IVR 会誌 Jpn J Intervent Radiol Vol.17 No.4 2002

State of the Art
Non-vascularInterventional Radiology for Lung Tumors

1.Tips of the Lung Biopsy

1) CT Fluoroscopy Guided Biopsy of Lung Nodules
Department of Radiology, Hitachi General Hospital
Toshiyuki Irie

CT fluoroscopy was developed for realtime observation of needle advancing. However, this realtime and continuous observation increases the radiation dose both on the patient and the physician’s hand. I-I devices are handy and simple to assist lung nodule biopsy under CTF guidance. Intermittent use of CTF is recommended because the doses are decreased and the hit ratio is increased compared with continuous use.
Key words
● CT, technology
● Fluoroscopy, technology
● Lung, biopsy

2) Complications of CT-guided Lung Biopsy and its Treatment
Department of Radiology,Center for Advanced Medical Technologys Nippon Medical School
Yuji Okajima, Hiroyuki Tajima, Ken Nakazawa, Tsuyoshi Fukunaga, Shiro Onozawa, Jun Watari, Yasushige Komada, Yutaka Abe, Satoru Murata, Tatsuo Kumazaki

The recent proliferation of computed tomography(CT) has led to the detection of small nodular lesions in the lung fields, not easily found by conventional thoracic plain X-ray. The introduction of lung cancer screening using CT is also a likely factor. Since Haaga et al. made the first report of a method for CT-guided biopsy of small nodular lesions in the lung field, CT- guided lung biopsy has come into widespread use, the complications of CT-guided lung biopsy are not rare. Pneumothorax, pulmonary hemorrhage and hemoptysis are relatively common, while malignant cell dissemination and air embolism are rare. Enough knowledge of the prevention and treatment of such complications enhance the safety of CT-guided lung biopsy.
Key words
● CT, guidance
● Lung neoplasm
● Complication

3) Pathological Knowledge Necessary for Lung Biopsy
Department of Patholgoy and Molecular Diagnostics, Aichi Cancer Center
Yasushi Yatabe

In terms of the in site of origin, lung cancers can be divided into two : central type and peripheral type. For the central type, bronchoscopy is quite effective to obtain tumor tissue, and this technique leads to the definite diagnose of most squamous cell carcinomas and small cell carcinomas. In contrast, CT-quided needle biopsy is one of a few ways to make the diagnosis of the peripheral type. In this paper, tips of the lung biopsy, based on my experience as a pathologist in Aichi Cancer Center, are described. Our new procedure, rapid cytologic accessment for biopsied tissue with touch smear, is also introduced.
Key words
● CT-guided needle biopsy
● Lung tumor
● Pathologic diagnosis

2.Preoperative Localization of Small Pulmonary Lesions :
Use of Hookwire and Suture System
Department of Radiology, Cancer and Thoracic Surgery1), Okayama University Medical School
Shuichi Dendo, Susumu Kanazawa, Kotaro Yasui, Hidefumi Mimura, Tsuyoshi Hyodo
Toshihiro Iguchi, Yasuhiro Fujiwara, Yoshio Hiraki, Akio Ando1), Nobuyoshi Shimizu1)

Preoperative localization before video-assisted thoracic surgery(VATS) is sometimes required when the lesion is too small or too far from the pleural surface to be recognized by the surgeon. Preoperative localization using a short hookwire and suture system is a useful method, associated with a high success rate(97.6%), applicability to multiple lesions, patient comfort, and no serious complications in our experience.
Key words
● CT
● Nodule

3.Percutaneous Radiofrequency Ablation for Lung Tumors
Department of Radiology and 2nd Surgery1), Osaka City University, Medical School
Toshiyuki Matsuoka, Akira Yamamoto, Yoshimasa Oyama, Tomohisa Okuma, Saori Tanaka, Terue Okamura, Kenji Nakamura, Ryusaku Yamada, Yuichi Inoue, Kiyotoshi Inoue1), Tatsuya Nishida1)
Department of Radiology, Kobe Nishi Shimin Hospital
Masami Toyoshima

Recently, radiofrequency-based procedures have been widely used for the treatment of malignant tumors, and satisfactory clinical results have been reported for the treatment of liver tumor. However, the clinical benefit of regarding RFA(radiofrequency ablation) for lung tumors has not yet been established. Here, we demonstrate the basic concepts and clinical applications, and evaluate the technical safety and efficacy of this procedure. Since June 2000, 26 pulmonary tumors were treated using percutaneous RFA with LeVeen Needle. The procedure was performed under CT guidance after local anesthesia. Tumor ablation was performed using lower output energy under 70 watts compared with the cases of liver tumors. Pneumothorax and mild fever were observed in about one half of cases, but there were no severe complications. On CT images obtained after ablation, ground glass-like round high density appeared and then it was slightly reduced. Mean observation period was 8.9 months. Four of 26 tumors became scarred, of which 3 which were incompletely ablated due to pain relapsed. Although more time will be needed to adequately evaluate the outcome, percutaneous radiofrequency ablation is technically easy, and appears useful as a new method of treatment for lung tumors.
Key words
● Radiofrequency ablation
● Lung tumor
● Thermal coagulation

Case Report
A Case of Transcatheter Embolization for Multiple Intrahepatic Portosystemic Venous Shunts
Department of Radiology, Surgery1) and Internal Medcine2), Tokyo Medical University Kasumigaura Hospital
Kazuhiro Saito, Fumio Kotake, Yasuhisa Goto1), Takafumi Tabuchi1)
Hiroyuki Miura2), Eiichi Hatao2)
Depaetment of Radiology, Tokyo Medical University
Toru Saguchi, Naoki Ito, Kimihiko Abe

A 71-year-old female was referred to our hospital for tremor of extremities. The serum ammonia level was considerably elevated, so hepatic encephalopathy was suspected. Superior mesenteric arteriography revealed numerous intrahepatic portosystemic shunts. Transcatheter embolization was performed by mesenteric venous approach after a small abdominal incision. To prevent coil migration, a balloon catheter was inserted to the hepatic vein from the right femoral vein. Seven shunts in right hepatic lobe were embolized with coils. There was no change in the pressure of main portal trunk after the embolization procedure, and the pressure was 9aHn. The post embolization course was uneventful. The serum ammonia level has been decreased and she has been free of hepatic encephalopathy for 16 months after this procedure.
Key words
●Multiple intrahepatic portosystemic venous shunts

Case Report
A Case of Duodenal Obstruction due to Pancreatic Carcinoma Treated with Magnet Compression Anastomosis and Covered Metallic Stent
Departments of Radiology and Oncoradiology, Nara Medical University
Shigeo Yokotani*, Hiroshi Sakaguchi, Hiroshi Anai, Satoru Sueyoshi, Takehiro Tanaka, Yoshihiro Matsuo, Takahiro Itoh, Hitoshi Yoshimura, Hajime Ohishi, Kimihiko Kichikawa
(* : Departments of Radiology, Nara Prefectural Mimuro Hospital)
Departments of Radiology, Nara Prefectural Nara Hospital, IVR center, Sougou Daiyuukai Hospital1)

Tetsuya Yoshioka, Hideo Uchida1)

A 62-year-old-female with persistent duodenal stenosis after radiation therapy for pancreatic cancer was treated by magnet compression anastomosis between stomach and jejunum. After the creation of gastrojejunal anastomosis, the fistula was too narrow to improve her symptoms. A covered metallic stent 12a in diameter was deployed to keep the fistula large enough to function well, following dilation of the fistula with a 10-a balloon catheter. The usefulness of the combination of magnet compression anastomosis and covered metallic stent deployment is suggested in selected patients.
Key words
●Pancreatic cancer
●Magnet compression anastomosis
(Yamanouchi method)
●Covered metallic stent

Case Report
Percutaneous Transluminal Angioplasty(PTA) for Portal Vein Stenosis after Right Hepatic Lobectomy
Department of Radiology, Saga Medical School
Koichi Matsumoto, Akira Kato, Akira Uchino, Sho Kudo
Department of Radiology and Surgery1), Shiroishi Hospital
Jyunichi Nojiri, Michito Mori, Koji Dairaku1)

We report a case of successful PTA for portal vein stenosis after right hepatic lobectomy. The patient is a 71-year-old man who presented with acute liver failure after right hepatic lobectomy for a large metastatic liver carcinoma. Contrast CT and angiography revealed stenosis of the portal vein near the surgical clips. We treated this stenosis by PTA using a curved balloon catheter. There was residual stenosis angiographically after the procedure. However, pressure gradient in the portal vein and dilated collateral vessels were no longer present. No procedure related complications were observed, and liver function gradually improved after the procedure.
Key words
●Portal vein
●Stenosis or obstruction
●Transluminal angioplasty

Case Report
Acute Pulmonary Embolism Treated with the Hydrolyser : A Case Report
Department of Radiology and Surgery1), Health Insurance Hitoyoshi General Hospital
Yoshimi Hatanaka, Miyuki Torashima, Mitsuhiro Inoue1), Tetsurou Morisaki1), Masami Kimura1)
Department of Radiology, Kumamoto University Medical School
Yasuyuki Yamashita

We report a 66-year-old man with acute pulmonary embolism treated by percutaneous embolectomy using a Hydrolyser catheter. He presented with chest pain and dyspnea 4 days following total gastrectomy. CT and pulmonary arteriogram revealed extensive thrombus within the right pulmonary artery. Mechanical thrombectomy was performed with the Hydro-lyser catheter and postthrombectomy arteriogram showed partial resolution of the thrombus of the right pulmonary artery. Follow-up angiogram after thrombolytic therapy and heparin therapy revealed no filling defect within the pulmonary artery. Mechanical thrombectomy with the Hydrolyser catheter can be a new option for the treatment of pulmonary embolism.
Key words
●Pulmonary embolism

Technical Note
Implantation of the Intra-arterial Port-Catheter System Via the Femoral Artery Using a 2.7 F Double Spiral Coaxial Catheter
Department of Radiology, Kurume University School of Medicine
Masamichi Koganemaru, Osamu Edamitsu, Masaaki Nonoshita, Kenkichi Baba, Naofumi Hayabuchi
Department of Radiology, Chikugo Municipal Hospital
Tatsuyuki Tohnan

We usually implant the intra-arterial port-catheter system via the femoral artery in order to reduce the risk of cerebral infarction that may be caused by catheter implantation via the subclavian artery. However, it is sometimes difficult to insert the catheter in the proper position in cases in which the celiac artery branches down steeply from the aorta or with stricture or tortuosity of the common hepatic artery.
In this report we describe the initial experience of a 2.7F double spiral coaxial catheter that is characterized by a tip mounted shape memory alloy to stabilize the position of the catheter. The surface of the catheter is coated with Polyvinylpyrolydon which acts as an anti-coagulant. A 2.7F double spiral coaxial catheter was placed in 28 patients. After making a slit or a side hole, the 2.7 F double spiral coaxial catheter was inserted via a 5F catheter. The success rate of implantation was 96.4%(27/28). One failure case was experienced in the early stage, when the 2.7F double spiral coaxial catheter was stuck in the 5F catheter, and it was surmised that the unsuccessful slit stuck the catheter, impeding its movement.
In conclusion, a 2.7 F double spiral coaxial catheter is useful for patients in whom placement of a 5F catheter would seem to be difficult and in which the coaxial method is easier than the usual method.
Key words
●Port-catheter system(Reservoir)
●Coaxial catheter