resonance in Medicine

雑誌

Magnetic Resonance in Medical Sciences (ISSN:13473182)

巻号頁・発行日

vol.15, no.1, pp.111-120, 2016-01-01 (Released:2016-01-12)

参考文献数

28

被引用文献数

7 9

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Purpose: We attempted to clarify the relationship between the signal intensity (SI) in the hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance (MR) imaging and the efficacy of hepatic arterial infusion chemotherapy (HAIC) in hepatocellular carcinomas (HCCs).Methods: We enrolled 14 patients with HCCs who underwent gadoxetic acid-enhanced MR imaging prior to HAIC using cisplatin and 5-fluorouracil. In the hepatobiliary phase, we calculated the SI of the HCCs and the background liver. In cases with multiple HCCs, we calculated the SI of the largest lesion. Patients were classified into high (n = 7) and low intensity (n = 7) groups based on the median value of the SI ratio (SI of the tumor/SI of the background liver). We analyzed progression-free survival using the Kaplan-Meier method and the log-rank test. In the 5 patients with a history of HCC surgery, we compared the expression of immunohistochemical organic anion-transporting polypeptide (OATP) 8 between the high and low intensity groups by chi-square test.Results: The SI ratios were 0.568 ± 0.093 (mean ± standard deviation) in the high intensity group and 0.251 ± 0.086 in the low intensity group. Compared to the group with low signal intensity, the group with high signal intensity demonstrated significantly lower serum levels of alpha fetoprotein (AFP) (P = 0.0350), significantly higher progression-free survival (P = 0.0108), better differentiation of tumor grade at histologic examination (P = 0.0253), and significantly higher OATP8 expression (P = 0.0253).Conclusion: Patients with HCCs of high SI ratio in the hepatobiliary phase of gadoxetic acid-enhanced MR imaging can respond better to HAIC.

著者

Yukihisa Takayama Akihiro Nishie Daisuke Okamoto Nobuhiro Fujita Yoshiki Asayama Yasuhiro Ushijima Tomoharu Yoshizumi Masami Yoneyama Kousei Ishigami

出版者

Japanese Society for Magnetic Resonance in Medicine

雑誌

Magnetic Resonance in Medical Sciences (ISSN:13473182)

巻号頁・発行日

pp.mp.2020-0151, (Released:2021-04-20)

参考文献数

33

被引用文献数

4

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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.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.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 (P < 0.05).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.

著者

Noriaki Wada Akio Furuya Toshihiro Ike Naofumi Kasai Shohei Takata Yoshiaki Tao Yoshiki Asayama

出版者

Japanese Society of Interventional Radiology

雑誌

Interventional Radiology (ISSN:24320935)

巻号頁・発行日

pp.2019-0002, (Released:2019-08-23)

参考文献数

24

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Objective: The clinical features and outcomes of bronchial arterial embolization (BAE) for hemoptysis were investigated, and we aimed to identify the factors associated with recurrent hemoptysis after BAE.Patients and Methods: Thirty-three consecutive patients treated with BAE for hemoptysis between July 2011 and June 2018 in a single medical center were retrospectively analyzed. Sex, age, body mass index, smoking history, comorbidity, laboratory data, etiology, angiographic findings, number and variety of embolized vessels, adverse events, and outcomes were evaluated.Results: The median age at the time of first BAE was 71 years (interquartile range [IQR], 59.5-86.5 years). The most common etiologies were cryptogenic hemoptysis (n=6), non-tuberculosis mycobacteriosis (n=6), pulmonary aspergillosis (n=5), bronchiectasis (n=5), and others (n=11). The common angiographic findings were neo-vascularization (n=31) and hypertrophied vessels (n=19). Eight patients (24%) experienced recurrence after BAE during the median follow-up time of 15 months (IQR, 4-25.5 months), and recurrence occurred in two patients (6%) within 1 month and in one patient (3%) after 3 years. The recurrence-free time after BAE was significantly shorter in patients with ≥20 pack-years smoking history (p=0.0218) and patients using anticoagulants or antiplatelet agents (p=0.0032). No moderate to severe adverse events related to BAE were encountered.Conclusion: BAE is a safe and effective treatment to control hemoptysis. However, recurrence occurred in 24% of our patient series. A smoking history of ≥20 pack-years and the use of anticoagulants or antiplatelet agents may be associated with a higher rate of recurrent hemoptysis following BAE.