1.N-Butyl Cyanoacrylate Embolization with Blood Flow Control of an Arterioportal Shunt That Developed after Radiofrequency Ablation of Hepatocellular Carcinoma.
Tetsuo SONOMURA ; Nobuyuki KAWAI ; Kazushi KISHI ; Akira IKOMA ; Hiroki SANDA ; Kouhei NAKATA ; Hiroki MINAMIGUCHI ; Motoki NAKAI ; Seiki HOSOKAWA ; Hideyuki TAMAI ; Morio SATO
Korean Journal of Radiology 2014;15(2):250-253
We present a case of a patient with rapid deterioration of esophageal varices caused by portal hypertension accompanied by a large arterioportal shunt that developed after radiofrequency ablation of hepatocellular carcinoma. We used n-butyl cyanoacrylate (NBCA) as an embolic material to achieve pinpoint embolization of the shunt, because the microcatheter tip was 2 cm away from the shunt site. Under hepatic arterial flow control using a balloon catheter, the arterioportal shunt was successfully embolized with NBCA, which caused an improvement in the esophageal varices.
Aged
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Arteriovenous Fistula/etiology/radiography/*therapy
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Carcinoma, Hepatocellular/*surgery
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Catheter Ablation/*adverse effects
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Embolization, Therapeutic/*methods
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Enbucrilate/*therapeutic use
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Esophageal and Gastric Varices/etiology/*therapy
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Hepatic Artery/*abnormalities/radiography
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Humans
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Liver Neoplasms/*surgery
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Male
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Portal Vein/*abnormalities/radiography
2.Radiofrequency Ablation for Viable Hepatocellular Carcinoma around Retained Iodized Oil after Transcatheter Arterial Chemoembolization: Usefulness of Biplane Fluoroscopy Plus Ultrasound Guidance.
Ji Hye MIN ; Min Woo LEE ; Hyunchul RHIM ; Dongil CHOI ; Young Sun KIM ; Young Jun KIM ; Dong Ik CHA ; Hyo K LIM
Korean Journal of Radiology 2012;13(6):784-794
OBJECTIVE: To assess the technical feasibility and local efficacy of biplane fluoroscopy plus US-guided percutaneous radiofrequency ablation (RFA) for viable hepatocellular carcinoma (HCC) around retained iodized oil after transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS: Our prospective study was approved by our institutional review board and informed consent was obtained from all participating patients. For patients with viable HCC around retained iodized oil after TACE, biplane fluoroscopy plus US-guided RFA was performed. We evaluated the rate of technical success and major complications on a post-RFA CT examination and local tumor progression with a follow-up CT. RESULTS: Among 40 consecutive patients, 19 were excluded due to one of the following reasons: poorly visible HCC on fluoroscopy (n = 13), high risk location (n = 2), RFA performed under monoplane fluoroscopy and US guidance (n = 2), and poorly identifiable new HCCs on US (n = 2). The remaining 21 patients with 21 viable HCCs were included. The size of total tumors ranged from 1.4 to 5.0 cm (mean: 3.2 cm) in the longest diameter. Technical success was achieved for all 21 HCCs, and major complications were observed in none of the patients. During the follow-up period (mean, 20.3 months; range, 6.5-29.9 months), local tumor progression was found in two patients (2/21, 9.5%). Distant intrahepatic metastasis developed in 76.2% (16/21) of patients. CONCLUSION: When retained iodized oil around the tumor after TACE hampers the targeting of the viable tumor for RFA, biplane fluoroscopy plus US-guided RFA may be performed owing to its technical feasibility and effective treatment for viable HCCs.
Aged
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Aged, 80 and over
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Carcinoma, Hepatocellular/radiography/*surgery/therapy
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*Catheter Ablation
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*Chemoembolization, Therapeutic
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Complex Mixtures
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*Contrast Media
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Female
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*Fluoroscopy/methods
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Humans
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Iodized Oil/*administration & dosage
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Iohexol/analogs & derivatives/diagnostic use
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Liver Neoplasms/radiography/*surgery/therapy
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Male
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Middle Aged
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*Ultrasonography, Interventional
3.Radiofrequency Ablation Combined with Chemoembolization for Intermediate-Sized (3-5 cm) Hepatocellular Carcinomas Under Dual Guidance of Biplane Fluoroscopy and Ultrasonography.
Ji Hye MIN ; Min Woo LEE ; Dong Ik CHA ; Yong Hwan JEON ; Sung Wook SHIN ; Sung Ki CHO ; Hyunchul RHIM ; Hyo K LIM
Korean Journal of Radiology 2013;14(2):248-258
OBJECTIVE: To assess the technical feasibility and local efficacy of percutaneous radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) for an intermediate-sized (3-5 cm in diameter) hepatocellular carcinoma (HCC) under the dual guidance of biplane fluoroscopy and ultrasonography (US). MATERIALS AND METHODS: Patients with intermediate-sized HCCs were treated with percutaneous RFA combined with TACE. RFA was performed under the dual guidance of biplane fluoroscopy and US within 14 days after TACE. We evaluated the rate of major complications on immediate post-RFA CT images. Primary technique effectiveness rate was determined on one month follow-up CT images. The cumulative rate of local tumor progression was estimated with the use of Kaplan-Meier method. RESULTS: Twenty-one consecutive patients with 21 HCCs (mean size: 3.6 cm; range: 3-4.5 cm) were included. After TACE (mean: 6.7 d; range: 1-14 d), 20 (95.2%) of 21 HCCs were visible on fluoroscopy and were ablated under dual guidance of biplane fluoroscopy and US. The other HCC that was poorly visible by fluoroscopy was ablated under US guidance alone. Major complications were observed in only one patient (pneumothorax). Primary technique effectiveness was achieved for all 21 HCCs in a single RFA session. Cumulative rates of local tumor progression were estimated as 9.5% and 19.0% at one and three years, respectively. CONCLUSION: RFA combined with TACE under dual guidance of biplane fluoroscopy and US is technically feasible and effective for intermediate-sized HCC treatment.
Aged
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Antibiotics, Antineoplastic/administration & dosage
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Antineoplastic Agents/administration & dosage
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Carcinoma, Hepatocellular/*drug therapy/radiography/*surgery/ultrasonography
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Catheter Ablation/*methods
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Chemoembolization, Therapeutic/*methods
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Combined Modality Therapy
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Disease Progression
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Doxorubicin/administration & dosage
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Ethiodized Oil/administration & dosage
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Feasibility Studies
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Female
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Fluoroscopy
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Humans
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Liver Neoplasms/*drug therapy/radiography/*surgery/ultrasonography
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Male
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Postoperative Complications
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*Radiography, Interventional
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Retrospective Studies
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Tomography, X-Ray Computed
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Treatment Outcome
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*Ultrasonography, Interventional
4.Computed Tomographic-Guided Radiofrequency Ablation of Recurrent or Residual Hepatocellular Carcinomas around Retained Iodized Oil after Transarterial Chemoembolization.
Young Hwan KOH ; Joon Il CHOI ; Hyun Beom KIM ; Min Ju KIM
Korean Journal of Radiology 2013;14(5):733-742
OBJECTIVE: To assess the clinical efficacy, safety, and risk factors influencing local tumor progression, following CT-guided radiofrequency ablation (RFA) of recurrent or residual hepatocellular carcinoma (HCC), around iodized oil retention. MATERIALS AND METHODS: Sixty-four patients (M : F = 51 : 13, 65.0 +/- 8.2 years old) with recurrent or residual HCC (75 index tumors, size = 14.0 +/- 4.6 mm) had been treated by CT-guided RFA, using retained iodized oil as markers for targeting. The technical success, technique effectiveness rate and complications of RFA were then assessed. On pre-ablative and immediate follow-up CT after RFA, we evaluated the size of enhancing index tumors and iodized oil retention, presence of abutting vessels, completeness of ablation of iodized oil retention, and the presence of ablative margins greater than 5 mm. Also, the time interval between transarterial chemoembolization and RFA was assessed. The cumulative local tumor progression rate was calculated using the Kaplan-Meier method, and the Cox proportional hazards model was adopted, to clarify the independent factors affecting local tumor progression. RESULTS: The technical success and technique effectiveness rate was 100% and 98.7%, respectively. Major complications were observed in 5.6%. The cumulative rates of local tumor progression at 1 and 2 years were 17.5% and 37.5%, respectively. In multivariate analyses, partial ablation of the targeted iodized oil retention was the sole independent predictor of a higher local tumor progression rate. CONCLUSION: CT-guided RFA of HCC around iodized oil retention was effective and safe. Local tumor progression can be minimized by complete ablation of not only index tumors, but targeted iodized oil deposits as well.
Aged
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Carcinoma, Hepatocellular/*radiography
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Catheter Ablation/*methods
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Chemoembolization, Therapeutic/*methods
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Fat Emulsions, Intravenous
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Female
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Humans
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*Iodized Oil
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Liver Neoplasms/mortality/radiography/*therapy
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Male
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Middle Aged
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Neoplasm Recurrence, Local/*radiography
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Republic of Korea/epidemiology
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Surgery, Computer-Assisted/methods
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Survival Rate/trends
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Tomography, X-Ray Computed/*methods
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Treatment Outcome
5.A Case of Epidural Abscess Occurred after Liver Abscess Complicated by Transarterial Chemoembolization in a Patient with Metastatic Cancer to Liver.
Yong Jae LEE ; Gwang Ha KIM ; Do Youn PARK ; Suk KIM ; Chang Jun PARK ; Tae Kyun KIM ; Jung Hee KOH
The Korean Journal of Gastroenterology 2013;61(4):225-229
Transarterial chemoembolization (TACE) is one of the most effective therapies for unresectable hepatocelluar carcinoma or metastatic hypervascular tumors. Abscess occurring in the other organs beside the liver after TACE is a complication that often occurs, sometimes potentially fatal. We report a case of spinal epidural abscess occurred after liver abscess complicated by TACE in a patient with metastatic neuroendocrine tumors to the liver. A 67-year-old female underwent TACE first for the metastatic lesions to liver, with a history of pancreatoduodenectomy for the primary pancreatic neuroendocrine tumor. Four days after TACE, sudden high fever occurred, and liver abscess was found on abdominal CT. Two days later, back pain and radiating pain to the right leg occurred, and lumbar spine MRI showed spinal epidural abscess. After intravenous antibiotics for 8 weeks and partial laminectomy, the patient recovered and was discharged without complications.
Aged
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Anti-Bacterial Agents/therapeutic use
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Carcinoma, Hepatocellular/secondary/*therapy
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Chemoembolization, Therapeutic/*adverse effects
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Epidural Abscess/*etiology/microbiology/surgery
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Escherichia coli/isolation & purification
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Escherichia coli Infections/drug therapy
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Female
;
Humans
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Laminectomy
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Liver Abscess/*etiology
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Liver Neoplasms/secondary/*therapy
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Lumbar Vertebrae/microbiology/radiography
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Magnetic Resonance Imaging
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Neuroendocrine Tumors/pathology/surgery
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Pancreaticoduodenectomy
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Tomography, X-Ray Computed
6.A Simplified Technique of Percutaneous Hepatic Artery Port-Catheter Insertion for the Treatment of Advanced Hepatocellular Carcinoma with Portal Vein Invasion.
Sun Young CHOI ; Ah Hyun KIM ; Kyung Ah KIM ; Jong Yun WON ; Do Yun LEE ; Kwang Hun LEE
Korean Journal of Radiology 2010;11(6):648-655
OBJECTIVE: We assessed the outcomes of a simplified technique for the percutaneous placement of a hepatic artery port-catheter system for chemotherapy infusion in advanced hepatocellular carcinoma with portal vein invasion. MATERIALS AND METHODS: From February 2003 to February 2008, percutaneous hepatic artery port-catheter insertion was performed in 122 patients who had hepatocellular carcinoma with portal vein invasion. The arterial access route was the common femoral artery. The tip of the catheter was wedged into the right gastroepiploic artery without an additional fixation device. A side hole was positioned at the distal common hepatic artery to allow the delivery of chemotherapeutic agents into the hepatic arteries. Coil embolization was performed only to redistribute to the hepatic arteries or to prevent the inadvertent delivery of chemotherapeutic agents into extrahepatic arteries. The port chamber was created at either the supra-inguinal or infra-inguinal region. RESULTS: Technical success was achieved in all patients. Proper positioning of the side hole was checked before each scheduled chemotherapy session by port angiography. Catheter-related complications occurred in 19 patients (16%). Revision was achieved in 15 of 18 patients (83%). CONCLUSION: This simplified method demonstrates excellent technical feasibility, an acceptable range of complications, and is hence recommended for the management of advanced hepatocellular carcinoma with portal vein thrombosis.
Angiography
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Antineoplastic Agents/*administration & dosage
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Carcinoma, Hepatocellular/*drug therapy/pathology
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*Catheters, Indwelling/adverse effects
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Embolization, Therapeutic
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Female
;
Femoral Artery/surgery
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Fluoroscopy
;
*Hepatic Artery
;
Humans
;
Infusions, Intra-Arterial
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Liver Neoplasms/*drug therapy/pathology
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Male
;
Middle Aged
;
Portal Vein/*pathology
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*Radiography, Interventional
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Treatment Outcome