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1.
Nishiofuku H Tanaka T Sakaguchi H Yamamoto K Inoue M Sueyoshi S Shinnkai T Hasegawa M Kichikawa K 《Cardiovascular and interventional radiology》2009,32(4):796-800
We describe herein a patient who had hepatic metastases with an arteriovenous shunt and was treated by hepatic arterial infusion
chemotherapy. The arteriovenous shunt was diagnosed by 99mTc-macroaggregated albumin scintigraphy and hepatic venous embolization was performed to reduce shunt flow. 相似文献
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目的 探讨16层螺旋CT显示肝静脉的价值,优化扫描延迟时间和各种后处理技术,并分析国人肝静脉的解剖构成比.资料与方法 选取30例患者,分别于注射对比剂后50 s.60 s.70 s、80 s.90 s行肝区扫描,测量肝右或肝中静脉主干与肝实质的CT值,采用重复设计资料的方差分析得到肝静脉的最佳延迟时间;将重组原始图像进行最大密度投影(MIP)、容积再现(VR)和表面遮蔽显示(SSD)后处理,记录各种重组方法对肝静脉的显示级别,采用K related Friedman秩和检验得到最佳的后处理方法.以Nakamura和Marcos的解剖分类为标准,分析75例患者的解剖构成情况.结果 延迟70 s和VR为肝静脉的最佳延迟时间和后处理方法.国人肝静脉解剖以Nakamura Ⅰ型和Marcos Ⅰ型为主.结论 多层螺旋CT可清晰、准确地显示肝静脉,为临床提供了一种无创性的检查方法. 相似文献
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Ikeda O Kusunoki S Nakaura T Shiraishi S Kawanaka K Tomiguchi S Yamashita Y Takamori H Chikamoto A Kanemitsu K 《Cardiovascular and interventional radiology》2006,29(3):371-379
Hepatic arterial infusion (HAI) chemotherapy is effective for treating primary and metastatic carcinoma of the liver. We compared
the perfusion patterns of HAI chemotherapy on intra-arterial port-catheter computed tomography (iapc-CT) and fused images
obtained with a combined single-photon emission computed tomography/computed tomography (SPECT/CT) system. We studied 28 patients
with primary or metastatic carcinoma of the liver who bore an implantable HAI port system. All underwent abdominal SPECT using
Tc-99m-MAA (185 Mbq); the injection rate was 1 mL/min, identical to the chemotherapy infusion rate, and 0.5 mL/sec for iapc-CT.
Delivery was through an implantable port. We compared the intrahepatic perfusion (IHP) and extrahepatic perfusion (EHP) patterns
of HAI chemotherapy on iapc-CT images and fused images obtained with a combined SPECT/CT system. In 23 of 28 patients (82%),
IHP patterns on iapc-CT images and fused images were identical. In 5 of the 28 patients (18%), IHP on fusion images was different
from IHP on iapc-CT images. EHP was seen on fused images in 12 of the 28 patients (43%) and on iapc-CT images in 8 patients
(29%). In 17 patients (61%), upper gastrointestinal endoscopy revealed gastroduodenal mucosal lesions. EHP was revealed on
fused images in 10 of these patients; 9 of them manifested gastroduodenal toxicity at the time of subsequent HAI chemotherapy.
Fusion imaging using the combined SPECT/CT system reflects the actual distribution of the infused anticancer agent. This information
is valuable not only for monitoring adequate drug distribution but also for avoiding potential extrahepatic complications. 相似文献
4.
Iguchi T Arai Y Inaba Y Yamaura H Sato Y Miyazaki M Shimamoto H 《Cardiovascular and interventional radiology》2008,31(1):86-90
Purpose We retrospectively evaluated the safety and efficacy of preoperative initial hepatic arterial infusion chemotherapy (HAIC)
through a port-catheter system in patients with liver dysfunction due to synchronous and unresectable liver metastases. The
aim of HAIC was to improve patients’ clinical condition for later surgical removal of primary colorectal cancer.
Methods Port-catheter systems were placed radiologically in 21 patients (mean age 58.6 ± 8.1 years) with liver dysfunction due to
synchronous liver metastases from colorectal cancer. Initial HAIC of 1,000 mg/m2 5-fluorouracil was administered weekly as a 5 hr continuous infusion through this system. Surgical removal of the primary
lesion was planned after HAIC improved the liver function.
Results Port-catheter system placement was successful in all patients without severe complications. Patients were followed up for
a median of 309 days (range 51–998 days). After starting HAIC, no severe adverse events that caused drug loss and treatment
postponement or suspension were observed in any of the patients. HAIC was performed a mean of 4.5 ± 3.0 times and the liver
function improved in all patients. Curative (n = 18) or palliative (n = 1) surgical removal of the primary lesion was performed. The remaining 2 patients died because extrahepatic metastases
developed and their performance status worsened; thus, surgery could not be performed. The median survival times of all patients
and the operated patients were 309 and 386 days, respectively.
Conclusion Initial HAIC administration is a safe and efficacious method for improving liver function prior to operative resection of
primary colorectal cancer in patients with liver dysfunction due to synchronous and unresectable liver metastases. 相似文献
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多层螺旋CT头颈部低剂量对比剂血管成像的可行性研究 总被引:16,自引:0,他引:16
目的 探讨16排多层螺旋CT低剂量对比剂头颈部血管成像的可行性。资料与方法 30例头颈部CT血管成像(CTA)分为3组.采用不同的对比剂量:100ml、80ml和60ml。根据原始图像和最大强度投影(MIP)重建像评价3组病例颈部动脉、颅内动脉的显示程度、静脉充盈程度以及伪影;并测量动脉内对比剂的浓度。结果 颈动脉、椎动脉及颅内动脉在3组病例中均清晰显示.显示程度评分上3组间无统计学差异。静脉充盈程度和伪影的主观评分亦无显著性差异。3组动脉内的对比剂浓度均维持在较高的水平,统计学无显著性差异。结论 16排多层螺旋CT头颈部血管成像使用低剂量对比剂可以满足临床需要。 相似文献
6.
Hepatic arterial infusion chemotherapy (HAIC) has been performed for patients with life-threatening liver tumors resistant to standard therapies for more than 30 years. Placement of the port and catheter system for HAIC is performed by surgeons or interventional radiologists. Surgical placement requires laparotomy, whereas the interventional radiologic approach places a port and a catheter percutaneously. The interventional radiologic technique of implanting a port and catheter was originally developed in Japan in the 1980s. The procedure consists of arterial redistribution, catheter and port placement, and evaluation and management of the drug distribution. For the catheter and port placement, the subclavian artery, femoral artery, or inferior epigastric artery is used as an access route. We have used a subclavian artery for HAIC to have the stability of the system at the anterior chest wall and the ease to advance a catheter into hepatic arteries at the time of the placement; however, there are some risks, such as cerebral infarction, and the specific skills of a cutdown procedure are required to access the subclavian artery. No procedure can be perfectly appropriate for all patients, and we should consider what we choose on a case-by-case basis. With this video (available online at www.jvir.org), we hope many interventional radiologists will be aware that this could be within their scope of practice with training. 相似文献
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Jin Sil Kim Dong Wook Kim Kyoung Won Kim Gi Won Song Sung Gyu Lee 《Korean journal of radiology》2022,23(1):52
ObjectiveTo investigate whether the diagnostic performance of CT angiography (CTA) could be improved by modifying the conventional criterion (anastomosis site abnormality) to diagnose hepatic artery occlusion (HAO) after liver transplantation (LT) in suspected patients with Doppler ultrasound (US) abnormalities.Materials and MethodsOne hundred thirty-four adult LT recipients (88 males and 46 females; mean age, 52.7 years) with suspected HAO on Doppler US (40 HAO and 94 non-HAO according to the reference standards) were included. We evaluated 1) abnormalities in the HA anastomosis, categorized as a cutoff, ≥ 50% stenosis at the anastomotic site, or diffuse stenosis at both graft and recipient sides around the anastomosis, and 2) abnormalities in the distal run-off, including invisibility or irregular, faint, and discontinuous enhancement. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the conventional (considering anastomosis site abnormalities alone) and modified CTA criteria (abnormalities in both the anastomosis site and distal run-off) for the diagnosis of HAO were calculated and compared using the McNemar test.ResultsBy using the conventional criterion to diagnose HAO, the sensitivity, specificity, PPV, NPV, and accuracy were 100% (40/40), 74.5% (70/94), 62.5% (40/64), 100% (70/70), and 82.1% (110/134), respectively. The modified criterion for diagnosing HAO showed significantly increased specificity (93.6%, 88/94) and accuracy (93.3%, 125/134) compared to that with the conventional criterion (p = 0.001 and 0.002, respectively), although the sensitivity (92.5%, 37/40) decreased slightly without statistical significance (p = 0.250).ConclusionThe modified criterion considering abnormalities in both the anastomosis site and distal run-off improved the diagnostic performance of CTA for HAO in suspected patients with Doppler US abnormalities, particularly by increasing the specificity. 相似文献
10.
Nagaaki Marugami Toshihiro Tanaka Satoru Kitano Shinji Hirohashi Hideyuki Nishiofuku Aki Takahashi Hiroshi Sakaguchi Masaki Matsuoka Toshio Otsuji Junko Takahama Wataru Higashiura Kimihiko Kichikawa 《Cardiovascular and interventional radiology》2009,32(4):638-646
The purpose of this study was to investigate whether diffusion-weighted magnetic resonance imaging (DWI) is useful for early
detection of the response of hepatic colorectal metastases to hepatic arterial infusion chemotherapy (HAIC) with 5-fluorouracil
(5-FU). The subjects were 12 patients with hepatic colorectal metastases. The indwelling catheter for HAIC was placed in the
hepatic artery, and 1000 mg/m2 5-FU was given repeatedly once a week. DWI was performed before and 9 days after HAIC. The minimum and mean apparent diffusion
coefficient (ADC) values (minADC and meanADC) were measured. The relative change in ADC values (%ADC) and the relative change
in tumor size on follow-up CT after 3 months (reduction ratio) were determined. Liver metastases were divided into two groups,
responder and nonresponder. The correlation between %ADC and reduction ratio was determined, and %ADC was compared between
the two groups. Eleven patients successfully completed HAIC over the 3-month period; 48 metastatic lesions were evaluated.
Positive correlations were observed for relative change between %minADC and reduction ratio (r = 0.709) and between %meanADC and reduction ratio (r = 0.536). Both %minADC and %meanADC were significantly greater in the responder group than in the nonresponder group. With
the threshold determined as < 3.5%, the receiver-operating curve analysis showed higher sensitivity and specificity values
for %minADC (100% and 92.6%, respectively) than for %meanADC (66.7% and 74.1%, respectively). In conclusion, the relative
change in minimum ADC values on DWI may be useful for early detection of the response of liver metastases to HAIC with 5-FU. 相似文献
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肝动脉栓塞治疗外伤性肝破裂出血 总被引:1,自引:0,他引:1
目的探讨肝动脉栓塞术治疗外伤性肝破裂出血的临床疗效、关键技术及其并发症。资料与方法回顾性分析经B超及CT证实的外伤性肝破裂出血患者50例,采用超选择插管至病变血管,用明胶海绵和(或)弹簧圈栓塞,术后观察止血效果。结果 9例单纯用明胶海绵颗粒栓塞,41例用明胶海绵颗粒+钢圈联合栓塞。47例一次肝动脉栓塞后即成功止血;3例于首次栓塞后12~72 h复发出血,行第二次肝动脉栓塞后有2例完全止血康复,1例于第二次栓塞后2周并发肝脓肿和腹腔感染而死亡。49例随访3个月~3年无复发出血。结论肝动脉导管栓塞治疗外伤性肝破裂出血安全、有效。 相似文献
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肝动脉化疗、栓塞治疗原发性肝癌的临床研究(附188例分析) 总被引:2,自引:0,他引:2
目的:研究原发性肝癌肝动脉化疗、栓塞的疗效及其影响因素。材料与方法:回顾性分析188例肝癌肝动脉化疗、栓塞的临床随访资料。结果:总疗效为症状缓解占59.6%,肿瘤缩小占55%,AFP下降占37.8%,半年及1、2、3年生存率分别为75.4%、46%、23.5%、14.7%,平均生存期12.2月,最长已存活50月,获二步手术切除18例,对比分析了7个影响疗效的有关因素。结论:无或轻度肝硬化、早中期、单个肿瘤、直径<10cm、无门脉癌栓或肝动-静脉瘘、行栓塞治疗、治疗次数在3次以上者,其中远期疗效明显优于对应组。克服有关影响因素及综合治疗将会进一步提高肝癌化疗栓塞的疗效 相似文献
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Carolin Brockmann Susanne Jochum Maliha Sadick Kurt Huck Peter Ziegler Christian Fink Stefan O. Schoenberg Steffen J. Diehl 《Cardiovascular and interventional radiology》2009,32(4):630-637
We sought to study the accuracy of dual-energy computed tomographic angiography (DE-CTA) for the assessment of symptomatic
peripheral arterial occlusive disease of the lower extremity by using the dual-energy bone removal technique compared with
a commercially available conventional bone removal tool. Twenty patients underwent selective digital subtraction angiography
and DE-CTA of the pelvis and lower extremities. CTA data were postprocessed with two different applications: conventional
bone removal and dual-energy bone removal. All data were reconstructed and evaluated as 3D maximum-intensity projections.
Time requirements for reconstruction were documented. Sensitivity, specificity, accuracy, and concordance of DE-CTA regarding
degree of stenosis and vessel wall calcification were calculated. A total of 359 vascular segments were analyzed. Compared
with digital subtraction angiography, sensitivity, specificity, and accuracy, respectively, of CTA was 97.2%, 94.1%, and 94.7%
by the dual-energy bone removal technique. The conventional bone removal tool delivered a sensitivity of 77.1%, a specificity
of 70.7%, and an accuracy of 72.0%. Best results for both postprocessing methods were achieved in the vascular segments of
the upper leg. In severely calcified segments, sensitivity, specificity, and accuracy stayed above 90% by the dual-energy
bone removal technique, whereas the conventional bone removal technique showed a substantial decrease of sensitivity, specificity,
and accuracy. DE-CTA is a feasible and accurate diagnostic method in the assessment of symptomatic peripheral arterial occlusive
disease. Results obtained by DE-CTA are superior to the conventional bone removal technique and less dependent on vessel wall
calcifications. 相似文献
14.
Arteriobiliary fistula is a rare complication of hepatic intra-arterial chemotherapy. We report successful coil embolization
of an arteriobiliary fistula. An 80-year-old woman underwent percutaneous placement of an indwelling catheter into the replaced
right hepatic artery for intra-arterial chemotherapy of liver metastases. Coil embolization of the left hepatic artery was
not performed. The patient complained of abdominal pain during intra-arterial chemotherapy. Angiography revealed a fistula
between the replaced right hepatic artery and the common bile duct. The fistula was successfully treated by coil embolization
via the indwelling catheter, and the indwelling catheter was removed. Although such complications usually herald the termination
of intra-arterial chemotherapy, the patient underwent percutaneous implantation of a new catheter-port system, and intra-arterial
chemotherapy was restarted. 相似文献
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目的评价多层螺旋CT血管成像(MSCTA)在外周假性动脉瘤中的临床应用价值。资料与方法搜集2008年9月至2011年7月临床拟诊假性动脉瘤患者19例并行MSCTA检查,对比剂总量80~90 ml,注射流率3.0~3.5 ml/s,扫描延迟时间25~35 s,将获得的容积数据传至图像工作站进行多种后处理,重组技术包括多平面重组(MPR)、最大密度投影(MIP)和容积再现(VR)。结果 19例外周假性动脉瘤的MSCTA 4例为外科手术证实,15例同期行数字减影血管造影(DSA)证实,其中位于股总动脉6例,股浅动脉8例,股深动脉2例,肱动脉2例,胫后动脉1例,其中17例破口清晰显示,15例瘤腔周边见不规则低密度血栓或高密度血块影,4例仅显示假性动脉瘤瘤体、载瘤动脉及其破口。结论 MSCTA是一项简便、无创而可靠的影像检查技术,可以很好地显示假性动脉瘤的特征性影像,有重要临床应用价值,可作为外周假性动脉瘤的首选检查方法。 相似文献
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动脉灌注化疗对有无肝转移的进展期胃癌疗效的比较 总被引:3,自引:0,他引:3
本文对进展期胃癌并有肝转移41例(下称HM组)与无肝转移者35例(NHM)的X线和选择性动脉造影表现以及动脉灌注化疗(TAIC)的疗效作了比较,旨在了解原病灶与肝转移的联系以及TAIC的价值。每例均行CAG,贲门癌灌注动脉多取LGA+CA,胃体窦癌为CHA或CA,也可为LGA,用药绝大多数为FDM(5FU+CDDP+MMC)。结果表明HM组胃癌病变范围≥一个胃分区者和胃重中度变形者明显多于NHM组 相似文献
17.
Hiroshi Seki Toshirou Ozaki Makoto Shiina 《Cardiovascular and interventional radiology》2009,32(4):679-686
The purpose of this study was to assess retrospectively the sequential treatment of hepatic arterial infusion (HAI) chemotherapy
followed by systemic therapy using oxaliplatin plus 5-flourouracil (5-FU) and leucovorin, namely, FOLFOX, for patients with
liver metastases from colorectal cancer. We reviewed 20 patients with unresectable liver metastases from colorectal cancer.
Patients were initially treated with HAI chemotherapy until disease progression (5-fluorouracil, 1000 mg/m2 intra-arterial infusion, weekly) and then with FOLFOX thereafter (FOLFOX4, n = 13; modified FOLFOX6, n = 7). Adverse events, tumor response, and time to progression for each therapy were evaluated retrospectively, and overall
survival was estimated. Toxicity of HAI chemotherapy was generally mild. Of 20 patients, adverse events leading to treatment
discontinuation occurred in only 1 patient (5%) during initial therapy using HAI chemotherapy, while 9 patients (45%) exhibited
adverse events during subsequent FOLFOX therapy. For HAI chemotherapy and FOLFOX, objective response rates were 85.0% and
35.0%, respectively, and median time to progression was 11.6 and 5.1 months, respectively. Median overall survival was 30.1 months.
In conclusion, the sequence of HAI chemotherapy followed by FOLFOX is a promising treatment strategy for the long-term use
of active chemotherapeutic agents, leading to a superior tumor response and fewer toxic effects in patients with unresectable
liver metastases from colorectal cancer. 相似文献
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