Biomedical subjects
Publications and source records attributed to S Furui.
Differences in signal intensity involving lobes of the liver were noted in seven cases of liver tumor. The clinical significance and possible cause of these differences in lobar intensity are discussed.
Forty-two patients with hepatocellular carcinoma (HCC) were examined by magnetic resonance (MR) imaging. The presence of tumor was suggested in 41 of 42 cases by a high-intensity area on T2 weighted spin-echo (SE) images with a repetition time (TR) of 1.6 s. Specific findings of HCC such as the presence of a capsule, mosaic pattern, and tumor thrombus in major veins were noted in 10, two, and seven cases, respectively. In six cases the tumor pattern changed from a well-defined mass to an irregular, ill-defined one according to pulse sequence (SE: echo time 35 and 70 ms; TR 1.6 and 0.4 s). In our early experience MR was almost equal to conventional X-ray CT in the detection of main or daughter lesions and in the determination of extent and characterization of HCC.
Fourteen cases of microcystic adenoma (serous cystadenoma) of the pancreas were reviewed and radiological findings were correlated with pathological specimens. Microcystic adenomas appeared grossly either as solid tumors with innumerable tiny cysts or as honeycombed cystic tumors depending on the size and number of cysts and amount of connective tissue. Dynamic enhanced CT of the tumor reflected the amount of connective tissue and appeared as (a) densely enhanced spongy masses (n = 6: classic appearance); (b) cystic masses with (n = 6) or without (n = 1) enhanced septa; or (c) dense diffusely enhanced mass (n = 1). Ultrasound similarly showed a variety of features such as echogenic masses with or without small cystic portions, multilocular cysts, or mixed hyperechoic and hypoechoic masses. The ultrasonic features mainly reflected the dominant sizes of cysts. Angiography almost always showed inhomogeneously hypervascular masses with tumor vessels. The imaging diagnosis is easy and conclusive in classic subtypes, but a correct diagnosis can be made even in other subtypes. However, mucinous cystic neoplasm can be confused with microcystic adenoma with large cysts and a small amount of connective tissue, and islet cell tumors can be mistaken for microcystic tumors with minute cysts.
BACKGROUND/AIMS: Preoperative transhepatic portal vein embolization may not always be sufficient to achieve the desired changes in contralateral hepatic volume and function. The beneficial role of additional transcatheter arterial embolization performed after inadequate response to preoperative transhepatic portal vein embolization is described. METHODOLOGY: Four patients underwent both preoperative transhepatic portal vein embolization and transcatheter arterial embolization, and 6 control patients underwent preoperative transhepatic portal vein embolization only. Changes in right liver lobe volume fraction, residual left lobe volume fraction, and prediction score (low-risk, < 45; borderline, 45-55; high-risk > 55); were evaluated. RESULTS: 1) The change in right liver lobe volume after both preoperative transhepatic portal vein embolization and transcatheter arterial embolization (volume after/before) was 0.75 times that of the original level whereas after preoperative transhepatic portal vein embolization, they were only 0.81 times that of the original level. 2) The change in residual left liver volume after both preoperative transhepatic portal vein embolization and transcatheter arterial embolization (volume after/before) was 1.40 times that of the original level whereas after preoperative transhepatic portal vein embolization they were only 1.30 times than the original level. The changes in left liver volume after preoperative transhepatic portal vein embolization/transcatheter arterial embolization was more favorable than those after preoperative transhepatic portal vein embolization only. 3) The change in prediction score after both preoperative transhepatic portal vein embolization and transcatheter arterial embolization (after/before) was 0.81 times that of the original level. All prediction score in high-risk patients recovered to the borderline or safety zone. Change after preoperative transhepatic portal vein embolization only (before/after) was 0.87 times that of the original level. 4) All 4 patients who underwent both preoperative transhepatic portal vein embolization and transcatheter arterial embolization received right hepatic lobectomy successfully and returned to their normal life style. CONCLUSIONS: Preoperative occlusion of right hepatic inflow vessels increased the volume and function of the contralateral lobe where high-risk patients recovered to the borderline zone for major hepatic resection.
Intrahepatic tumor staining, which was clearly visualized by common hepatic arteriography, disappeared in balloon-occluded proper hepatic angiography. This finding is interesting in terms of changes in hemodynamics in normal and tumor-bearing livers following hepatic arterial occlusion with balloon catheters.
Eight patients with renal cancer underwent renal venography after renal arterial occlusion with a balloon catheter. Clear renal venograms were obtained easily. This method is strongly recommended, particularly if a balloon catheter is used for renal artery embolization.
Transcatheter arterial embolization (TAE) was performed in 20 patients with ruptured hepatocellular carcinoma (HCC). Bleeding was improved in all patients, but only four survived for over three months. Rerupture occurred in seven patients (35%) and the prognosis was extremely poor. TAE should be considered the treatment of choice for ruptured HCC; however, long-term survival was limited to those patients without portal extension of HCC. The severity of rupture also influenced the prognosis.
Transcatheter arterial embolization through pancreaticoduodenal arcade was performed in a patient with hepatocellular carcinoma using double catheter technique. This method is very useful for hepatic embolization in patients with occlusion and stenosis of the celiac axis or common hepatic artery.
In seven primary liver cancers (HCC 5, CCC 1, mixed 1), MR images (0.35 Tesla super-conducting) were compared with macroscopic appearances, and relaxation times (T1 and T2) with microscopic characteristics. MRI was able to reveal the gross appearance of five nodular lesions, but did not reveal one diffuse HCC and one nodular HCC with marked extracapsular extension. T2-weighted SE images could not demonstrate fibrous capsules around the tumor in four nodular HCCs. The T1 and T2 values of the tumors were longer than those of the surrounding liver parenchyma, and the T1 elongation corresponded roughly to the degree of necrosis and fibrosis within the tumors.
Among 224 hepatomas treated with transcatheter arterial embolization, ten patients who survived for three years are presented. All cases had nodular lesions and the volume ratio of tumor to liver was less than 10% in nine cases. Eight cases had no large venous extension, however, one had 90% occlusion of the portal trunk and the other had tumor thrombus within the inferior vena cava. Laboratory data showed liver function was largely spared in eight cases, whereas the other two had severe liver cirrhosis. CT and/or angiography showed an increase in tumor volume in eight cases after three years of survival. Beneficial factors for long-term survival and the limitations of embolization are also discussed.
Five cases with primary Budd-Chiari syndrome due to membranous obstruction of the hepatic segment of the inferior vena cava were examined by CT. In all cases, CT demonstrated caudate lobe enlargement, reticular low density within the liver parenchyma, splenomegaly, and collaterals via the ascending lumbar veins and azygous system. Pathological study revealed liver cirrhosis or fibrosis in all cases. In two cases, calcification was shown in the region of the hepatic segment of the inferior vena cava. Our results suggested that the CT appearance of primary Budd-Chiari syndrome was rather characteristic and useful in diagnosis, although membranous obliteration could not be shown directly on CT.
Intraarterial digital subtraction arteriography (IADSA) was performed in 94 patients with hepatic tumors and evaluated on the following subjects: 1) visualization of small arteries in arterial phase, compared with film study, 2) visualization of faint tumor stains in hepatogram phase, compared with film study, 3) visualization of portal venous branches by intraarterial digital subtraction portography (IADSP). Interventional angiography was performed in 76 patients. Contrast dose and injection rate of IADSA was approximately a third of film study without dilution. The position of the catheter was identical in IADSA and film study. IADSPs were performed with 15-20 ml of 76% Urografin, which was injected into the superior mesenteric artery at the rate of 5 ml/sec after infusion of prostaglandin E1. Comparison in arterial phase of 67 patients showed 24 (36%) IADSAs were equal to film study. Thirty-nine (58%) were inferior but adequate for the diagnosis of hepatic tumors. Comparison in hepatogram phase showed 24 (38%) IADSAs were superior to film study and all were satisfactory for the diagnostic purposes. Ninety-eight percent of 86 IADSPs gave information about the patency of the main portal vein. Fifty-five percent of IADSPs opacified third-order portal vein branches or further. IADSA of hepatic tumors not only save time and contrast dose but was also satisfactory in image quality for interventional angiography.
Transcatheter embolization has recently gained widespread acceptance in the treatment of a variety of conditions. To clarify the localization of therapeutic gelatin particles, we have described a simple and safe technique of labeling gelatin particles with 99mTc using stannous chloride solution. This technique provides satisfactory labeling efficiency and allows excellent scintigraphic images of therapeutic gelatin emboli, thus making it possible to clarify the localization of the injected embolic material in vivo.
Early experience in magnetic resonance (MR) images of the liver tumors is reported, based on 25 cases examined by a 0.35T superconducting machine (Magnetom, Siemens) using the spin echo technique. All main liver tumors were demonstrated as high intensity areas of varying degree in the spin echo image with a TR of 1,600 msec and a TE of 70 msec. All of them had prolonged T2 and T1. The smallest lesion detected on MR was 0.8 cm in diameter in the cases of multiple liver cysts and 1.5 cm in the cases of a solitary solid tumor. Normal vasculature of the liver was well-delineated, despite a far longer acquisition time compared with respiratory holding period. MR is a promising modality for liver imaging.
We report an unusual case of multilocular cystic hepatocellular carcinoma. The patient was a 42-year-old woman without liver cirrhosis but who had three multicystic mass lesions in the liver. Transcatheter arterial embolization was very effective and a survival time of more than 19 months was obtained.
Intraarterial digital subtraction portography (IADSP) via the superior mesenteric artery was performed in 50 patients with liver tumors. In most cases IADSPs provided images as good as conventional arterial portography through the superior mesenteric artery and they produced important information as to whether patients should be treated by transcatheter arterial embolization, surgical resection or chemotherapy. IADSP helps to reduce the examination time, the number of films and contrast material used, as well as the pain suffered by patients.
Intraarterial digital subtraction angiography (IADSA) of peripheral arteries with isotonic contrast material, which was prepared by diluting meglumine amidotrizoate (65% Angiografin), was performed in ten patients. In six, both IADSA and conventional screen-film arteriography were performed for comparison. Painless peripheral arteriography was achieved by IADSA with isotonic contrast material. Five IADSAs were safely done on an outpatient basis. Visualization of arteries by IADSA was satisfactory, but the details of smaller arteries were better shown by screen-film arteriography. Visualization of faint stains was better in IADSA. The authors believe that IADSA with isotonic contrast material is a method of choice for the diagnosis of vascular diseases and tumorous conditions of extremities, as well as for the purpose of preoperative vascular mapping. It is safely performed with smaller dose of contrast material on outpatient basis, and with less discomfort and cost for the patient.
Sclerosing hepatic carcinoma (SHC) is one of the variant primary liver carcinomas and is characterized by intense fibrosis which surrounds slender cords of neoplastic cells. We report on a 53-year-old male patient with SHC describing the radiological findings and clinical course after a transcatheter arterial embolization. To our knowledge, this was only the second reported case of SHC in Japan.