PURPOSE: To evaluate the safety and efficacy of Hickman catheter placement via the subclavian vein under fluoroscopic guidance with intravenous contrast injection. MATERIALS AND METHODS: During an eleven-month period, 187 Hickman catheters were percutaneously placed in 167 consecutive patients in an interventional radiology suite. Subclavian venous puncture was made with injection of contrast medium into the peripheral venous line. After subclavian venous access had been obtained, a subcutaneous tunnel was created using a peel-away sheath or a tunneler. The Hickman catheters were inserted through a peel-away sheath, the distal tip of which was at the junction of the right atrium and the superior vena cava. RESULTS: One hundred and eighty-six Hickman catheters were successfully placed; the one failure was due to an atomical tortuosity of the vein(0.53%). Complications included one case of subclavian vein occlusion (0.53%); three of line occlusion by thrombus (1.6%); one of oozing at the suture site (0.53%); six of infection or inflammation (3.2%); eight of natural removal (4.2%); one case of air embolism (0.53%) and two of malposition (0.1%). Major complications such as pneumothorax or arterial puncture leading to mediastinal hemorrhage did not, however, occur. CONCLUSION: The authors concluded that radiologic Hickman catheter placement offers advantages over traditional approaches in terms of safety, convenience, and time and cost savings.
Catheters ; Cost Savings ; Embolism, Air ; Heart Atria ; Hemorrhage ; Humans ; Inflammation ; Pneumothorax ; Punctures ; Radiology, Interventional ; Subclavian Vein* ; Sutures ; Thrombosis ; Vena Cava, Superior

PURPOSE: To determine the usefulness of microbubble contrast enhanced power Doppler ultrasonography (PDUS)for the detection of residual tumor in hepatocellular carcinomas (HCCs) treated by transcatheter arterialchemoembolization (TACE). MATERIALS AND METHODS: Fourteen nodular HCCs (size range: 1 - 7.3 cm, mean: 3.5) intwelve patients treated by TACE, and on the basis of follow-up liver CT, thought to have a residual tumor, wereincluded in this study. Between July 1997 and April 1998, PDUS examinations were performed with a 2-4 MHz convextransducer before and after intravenous injection of a microbubble contrast agent (Levovist(, Schering AG, Berlin,Germany). Real-time power Doppler ultrasonographic images were recorded on videotape and representative imageswere color-printed. Tumor vascularity was analyzed on real-time images with regard to its presence or absence, andchanges, and two observers reached a consensus. The results were compared with those of other diagnostic tests(three-phase helical CT, conventional angiography, percutaneous biopsy, and/or surgical pathology). RESULTS: Contrast-enhanced PDUS revealed intratumoral vascularity in ten of 14 tumors, none of which showed vascularity onunenhanced PDUS. In the remaining four tumors, both unenhanced and enhanced PDUS showed intratumoral tumorvascularity, which in all cases was more pronounced on enhanced than on unenhanced PDUS. Other diagnostic testsrevealed residual tumors in eleven lesions. CONCLUSION: Microbubble contrast-enhanced PDUS was more sensitivethan non-enhanced PDUS in depicting vascularity within a residual tumor and could be a useful method for thedetection of residual tumor in HCCs treated by TACE.
Angiography ; Biopsy ; Carcinoma, Hepatocellular* ; Consensus ; Follow-Up Studies ; Humans ; Injections, Intravenous ; Liver ; Microbubbles ; Neoplasm, Residual ; Tomography, Spiral Computed ; Ultrasonography, Doppler* ; Videotape Recording

PURPOSE: To evaluate the radiologic findings of granulomatous colitis on double contrast barium enema and changes on follow-up studies. MATERIALS AND METHODS: Serial double contrast barium enemas of six patients with granulomatous colitis confirmed by endoscopic biopsy were reviewed. We analyzed the radiologic findings and their follow-up changes, including aphthous ulcers, lymphoid hyperplasia, deep ulcers, cobble stone appearance, geographic ulcers, asymmetric involvement of ulcers, skip lesions, sinus tract, fistula formation, pseudosacculation, focal stricture, and small bowel involvement. RESULTS: Pretreatment double contrast baruim enema findings were aphthous ulcers in five patients, deep ulcer in six, cobble stone appearance in five, longitudinal geographic ulcers in two, fistulas in one, pseudo-sacculations in two, focal stricture in one, and pseudopolyps in six. Also, anal ulcers were observed in two patients, asymmetric involvement of ulcers in three, skip lesions in four, and small bowel involvement in five in five patients proved to have inactive disease after treatment, aphthous ulcers and deep ulcers disappeared. Geographic ulcers of two patients and anal ulcer of one patients decreased in size or depth. Pseudosacculation in one patient disappeared. Pseudopolyps decreased in two patients, increased in one, and decreased after increase in two. One patient whose disease remained active after treatment showed maintenance or increase of ulcers or fistula. And their pseudosacculation or focal stricture unchanged and pseudopolyps decreased. CONCLUSION: The major radiologic findings of chronic granulomatous colitis on double contrst barium enema are aphthous ulcer, deep ulcer, cobble stone appearance, discontinuity of the lesion, and coexistence of ulcers and pseudopolyps. And, double contrast barium enema is good follow-up modality because its findings correlate with clinical course of the granulomatous colitis after treatment.
Barium* ; Biopsy ; Constriction, Pathologic ; Crohn Disease* ; Enema* ; Fissure in Ano ; Fistula ; Follow-Up Studies* ; Humans ; Hyperplasia ; Stomatitis, Aphthous ; Ulcer

PURPOSE: To evaluate the radiologic findings of granulomatous colitis on double contrast barium enema and changes on follow-up studies. MATERIALS AND METHODS: Serial double contrast barium enemas of six patients with granulomatous colitis confirmed by endoscopic biopsy were reviewed. We analyzed the radiologic findings and their follow-up changes, including aphthous ulcers, lymphoid hyperplasia, deep ulcers, cobble stone appearance, geographic ulcers, asymmetric involvement of ulcers, skip lesions, sinus tract, fistula formation, pseudosacculation, focal stricture, and small bowel involvement. RESULTS: Pretreatment double contrast baruim enema findings were aphthous ulcers in five patients, deep ulcer in six, cobble stone appearance in five, longitudinal geographic ulcers in two, fistulas in one, pseudo-sacculations in two, focal stricture in one, and pseudopolyps in six. Also, anal ulcers were observed in two patients, asymmetric involvement of ulcers in three, skip lesions in four, and small bowel involvement in five in five patients proved to have inactive disease after treatment, aphthous ulcers and deep ulcers disappeared. Geographic ulcers of two patients and anal ulcer of one patients decreased in size or depth. Pseudosacculation in one patient disappeared. Pseudopolyps decreased in two patients, increased in one, and decreased after increase in two. One patient whose disease remained active after treatment showed maintenance or increase of ulcers or fistula. And their pseudosacculation or focal stricture unchanged and pseudopolyps decreased. CONCLUSION: The major radiologic findings of chronic granulomatous colitis on double contrst barium enema are aphthous ulcer, deep ulcer, cobble stone appearance, discontinuity of the lesion, and coexistence of ulcers and pseudopolyps. And, double contrast barium enema is good follow-up modality because its findings correlate with clinical course of the granulomatous colitis after treatment.
Barium* ; Biopsy ; Constriction, Pathologic ; Crohn Disease* ; Enema* ; Fissure in Ano ; Fistula ; Follow-Up Studies* ; Humans ; Hyperplasia ; Stomatitis, Aphthous ; Ulcer

Magnetic resonance (MR) imaging of thirteen patients with tuberous sclerosis were reviewed. Seven patients underwent computed tomography (CT). The characteristic MR finding of tuberous sclerosis was those of subependymal nodules which were best seen on short repetition time (TR) spin-echo images. Hypointensities within the nodules consistent with calcification were most evident on long TR images. Contrast enhancing lesions, indicative subependymal giant cell astrocytoma, occurred in four cases. Cortical tubers (n=11) and white matter lesions(n=8) exhibited long T1 and T2 relaxation characteristics although reversed pattern was noted in one newborn patients. Cortical tubers and white matter lesions had more irregular shapes in early childhood patients. MR imaging is the sensitive method in detection of gyral tubers and white matter lesions and also valuable in detecting giant all astrocytoma.
Astrocytoma ; Humans ; Infant, Newborn ; Magnetic Resonance Imaging ; Methods ; Relaxation ; Tuberous Sclerosis* ; White Matter

PURPOSE: For the treatment of arterial lesions occurring after catheterization, ultrasound-guided compressionrepair (UGCR) has recently been introduced. Using this technique, we repeatedly attempted treatment of theselesions and assessed their characteristics, as seen on US. MATERIALS AND METHODS: We prospectively studied 21patients who had suffered arterial injury (16 pseudoaneurysms and five arteriovenous fistulae) during arterialcatheterization. Occlusion of one pseudoaneurysm (PA) occurred spontaneously. UGCR was attempted in 20 casesinvolving arterial injury, including two which had occurred five months earlier. In six lesions, multiple attemptswere necessary. RESULTS: UGCR was successful in 18 (90%) of 20 arterial injuries, and all 15 PAs weresuccessfully treated;eight were completely closed at the first attempt, five were seen on follow-up US to havebeen closed after the first attempt, and two were completely closed at the second attempt. Three of fiveateriovenous fistulae (AVF) were successfully closed, one was completely closed at the first attempt, and two atthe second attempt. Mean compression time was 37(range:3-75)min in AVFs. Mean diameter of the cavity of PAs was3.8(range:1.5-10)cm;mean width of the track was 2.6(range:1-5)mm in PAs and 3.8(range:1.6-8)mm in AVFs. CONCLUSION: USGC can be successful after multiple attempts, even in patients with large cavity lesions and in chronic cases.AVFs with wide necks need a longer compression time and the results of the procedure are poorer.
Aneurysm, False* ; Catheterization ; Catheters ; Fistula ; Follow-Up Studies ; Humans ; Neck ; Prospective Studies

PURPOSE: To assess the effectiveness of subsegmental transcatheter arterial chemoembolization(TAE) forhepatocellular carcinomas(HCCs) on the basis of tumor necrosis rate. MATERIAL AND METHODS: Between May 1996 andMarch 1998, ten patients with single HCC after subsegmental TAE underwent surgical resection. Subsegmental TAE wasperformed by injecting a mixture of lipiodol and adriamycin followed by gelatin sponge particles into the distalbranches of the subsegmental arteries. Tumor size and the extent of necrosis were analyzed in ten resectedlesions, and in all patients, complications after subsegmental TAE were assessed. RESULTS: The size of resectedtumors ranged from 1 to 5,5cm. On histological examination, complete necrosis was seen in 6 to 10 resected lesionsand 95% necrosis in three. In the remaining lesion, 85% necrosis had occured. Complete necrosis was noted in 4 of6 small HCCs(less than 3cm in diameter), while in the remaining two the extent of necrosis was 95%. Nocomplications were observed. CONCLUSION: For the treatment of HCC, subsegmental TAE is safe and effective.Curative therapy must, however, involve follow-up and repeated TAE.
Arteries ; Carcinoma, Hepatocellular* ; Doxorubicin ; Ethiodized Oil ; Follow-Up Studies ; Gelatin ; Humans ; Liver Neoplasms ; Necrosis ; Porifera

PURPOSE: To evaluate the long-term patency of the Hanaro spiral stent (Solco Intermed, Seoul, Korea) when used as a palliative in patients with inoperable malignant biliary obstruction. MATERIALS AND METHODS: Between April 1996 and July 1998, 39 patients with malignant biliary obstruction underwent percutaneous placement of 48 Hanaro spiral stents. The causes of obstruction were bile duct carcinoma(n=18), pancreatic carcinoma (n=8), metastatic lymphadenopathy (n=5), gallbladder carcinoma (n=5), hepatocellular carcinoma (n=1) and other tumors (n=2). Using the kaplan-Meier method, patient survival and stent patency rates were estimated with regard to level of obstruction. RESULTS: As regards stent insertion, there was no technical failure. Overall 25- and 50-week survival rates for the entire patient group were 50% and 11%, respectively, while overall stent patency rates at 25 and 50 weeks were 42 % and 11 %, respectively. Twenty-five-week stent patency rates in patients with common bile duct (CBD) and hilar obstruction were 51 % and 18 %, respectively. The stent patency rates in the CBD obstruction group was significantly higher than that in the hilar obstruction group (p < 0.05). CONCLUSION: In patients with CBD obstruction, the clinical efficacy of Hanaro spiral stent was superior to that in patients with hilar obstruction. However, Hanaro spiral stents showed a lower patency rate with regard to patient survival, and further investigation is required.
Bile Ducts ; Carcinoma, Hepatocellular ; Common Bile Duct ; Gallbladder ; Humans ; Lymphatic Diseases ; Seoul ; Stents* ; Survival Rate

PURPOSE: To determine MRI features of tumor response in the early phase of preoperative chemotherapy in malignant tumors after intraarterial chemotherapy of VX-2 tumor in the rabbit thigh. MATERIALS AND METHODS: VX-2 tumors were induced in the thighs of eleven New Zealand white rabbits and intraarterial infusion of Cis-Platinum (3mg/kg) was performed in six. Pre- and post-contrast enhanced MR images and angiographies were obtained prior to and two weeks after chemotherapy. Five rabbits with VX-2 tumors were imaged at these same interval. Difference in MRI changes between the two groups were analysed and MRI findings were compared with angiographic and histologic findings. RESULTS: All VX-2 tumors showed rapid extensive necrosis, the most prominent MRI change in the chemotherapeutic group was decreased thickness of the enhancing rim which in the control group had increased (p = 0.083 and p = 0.374, respectively). The enhancing rim reflected the peripheral capsule with surrounding edema, inflammatory change, and tumors which were histologically viable. On angiography, it coincided with tumor staining. Change in tumor size was not significantly different between the two groups. In the chemotherapeutic group, a marginal necrotic band was the most prominent histologic feature. CONCLUSION: In the VX-2 tumor, chemotherapeutic response is seen on MRI as decreased thickness of the rim, and this reflects the tumor capsule and viable tumors. MRI can provide guidance in planning the treatment of malignant soft tissue tumors.
Angiography ; Angiography, Digital Subtraction* ; Cisplatin* ; Drug Therapy ; Edema ; Infusions, Intra-Arterial ; Magnetic Resonance Imaging* ; Necrosis ; Neoplasms, Experimental ; Rabbits ; Thigh

PURPOSE: Our study was designed to investigate the value of different imaging techniques in the early detection of VX-2 carcinoma in rabbit livers by direct comparison of sonography, CT, and MR imaging with pathologic specimens. MATERIALS AND METHODS: VX-2 carcinomas were induced in 20 rabbit livers by direct inoculation of 0. 1ml of aliquot of the tumor tissue suspension (1 x 106/mm3) to hepatic parenchyma with an 18 gauge needle after laparotomy. One week after the inoculation of tumor cells, sonography with a 5 MHz transducer, CT after a bolus injection of contrast medium (3 mL/kg), and Tl-weighted MR imaging at a 2. 0T with spin-echo techniques (TR/TE:500/30 msec, 2000/30, 80 msec) as well as enhanced Tl-weighted MR imaging with GD-DTPA (0. 1 mmole/kg) were performed in each rabbit. RESULTS: At pathologic specimens, adequate induction of tumor nodules were 69 with 3--21 mm size (average 8. 3 mm). All 69 tumors had fibrous capsules and central necrosis pathologically. The sensitivities of sonography, contrast enhanced CT and MR imaging were 54%, 61%, and 87%, respectively. Among MR images, the sensitivities of Tl-weighted images, proton density images, T2-weighted images, and enhanced Tl-weighted images were 33%, 77%, 83%, and 81%, respectively. On sonograms and CT scans, VX-2 carcinomas show variable appearance regardless of the tumor size and histopathologic findings. On MR images, the tumors were ring shape with variable thickness on all pulse sequences. There was no significant correlation among the findings of three imaging techniques. CONCLUSION: MR imaging has the highest detectability for the VX-2 carcinomas in rabbit liver. Therefore, MRI may be the most valuable imaging technique for the detection of small hepatic tumors with extensive necrosis like VX-2 carcinomas.
Capsules ; Gadolinium DTPA ; Laparotomy ; Liver* ; Magnetic Resonance Imaging ; Necrosis ; Needles ; Protons ; Tomography, X-Ray Computed ; Transducers