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Objective: This study aimed to investigate the difference between the extent of centrilobular emphysema (CLE) and paraseptal emphysema (PSE) on follow-up chest CT scans and their relationship to the cross-sectional area (CSA) of small pulmonary vessels., Methods: Sixty-two patients (36 CLE and 26 PSE) who underwent 2 chest CT scans were enrolled in this study. The percentage of low attenuation volume (%LAV) and total CSA of the small pulmonary vessels <5 mm 2 (%CSA < 5) were measured at the 2 time points. Analysis of the initial %CSA < 5 and the change in the %LAV and %CSA < 5 on follow-up imaging was performed., Results: The initial %CSA < 5 was not significantly different between the CLE and the PSE groups (CLE, 0.66 vs. PSE, 0.71; P = 0.78). There was no significant difference in the longitudinal change in the %LAV between the 2 groups (CLE, -0.048% vs. PSE, 0.005%; P = 0.26). The longitudinal change in the %CSA < 5 in patients with PSE significantly decreased compared with those with CLE (CLE, 0.025% vs. PSE, -0.018%; P = 0.02)., Conclusions: The longitudinal change in the %CSA < 5 was significantly different for patients with CLE and PSE, demonstrating an important pathophysiological difference between the subtypes., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

The central venous port has been widely used for patients who require long-term intravenous treatments, and the number of palcement has been increasing. The Japanese Society of Interventional Radiology developed a guideline for central venous port placement and management to provide evidence-based recommendations to support healthcare providers in the decision-making process regarding the central venous port. The guideline consisted of two parts: (i) a comprehensive review of topics including preoperative preparation, techniques for placement or removal, complications, and maintenance methods and (ii) recommendations for the six clinical questions regarding blood vessels for central venous port placement, port implantation site, prophylactic antibiotic therapy, imaging guidance for puncture, disinfectant prior to accessing the central venous port, and the optimal procedure at the end of drug administration via the central venous port, generated on the basis of the rating quality of evidence by systematic review., Competing Interests: Hidefumi Mimura received grants from Terumo Corporation and Toray Medical Co., Ltd. Shunsuke Sugawara received honorarium from Becton, Dickinson and Company (Medicon). Tomoaki Yamanishi received honorarium from Terumo Corporation and Stryker Corporation., (© 2023 Japanese Society of Interventional Radiology.)

We report a case of recurrent internal iliac artery aneurysm previously treated with a combination of stent graft placement and coil embolization in an 85 year-old male patient. The patient was scheduled for the direct puncture embolization of the superior gluteal artery. The patient was placed in a prone position under general anesthesia. An 18G-PTC needle was inserted into the superior gluteal artery under ultrasonographic guidance. A 2.2F microcatheter was inserted through an outer needle and advanced to the aneurysmal sac. Coil embolization was successfully performed without endoleaks. This approach is technically feasible when other treatment options fail or are deemed unsuitable., Competing Interests: Disclosure Statement (COI)All authors have no conflicts of interest that could influence this report., (© 2023 The Editorial Committee of Annals of Vascular Diseases.)

Purpose: This study aimed to investigate the association between the results of pulmonary function tests (PFTs) in patients with chronic obstructive pulmonary disease (COPD) and the size of their diaphragmatic crus (DC) using inspiratory and expiratory CT., Materials and Methods: Thirty-three patients who underwent inspiratory and expiratory CT and PFTs between July and December 2019 were studied retrospectively. The short axis, long axis, and cross-sectional area (CSA) of the bilateral DC were measured, and the percentage change of the DC after expiration (% change of DC) in the size was calculated. The correlation between the results of the PFTs (forced expiratory volume in 1 s [FEV 1 ], FEV 1 /forced vital capacity [FVC], and percent predicted FEV 1 [%FEV 1 ]) and the size and % change of DC was statistically analyzed., Results: Significant correlations were observed between the short axis of the right and left DC at expiration and PFTs (FEV 1 , r = -0.35, -0.48, p = 0.04, .007; FEV 1 /FVC, r = -0.52, -0.65, p = 0.002, < .001; %FEV 1 , r = -0.56, -0.60, p < 0.001, < 0.001; respectively), between the CSA of the right DC at expiration and PFTs (FEV 1 /FVC, r = -0.42, p = 0.01; %FEV 1 , r = -0.41, p = 0.017; respectively), and between the % change of the short axis of the left DC and the CSA of the left DC and PFTs (FEV 1 , r = 0.64, 0.56, p < 0.001, .001; %FEV 1 , r = 0.52, 0.51, p = 0.004, 0.004; respectively). The smaller the short axis of the DC and CSA at expiration and the larger the % change in DC of the CSA, the lower the airflow limitation., Conclusion: There were significant correlations between airflow limitation and the short axis of the bilateral DC at expiration, and the % change in the DC of the CSA. Certain CT measurements of the DC may reflect airflow limitation in patients with COPD., (© 2022. The Author(s).)

Iterative reconstruction (IR) improves image quality compared with filtered back projection (FBP). This study investigated the usefulness of model-based IR (forward-projected model-based iterative reconstruction solution [FIRST]) in comparison with FBP and hybrid IR (adaptive iterative dose reduction three-dimensional processing [AIDR 3D]) in low-dose paranasal CT. Twenty-four patients with paranasal sinusitis who underwent standard-dose CT (120 kV) and low-dose CT (100 kV) scanning before and after medical treatment were enrolled. Standard-dose CT scans were reconstructed with FBP (FBP120), and low-dose CT scans with FBP (FBP100), AIDR 3D, and FIRST. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in three anatomical structures and effective doses were compared using Mann-Whitney U test. Two radiologists independently evaluated the visibility of 16 anatomical structures, overall image quality, and artifacts. Effective doses in lowdose CT were significantly reduced compared with those in standard-dose CT (0.24 vs 0.43 mSv, p<0.001). FIRST achieved significantly higher SNR (p<0.01, respectively) and CNR (p<0.001, respectively) of evaluated structures and significant improvement in overall image quality (p<0.001), artifacts (p<0.001), and visibility related to muscles (p<0.05) compared to FBP120, FBP100, and AIDR 3D. FIRST allowed radiation-dose reduction, while maintaining objective and subjective image quality in low-dose paranasal CT., Competing Interests: No potential conflict of interest relevant to this article was reported.

Purpose: Matching the diameter of the deep inferior epigastric artery (DIEA) and perforating branch (PB) of the internal thoracic artery (ITA) is important for arterial anastomosis during breast reconstruction using the DIEA flap. An anatomic investigation of these arteries was performed using multidetector row computed tomography (MDCT)., Patients and Methods: Contrast-enhanced MDCT data of 50 women (aged 18-90 years) covering the neck to the groin were analyzed. The diameter of the PBs of the ITA at their origins from the first to the sixth intercostal space and of the DIEA 20 mm from the bifurcation of the external iliac artery were measured., Results: The mean diameters of the right and left DIEAs were 1.53 ± 0.263 mm and 1.53 ± 0.306 mm, respectively. The diameter of the PBs in the second and third intercoastal spaces was the same as the diameter of the DIEA, bilaterally., Conclusion: It is suggested that anastomosis of the DIEA with PBs of the ITA in the second and third intercoastal spaces is optimal for DIEA flap grafting. Our results could contribute to making vascular anastomosis easier, thereby reducing the burden on both surgeons and patients., (© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

To investigate the usefulness of texture analysis to discriminate between cervical lymph node (LN) metastasis from cancer of unknown primary (CUP) and cervical LN involvement of malignant lymphoma (ML) on unenhanced computed tomography (CT). Cervical LN metastases in 17 patients with CUP and cervical LN involvement in 17 patients with ML were assessed by 18 F-FDG PET/CT. The texture features were obtained in the total cross-sectional area (CSA) of the targeted LN, following the contour of the largest cervical LN on unenhanced CT. Values for the max standardized uptake value (SUVmax) and the mean SUV value (SUVmean), and 34 texture features were compared using a Mann-Whitney U test. The diagnostic accuracy and area under the curve (AUC) of the combination of the texture features were evaluated by support vector machine (SVM) with nested cross-validation. The SUVmax and SUVmean did not differ significantly between cervical LN metastases from CUP and cervical LN involvement from ML. However, significant differences of 9 texture features of the total CSA were observed ( p = 0.001 - 0.05). The best AUC value of 0.851 for the texture feature of the total CSA were obtained from the correlation in the gray-level co-occurrence matrix features. SVM had the best AUC and diagnostic accuracy of 0.930 and 84.8%. Radiomics analysis appears to be useful for differentiating cervical LN metastasis from CUP and cervical LN involvement of ML on unenhanced CT., Competing Interests: The authors have declared no conflicts of interest.

Purpose: To retrospectively assess the feasibility, safety, and efficacy of artificial carbon dioxide (CO 2 ) pneumothorax for computed tomography (CT) fluoroscopy-guided percutaneous radiofrequency (RF) ablation of hepatocellular carcinoma (HCC)., Materials and Methods: This study included 26 sessions of 24 patients in whom the creation of artificial CO 2 pneumothorax was attempted to avoid the transpulmonary route during CT fluoroscopy-guided percutaneous RF ablation of HCC between April 2011 and December 2017. In these 26 sessions, 29 HCCs (mean tumor diameter: 12 mm, range: 6-22 mm) were treated., Results: Adequate lung displacement after induction of artificial CO 2 pneumothorax was achieved in 23 of the 26 sessions (88.5%). In the remaining three sessions, transpulmonary RF ablation, transthoracic extrapulmonary RF ablation after switching to an artificial pleural effusion procedure, or RF ablation with electrode insertion in the caudal-cranial oblique direction was performed. No major complications were found. Among the 29 treated tumors, one (3.4%) showed local progression, and the other 28 (96.6%) were completely ablated at the last follow-up (mean follow-up period: 39.3 months, range: 7-78 months)., Conclusion: Artificial CO 2 pneumothorax for CT fluoroscopy-guided percutaneous RF ablation appeared to be a feasible, safe, and useful therapeutic option for HCC., (© 2021. Japan Radiological Society.)

Differentiating between nasopharyngeal cancer and nasopharyngeal malignant lymphoma (ML) remains challenging on cross-sectional images. The aim of this study is to investigate the usefulness of texture features on unenhanced CT for differentiating between nasopharyngeal cancer and nasopharyngeal ML. Thirty patients with nasopharyngeal tumors, including 17 nasopharyngeal cancers and 13 nasopharyngeal MLs, were underwent 18 F-FDG PET/CT. All nasopharyngeal cancers and 7 of 13 nasopharyngeal MLs were confirmed by endoscopic biopsy. On unenhanced CT, 34 texture features were analyzed following lesion segmentation in the maximum area of the target lesion. The Mann-Whitney U test and areas under the curve (AUCs) were used for analysis and to compare the maximum standardized uptake values (SUV)max, SUVmean, and 34 texture features. A support vector machine (SVM) was constructed to evaluate the diagnostic accuracy and AUCs of combinations of texture features, with 50 repetitions of 5-fold cross-validation. Differences between the SUVmax and SUVmean for nasopharyngeal cancers and nasopharyngeal MLs were not significant. Significant differences of texture features were seen, as follows: 1 histogram feature ( p = 0.038), 3 gray-level co-occurrence matrix features ( p < 0.05), and 1 neighborhood gray-level different matrix feature (NGLDM) ( p = 0.003). Coarseness in NGLDM provided the highest diagnostic accuracy and largest AUC of 76.7% and 0.82, respectively. SVM evaluation of the combined texture features obtained the highest accuracy of 81.3%, with an AUC of 0.80. Combined texture features can provide useful information for discriminating between nasopharyngeal cancer and nasopharyngeal ML on unenhanced CT., Competing Interests: The authors have declared no conflicts of interest.

Background: Depending on the size and site of the venous malformation (VM), patients with VM often experience pain and swelling. VMs in the head and neck typically have lower pain rates due to complications than VMs in the limbs and trunk. We evaluated the heuristics on VM pain by statistically analyzing data of patients with VM from a multicenter database in Japan., Methods: We collected data on age, sex, pain, lesion site, lesion depth, and lesion size for 2199 clinical cases with common VMs. We created categories for lesion depth and size and excluded multiple lesion cases that overlapped in these categories. Next, we constructed cross-tabulation tables to analyze the factors that contributed to pain. Finally, we evaluated the risk of pain in patients with VM by performing binomial logistic regression analysis based on age, sex, lesion site, lesion depth, and lesion size., Results: For patients with limb and trunk VMs, the most frequent site of pain was the muscle, tendon, and bone, with an incidence of 79%, followed by the skin and subcutis, with an incidence of 43%. For patients with head and neck VMs, the most frequent site of pain was the muscle, tendon, and bone, with an incidence of 28%, followed by the skin and subcutis, with an incidence of 11% (P < .01). For pain incidence by lesion size, pain most frequently occurred in lesions >10 cm (67%), followed by lesions between 5 cm and 10 cm (56%) and lesions <5 cm (29%)., Conclusions: Our study indicated a clear order of factors that contributed to pain: lesion site > lesion depth > lesion size. Age was also an important factor. Infants and children had low pain complication frequencies with limb and trunk VMs. As the patients aged, the pain frequency became higher, reaching 50% at almost 7 years of age., (Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Purpose: We presented a new method of sac embolization using n-butyl-cyanoacrylate (NBCA) with balloon occlusion of the aorta (SEBOA) that can facilitate decreasing flow rate of the involved branches with the goal of type 2 endoleak resolution after endovascular aortic repair (EVAR)., Technique: This technique is demonstrated in six patients who required type 2 endoleak treatment including previous technical failure. A transarterial approach was performed in four patients and transabdominal direct puncture in two. Technical success was defined as complete embolization of both involved branches and sac on postoperative CT. Sacography under balloon occlusion of the aorta demonstrated decreased flow rate of the all involved branches in all patients. SEBOA was performed using 25 or 33% of NBCA diluted with lipiodol. Technical success was obtained in 3 of 6 patients, and one major complication was observed with adhesion of NBCA to the microcatheter resulting in foreign body retention., Conclusion: SEBOA may help solve the difficulty of type 2 endoleak treatment after EVAR as decreased flow rate of the involved branches under balloon occlusion of the aorta was achieved in all patients. However, protocols regarding concentration of NBCA or using other embolic materials are needed to improve the success rate.

Purpose: To evaluate the effect of air, CO 2 and contrast medium-air on the dwell time (DT) stability of sodium tetradecyl sulfate (STS) foam., Materials and Methods: Three types of foam sclerosants (air-foam, CO 2 -foam, contrast-air-foam) were injected eight times into an inclined straight plastic tube (internal diameters 4 mm and 10 mm) filled with a blood substitute. Injections were captured by CCD camera, and images were transferred for digital analysis and calculation of DT., Results: Contrast-air-foam and air-foam in a 4-mm tube showed 5.6-/3.3-fold greater DT compared to CO 2 -foam, respectively (P = 0.001). Contrast-air-foam in a 10-mm tube showed 2.1-fold greater DT compared to CO 2 -foam (P = 0.0167)., Conclusion: A mixture of air and iodinated contrast improves the stability of STS foam compared to mixtures using only air or CO 2 . Further, animal and clinical studies are needed to validate this in vitro result.

A 64-year-old man was scheduled to undergo endovascular aneurysm repair for an abdominal aortic aneurysm (AAA). Since preoperative computed tomography showed an AAA with common iliac artery and internal iliac artery (IIA) aneurysms, IIA embolization was scheduled. Embolization using a coil was supposed to be performed; however, the lateral sacral artery could not be selected. For this reason, IIA embolization using N-butyl-2-cyanoacrylate (NBCA) was undertaken. During embolization, the median sacral artery was unexpectedly embolized through the lateral sacral artery. The patient complained of drop foot just after embolization; he was diagnosed with iatrogenic common peroneal nerve palsy. We have learned that sciatic nerve palsy can occur in cases of embolization with a liquid NBCA-Lipiodol mixture to the lateral or sacral median artery.

The malignant phyllodes tumor is a relatively rare neoplasm and has not previously been a therapeutic target of interventional radiology. Herein, we report a successful case of preoperative chemoembolization of a giant malignant phyllodes tumor. The objective was to achieve sufficient tumor shrinkage before surgery to avoid the requirement for skin grafting after resection. Intra-arterial epirubicin infusion and subsequent embolization with Embosphere Microspheres (BioSphere Medical, Rockland, MA, USA) was undertaken three times over the course of 6 weeks and was well tolerated. The patient underwent surgery without skin grafting. Neither local recurrence nor distant metastasis was observed at 6 months after surgery.

Purpose: To assess cost-effectiveness of sclerotherapy for venous malformations (VMs) to improve patient quality of life (QOL)., Materials and Methods: This prospective study enrolled 28 patients with symptomatic VMs who underwent sclerotherapy. EuroQol-5 Dimension (EQ-5D) and Short-Form 36 (SF-36) Health Survey were used to measure health-related QOL. Questionnaires were collected before and 1, 3, 6, and 12 months after sclerotherapy. Quality-adjusted life years (QALYs) were calculated using EQ-5D score as a measure of health utility. Medical costs obtained from the hospital accounting system and other costs of staff, drugs, materials, and angiographic equipment were calculated for each procedure. Cost-effectiveness was analyzed using incremental cost-effectiveness ratio (ICER) as the medical cost/gain of QALYs., Results: Median EQ-5D scores improved from 0.768 (range, 0.705-1) to 1 (range, 0.768-1) after 6 months (P = .023) and 1 (range, 0.768-1) after 12 months (P = .063). The gain of QALYs at 12 months was 0.043. The mean medical cost was ¥281,228 ($2,337). The pain group (baseline bodily pain scale of SF-36 score < 70) showed greater improvement in median EQ-5D score, from 0.705 (range, 0.661-0.768) to 0.768 (range, 0.705-1) after 6 months (P = .041) and 0.768 (range, 0.768-1) after 12 months (P = .049). ICER at 12 months was ¥6,600,483 ($54,840) in the overall group and decreased to ¥3,998,113 ($33,218) in the pain group, < ¥6,000,000 ($49,850), threshold for acceptance of a public health benefit in Japan, even accounting for 50% increase in costs., Conclusions: Sclerotherapy was cost-effective for improving QOL for symptomatic VMs, especially for patients with moderate to severe pain., (Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: This multicenter phase I/II study evaluated the safety, feasibility, and initial efficacy of radiofrequency ablation (RFA) for small malignant renal tumors., Methods: Thirty-three patients were enrolled in the study. A single session of RFA was performed in patients with a renal tumor of 1-3 cm in greatest diameter, with the exception of lesions adjacent to the renal hilum. The primary endpoint was the safety of renal RFA, and the secondary endpoints were its feasibility and initial efficacy for local control, as well as the incidence and grade of adverse events. Clinical efficacy was evaluated by CT scans within 1 week and at a further 4 weeks after the procedure using the criteria adapted from the Response Evaluation Criteria in Solid Tumors., Results: The RFA procedure was completed in 100% (95% confidence interval [CI] 89-100%) of all 33 patients. There were no severe adverse events (0% [95% CI 0-11%]). Among the 33 patients, a complete response, partial response, progressive disease, and stable disease were seen in 28 (85%), 0 (0%), one (3%), and one (3%) patient(s), respectively, with a tumor response rate of 85% [95% CI 68-95%]). Three patients (9%), including one ineligible patient (3%), were not evaluable. Out of 30 evaluable patients, a complete response was achieved in 28 (93%)., Conclusion: The current multicenter trial revealed that RFA is a safe, feasible, and effective treatment for small malignant renal tumors in patients who are not candidates for surgery.

The aim of the present study was to assess the diagnostic usefulness of Fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the prediction of local recurrence of malignant lung tumors by analyzing the pre-radiofrequency ablation (RFA) maximal standardized uptake value (SUV(max)). We performed a historical cohort study of consecutive malignant lung tumors treated by RFA from January 2007 to May 2008 at Okayama University Hospital. We selected only lung tumors examined by PET/CT within 90 days before RFA and divided them (10 primary and 29 metastatic) into 3 groups according to their tertiles of SUV(max). We calculated recurrence odds ratios in the medium group and the high group compared to the low group using multivariate logistic analysis. After we examined the relationship between SUV(max) and recurrence in a crude model, we adjusted for some factors. Tumors with higher SUV(max) showed higher recurrence odds ratios (medium group; 1.84, high group; 4.14, respectively). The tumor size also increased the recurrence odds ratio (2.67); we thought this was mainly due to selection bias because we excluded tumors less than 10mm in diameter. This study demonstrated the pre-RFA SUV(max) in PET/CT may be a prognostic factor for local recurrence of malignant lung tumors.

The application of radiofrequency ablation for the treatment of lung cancer by our group at Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences began in June 2001, and in the present report, we review our 10-year experience with this treatment modality at Okayama University Hospital. The local efficacy of radiofrequency ablation for the treatment of lung cancer depends on tumor size and the type of electrode used, but not on tumor type. An important factor for the prevention of local failure may be the acquisition of an adequate ablative margin. The combination of embolization and radiation therapy enhances the local efficacy. Local failure may be salvaged by repeating the radiofrequency ablation, particularly in small tumors. Survival rates after radiofrequency ablation are quite promising for patients with clinical stage I non-small cell lung cancer and pulmonary metastasis from colorectal cancer, hepatocellular carcinoma, and renal cell carcinoma. The complications caused by radiofrequency ablation can be treated conservatively in the majority of cases. However, attention should be paid to rare but serious complications. This review shows that radiofrequency ablation is a promising treatment for patients with lung cancer.

Objective: The objective of our study was to retrospectively evaluate the incidence of and the risk factors for pneumothorax and chest tube placement after CT fluoroscopy-guided lung biopsy., Materials and Methods: We analyzed 1,098 CT fluoroscopy-guided lung biopsies conducted with 20-gauge coaxial cutting needles for 1,155 lesions in 1,033 patients. Apart from evaluating the incidence of pneumothorax and chest tube placement, the independent risk factors for pneumothorax and chest tube placement for pneumothorax were determined using multivariate logistic regression analysis., Results: The overall incidence of pneumothorax was 42.3% (464/1,098). Chest tube placement was required for 11.9% (55/464) of pneumothoraces (5.0% [55/1,098] of the total number of procedures). The significant independent risk factors for pneumothorax were no prior pulmonary surgery (p = 0.001), lesions in the lower lobe (p < 0.001), greater lesion depth (p < 0.001), and a needle trajectory angle of < 45 degrees (p = 0.014); those for chest tube placement for pneumothorax were pulmonary emphysema (p < 0.001) and greater lesion depth (p < 0.001)., Conclusion: Pneumothorax frequently occurred and placement of a chest tube was occasionally required for pneumothorax after CT fluoroscopy-guided lung biopsy. To reduce the risk of pneumothorax necessitating chest tube placement, physicians should adopt the shortest needle path to the lesion.

Recent technological development has allowed expanding applications of radiofrequency ablation (RFA) for malignant tumor therapy. We report a case with a spinal metastatic tumor treated with combination of percutaneous vertebroplasty (PVP) that provides pain relief and spinal stabilization and RFA. A 68-year-old male who had undergone resection of left ureteric carcinoma was referred to our hospital with lower back pain due to the fifth lumbar (L5) vertebral metastatic tumor. Conventional radiation therapy was discontinued because of pneumonia. One year later, the patient was admitted again with weakness of the right knee and foot and severe pain of the back and the right lower extremity. Radiographs demonstrated a compressive fracture of the L5 vertebra predominantly on the right side. CT and MRI showed a tumor of the L5 body invading the right pedicle, the intervertebral foramen, and the retroperitoneal space. RFA was performed in the ventral part of the L5 body, and then around the right L5/the first sacral intervertebral foramen. Temperature and time for ablation ranged from 74 degrees C to 95 degrees C and from 11 min. to 30 min., respectively. Next, PVP was performed by the right transpedicular approach. Bone cement was injected into the L5 body and the pedicle by an amount of 3.0 ml in total without technical complications. Postoperatively, visual analogue scale demonstrated decreased pain degree from 10 cm to 5.4 cm. Combined treatment with RFA and PVP is a feasible and promising procedure for spinal metastatic tumors. Further evaluation is necessary to confirm its long-term efficacy.

To clarify the incidence, background, and progress of hepatic infarction following interventional procedures, cases of hepatic infarction following interventional procedures at our department during the last decade were identified by reviewing the clinical records of 1982 abdominal angiography and interventional procedures and records of abdominal CT. Nine episodes (0.5%) in 8 patients were identified as hepatic infarction following an interventional procedure. Five episodes were preceded by embolization of the hepatic or celiac artery at emergency angiography for postoperative bleeding with hemorrhagic shock. Three episodes followed the elected interventional procedure for hepatocellular carcinoma, and the remaining episode occurred after 12 months of chemoinfusion through an indwelling catheter in the hepatic artery and portal vein. Hepatic arterial occlusion in all episodes and portal venous flow abnormality in 5 episodes were observed on angiography. Four patients whose liver function was initially impaired died of hepatic infarction, although the extent of the disease on CT did not appear to be related to the mortality. Multiple risk factors, including arterial insufficiency, were observed in each patient. The incidence of hepatic infarction following interventional procedures in this series was low but sometimes fatal, and occurred most frequently in emergency embolization in hemorrhagic shock.

We performed radiofrequency ablation (RFA) for 14 patients with hepatocellular carcinoma (HCC) between May 2001 and March 2002. The underlying hepatic disease was type C liver cirrhosis in all patients. Seven patients had a solitary lesion, and 7 patients had multiple lesions. RFA was chosen for the primary tumor in 5 cases and for a recurrent tumor in 9 cases. Three cases of well differentiated HCC were included. Transcatheter arterial embolization (TAE) was performed in 10 cases simultaneously. Nine patients received RFA under general anesthesia (open laparotomy: 5 cases, transthoracic: 1 case, CT guided: 2 cases, US guided: 1 case) and 5 patients under local anesthesia (CT guided: 2 cases, US guided: 3 cases). RFA was performed for 12 minutes in each session and the mean number of sessions per patient was 3.2. Excellent ablation was achieved in all cases according CT evaluation, and no additional therapy was needed. No recurrences have been found in any cases so far. RFA for HCC achieved excellent therapeutic effect in combination with other therapies as multimodal therapy.

Purpose: To evaluate use of a short hook wire and suture system for preoperative localization of pulmonary nodular lesions., Materials and Methods: Percutaneous localization of 168 lesions was performed with computed tomographic (CT) guidance in 150 patients. Patients were classified into three groups: a 3-year early-learning experience of treatment of 40 lesions mainly in one institution (group A1), a more recent 4-year experience of treatment of 88 lesions in the same institution (group A2), and the roughly synchronous recent 3-year experience of treatment of 40 lesions in a different hospital (group B)., Results: The hook wire was successfully placed without dislodgment in 146 patients, accounting for 164 (97.6%) of 168 lesions. Group A2 showed a success rate of 100%. There was no difference in patients among the three groups in regard to size of lesions or their distance from the pleural surface. In patients in groups A2 and B, the proportion of nodules with ground-glass opacity and primary lung carcinoma at CT was significantly greater than that in patients in group A1. In 168 placements, nonsymptomatic pneumothorax cases were observed in 54 (32.1%), hemorrhages into the lung were observed in 25 (14.9%), and hemorrhage into the pleural space was observed in one (0.6%). No patient complained of notable pain during or after the procedure, and no serious complication was experienced. Unsuccessful placement was caused by too shallow a puncture with the introducer needle., Conclusion: This system with a flexible suture for preoperative localization has a high success rate., (Copyright RSNA, 2002)