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Because acute small bowel ischemia has a high mortality rate, it requires rapid intervention to avoid unfavorable outcomes. Computed tomography (CT) examination is important for the diagnosis of bowel ischemia. Acute small bowel ischemia can be the result of small bowel obstruction or mesenteric ischemia, including mesenteric arterial occlusion, mesenteric venous thrombosis, and non-occlusive mesenteric ischemia. The clinical significance of each CT finding is unique and depends on the underlying pathophysiology. This review describes the definition and mechanism(s) of bowel ischemia, reviews CT findings suggesting bowel ischemia, details factors involved in the development of small bowel ischemia, and presents CT findings with respect to the different factors based on the underlying pathophysiology. Such knowledge is needed for accurate treatment decisions.

INTRODUCTION We evaluated the safety margin in patients with hepatocellular carcinoma (HCC) in the hepatic dome who underwent computed tomography (CT)- or ultrasound (US)-guided radiofrequency ablation (RFA). MATERIAL AND METHODS Included in this single-center study were 46 patients with 56 HCCs in the hepatic dome undergoing RFA after transarterial chemoembolization from January 2009 to December 2016. Thirty were addressed with CT fluoroscopy and 26 with US guidance. The technical success, safety margin, and local tumor progression (LTP) were evaluated. RESULTS Technical success rate was 100% in the CT-RFA and 84.6% in the US-RFA group (p = .04). The average safety margin was 4.8 mm in the CT-RFA and 3.0 mm in the US-RFA group (p = .01). There was no LTP among the HCCs with a safety margin >3 mm achieved in 73.3% CT-RFA and 42.3% US-RFA group tumors (p = .03). Of the US-RFA group, six required additional RFA. There was no significant inter-group difference in LTP (p = .36). CONCLUSION CT-guided RFA was superior to US-guided RFA with respect to the technical success rate and the acquisition of an appropriate safety margin in patients with HCC in the hepatic dome.

Background Liver cysts are common, with most cases being asymptomatic. In symptomatic cases, the disease is amenable to treatment. However, huge or multiple liver cysts with vascular narrowing and associated systemic symptoms are extremely rare. Furthermore, the performance of a reliable and effective surgery in such cases remains a major problem. Here, we report a case of multiple giant liver cysts with impaired blood flow surgically treated in a hybrid operating room. Case presentation A 73-year-old male presented to a previous doctor with leg edema and dyspnea on exertion; computed tomography revealed that the cause complaint was right lung and heart compression and inferior vena cava (IVC) stenosis due to huge liver cysts in the caudal lobe. The patient was referred to our hospital because of disease recurrence despite percutaneous aspiration of the cyst. Multiple liver cysts were observed in addition to the drained cysts, two of which were located on both sides of the IVC and caused IVC stenosis. We performed open surgery for the liver cysts and used the hybrid operating room for intraoperative IVC angiography and measuring the hepatic vein and portal vein (PV) pressure. We performed unroofing of the hepatic cyst and cauterization of the cyst wall on the hepatic side. Angiography was performed before and after unroofing of the liver cysts, and IVC stenosis release was confirmed. IVC pressure measured at the peripheral side of the stenosis and PV pressures were continuously measured during surgery and were confirmed to have decreased during the opening of the liver cysts. The patient had a good postoperative course and was discharged on the 10th postoperative day. No recurrence was observed 6 months postoperatively. Conclusions Cyst unroofing surgery using angiography in a hybrid operating room is a useful treatment for deep hepatic lesions in that vascular stenosis improvement can be intraoperatively confirmed. Moreover, in cases wherein the cyst compresses the vasculature, intraoperative monitoring of IVC and PV pressures can be used to prove that the liver cyst is hemodynamically involved.

Background Balloon-occluded retrograde transvenous obliteration (B-RTO) is a treatment option for patients with gastric varices (GVs). This study aimed to clarify the clinical significance of portal hypertension estimated by the hepatic venous pressure gradient (HVPG), subsequent exacerbation of esophageal varices (EVs), and prognosis of patients who underwent B-RTO for GVs. Methods Thirty-six patients with GVs treated with B-RTO were enrolled in this study, and their HVPG was measured before (pre-HVPG) and on the day after B-RTO (post-HVPG). After B-RTO, patients were followed-up for median 24.5 (3–140) months. Clinical factors related to EV exacerbation and prognosis after B-RTO were retrospectively analyzed. Results Post-HVPG increased from pre-HVPG in 21 out of 36 patients (58%), and overall post-HVPG was significant higher compared to pre-HVPG (P = 0.009). During the observation period, EV exacerbation was developed in 19 patients (53%), and the cumulative EV exacerbation rates at 1, 3, and 5 years after B-RTO were 27%, 67%, and 73%, respectively. Pre-HVPG was not correlated to EV exacerbation, but elevated post-HVPG of ≥ 13 mmHg (P P P

Purpose: Computed tomography (CT)-guided percutaneous drainage has been used to address pelvic abscesses because it is safe and minimally invasive. However, CT-guided drainage has the limitation that the puncture route should be on the same axial slice. A technique for puncturing in the cranio-caudal direction under CT fluoroscopy is needed. Case report: An 82-year-old man with an abscess due to rectal cancer was scheduled for CT-guided drainage to improve his general condition before radical surgery. Drainage was performed via a perineal approach to localize the drainage tract in the resection area to avoid dissemination of cancer cells. To perform a puncture in the cranio-caudal direction we controlled the needle like a joystick and advanced it under CT fluoroscopy while moving the CT gantry cranially to follow the needle tip throughout the puncture. Our unique technique yielded successful CT-guided puncture in the cranio-caudal direction. Conclusions: Our unique technique overcomes the limitations of CT-guided cranio-caudal puncture and may allow the drainage of abscesses whose treatment was heretofore difficult.

Background Patients with hepatocellular carcinoma (HCC) and macrovascular invasion (MVI) who receive systemic chemotherapy have a poor prognosis. This study aimed to determine if one-shot cisplatin (CDDP) chemotherapy via hepatic arterial infusion (HAI) combined with radiation therapy (RT) prior to systemic chemotherapy could improve the outcomes of these patients. Methods This study consisted of 32 HCC patients with the following eligibility criteria: (i) portal vein invasion 3/4 and/or hepatic vein invasion 2/3; (ii) received one-shot CDDP via HAI; (iii) received RT for MVI, (iv) a Child–Pugh score ≤ 7; and (v) an Eastern Clinical Oncology Group Performance Status score of 0 or 1. To determine the therapeutic effect, we collected information on patient characteristics and took contrast-enhanced computed tomography at the start of the therapy and every 2 to 4 months after the start of therapy. We evaluated the overall response of the tumor and tumor thrombosis according to modified Response Evaluation Criteria in Solid Tumors. We assessed patient data using the Mann–Whitney U and Fisher exact tests and evaluated overall survival and progression-free survival using the log-rank test. Results The overall response rate at the first evaluation performed a median of 1.4 weeks after HAI was 16% for the main intrahepatic tumor and 59% for the MVI. The best responses were the same as those of the first-time responses. The duration of median survival was 8.6 months, and progression-free survival of the main intrahepatic tumor was 3.2 months. Predictive factors for overall survival were the relative tumor volume in the liver and the first therapeutic response of MVI. There were no severe adverse events or radiation-induced hepatic complications. Conclusions One-shot CDDP via HAI and RT were well tolerated and showed immediate and favorable control of MVI. Thus, this combination shows potential as a bridging therapy to systemic chemotherapy.

The overall survival of patients with advanced hepatocellular carcinoma with tumor thrombosis of the main trunk or bilobar branches of the portal vein is extremely poor. Moreover, there is no standard treatment established for the condition. Herein, we present the case of a 65-year-old man who were treated the patient with hepatic arterial infusion chemotherapy, radiation therapy for tumor thrombosis, portal vein stent placement, lenvatinib administration, and renal venous shunt embolization. A complete response was observed according to mRECIST and the patient has been alive for 14 months since treatment initiation with no tumor recurrence.

Hepatic encephalopathy that occurs long after liver transplantation (LT) is an uncommon condition. Here, we describe the successful case of a 65-year-old patient who underwent interventional radiology (IVR) using a transmesenteric approach under minilaparotomy for hepatic encephalopathy because of a portosystemic shunt 11 years after ABO-incompatible living donor LT with splenectomy. Enhanced computed tomography confirmed a huge portosystemic shunt and left gastric vein (LGV)-esophageal-azygos vein, which was not treated during LT. Liver stiffness measurements based on transient elastography did not show severe fibrosis in the liver graft. Since the hyperammonemia could not be managed with conventional medical treatment, balloon-occluded retrograde transvenous obliteration (BRTO) was indicated. However, it was difficult to perform because the drainage vein could not be approached from the inferior vena cava (IVC). Surgical shunt ligation was also difficult because of the history of multiple laparotomies. Although intraperitoneal adhesion was severe, the portosystemic shunt was successfully embolized with metallic coils and a plug by IVR using a transmesenteric approach under minilaparotomy. No complications occurred during the operation. His symptoms improved after the operation. The ammonia level and portal flow by ultrasound also improved. He was discharged 14 days after surgery without any complications.

We evaluated the usefulness of the Amplatzer vascular plug (AVP) for preoperative embolization before distal pancreatectomy with en bloc celiac axis resection (DP-CAR). Between April 2010 and September 2017, 19 patients with locally advanced pancreatic body cancer underwent preoperative embolization of the common hepatic and the left gastric artery (CHA, LGA) with AVP or coils. We compared the embolization success rate, embolization-related complications, the time required for preoperative embolization before DP-CAR and the procedure costs in patients whose CHA was AVP- (n = 7) or coil (n = 12) embolized. The success rate for preoperative AVP and coil embolization was 100% and 83.3%, respectively. The median procedure time was shorter in patients whose CHA was embolized with AVP than coils; the difference was not significant (p = 0.045). The total cost was significantly lower for AVP than coil embolization (p = 0.01). The AVP is useful for the preoperative embolization of the CHA before DP-CAR.

Aim This study aimed to retrospectively determine the feasibility and safety of computed tomography (CT)-guided intrathoracic and bone re-biopsy for patients with non-small cell lung cancer (NSCLC). Materials and methods Seventeen patients underwent CT-guided intrathoracic or bone re-biopsy for the determination of epidermal growth factor receptor (EGFR) T790M mutation and/or programmed cell death-ligand 1 (PD-L1) expression. The characteristics of each lesion, success rate of analyses, and complications were investigated. Results Specimens from 16 out of the 17 patients were adequate for evaluation of EGFR T790M mutation and/or PD-L1 expression. The mean diameter of the lesions was 40 mm, the mean procedural time was 24 minutes, and the median number of punctures was 2. There were no significant differences in lesion characteristics and success rates between CT-guided intrathoracic and bone re-biopsies. No serious complications occurred. Conclusion Both CT-guided intrathoracic and bone re-biopsies for patients with NSCLC were feasible and safe.

To identify factors benefiting from computed tomography during hepatic arteriography (CTHA) in addition to dynamic CT studies at the preoperative evaluation of the hypervascularity of hepatocellular carcinoma (HCC). We retrospectively divided 45 patients with HCC, who underwent both dynamic CT (dCT) and CTHA, into two groups based on the number of hypervascular HCCs identified on dCT and CTHA studies. In group A, the number of HCCs identified by dCT and CTHA was the same and additive CTHA had not been indicated. In group B, fewer HCCs were counted on dCT than on CTHA images, indicating that additive CTHA studies had been appropriate. We compared the patient characteristics, the serum alpha-fetoprotein level, and the tumor-liver contrast (TLC) of the main tumor on dCT scans of both groups. To identify factors alerting to the benefit of additional CTHA studies, we performed univariate logistic regression analysis. Statistically significant parameters were subjected to receiver operating characteristic analysis for obtaining the optimal cutoff value indicative of the benefit of CTHA. Univariate analysis identified only the TLC of the main tumor on dCT images as a significant factor for the benefit of CTHA images (P

The aim of this study was to investigate the incidence and timing of subsequent fractures in patients treated with and without percutaneous vertebroplasty (PVP). We reviewed 794 patients who underwent 1500 PVPs with polymethylmethacrylate (PMMA) at our institution between January 1999 and December 2009. We also reviewed 349 patients with vertebral fractures who underwent conservative treatment without PVP between October 1999 and December 2009 and compared the incidence and timing of subsequent fractures in the two groups. Among the 794 patients treated by PVP, 171 (21.5%) suffered 336 new vertebral fractures. Among the patients not treated by PVP, 82 (23.5%) presented with 154 new fractures. There was no statistically significant difference (P = 0.46). Among the PVP-treated patients, one-half of new fractures occurred at a level adjacent to the treated level, and they occurred significantly sooner than nonadjacent level fractures (log-rank test, P < 0.01). PVP did not increase the incidence of new compression fractures compared with conservative treatment, but half of the new fractures at the adjacent vertebral bodies occurred sooner.