IVR 会誌 Jpn J Intervent Radiol Vol.17 No.1 2002 

State of the Art
Interventional Procedures Bone and Joint Radiology

Percutaneous Bone Biopsy
Department of Radiology, Mitsui Memorial Hospital
Kenji Ibukuro, Hozumi Fukuda, Koichi Mori, Yoshihiro Inoue,
Department of Radiology, Futyu Keijinkai General Hospital
Toshitaka Tsukiyama

Most bone lesions can be diagnosed by various imaging modalities and clinical information. However some bone lesions are radiologically atypical, therefore, it is difficult to differentiate metastatic bone tumor from primary bone disease. Percutaneous bone biopsy enables us to diagnose such lesions or primary disease, so that proper therapy can be performed. We performed 29 percutaneous bone biopsies under CT guidance, especially to confirm metastatic bone lesions. Overall accuracy of bone biopsy is 86%.
Since the needle tract is confirmed before biopsy to avoid neurovascular complications, bone biopsy under CT guidance is considered to be safer then that performed under fluoroscopy. Destroyed cortex of bone can be penetrated by an 18G needle and an adequate sample is obtained ; however, a 14G biopsy needle is sometimes necessary to penetrate the cortex. Semi-automatic 20G biopsy needle is useful to obtain adequate tissue materials for pathologic diagnosis. To rule out infectious disease, it is necessary to send the aspirated sample for culture. It is reported that aspiration and core biopsy are complementary with the accuracy of bone biopsy 80~90%.
Percutaneous bone biopsy technique is also utilized for vertebroplasty, steroid injection therapy for Langerhans’ cell histiocytosis, and percutaneous resection or ablation for osteoid osteoma.
Key words
● Bone
● Biopsy
● CT guidance

CT Guided Percutaneous Laser Disk Decompression for Cervical and Lumbar Disk Herniation
Departments of Radiology, and Neurosurgery1), Jikei University
Michiko Dohi, Junta Harada, Kunihiko Fukuda,
Tsutomu Koyama1), Hiromichi Nakazaki1), Toshiaki Abe1)

Percutaneous laser disk decompression(PLDD) is simplicity, minimal invasiveness and effective method for disk herniation. Proper patient selection and correct needle placement are needed to perform successful PLDD. From this point of view, we chose CT, which has a good spatial and temporal resolution, to guide and monitor this procedure. All procedure for 158 lumbar and 7 cervical disk herniations were safely and accurately performed without any major complication by the aid of CT images that allow visualizing the vaporized gas and bony structure around disk, occasionally a nerve root. CT-guided technique provides safe and accurate PLDD. PLDD shows promise in the management of radiculalgia.
Key words
● CT guidance
● Laser ablation
● Disk herniation

Practice of Percutaneous Vertebroplasty
Department of Radiology, Kanazawa University
Takeshi Kobayashi, Tsuyoshi Takanaka, Osamu Matsu

Percutaneous vertebroplasty is a minimally invasive procedure that offers a marked therapeutic option for patients suffering from osteoporotic or tumor-related vertebral fractures and pain. This technique consists of the percutaneous injection of a bone-cement, most commonly polymethylmethacrylate(PMMA), into an affected vertebral body under imaging guidance. This procedure was introduced for tumor-related vertebral fractures and pain in Europe in 1987, but now is mainly used to treat pain following osteoporotic compression fractures in the United States. In Japan, we developed this procedure under CT-fluoroscopic guidance in 1997. We described the practical aspects of this technique, such as its indications, techniques and effects.
Key words
● Percutaneous vertebroplasty
● CT-fluoroscopic guidance
● Malignant vertebral tumor
● Osteoporosis

Interventional MRI
Department of Radiology, Nagoya University School of Medicine
Hiroshi Fukatsu

MR guided interventional procedures have become useful clinical tools recently. In this article the authors discuss the usefulness and problems of MR-guided needle biopsy and MR-guided laser induced thermotherapy(LITT) for clinical cases. MR enabled optimal plane monitoring with desired image contrast during the procedure without X-ray irradiation for puncture and tissue sampling. Also only MR could non-invasively provide interstitial temperature information during laser ablation. Bone and soft tissue lesions are likely to be candidates for MR interventions because they are free from any physiological motions. and radiologists should compare MR-guidance with CT- or US guidance for individual cases in order to achieve a less invasive diagnosis or treatment.
Key words
● MR fluoroscopy
● Needle biopsy
● Laser induced thermotherapy

Original Article
The Efficacy of Percutaneous Injection Therapy for Pelvic Bone Metastases Using Surgical Bone Cement
Department of Radiology, Oita Red Cross Hospital
Shinichiro Ueno
Department of Radiology, Oita Medical University
Norio Hongo, Kunihiro Asai, Rieko Shuto,Fumika Nakano, Shunro Matsumoto, Hiromu Mori

 Purpose : To evaluate the usefulness of the percutaneous injection of acrylic surgical cement for treatment of pelvic bone metastases.
Materials and Methods : Acrylic surgical cement was injected percutaneously 8 times in 7 patients with malignant pelvic bone metastases under the guidance of CT fluoroscopy. It was administered in combination with transcatheter arterial embolization and/or radiotherapy. We evaluated the number of punctures, total dose of bone cement, procedure time, relief from pain, percentage of cement accumulation within the lesion, bone stabilization and any complications that occurred. The mean follow - up period was 4.8 months(range : 24 days to 9 months).
Results : The mean number of punctures was 3. The mean amount of filling cement used was 15.3p. All of the patients reported relief from pain within 7days. There was no correlation between the degree of cement accumulation within the lesion and the analgesic response. No fractures occurred after the cement injection. We experienced 3 leakages. Of the 7 patients studied,
two had transient ischialgia, probably due to the heat of polymerization.
Conclusions : Percutaneous injection of acrylic surgical cement is an effective therapy for pelvic bone metastases, as it promotes rapid pain relief and bone stabilization.
Key words
 ● Percutaneous acetabuloplasty
 ● Interventional radiology
 ● Bone metastasis
 ● Acrylic surgical cement
 ● CT fluoroscopy

Original Article
The Complications of Central Venous Port Access System
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
*Present) Department of Radiology, National Kyushu Canter Center

Toshiro Kuroiwa*, Hiroshi Honda, Kengo Yoshimitsu, Hiroyuki Irie,
Hitoshi Aibe, Kenji Shinozaki, Kouji Masuda

 We performed placements of central venous port access system(intravenous hyperalimentation port, IVH port) for 10 patients and the complications were assessed. 6 patients had malignant tumors, 3 had Crohn’s disease, and 1 had necrotizing pancreatitis. The main purpose of IVH port was to administer systemic chemotherapy in 6 patients with malignant liver tumors and home total parenteral nutrition(HTPN) in 4 patients with benign diseases. Technical approach was performed using an ultrasound-guided puncture of a subclavian vein in 3 cases, and another was catheter exchange method for IVH catheter, which was previously placed through a subclavian vein. The catheter tip was placed in the superior vena cava in each case. The catheter was connected to a port implanted subcutaneously in the subclavicular region. There was no complication during the procedure. The observation period after placement ranged from 11 to 588 days(mean : 207 days).
The complications after placement were observed in 4 cases. These included partial exposure of the IVH ports in 2 cases, occlusion of the indwelling catheter in 1, and dislocation of the catheter tip to the jugular vein in 1. Catheter-port access systems were replaced on the contralateral side in 2 cases, and it was removed in 1 case. In the case of the dislocation of the catheter tip to the right jugular vein, a 5 Fr. pig-tail catheter was introduced via the femoral vein, and the dislocated catheter tip was corrected in the superior vena cava by entangling the 5 Fr. pig-tail catheter.
The central venous catheter-port access system makes it possible for patients unable to eat oral diets to receive HTPN thereby improving their quality of life. However, some complications may occur and guidance for self-management of their IVH port might be necessary during their admission to hospital.
Key words
 ● Implantable port
 ● Intravenous hyperalimentation
 ● Home total parenteral nutrition
 ● Complication

Case Report
Two Cases of Bilateral Renal Cancer that Were Treated with Resection of One Kidney and Selective Transarterial Embolization of the Other Kidney Using a Mixture of Absolute
Ethanol and Iodized Oil : One and a half years’follow-up
Department of Radiology, Kameda Medical Center
Nobumaro Ihara, Naobumi Yashiro, Takahiro Kinoshita, Jun Yoshigi

 We report 2 cases of renal cell carcinoma in solitary kidney treated with selective transarterial embolization with the mixture of absolute ethanol and iodized oil(Lipiodol). In both cases, radical nephrectomy of contralateral kidneys had been performed due to renal cell carcinomas.
No recurrences or renal failure was were found during the follow-up period of one and a half years. Our method can be an option for the treatment for the patients with bilateral renal cell carcinoma.
Key words
 ● Transarterial embolization
 ● Bilateral renal cell carcinoma
 ● Absolute ethanol

Case Report
Transcatheter Arterial Embolization to Control Severe Bleeding in Advanced Breast Cancer
-Report of Two Cases-
Department of Radiation Technology, College of Medical Technology, Hokkaido University
Yutaka Morita
Department of Surgery, Otaru Kyokai Hospital
Kazuhiko Naoe, Takeshi Kawamura, Toshimichi Asano,
Yoshitaka Nakakubo, Tomoo Okushiba, Fujio Watanabe, Tomoyoshi Atsuta

 Two cases of successful transcatheter arterial embolization(TAE) for uncontrollable hemorrhage of advanced breast cancer are presented. The vasculo-anatomical characteristics of the breast consist of multiple arterial blood supply and complicated anastomoses.
The detailed vascular anatomy of the breast is discussed in relation to the multiplicity of the arterial blood supply and the variety of arterial anastomoses. According to these vascular characteristics and our experience of two cases, a suitable procedure for TAE is embolization from the distal and proximal ends of the bleeding artery using a coaxial microcatheter system and microcoils. Controversial problems with TAE for bleeding of advanced breast cancer are as follows :
1) Identification of the bleeding artery is difficult.
2) There are no difinite standards of limited area of embolization because of the variety of arterial anostomoses.
3) It is possible to obliterate the approach for arterial infusion chemotherapy.
Key words
 ● Breast cancer
 ● Transcatheter arterial embolization
 ● Coaxial microcatheter system

Technical Note
Marking of Peripheral Small Lesion of Lung, Using Color Collagen before Resection on VATS(video-associated thoracoscopic system)
Departments of Radiology and Thoracic surgery1), Yokosuka Kyousai Hospital
Megumi Nakamura, Yasuhiko Fujita, Satoru Kuroda, Youji Tsuchie,
Takao Moroboshi1)

 In the present study, small peripheral lesions in the lung were marked with color collagen under CT in 11 patients, prior to thoracoscopic resection. Marking could be accomplished in all patients without induction of any complications. The marked lesions were very easily identified and distinguished from the surrounding pulmonary parenchyma. Marking with color collagen was an easy and useful method of facilitating thoracoscopic pulmonary resection for peripheral lung tumors indicating the possible contribution of this marking method to the early treatment of primary lung cancer.
Key words
 ● Color collagen
 ● CT guided marking
 ● Small lung lesion