CURRENT STATE OF SELF‐EXPANDABLE METALLIC STENT PLACEMENT FOR GASTRIC OUTLET OBSTRUCTION

Self‐expandable metallic stents are being used increasingly to maintain luminal patency in patients with unresectable gastric outlet obstruction. Stent technology has facilitated placement of the stent in the pyloric or duodenal obstruction. An example of advances in technology is the innovative through‐the‐scope (TTS) stent, which is not yet commercially available in Japan. Enteral stents provide a high success rate, quick relief from symptoms, and an improvement in the performance score, although some complications remain. This article reviews the current status of stent placement for gastric outlet obstructions. The self‐expandable metallic stent seems to provide a potentially attractive alternative to surgical bypass, since most of these patients are terminally ill with a limited life expectancy. Available data is currently insufficient to clarify the use of stents for gastric outlet obstructions, therefore a prospective randomized comparison is required to compare this procedure with surgical alternatives.     

SUCCESSFUL PLACEMENT OF SELF‐EXPANDABLE METALLIC STENTS FOR DOUBLE COLORECTAL CANCERS

Stent placement for the palliation of unresectable colon cancer is an alternative to surgical treatment that has recently become popular. A dedicated stent for colorectal cancer is not available in Japan. We report a patient with two colonic obstructions who underwent a successful palliative treatment using two stents. He was admitted to Toho University Ohashi Medical Center because of ileus. A colonoscopy revealed two advanced lesions with stenosis in the sigmoid and transverse colon. Because he had multiple liver metastases and severe Alzheimer dementia, we selected palliative stent placement for the treatment of both strictures. We placed a covered stent in the sigmoid colon stricture and subsequently attempted to place a second stent in the transverse colon stricture. However, the second stent could not be placed in the transverse colon because the modified delivery system could not pass through the first stent in the sigmoid colon. This probably led to a twisting of the stent in the sigmoid colon. We next used the 24 F introducer sheath that is included in Keller‐Timmermans Introducer Sets. This strategy allowed the modified delivery system to be easily passed through the initial stent in the sigmoid colon and then advanced into the transverse colon stricture, enabling both stents to be positioned properly.     

Detection of malignant hepatic tumors: comparison of gadolinium-and ferumoxide-enhanced MR imaging

OBJECTIVE: The purpose of our study was to compare how well gadolinium-enhanced and ferumoxide-enhanced MR imaging reveal malignant hepatic tumors. SUBJECTS AND METHODS: Both gadolinium-enhanced and ferumoxide-enhanced MR imaging were separately performed in 53 patients with a total of 87 malignant hepatic tumors (57 hepatocellular carcinomas, 28 metastases, two cholangiocarcinomas). Thirty-one of the 53 patients had hepatic cirrhosis. Images were reviewed by three independent off-site observers. Observer performance was evaluated by means of sensitivity, specificity, and receiver operating characteristic curve analyses. RESULTS: Gadolinium-enhanced MR imaging outperformed ferumoxide-enhanced MR imaging in sensitivity (81% versus 62%, p < 0.01) for malignant-tumor detection. Specificity was comparable (94%) between the two types of MR imaging. Area under receiver operating characteristic curve (A(z)) value was significantly higher with gadolinium-enhanced MR imaging than with ferumoxide-enhanced MR imaging in patients overall (A(z) = 0.896 versus 0.805, p < 0.001), in patients with cirrhosis (A(z) = 0.907 versus 0.807, p < 0.001), and in patients without cirrhosis (A(z) = 0.899 versus 0.834, p < 0.01). The superiority was enhanced in the subset of patients with cirrhosis. CONCLUSION: Gadolinium-enhanced MR imaging outperforms ferumoxide-enhanced MR imaging in revealing malignant hepatic tumors. Gadolinium-enhanced MR imaging is recommended, particularly for patients with cirrhosis.     

TI-201 SPECT compared with histopathologic grade in the prognostic assessment of cerebral gliomas

PURPOSE: Although TI-201 SPECT has been used to evaluate the malignant grade of cerebral gliomas, the gold standard continues to be histopathologic examination. The authors assessed and compared the prognostic abilities of the two studies using survival analysis. MATERIALS AND METHODS: Twenty-nine patients underwent 34 sessions of TI-201 SPECT plus surgery for primary or recurrent cerebral gliomas 12 to 78 months before this analysis. Using conventional survival analyses, such as the log-rank test, Cox regression, and the Akaike cross-tab method, the authors evaluated the prognostic significance of 10 variables: histopathologic grade, TI-201 SPECT, Tc-99m HMPAO SPECT, tumor cell viability, radionecrosis, neurologic defects, clinical improvement, surgery, chemotherapy, and external beam radiotherapy. RESULTS: TI-201 SPECT was most strongly related to prognosis, followed by histopathologic grade. The other variables had little prognostic value. The Cox stepwise selection procedure indicated that TI-201 SPECT was the only independent predictor of outcome, whereas histopathologic analysis was eliminated from the prognostic model. However, the Kaplan-Meier survival curve and the Akaike method indicated that histopathologically low-grade tumors were more closely associated with longer-term survival than were TI-201 low uptake tumors. CONCLUSIONS: TI-201 SPECT is not only closely correlated with the histopathologic grade of tumor but is a significantly better predictor of outcome than histopathologic grade. However, histopathologic examination may provide additional information on longer-term survival. TI-201 SPECT is a valuable procedure, especially in patients in whom a histologic diagnosis of possible glioma cannot be made.     

Spectrum of CT findings in pediatric patients after partial liver transplantation.

Liver transplantation is an accepted therapy for patients with severe liver diseases. In pediatric liver transplantation, the application of reduced-size and split-liver transplantation has expanded the donor pool. The development of living related donor partial liver transplantation has further increased the availability of donors. Complications in patients after living related transplantation include hepatic arterial thrombosis, portal venous stenosis and thrombosis, hepatic venous stenosis, biliary stenosis or leak, biloma formation, fatty liver, extrahepatic fluid collection, posttransplantation lymphoproliferative disorder, and organ rejection. Ultrasonography is the primary imaging modality for evaluation of the vascular system of patients after liver transplantation, and computed tomography is useful to help diagnose hepatic parenchymal abnormalities including infarction, congestion, and fatty change; intrahepatic biliary damage; and extrahepatic disorders, including abnormal fluid collections, varicose veins, and lymphadenopathy.     

F-18 fluorodeoxyglucose uptake in a solid pseudopapillary tumor of the pancreas mimicking malignancy

Solid pseudopapillary tumors (SPTs), predominantly affecting young women, are rare pancreatic tumors. It is reported that imaging features of SPT are solid and cystic components, and there is intratumoral hemorrhage and calcification. However, findings of positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG) with pathologic correlation have not been fully evaluated. We present a case of SPT that mimicked malignancy on FDG-PET.     

Diagnostic outcomes of esophageal cancer by artificial intelligence using convolutional neural networks

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Transcatheter arterial embolization for bleeding from bile duct tumor thrombi of hepatocellular carcinoma

BACKGROUND/AIMS: Advanced hepatocellular carcinoma usually invades the portal vein, forming tumor thrombi. Invasion of the bile duct, i.e., intrabile tumor growth or bile duct tumor thrombi is rare. Patients with bile duct tumor thrombi present with obstructive jaundice, abdominal pain or hemobilia. Hemobilia due to bile duct tumor thrombi is sometimes massive and fatal. The purpose of our study was to evaluate the effectiveness of transcatheter arterial embolization for hemobilia caused by bile duct tumor thrombi of hepatocellular carcinoma. METHODOLOGY: Between 1993 January and 2000 December, transcatheter arterial embolization was performed in 4 patients with hemobilia and gastrointestinal bleeding from bile duct tumor thrombi of hepatocellular carcinoma. RESULTS: In all 4 patients, transcatheter arterial embolization was successfully performed and resulted in cessation of bleeding. One patient had recurrent hemobilia, which was controlled by another transcatheter arterial embolization. Three patients were discharged from hospital after transcatheter arterial embolization. Patients died of hepatic failure or multiple tumors 5 to 7 months after the onset of hemobilia, although hemobilia had been fully controlled. CONCLUSIONS: Transcatheter arterial embolization seemed to be effective for the control of massive hemobilia caused by bile duct tumor thrombi associated with hepatocellular carcinoma.     

External cervical resorption detected via cone‐beam computed tomography in a patient with myelin oligodendrocyte glycoprotein antibody–associated disease: A case report

External cervical resorption may occur in patients with MOG antibody–associated disease, which is clearly detected on cone‐beam computed tomography. Therefore, dental screening is essential for these patients before initiating bisphosphonate therapy. Larger sample sizes are crucial to determine any possible association between external cervical resorption and MOG antibody–associated disease.