Abstract: INTRODUCTION: This study aimed to define the patterns of basal cerebral venous drainage (BCVD) from cavernous sinus dural arteriovenous fistulas (CSDAVFs). MATERIALS AND METHODS: Forty sets of selective angiographic data from 36 patients with spontaneous CSDAVFs (age range, 53-79 years) were retrospectively analyzed for their drainage patterns. Three types of BCVD were observed, i.e., superolateral type, BCVD via the deep middle cerebral vein or uncal vein; posterolateral type, BCVD via the superior petrosal sinus and petrosal vein; and posteromedial type, BCVD via the bridging vein and the anterior pontomesencephalic vein. MR images and/or 3D-DSA images were also reviewed when available. RESULTS: BCVD from CSDAVF was found in 12 patients (30%), and the other drainage routes included the superior ophthalmic vein in 25 (63%), the inferior petrosal sinus in 17 (43%), the superficial middle cerebral vein in 17 (43%), intercavernous sinus in 15 (38%), the superior petrosal sinus in seven (18%), and pterygoid plexus in two (5%), respectively. In 12 patients with BCVD, superolateral type was found in four (33%), posterolateral type in five (42%), and posteromedial type in seven (58%). Four cases of posteromedial type were associated with other types of BCVD. CONCLUSION: CSDAVFs are often associated with BCVD via three different pathways. The posteromedial type via the bridging vein is the most frequent type of BCVD.
Abstract: INTRODUCTION: We evaluated the normal venous anatomy of the anterior medullary/anterior pontomesencephalic venous (AMV/APMV) system and bridging veins connected to the dural sinuses using magnetic resonance (MR) imaging and demonstrated cases of dural arteriovenous fistulas (DAVFs) with bridging venous drainage. MATERIALS AND METHODS: MR images obtained using a 3D gradient echo sequence in 70 patients without lesions affecting the deep or posterior venous channels were reviewed to evaluate the normal anatomy of the AMV/APMV system and bridging veins. MR images and digital subtraction angiography in 80 cases with intracranial or craniocervical junction DAVFs were reviewed to evaluate the bridging venous drainage from DAVFs. RESULTS: MR images clearly revealed AMV/APMV in 35 cases. Fifteen cases showed a direct connection between AMV and APMV, while 15 cases showed an indirect communication via the transverse pontine vein or the bridging vein. In the five remaining cases, the AMV and APMV end separately to the bridging vein or the transverse pontine vein. Bridging veins were identified in 34 cases, connecting to the cavernous sinus in 33, to the suboccipital cavernous sinus in 11, and the inferior petrosal sinus in five cases. In 80 DAVF cases, seven of 40 cavernous sinus DAVFs, two craniocervical junction DAVFs, and one inferior petrosal sinus DAVF drained via bridging veins to the brain stem. CONCLUSION: The AMV/APMV and bridging veins showed various anatomies and frequently showed a connection to the cavernous sinus. Knowledge of the venous anatomy is helpful for the diagnosis and intravascular treatment of DAVFs.
Abstract: OBJECTIVE: To demonstrate the contrast-enhancement behavior of pancreatic carcinoma on dynamic contrast-enhanced CT (DCE-CT), and the relationship between the degree of contrast-enhancement and the vascularity (vessel density) and amount of fibrous stroma (fibrosis within the tumor) on pathological specimen. METHODS: The contrast-enhancement values were measured by producing the subtracting images for obtaining largest region of interests to reduce measurement errors and variability. Vascularity was determined by immunostaining of the tissue sections with factor 8 and the fibrous stroma was determined by picrosirius staining. Correlation of the findings of DCE-CT with pathological findings was performed in 21 patients with pancreatic carcinoma. RESULTS: All but one patient exhibited a gradually increasing enhancement, but there was considerably wide range in contrast-enhancement values of tumors. Examination of the overall relationship between vascularity and fibrous stroma with contrast-enhancement behavior showed that tumor with more fibrosis and higher vascularity had a higher contrast effect through all phases of dynamic study. Tumors having liver metastases tended to be less fibrotic than tumors without liver metastases. CONCLUSION: The contrast-enhancement behavior of pancreatic carcinoma may be helpful in estimating vascularity and the extent of tumor fibrosis and possibility of liver metastases.
Abstract: AIM: To describe the imaging features of inferior mesenteric vein (IMV)-inferior vena cava (IVC) shunts, and to describe a treatment strategy for portosystemic encephalopathy, which can be caused by them. MATERIALS AND METHODS: Between 2000 and 2004, we treated seven patients who had symptomatic IMV-IVC shunts. The results of imaging investigations, which included contrast-enhanced computed tomography (CT), angiography, and CT during arterial portography, were reviewed retrospectively. We also present our results in the four patients who were treated by retrograde transcaval obliteration (RTCO). RESULTS: The IMV-IVC shunts had a tortuous or cirsoid appearance ranging in size from 7.2-14.6 mm. The shunts were located at a level near to the first branch of the inferior mesenteric artery. The four patients were successfully treated by RTCO and their clinical symptoms improved. CONCLUSION: IMV-IVC shunts show a tortuous or cirsoid appearance, connecting at or near the first branch of the inferior mesenteric artery. For symptomatic IMV-IVC shunts, RTCO is recommended as the first choice treatment.
Abstract: PURPOSE: The aim of this study was to determine the computed tomographic (CT) criteria for diagnosing the second portion of the extrapancreatic neural plexus (PLX-II) invasion by carcinoma of the pancreatic head region on thin-section helical CT. MATERIALS AND METHODS: A total of 41 patients with carcinoma of the pancreatic head region (17 in the pancreas, 24 in the lower common bile duct) underwent three-phase helical CT (collimation 5 mm; reconstruction 2.5 mm) before surgery. Two criteria were established for the assessment of the PLX-II running between the superior mesenteric artery (SMA) and the medial margin of the uncinate process: criterion A: assessment of the area around the SMA and inferior pancreaticoduodenal artery; criterion B: assessment of the jejunal trunk. RESULTS: PLX-II invasion was pathologically confirmed in 19 patients with pancreatobiliary carcinoma. For criterion A, all 19 patients with positive PLX-II invasion and 20 of the 22 with negative PLX-II invasion were correctly diagnosed (sensitivity 100%; specificity 91%; accuracy 95%). For criterion B, 3 of the 17 patients with positive PLX-II invasion and all 20 with negative PLX-II invasion were correctly diagnosed (sensitivity 18%; specificity 100%; accuracy 62%). The two false-positive cases using criterion A were correctly diagnosed using criterion B. CONCLUSION: Thin-section helical CT provides sufficient diagnostic ability regarding PLX-II invasion by carcinoma of the pancreatic head region.
Abstract: A 77-year-old man was transferred to the hospital with swelling of his neck and oropharynx after a stab injury to his oral cavity with pruning shears. Findings at complete neurologic examination were normal. Contrast-enhanced computed tomography (CT) and angiography revealed a pseudoaneurysm at the pharyngeal portion of the right internal carotid artery. Endovascular treatment was undertaken by using the double bare stent technique. The pseudoaneurysm was completely occluded immediately after the procedure. There were no complications. There were no further symptoms or evidence of recurrence of the aneurysm during the 18-month follow-up period. The double bare stent technique is safe and effective for the treatment of zone III carotid artery stab injuries.
Abstract: Although dural arteriovenous fistulas (DAVFs) occur in any structure that is covered by the dura mater, DAVFs at the posterior condylar canal have not been reported. We present a DAVF that involves the posterior condylar canal and drains into the posterior condylar vein and the occipital sinus, which was treated by selective transvenous embolization. Knowledge of venous anatomy of the craniocervical junction and careful assessment of the location of the arteriovenous fistula can contribute to successful treatment.
Abstract: BACKGROUND AND PURPOSE: Basal cell adenomas (BCAs) are rare tumors of the parotid gland. Only a few case reports describing MR imaging features of BCA have been published. The aim of this study was to describe and characterize the MR findings of BCAs of the parotid gland. MATERIALS AND METHODS: We retrospectively reviewed MR images of BCA with pathologic correlation in 8 cases (2 men and 6 women; age range, 52-82 years) collected between January 1992 and August 2004 from our pathologic data base. All MR images were retrospectively evaluated with respect to the marginal morphology, signal intensity (SI), and enhancement behavior by 2 experienced radiologists. RESULTS: On pathologic examination, 5 tumors were solid type, 2 were trabecular type, and 1 was membranous type. All of the tumors were well circumscribed with smooth contours. Cystic changes were seen in 4 cases. On T1-weighted images (T1WI), 7 tumors showed homogeneously low SI equal to muscle and one showed heterogeneously low SI. On T2-weighted images (T2WI), all of them showed slightly lower SI than that of surrounding parotid tissue. On gadolinium-enhanced T1WI, 6 tumors demonstrated moderate enhancement and one demonstrated strong enhancement (membranous type). Dynamic studies were performed in 4 cases. All showed rapid and prolonged enhancement. CONCLUSION: MR imaging findings of BCA were well-defined and smooth marginal morphologies, relatively low SI on both T11W and T2WI, and rapid and prolonged enhancement on dynamic study. Although BCAs are rare, they should be suspected when a tumor shows all of the characteristics noted here.
Abstract: BACKGROUND: The cavernous sinus communicates with several para-cavernous sinus venous structures, receiving blood flow from the superficial middle cerebral vein (SMCV), the sphenoparietal sinus (SPS), and the superior ophthalmic vein, and draining into the superior and inferior petrosal sinuses and pterygoid and basilar plexuses. Anatomic variations of these veins have been previously reported; however, some details, such as the relationship between the SPS and the SMCV, are incompletely characterized. The anatomic variations of para-cavernous sinus veins, especially drainage patterns of the SMCV, were evaluated on MR imaging. MATERIALS AND METHODS: Thirty-seven patients, including those without any lesions affecting the cavernous sinus or para-cavernous veins and patients with carotid cavernous fistulas, were examined by using fat-suppressed contrast-enhanced 3D fast gradient-echo MR imaging. Two neuroradiologists evaluated the images on a viewer, regarding the normal anatomy and the pathologic findings of the para-cavernous sinus veins. RESULTS: The fat-suppressed 3D fast gradient-echo MR images clearly depicted the para-cavernous sinus venous structures in all patients. SMCVs had 4 variations in the drainage patterns. The most frequent pattern was drainage into the SPS (39%), and other types were draining into cavernous sinus, pterygoid plexus, and tentorial sinus. The SPS had 3 variations. The most frequent pattern was drainage into cavernous sinus (72%), and others were the hypoplastic type or those draining into pterygoid plexus. CONCLUSION: The fat-suppressed 3D fast gradient-echo MR image is useful for evaluating the venous structures in the skull base. Knowledge of the variations is important for diagnosis and endovascular treatment of the cavernous sinus lesions.
Abstract: PURPOSE: To develop a new coaxial balloon catheter system and evaluate its clinical feasibility for balloon-occluded retrograde transvenous obliteration (B-RTO). METHODS: A coaxial balloon catheter system was constructed with 9 Fr guiding balloon catheter and 5 Fr balloon catheter. A 5 Fr catheter has a high flexibility and can be coaxially inserted into the guiding catheter in advance. The catheter balloons are made of natural rubber and can be inflated to 2 cm (guiding) and 1 cm (5 Fr) maximum diameter. Between July 2003 and April 2005, 8 consecutive patients (6 men, 2 women; age range 33-72 years, mean age 55.5 years) underwent B-RTO using the balloon catheter system. Five percent ethanolamine oleate iopamidol (EOI) was used as sclerosing agent. The procedures, including maneuverability of the catheter, amount of injected sclerosing agent, necessity for coil embolization of collateral draining veins, and initial clinical results, were evaluated retrospectively. The occlusion rate was assessed by postcontrast CT within 2 weeks after B-RTO. RESULTS: The balloon catheter could be advanced into the proximal potion of the gastrorenal shunt beyond the collateral draining vein in all cases. The amount of injected EOI ranged from 3 to 34 ml. Coil embolization of the collateral draining vein was required in 2 cases. Complete obliteration of gastric varices on initial follow-up CT was obtained in 7 cases. The remaining case required re-treatment that resulted in complete obstruction of the varices after the second B-RTO. No procedure-related complications were observed. CONCLUSION: B-RTO using the new coaxial balloon catheter is feasible. Gastric varices can be treated more simply by using this catheter system.
Abstract: OBJECT: The authors compared the usefulness of three-dimensional (3D) reconstructed computerized tomography (CT) angiography with 3D digital subtraction (DS) angiography in assessing intracranial aneurysms after clip placement. A retrospective review of clinical cases was performed. METHODS: Between May 2001 and May 2003, 17 patients with a total of 20 intracranial aneurysms underwent 3D CT and 3D DS angiography following clip placement. The authors assessed the presence or absence of residual aneurysm necks and stenoocclusive changes in the parent artery and the neighboring artery. The efficacy of CT angiographic visualization was also evaluated. In 12 of the 20 aneurysms, both 3D modalities similarly demonstrated the residual aneurysm neck and stenoocclusive changes in the parent artery and neighboring artery. Three-dimensional CT angiography failed to demonstrate three of the aneurysms, and the studies were not considered suitable for evaluation because of the presence of metallic artifacts. In the remaining five studies, the 3D CT angiograms did not effectively demonstrate the neighboring and parent arteries. The detectability of residual aneurysm necks was correlated with the clip material and with the number of clips applied. CONCLUSIONS: Three-dimensional DS angiography is still necessary in cases involving multiple clips or with cobalt alloy clips because the clips appear as metal artifacts on 3D CT angiography.
Abstract: Adenoid cystic carcinoma (ACC) of the uterine cervix is a rare primary neoplasm of the uterus that occurs in post-menopausal women; its radiological findings have not been described previously. We present the MR findings of a case of ACC. The mass exhibited homogeneous low-signal intensity on T1-weighted images. On T2-weighted images, the mass showed high-signal intensity with a lobulated contour and multiple septum-like internal architectures. It also contained spots of very high-signal intensity, which would represent the mucin in the glandular lumen. The multiple septum-like internal architectures probably represented interglandular fibrous stroma. These MRI findings may be helpful for future diagnoses of ACC of the uterine cervix.
Abstract: PURPOSE: The purpose of this study was to compare the characteristics of shaped microcatheters, including shapability, durability, and luminal changes. MATERIALS AND METHODS: Eleven brands of steam-shaped microcatheters and one brand of preshaped microcatheter were evaluated. There were 2 nonreinforced and 10 reinforced devices supported by coils. For evaluation of shapability, the tip angle of 6 samples of each brand were measured after steam-shaping for 20 seconds with a shaping mandrel bent at a 90 degrees or 150 degrees angle. The ability to maintain the shaped angle after guidewire insertion stress (durability) was compared by calculation of the change in the tip angle by using 3 samples of each brand. Luminal change after steam shaping was evaluated by calculation of narrowing rate of the smallest diameter and observation of the surface morphology of the mold of each catheter lumen by using a silicone polymer by means of a fluorescent projection method. RESULTS: The nonreinforced microcatheters and the fiber-braided microcatheter showed higher shapability than the others. The degree of distal microcatheter straightening with the microguidewire insertion was less pronounced in the preshaped microcatheter and the fiber-braided microcatheter. Spontaneous recovery to the initial tip angle 5 minutes after the guidewire procedure was observed in 10 brands to various degrees (87%-98%). Irregular luminal surface morphology at the angled portion was found in 6 reinforced brands. One nonreinforced catheter and the fiber-braided catheter showed high narrowing rates >6%. CONCLUSION: There are differences in shapabilty, durability, and luminal changes of steam shaping in 12 brands of microcatheters. These characteristics could be important factors in catheter choice for endovascular procedures.
Abstract: Four patients with gastric varices without catheterizable draining veins through a systemic vein were treated with transportal intravariceal sclerotherapy with n-butyl-2-cyanoacrylate (NBCA). In all patients, the gastric varices were successfully obliterated with 2-5 mL of NBCA-lipiodol mixture injected via a microcatheter introduced into the varices with transhepatic or transileocolic portal venous access. No complications related to the procedure were encountered. Follow-up gastroendoscopy showed disappearance (n = 3) or marked decrease (n = 1) of the varices. Neither recurrent gastric varices nor variceal bleeding were observed during the follow-up period (6-46 months). Transportal intravariceal sclerotherapy is useful for obliteration of gastric varices in selected cases.
Abstract: Percutaneous transluminal balloon angioplasty (PTA) has been used in the treatment of critical stenosis of the intracranial vertebrobasilar artery (VBA). PTA of the intracranial VBA carries the risk of fatal complications such as arterial dissection or acute occlusion as well as postoperative restenosis. The estimated risk of periprocedural complications and restenosis were approximately 20% and 27%. The use of recently developed stents could prevent these problems of PTA. We present two cases of restenosis of the intracranial VBA after PTA which stenoses were successfully retreated with endovascular stenting using flexible coronary stents without any complications. Neither restenosis nor other recurrent symptoms were observed during the 4- and 6-month follow-up period. Reviewing the literature of 33 cases and our 2 cases, the overall complication rates related to stenting and restenosis were 5.6% and 7.8%. Endovascular stenting for the treatment of intracranial VBA can reduce the risk of arterial dissection and restenosis.
Abstract: The sensitivities and specificities of three-dimensional time-of-flight MR angiography (3D-TOF MRA) and 3D digital subtraction angiography (3D-DSA) were compared for evaluation of cerebral aneurysms after endosaccular packing with Guglielmi detachable coils (GDCs). Thirty-three patients with 33 aneurysms were included in this prospective study. 3D-TOF MRA and 3D-DSA were performed in the same week on all patients. Maximal intensity projection (MIP) and 3D reconstructed MRA images were compared with 3D-DSA images. The diameters of residual/recurrent aneurysms detected on 3D-DSA were calculated on a workstation. In 3 (9%) of 33 aneurysms, 3D-TOF MRA did not provide reliable information due to significant susceptibility artifacts on MRA. The sensitivity and specificity rates of MRA were 72.7 and 90.9%, respectively, for the diagnosis of residual/recurrent aneurysm. The diameters of residual/recurrent aneurysms that could not be detected by MRA were significantly smaller than those of detected aneurysms (mean 1.1 vs mean 2.3 mm). In one aneurysm of the anterior communicating artery (ACoA), the relationship between the residual aneurysm and the ACoA was more evident on MRA than DSA images. MRA can detect the recurrent/residual lumen of aneurysms treated with GDCs of up to at least 1.8 mm in diameter. 3D-TOF MRA is useful for follow-up of intracranial aneurysms treated with GDCs, and could partly replace DSA.
Abstract: This study describes the imaging features of the intrahepatic portohepatic venous (PHV) shunt, which is a potential cause of portosystemic encephalopathy in Rendu-Osler-Weber disease. Six patients with Rendu-Osler-Weber disease (two men, four women; age range 42-73 years) were retrospectively studied. There were two from one family and three from another family. Of these patients, one was diagnosed with definitive portosystemic encephalopathy because of a psychiatric disorder. We retrospectively reviewed the radiological examinations, including abdominal angiography (n=6), three-phase dynamic helical computed tomography (CT; n=3), and conventional enhanced CT (n=1). In one patient, CT during angiography and CT angioportography were also performed. Evaluation was placed on the imaging features of intrahepatic PHV shunts. On angiography, intrahepatic PHV shunts showing multiple and small shunts <5 mm in diameter in an apparent network were detected in all patents. In two patients, a large shunt with a size of either 7 or 10 mm was associated. These intrahepatic PHV shunts were predominantly distributed in the peripheral parenchyma. Intrahepatic PHV shunts would be characterized by small and multiple shunts in an apparent network on the periphery with or without a large shunt.
Abstract: BACKGROUND: The treatment of patients with advanced hepatic hilar duct carcinoma is a challenging problem. The current study was performed to evaluate the outcome of patients with advanced hepatic hilar duct carcinoma who received external beam radiotherapy (EBRT) combined with transarterial chemotherapy and infusion of a vasoconstrictor. METHODS: Between April 1993 and December 2002, 23 patients with histopathologically confirmed hilar duct carcinoma entered the study. The median total dose of EBRT was 41.4 grays (Gy). Transarterial chemotherapy was performed twice during EBRT. It was comprised of an infusion of a cocktail of 20 mg of epirubicin, 10 mg of mitomycin C, and 500 mg of 5-fluorouracil and was administered 1 minute after injection of epinephrine via a catheter introduced in the hepatic arteries. After the combined treatment, the patients underwent biliary endoprosthesis after evaluation of the initial response to treatment by percutaneous transhepatic cholangiography (PTC). The initial responses based on PTC were classified into four categories: CR, no stenosis; PR, relief of stenosis/obstruction; NC, no change; and PD, progressive stenosis/obstruction. The outcome parameters were survival rates and time, as well as frequency and type of complications. RESULTS: Excluding 1 patient who discontinued the treatment, the initial responses of 22 patients were 1 CR (5%), 8 PR (36%), 11 NC (50%), and 2 PD (9%). The response rate was 41%. The overall survival rates at 1 year, 2 years, and 3 years after treatment were 59%, 36%, and 18%, respectively. CONCLUSIONS: The combination of radiotherapy, transarterial infusion chemotherapy, and concurrent infusion of a vasoconstrictor can be delivered safely with good efficacy for patients with advanced hilar duct carcinoma.
Abstract: The aim of this study was to evaluate CT and MRI findings in xanthogranulomatous cholecystitis (XGC) and to correlate the imaging findings with various pathologic parameters. The study included 13 patients with histopathologically confirmed XGC. The CT ( n=13) and MRI ( n=5) obtained in these patients were evaluated retrospectively. On CT, low-attenuation areas in the wall of XGC correlated with foam and inflammatory cells or necrosis and/or abscess in XGC. Areas of iso- to slightly high signal intensity on T2-weighted images, showing slight enhancement at early phase and strong enhancement at last phase on dynamic study, corresponded with areas of abundant xanthogranulomas. Areas with very high signal intensity on T2-weighted images without enhancement corresponded with necrosis and/or abscesses. Luminal surface enhancement (LSE) of gallbladder wall represented preservation of the epithelial layer. The early-enhanced areas of the liver bed on dynamic CT and MR images corresponded with accumulation of inflammatory cells and abundant fibrosis. Our results indicate that CT and MRI findings correlate well with the histopathologic findings of XGC.
Abstract: Intracranial dural arteriovenous fistulas (AVFs) can occur anywhere within the dura mater. Patients may be clinically asymptomatic or may experience symptoms ranging from mild symptoms to fatal hemorrhage, depending on the location (eg, cavernous sinus, transverse-sigmoid sinus, tentorium, superior sagittal sinus, anterior fossa) and venous drainage pattern of the AVF. In the past, dural AVFs have been treated with a variety of approaches, including surgical resection, venous clipping, transcatheter embolization, radiation therapy, or a combination of these treatments. Recent developments in catheter intervention now allow most patients to be cured with transcatheter embolization, although stereotactic radiation therapy is demonstrating good results in an increasing number of cases and surgery is still the preferred option in some cases. Familiarity with drainage patterns, the risk of aggressive symptoms, recent technical advances, and current treatment strategies is essential for the treatment of intracranial dural AVFs.
Abstract: The authors have developed a novel "turn-back" technique with use of a shaped microcatheter for superselective catheterization of arteries originating at acute angles. Herein this technique is described in clinical use for superselective catheterization of several arteries including the middle hepatic artery, right gastric artery, right inferior phrenic artery, and tracheal artery in six patients after failed catheterization by conventional techniques as a result of difficult geometry of the arteries. Superselective catheterization and intervention were successfully performed without complication in all cases. This turn-back technique is useful for superselective catheterization of arteries originating at acute angles.
Abstract: PURPOSE: The purpose of this study was to evaluate the usefulness of a new mechanical detachable coil system (Detach-18/-11) for percutaneous transvenous embolization (TVE) of dural arteriovenous fistulas (AVFs) involving the cavernous sinus. MATERIALS AND METHODS: Five patients with dural AVF involving the cavernous sinus were treated by TVE with the use of the Detach-18/-11 system alone. All procedures were analyzed with regard to the processes of introduction, delivery, and/or retrieval of the Detach-18/-11 system, and angiographical and clinical outcome. RESULTS: A total of 70 detachable coils (37 spiral-type coils and 33 J-type coils) were used. Two coils were easily retrieved after introduction. The remaining 68 coils were easily delivered within 30 seconds. Neither premature detachment nor coil migration was observed. Of the five dural AVFs, three were completely occluded and two were nearly completely occluded immediately after embolization. Follow-up angiography showed complete occlusion in all cases. Clinical symptoms had disappeared within one month, and no recurrent symptoms were observed during follow-up (from 5 to 36 months). CONCLUSION: Our results support the safety and reliability of the Detach-18/-11 system for TVE of dural AVF. The availability of various types of this coil system allows sufficient packing of the involved sinus.
Abstract: We report a rare complication following parent-artery occlusion in a patient with radiation-induced carotid pseudoaneurysms. Both the right internal carotid artery pseudoaneurysm and the recurrent external carotid artery pseudoaneurysm were treated by parent-artery occlusion with coils. Although rebleeding was not observed after the second embolization, angiography and endoscopy at the 12-month follow-up showed dispersion and migration of coils into the pharynx and the external auditory canal due to progressive radiation necrosis.
Abstract: A ruptured blisterlike aneurysm of the supraclinoid ICA rarely occurs. Nevertheless, it is recognized as a dangerous lesion because of the high risk of intraoperative bleeding associated with this lesion's wide fragile neck. There has been only one report of a blisterlike aneurysm treated by endosaccular packing after surgical wrapping. The authors describe the case of a ruptured blisterlike aneurysm with a pseudoaneurysm cavity, which was treated by coil embolization. This 63-year-old woman suffered a subarachnoid hemorrhage (SAH). Three cerebral aneurysms were identified on cerebral angiograms. A large saccular aneurysm at the ophthalmic portion of the right ICA was embolized with Guglielmi Detachable Coils (GDCs). Two small hemipherically shaped aneurysms on the C-2 and C-3 portions of the left ICA were observed conservatively. Thirteen days later, recurrent SAH was identified on computerized tomography scans. Angiography demonstrated the formation of a pseudoaneurysm from the aneurysm on the C-2 portion of the left ICA. Endosaccular embolization with GDCs was performed 40 days after admission. Disappearance of the pseudoaneurysm cavity and residual dome filling was seen immediately after the procedure. Follow-up angiography performed 9 months after embolization demonstrated complete obliteration of the aneurysm. This case illustrates that when treatment options for a blisterlike aneurysm with a pseudoaneurysm are unsuitable during the acute phase, coil embolization can be applied following progression of the lesion into a saccular aneurysm during the chronic stage.
Abstract: OBJECTIVE: Recurrent hepatocellular carcinoma (HCC) often occurs with extrahepatic arterial supply (parasitic supply), essentially due to liver intraarterial chemoembolization, which could potentially hamper retreatment. The right inferior phrenic artery (RIPA) is the most frequent extrahepatic feeding artery. We investigated computed tomography (CT) findings of parasitic supply by the RIPA, and discuss the utility of multiphasic CT for prediction of parasitic supply from RIPA. METHOD: Medical records, CT scans, and angiograms in 20 patients with HCC fed by RIPA were reviewed. Forty-two patients with HCC but without parasitic supply were enrolled as the control group. After injection of contrast medium (300 mg I/mL) at a rate of 3 mL/s (total amount, 100 mL), CT images were obtained at 30 seconds, 60 seconds, and 150 seconds with scanning parameters of 7-mm collimation, 1:1 pitch, and 3.5-mm reconstruction. Two radiologists evaluated the previous treatment, patency of the hepatic arteries, location of tumors, and detectability and diameter of the RIPA. RESULTS: CT demonstrated at least one portion of RIPA in all patients in both groups. The distal portions of RIPA were detected on CT more frequently in the parasitic group (75%) than in the control group (7.1%). The mean diameter of the RIPA in the parasitic group was 2.3 mm (range; 1.6-3.8), and was larger than that of the control group (mean; 1.3 mm and range; 0-4.1mm) with statistical significance (P < 0.01). CONCLUSIONS: Multiphasic CT could demonstrate the presence of parasitic supply to HCCs from RIPA. Visualization of RIPA at the distal portion on CT would be a clue of parasitic supply from RIPA.
Abstract: We report four cases of mucin-producing carcinoma of the gallbladder (three papillary adenocarcinomas and one mucinous carcinoma), with an emphasis on imaging features. Our findings suggest that when a papillary protrusion or thickened wall, including cystic areas and/or calcifications, is seen radiologically in the enlarged gallbladder, mucin-producing carcinoma of the gallbladder should be included in the differential diagnosis.
Abstract: OBJECTIVE: Intrahepatic portosystemic venous shunt is relatively rare and not well recognized. Awareness of intrahepatic communications is important because they can cause encephalopathy, and most of these shunts can be completely cured by transcatheter embolization. In this study, we describe the angiographic findings and transcatheter embolization techniques using several approaches for the treatment of intrahepatic portosystemic venous shunt. MATERIALS AND METHODS: Between 1989 and 2001, we treated 10 patients with symptomatic intrahepatic portosystemic venous shunt by performing transcatheter embolization with Gianturco coils, fibered platinum coils, detachable balloons, and detachable microcoils using one of three approaches to access the portal venous system: transileocolic obliteration (n = 2), percutaneous transhepatic obliteration (n = 4), or retrograde transcaval obliteration (n = 4). RESULTS: In all patients, complete obliteration or nearly complete obliteration was confirmed angiographically, and symptoms related to portal-systemic encephalopathy improved after treatment. Complications were observed in three patients: adhesive ileus in a patient treated by transileocolic obliteration and thrombosis of intrahepatic portal branches in two patients treated by percutaneous transhepatic obliteration. CONCLUSION: On angiography, two types of intrahepatic portosystemic venous shunt were seen: intrahepatic portal venous-hepatic venous communication and intrahepatic portal venous-perihepatic venous communication. Transcatheter embolization is effective for treatment of intrahepatic portosystemic venous shunt. Retrograde transcaval obliteration is the least invasive technique and is recommended as the first choice for treatment of portosystemic venous shunt except in patients with multiple shunts.
Abstract: Since its introduction in the mid-1990s, balloon-occluded retrograde transvenous obliteration (BRTO) has become widely accepted in Japan as a minimally invasive, highly effective treatment for gastric varices. Sufficient filling and stagnation of the sclerosing agent in the entire variceal complex is essential for successful BRTO of gastric varices. However, the success of BRTO in this context also requires familiarity with the hemodynamic features of the varices, including the patterns of their afferent and draining veins, which affect the degree of difficulty in performing BRTO. Thus, accurate assessment of the hemodynamic pattern before and during each procedure is essential for successful treatment. Sixty cases of gastric varices that were successfully treated with transcatheter techniques over the past 5 years were reviewed and analyzed. From this study, a classification system for gastric varices was developed that is based on the hemodynamic pattern of the varices.
Abstract: Most parotid tumors grow slowly, whether benign or malignant; thus, it is difficult to predict the malignant or benign nature of a tumor clinically. Magnetic resonance imaging may have a place in the diagnostic work-up of parotid tumors. The purpose of this article is to illustrate the MR imaging findings of parotid tumors and to correlate them to pathologic findings. The MR imaging may be helpful in differentiation of benign and malignant tumors of the parotid gland, and can provide important clues in the diagnosis of their histologies.
Abstract: Balloon-occluded retrograde transvenous obliteration (BRTO) has become the treatment of choice for gastric varices at many institutions in Japan. However, in some cases that involve complex types of afferent or draining veins, the use of standard BRTO for the treatment of gastric varices may be associated with several difficulties that can lead to unfavorable results. In such cases, additional techniques are required for successful treatment. These techniques include stepwise injection of the sclerosing agent, selective injection of the agent via a microcatheter, coil embolization of the afferent gastric veins, double-balloon catheterization, and BRTO performed with percutaneous transhepatic portal venous access or transileocolic venous access. The majority of gastric varices can be treated successfully with a combination of these techniques. However, accurate assessment of the variceal hemodynamic pattern is the most important factor in ensuring successful treatment.
Abstract: OBJECTIVE: Detection of a small residual lumen after coil embolization is often difficult because of the coil mass and the overlap of the cerebral arteries. The purpose of this study was to assess the usefulness of virtual endoscopic (VE) analysis of three-dimensional digital subtraction angiographic (DSA) images for evaluation of aneurysmal occlusion immediately after the procedure. METHODS: Twenty-seven intracranial aneurysms were treated with coil embolization using a three-dimensional DSA system. Biplane and rotational DSA scanning was performed before and immediately after the procedures. VE images were obtained at a separate workstation, after transfer of the rotational images. Two-dimensional (2D) DSA images and VE images obtained after the procedure were assessed with respect to aneurysmal occlusion. Morphological outcomes and other factors, including location, size, volumetric ratio (coil volume/aneurysm volume), and residual sites, were also evaluated. RESULTS: Seven aneurysms were evaluated as complete occlusion (CO) on both 2D DSA images and VE images. Twelve aneurysms exhibited residual lumina on both 2D DSA images and VE images. Five aneurysms were evaluated as CO on 2D DSA images and as incomplete occlusion on VE images. There were no recurrences among the aneurysms that were evaluated as CO on VE images. Two of five aneurysms that were evaluated as CO on 2D DSA images and as incomplete occlusion on VE images demonstrated regrowth in follow-up examinations. Residual sites and volumetric ratios were correlated with aneurysmal regrowth. CONCLUSION: VE imaging can demonstrate a residual lumen more frequently than can 2D DSA imaging and is useful for evaluating aneurysmal occlusion after coil embolization.
Abstract: A patient with subdural hematoma associated with multiple mycotic intracranial aneurysms is reported. A 22-year-old woman presented with headache and disturbance of consciousness. A CT showed subdural hematoma at the tentrium and the left cerebral convexity. Conservative treatment and was used and she was discharged 10 days later. However, follow-up CT demonstrated a parenchymal hematoma in the right posterior temporal lobe. Cerebral angiography demonstrated a large right posterior cerebral aneurysm and multiple right middle cerebral aneurysms. A cardiac ultrasonography showed a verruca at the mitral valve. The posterior cerebral aneurysms increased in size and one new middle cerebral aneurysm appeared at follow-up angiography one week later. Endovascular treatment with coils was applied for the right posterior cerebral aneurysm, and others were treated with antibiotic therapy under serial observation, using MR angiography. She was discharged without any symptoms two months after embolization. Follow-up angiography at one year after embolization showed disappearance of the aneurysms. The possibility of mycotic aneurysm should be considered in the differential diagnosis of non-traumatic acute subdural hematoma.
Abstract: BACKGROUND AND PURPOSE: Although neuroangiography remains the criterion standard standard for the detection of and surgical/interventional planning for cerebrovascular diseases, it usually requires that patients be confined to bed rest for several hours after angiography to prevent local complications. Decreasing catheter size has reduced the risk of hemorrhagic complications associated with early ambulation after angiography. For this study, we prospectively evaluated the clinical feasibility of a 3.3F catheter/sheath system for selective neuroangiography. METHODS: One hundred seventeen consecutive patients (49 men, 68 women; age range, 18-83 years; mean age, 56.9 years) underwent selective neuroangiography using 3.3F catheters. The exclusion criteria for this study included a subsequent surgical/neurointerventional procedure performed within 18 hours and necessity of arch aortography, which is routinely performed for the first examination of patients with ischemic cerebrovascular diseases. The procedure was evaluated prospectively in terms of success rate, compression time of the arterial puncture site, and periprocedural complications. RESULTS: Selective catheterization of the intended arteries was performed in 99% of the carotid arteries and 97.4% of the vertebral arteries. No neurologic complications or local hemorrhagic complications were observed. Manual compression time after the procedure ranged from 3 to 7 minutes (mean, 3.7 minutes), and patient bed rest after the procedure ranged from 2 to 3 hours (mean, 2.04 hours). CONCLUSION: Selective neuroangiography with a 3.3F catheter/sheath system is feasible and enables early ambulation in selected patients.
Abstract: Two cases of a second dural arteriovenous fistula (DAVF), both developing in different locations after selective transvenous embolization of the first DAVF, are presented. One recurrent DAVF developed on the sigmoid sinus 5 months after transvenous embolization of a DAVF in the paratransverse sinus channel, and the other recurrence developed around the jugular bulb 5 months after transvenous embolization of a cavernous DAVF. The former was obliterated by a second embolization, and the latter disappeared spontaneously at 20 months.
Abstract: BACKGROUND AND PURPOSE: We investigated the sensitivity of 3D-time-of flight (3D-TOF) magnetic resonance angiography (MRA) in the detection of cerebral aneurysms with the use of 3D digital subtraction angiography as the gold standard. We also evaluated the effects of location and number of aneurysms (and experience of the reader) on the sensitivity. METHODS: 3D-TOF MRA was performed in 82 patients with 133 cerebral aneurysms. Each patient underwent rotational angiography. Three-dimensional reconstructed images were obtained from data of the rotational angiography (as the gold standard). A blind study with 4 readers of different experiences was performed to evaluate the diagnostic accuracy of 3D-TOF MRA for cerebral aneurysms. RESULTS: One hundred five (79%) of all 133 aneurysms were detected with MRA by a neuroradiologist, 100 (75%) were detected by an experienced neurosurgeon, 84 (63%) were detected by a general radiologist, and 80 (60%) were detected by a resident neuroradiologist. For each reader, the detectability was lower for small aneurysms (<3 mm in maximum diameter) and/or for those located at the internal carotid artery and anterior cerebral artery. False-positive aneurysms were 29 for the neuroradiologist, 19 for the neurosurgeon, 31 for the general radiologist, and 30 for the resident neuroradiologist; most of the aneurysms were at the internal carotid artery. Causes of the false-positive and false-negative results included complex flow in a tortuous artery and susceptibility artifacts. CONCLUSIONS: Although MRA is useful in the diagnosis of cerebral aneurysms, sufficient experience and careful attention are necessary for accurate diagnosis of aneurysms located at the internal carotid and anterior cerebral arteries.
Abstract: Desmoplastic fibroblastoma (collagenous fibroma) developing as a slowly enlarging lower abdominal mass is described. The lesion had inhomogeneous low signal intensity (SI) on T1-weighted images, and mixed SI as low SI within high SI on T2-weighted images. On post-contrast T1-weighted images, the mass showed inhomogeneous enhancement. Histologically, the areas showing low SI on both post-contrast T1- and T2-weighted images consisted of dense collagenous components and reduced cellularity compared with the areas showing high SI on them.
Abstract: BACKGROUND AND PURPOSE: Complete occlusion of intracranial aneurysms is the goal of endovascular treatment and is influenced by several aneurysm-related anatomic factors. The anatomic features of aneurysms can be characterized by three-dimensional reconstructed images by use of rotational digital subtraction angiography (3D-DSA). The purpose of this study was to determine the anatomic factors that could help predict complete endosaccular packing of cerebral aneurysms by use of 3D-DSA and to design a simple scoring system to predict the difficulty of achieving complete occlusion of the aneurysm. METHODS: Forty-seven patients with 47 intracranial berry (<12 mm) aneurysms underwent 3D-DSA. Aneurysms were subsequently treated by endosaccular packing with coils. The following aneurysm-related anatomic parameters were measured on 3D-DSA images: largest diameter, neck size, dome-to-neck ratio, shape, and relationship to the neighboring artery. The relationship between each parameter and the rate of successful treatment was determined, and a score used to rate difficulty of attaining occlusion (ie, difficulty score) was developed on the basis of the identified predictors of successful treatment. Subsequently, we assessed the correlation between the score and the rate of successful occlusion. RESULTS: Four anatomic parameters correlated significantly with the rate of successful occlusion: neck size (P =.014), shape (P=.042), dome-to-neck ratio (P <.01), and relationship to neighboring artery (P=.025). The difficulty score based on two parameters (dome-to-neck ratio and relationship to neighboring artery) significantly correlated with the occlusion rate (r = 0.63, P <.01). CONCLUSION: In this population, the difficulty score based on 3D-DSA findings provides useful information for prediction of successful endovascular treatment for intracranial aneurysms.
Abstract: In the embryonic period, several developmental anomalies of the cerebral arteries occur. The knowledge of these anatomic variations of the cerebral artery is important to avoid the unnecessary surgery and to undergo surgery or interventional radiology with safety. We reviewed 3000 MR angiographies and 700 cerebral angiographies of the previous 5 years to assess cerebral arterial system, and to illustrate the embryological development, imaging findings, occurrence, and clinical significance of the anatomic variation of the cerebral arteries. The normal development and variations of the cerebral arteries are depicted. Knowledge of the anatomic variations is important since it can influence surgical and interventional procedure.
Abstract: The purpose of this study was to assess the CT findings and significance of hormone determination in the peripheral blood of asymptomatic patients with pheochromocytoma and paraganglioma. CT findings in 29 patients with surgically proven pheochromocytoma(n = 19) and paraganglioma(n = 10) were reviewed. Nine patients(31%) were symptomatic and 20 (69%) were asymptomatic. Tumor size ranged from 39 mm to 114 mm(mean: 60 mm) in symptomatic patients and 11 mm to 100 mm(mean: 50 mm) in asymptomatic ones. Of the 9 symptomatic patients and 18 asymptomatic patients, a homogeneous solid pattern was seen in 4 and 4, mixed pattern in 2 and 6, and massive necrotic pattern in 3 and 8 patients, respectively, on CT scans. The CT attenuation values in symptomatic cases ranged from 30 HU to 50 HU(mean: 41 HU) on precontrast CT scans and 60 HU to 111 HU(mean: 77 HU) on postcontrast CT scans, while those in asymptomatic cases ranged from 15 HU to 48 HU(mean: 33 HU) on precontrast CT scans and 66 HU to 133 HU(mean: 95 HU) on postcontrast CT scans. There were no statistically significant differences in tumor size, homogeneity, or CT attenuation values between symptomatic and asymptomatic patients. All symptomatic patients and 17(89%) of 19 asymptomatic cases showed elevated levels of catecholamine (epinephrine) or norepinephrine in the peripheral blood. Our study showed that the CT findings in asymptomatic patients were similar to those in symptomatic patients, and 89% of asymptomatic patients showed elevation of catecholamine in the peripheral blood. Determination of catecholamine level in the peripheral blood is recommended for preoperative diagnosis in patients suspected of having asymptomatic pheochromocytoma or paraganglioma on CT scans.
Abstract: The hypoglossal canals are an unusual location for dural arteriovenous fistulas (AVFs) to appear. One previous report of dural AVFs involving the hypoglossal canal has been published. In the present paper, the authors describe a dural AVF within the hypoglossal canal, which presented with ocular symptoms and was successfully treated by selective transvenous embolization. Magnetic resonance imaging and contralateral carotid arteriography were useful for determination of the exact location of the fistulous pouch, which was later packed with coils. Selective transvenous coil embolization with careful assessment of the location and pattern of the venous drainage of the dural AVF is a safe and effective treatment.
Abstract: The aim of this study was to evaluate the usefulness of technetium-99m (Tc-99m) pertechnetate scintigraphy with lemon juice stimulation in the diagnosis of Warthin's tumor and its correlation with Tc-99m uptake, tumor size, and histologic subtype. Tc-99m pertechnetate scintigraphy before and after lemon juice stimulation and pathologic specimens of 34 Warthin's tumors and 47 non-Warthin's lesions were retrospectively evaluated. Tc-99m uptake of Warthin's tumors before and after stimulation was visually graded as follows: absent; indeterminate; low grade; definite; and strong. Tumor size was defined as maximum diameter of the tumor measured from the surgical specimen. Warthin's tumors were classified into three histologic subtypes according to the ratio of epithelial and lymphoid stromal components: predominant epithelial; intermediate; and low-grade epithelial types. Eighteen of 34 (53%) Warthin's tumors and one benign lymphoepithelial cyst showed higher uptake than that of the normal parotid gland on Tc-99m scintigraphy before lemon juice stimulation. Thirty-two of the 34 (94%) Warthin's tumors, one benign lymphoepithelial cyst, one pleomorphic adenoma, and one oncocytoma revealed higher uptake than that of the normal parotid gland on Tc-99m scintigraphy after lemon juice stimulation. The mean size was 37 mm in strong uptake Warthin's tumors, 24 mm in definite uptake tumors, 19 mm in low-grade uptake tumors, and 12 mm in low-grade uptake tumors excluding those tumors with large cystic component. There was a significant correlation between tumor size and degree of Tc-99m uptake after lemon juice stimulation. However, there was no correlation between histologic subtype and Tc-99m uptake, and histologic subtype and tumor size in Warthin's tumors. Our study concludes that Tc-99m pertechnetate scintigraphy with lemon juice stimulation is useful for the detection and diagnosis of Warthin's tumor. The degree of uptake in Warthin's tumor on Tc-99m scintigraphy with lemon juice stimulation depends mainly on tumor size and the presence of large cystic component in it.
Abstract: The root of the small-bowel mesentery (SBM) is an important peritoneal fold that is contiguous to other peritoneal ligaments and mesocolons. Several pathologic conditions can occur in the SBM itself, and diseases that spread through the connections from adjacent organs frequently involve it. The root of the SBM is contiguous to the hepatoduodenal ligament around the superior mesenteric vein (SMV) and contiguous to the right side of the transverse mesocolon around the gastrocolic trunk. The inferior mesenteric vein, which is a landmark of the descending mesocolon, runs along the left side of the root of the SBM. Malignant neoplasms can spread to the SBM by means of direct extension, extension along the neural plexus, extension along neighboring ligaments, or extension along lymphatic vessels. Inflammatory conditions such as pancreatitis and perforation of a jejunal diverticulum can also spread to the SBM. Anomalies that can occur in the SBM include rotation anomalies and internal hernia. Vascular lesions of the SBM include thrombosis of the superior mesenteric artery (SMA), acute SMV thrombosis, SMA dissection, arterioportal fistula, and portal venous gas. Other pathologic conditions that can occur in the SBM are edema or congestion, mesenteric tear, mesenteric panniculitis, and tumors or tumorlike lesions.
Abstract: OBJECTIVE: The purpose of this study was to evaluate and clarify the clinical significance of CT scans of the inferior peripancreatic veins. MATERIALS AND METHODS: Forty-three patients with suspected pancreatic disease underwent three-phase helical CT (collimation, 5 mm; reconstruction, 2.5 mm; scan delay, 30, 60, and 150 sec). The frequency of visualization on CT of the anterior and posterior inferior pancreaticoduodenal veins, inferior pancreaticoduodenal vein, and first jejunal trunk was assessed and correlated with angiographic and pathologic findings. RESULTS: The frequency of visualization of normal inferior peripancreatic veins in patients (n = 22) with a normal portomesenteric vein was 36% for the anteroinferior pancreaticoduodenal vein, 36% for the posteroinferior pancreaticoduodenal vein, 59% for the inferior pancreaticoduodenal vein, and 100% for the first jejunal trunk. The smaller inferior peripancreatic veins were frequently not visualized when normal. In patients (n = 13) with pancreatic carcinoma involving the portosuperior mesenteric vein, all of the inferior peripancreatic veins were dilated and easily recognizable. When the tumor did not involve the portosuperior mesenteric vein but did involve the anteroinferior pancreaticoduodenal, posteroinferior pancreaticoduodenal, and inferior pancreaticoduodenal veins (n = 8), some of the other peripancreatic veins (first jejunal trunk, anterior and posterior superior pancreaticoduodenal veins, and gastrocolic trunk) were dilated. Dilatation indicated tumor extension to the third portion of the duodenum. In patients (n = 7) with involvement of the inferior pancreaticoduodenal vein, the first jejunal trunk, or both without the involvement of the portosuperior mesenteric vein, dilatation of the other peripancreatic veins (anteroinferior pancreaticoduodenal vein, posteroinferior pancreaticoduodenal vein, anterosuperior pancreaticoduodenal vein, posterosuperior pancreaticoduodenal vein, and gastrocolic trunk) indicated tumor invasion of only the second portion of the extrapancreatic nerve plexus (n = 4) and tumor invasion of both the second portion of the extrapancreatic nerve and the mesenteric root (n = 3). CONCLUSION: Dilatation of peripancreatic veins with nonvisualization of inferior peripancreatic veins suggests tumor invasion of peripancreatic tissue.
Abstract: This study illustrates the local spread of lower bile duct cancer with thin-section helical CT in correlation with the surgical and pathological findings. Pathologically, 16 patients had pancreatic invasion, 4 had small bowel mesentery invasion, 7 had extrapancreatic nerve plexus invasion, and 3 patients had vascular invasion. On thin-section helical CT, pancreatic invasion was correlated to the clarity or non-clarity of the bile duct mass-pancreas border and the presence of an intrapancreatic mass. Cases with small bowel mesentery and extrapancreatic nerve plexus invasion showed mass or stranding around the superior mesenteric artery and/or inferior pancreatoduodenal artery. Vascular invasion was seen as tumor contiguity to these vessels.
Abstract: We report a rare case of congenital extrahepatic portocaval shunt diagnosed during evaluation of hyperplastic nodules in the liver. Diagnostic imagings showed hypoplasia of the intrahepatic portal venous system and splanchnic portal venous return to the inferior vena cava through aberrant vessels. Altered hepatic blood flow dynamics due to this shunt may have been implicated in the etiology of the hepatic hyperplastic nodules.
Abstract: OBJECTIVE: To evaluate the diagnostic accuracy of three-dimensional reconstructed images from rotational digital subtraction angiography in the surgical treatment of intracranial aneurysms. METHODS: Twenty-two patients with 34 intracranial aneurysms underwent biplane angiography (40 degrees per s, 4.5 degrees per image, 8.8 frames per s). Three-dimensional (3-D) reconstructed images were obtained at a separate Advantage 3.1 workstation (General Electric, Milwaukee, WI) after the rotational images were transferred. The available visualization techniques included maximum intensity projection, shaded surface display, and virtual endoluminal view. All images were evaluated in correlation with intrasurgical visual data recorded on digital videotapes. RESULTS: 3-D reconstructed images correlated well with surgical findings. The shape of the aneurysms, their neck size, and their relationships to the parent vessels and other branches were depicted clearly, especially compared with images obtained by two-dimensional conventional digital subtraction angiography and magnetic resonance angiography. CONCLUSION: 3-D digital subtraction angiography enables the surgeon to understand the 3-D structure of lesions and is very useful in planning the surgical treatment of cerebral aneurysms.
Abstract: Septic thrombus formation of both the main portal vein and its intrahepatic branches were observed on CT in a patient with peripancreatic abscess. The septic thrombosis of portal vein (STPV) extended from the level of porta hepatis into the intrahepatic branches, but the portal vein and superior mesenteric vein at the level of pancreatic head were preserved with no evidence of thrombosis angiographically. The gas-containing abscess near the head of the pancreas extended toward the hepatic hilum and surrounded the portal vein and its branches on CT. It was concluded that these thrombi of portal vein branches at porta hepatis and intrahepatic branches were caused by extensions of peripancreatic abscess via the hepatoduodenal ligament and ligamentum teres. Computed tomography was useful in depicting the ligamentous spread of peripancreatic abscess resulting in STPV.
Abstract: PURPOSE: To evaluate the usefulness of balloon-occluded retrograde transvenous obliteration (B-RTO) in the treatment of gastric varices. MATERIALS AND METHODS: Twenty-one patients with ruptured or high-risk gastric varices underwent B-RTO. A 5-7F balloon catheter was advanced into the gastrorenal shunt and/or gastrophrenic shunt from the femoral vein. Five percent ethanolamine oleate iopamidol (EOI) was injected via the balloon catheter or a microcatheter that was advanced through the balloon catheter. EOI was withdrawn via the catheter after stagnation for 30-60 minutes. Contrast enhanced CT findings, endoscopic findings, and liver and renal function tests were evaluated before and after B-RTO. RESULTS: Nineteen patients (90%) were successfully treated with B-RTO. In 17 of them, CT within two weeks after B-RTO showed complete thrombosis of the gastric varices, and the varices had disappeared or markedly regressed on endoscopy after 1-3 months. In the other two patients, in whom CT showed partial thrombosis of the varices, the varices regressed minimally. Liver and renal function tests did not show significant changes in 17 of 19 patients (89%). Transient worsening of liver function was seen in one patient in whom a small amount of EOI moved into the splenic vein during balloon occlusion. Acute renal failure occurred in the other patient with the use of 50 ml of EOI. CONCLUSION: B-RTO is an effective therapy for gastric varices. However, careful attention should be paid to the amount of EOI and hemodynamic change caused by shunt occlusion.
Abstract: BACKGROUND: Arteriovenous malformations (AVMs) of the mandible are relatively rare and potentially life-threatening lesions. Treatment is usually difficult. This study presents a case with high-flow AVM of the mandible in which most of the AVM were occluded by transvenous coil embolization. METHODS: Transvenous embolization using several size 57 microcoils and 3 Gianturco coils was performed through a right femoral vein access. The small residual AVM was occluded by superselective transarterial injection of cyanoacrylate. RESULTS: Angiography after embolization showed almost complete obliteration of AVM. Panoramic radiograph 2 years after treatment confirmed reossification. There was no recurrence of the symptoms in a follow-up evaluation 2 years later. CONCLUSION: Transvenous coil embolization may be a safer and more effective method in the treatment of mandibular AVM.
Abstract: Abdominal images were obtained after the intravenous injection of 99mTc-HSA-D in 8 patients with protein-losing gastroenteropathy (PLG). Six neck images and 7 abdominal images were obtained in 11 patients with ischemic heart disease as a control study. We evaluated all the images with respect to visualization, initial appearance time, and movement of abnormal radioactivity. In 7 of 8 patients with PLG, abnormal radioactivity in the intestine appeared from 10 min to 4 hours after injection, and moved 6 hours after injection. In 6 of 7 abdominal images of control cases, slight activity was observed in the alimentary tract 6 hours or 24 hours after injection. The thyroid was not visualized in any of the 6 cases. In conclusion, if radioactivity in the alimentary tract was first observed 6 hours or later after injection, the diagnosis of PLG may be difficult by this method alone. It still may be necessary to perform the alpha 1-antitrypsin test for the correct diagnosis of PLG.
Abstract: We evaluated the antithrombogenicity of 4F-catheters coated with the new antithrombogenic material fluorine-acryl- styrene-urethane-silicone (FASUS) graft-block copolymer by dissecting microscopic and scanning electron microscopic observations. These catheters were temporarily used for the infusa-A-port, which was prepared for the treatment of four patients with bladder cancer. Two heparin-coated catheters were also evaluated. All FASUS-coated catheters contained thrombi consisting of red thrombi and/or fibrin thrombi. Massive red thrombus was seen at the site of curvature of the catheters, 1 cm distal to the tip of the catheter. However, the portion 20 cm distal to the tip of the catheter had no red thrombus, but contained minimal fibrin thrombus or plasma protein. The heparin-coated catheters showed the same findings as the FASUS catheters. The FASUS-coated catheters were not superior in antithrombogenicity to the heparin-coated catheters. It was concluded that the FASUS-coated catheters used in this study seemed to have problems in regard to their preshaped curvature and the material used in catheter. These aspects need to be improved.
Abstract: We report MRI in a patient with portal-systemic encephalopathy, in which the high signal in the basal ganglia on T1-weighted images showed marked resolution after successful embolization of the intrahepatic portal-systemic venous shunt.
Abstract: To evaluate the safety and efficacy of a new 4 French (F) catheter/sheath system with large lumina for selective abdominal arteriography and intervention, the usefulness of the 4F sheath (4F group, 88 patients) was compared with that of a 5.5F sheath and a 7F sheath (5.5F group, 7F group, 156 patients). The compression time of the arterial puncture site and the ambulation time in the 4F group were significantly shorter than those in the 5.5F and 7F groups. The hemorrhagic complication rate in the 4F group (15%) was less than those in the 5.5F group (23%) and 7F group (27%). The severity of hemorrhagic complications in the 4F group (hematoma 2.3%, woozing 14%, and rhexis 0%) was significantly less than in the 5F group (3%, 21%, 0%) and 7F group (11%, 19%, 2.4%). The controlability of the 4F catheter as compared with a 5F catheter was estimated in 35 patients by questionnaire. The torque transmissibility and the endurability of the kink of the 4F catheter were poor in comparison with the 5F catheter. However, with respect to the ability to follow over a guidewire, the 4F catheter showed great advantage over the 5F catheter. It is concluded that the 4F catheter/sheath system is feasible for general use in selective abdominal arteriography and interventions.
Abstract: Little attention has been paid to the ultrasound differentiation of benign abdominal lymphadenopathy from the malignant type. We reviewed 133 ultrasound examinations of 116 patients with lymphadenopathy seen over the upper abdomen and high retroperitoneum to clarify the differences in ultrasound findings of enlarged lymph nodes caused by benign and malignant abdominal diseases. The location, number, internal texture, size, length/thickness ratio of the lymph nodes, and relation with hepatitis virus infection were evaluated. Among 75 patients with benign diseases, 63 patients showed liver dysfunction and 42/65 (65%) showed positive hepatitis C virus antibody (HCV-Ab). Enlarged lymph nodes were seen over the common hepatic artery or hepatoduodenal ligament in 84%. Most patients had fewer than 4 enlarged nodes, and 46 patients had a single enlarged node. The length/thickness ratio of nodules was more than 2.5 in 63%. In 41 patients with malignant diseases, enlarged lymph nodes tended to be more widespread in location, larger in number, and smaller in length/thickness ratio than those of benign diseases. Lymphadenopathy over the common hepatic artery or hepatoduodenal ligament may suggest the presence of chronic active hepatitis, especially relating to HCV infection, even though hepatic sonotexture is normal on ultrasound examination.
Abstract: We have developed an afterloading procedure using Cs needle for tongue carcinoma. Seven patients with T1-2NO squamous cell carcinoma of the oral tongue were treated by this method at the Oita Medical University between 1988 and 1994. This method reduced the radiotherapist's radiation exposure and resulted in good local control in the primary site. We have found no other report of a case treated in this way. We emphasize that cesium therapy using an afterloading procedure is very useful in treating tongue carcinoma.
Abstract: OBJECTIVE: Thymic diseases can arise from remnants of thymic tissues along the path of fetal descent and may simulate thyroid tumors or lymphadenopathy. MATERIALS AND METHODS: We present two patients with a cervical mass arising from the cervical thymus that was caused by incomplete descent of the thymus into the mediastinum. RESULTS: In one patient a cervical mass was surgically confirmed to be a cervical thymoma, which simulated a thyroid cancer on CT and 201Tl-scintigraphy. In another patient, cervical thymic hyperplasia arising from an incompletely descended thymus was surgically confirmed. The isointensity between the cervical mass and an enlarged mediastinal thymus was recognized on MRI. CONCLUSION: If a cervical mass is located in the region of the lower pole of the thyroid or if there is a connection or the same intensity between the cervical mass and the mediastinal thymus on MRI, a diagnosis of a cervical mass of thymic origin should be considered.
Abstract: Two cases of painless subacute thyroiditis were presented in whom fever, fatigue and arthralgia except for thyroidal pain and swelling were complained. Until a intense uptake of the thyroid was found on radiogallium scintigraphy, the examinations of the thyroid had not been done. Laboratory data showed increased erythrocyte sedimentation rate, C-reactive protein and serum alkaline phosphatase, and mild leukocytosis. Skeletal, hepatic and biliary diseases were denied. In patients who have fever, increased erythrocyte sedimentation rate and serum alkaline phosphatase elevation without apparent sources, thyroid function should be evaluated because subacute thyroiditis can be associated with elevation of the serum alkaline phosphatase.
