Jpn J Intervent Radiol Vol.27 No.1 2012

State of the Art
Interventional Radiology with Ultrasound

An Introduction  
Naoki Hirokawa
Department of Radiology, Sapporo Medical University

1. Fundamentals of Ultrasound

1)On the Safety of Diagnostic Ultrasound
-Mechanisms of Biological Effects and Guide for Safe Use-

Graduate School of Information Science and Technology, Hokkaido University
Nobuki Kudo

Thermal and non-thermal mechanisms of biological effects caused by ultrasound exposure are briefly reviewed, and exposure conditions of ultrasound to achieve diagnostic safety and therapeutic effectiveness are discussed. Thermal and mechanical indices developed to show the likelihood to produce biological effects are explained, and their relation to output limitation of diagnostic ultrasound is introduced. New ultrasound techniques, contrast ultrasound imaging, acoustic radiation force impulse imaging and sonoporation therapy, were discussed from the viewpoint of biological safety, and the importance of both continuing basic studies on ultrasound safety and adhering to the ALARA principle is enhanced.

Key words

  • Ultrasound safety
  • Thermal effects
  • Non-thermal effects
  • ALARA principle

1. Fundamentals of Ultrasound

2)Ultrasonography for IVR-Proper Equipment Setting and Scanning-

Clinical Laboratory and Transfusion/Diagnostic Center for Sonography,
Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
Mutsumi Nishida, Daisuke Abo, Yu Hasegawa, Takeshi Soyama, Yusuke Sakuhara

Although, ultrasound has been used in non-vascular IVR for diagnostic biopsy, therapeutic drainage and other treatment techniques over the last decade, it is doubful if the proper equipment setting and scanning are considered during a session in IVR. If the setting and scanning are appropriate, it will be easier and safer to perform IVR. Several key points and techniques are described.

Key words

  • Ultrasonography
  • IVR
  • Liver


2. Interventional Radiology with Ultrasound

1)Radiofrequency Ablation Therapy for Hepatocellular Carcinoma Using the System with Volume-Data

Center for Gastroenterology and Department of Radiology1), Teine-Keijinkai Hospital
Takeshi Matsui, Kunihiko Tsuji, Akiko Tomonari, Toshifumi Kim, Hayato Shida
Jong-Hong Kang, Hiroyuki Maguchi, Yoshihisa Kodama1), Yasuo Sakurai1)

Radiofrequency ablation therapy (RFA) for hepatocellular carcinoma (HCC) is widely performed as curative treatment, most of it under ultrasound guidance. Some nodules cannot be visualized clearly on sonography but can be visualized on computed tomography imaging (CT) or magnetic resonance imaging (MRI). Recently, a system that synchronizes real-time ultrasound images with CT, MRI or ultrasound images has been developed and has greatly helped in treating HCC. In addition, it is useful for the evaluation of RFA for HCC. We introduce RFA for HCC using this system with Volume-Data and present clinical application methods.

Key words

  • RFA
  • Volume-Data
  • HCC
  • 3D-US imaging


2. Interventional Radiology with Ultrasound

2)Efficacy of Endosonography-Guided Biliary Drainage (ESBD)

Department of Gastroenterology, Sendai City Medical Center
Shinsuke Koshita, Jun Horaguchi, Naotaka Fujita, Yutaka Noda, Go Kobayashi
Kei Ito, Yoshihide Kanno, Takahisa Ogawa, Kaori Masu, Syoutarou Ishii

Endosonography-guided biliary drainage (ESBD), which was first reported in 2001 by Giovannini et al., has recently been performed mainly in cases of biliary obstruction when endoscopic biliary drainage (EBD) is unsuccessful. The technical success rate and complication rate of ESBD have been reported to be 75-100% and 0-50%, respectively. In performing ESBD, due to the short patency periods of plastic stents, self-expandable metallic stents (SEMS) should be used for cases with possible long-term survival as SEMS has longer patency periods. Lack of specialized endoscopic devices to perform ESBD has prevented its widespread use. Although the indications for ESBD have not been established, ESBD, at least, is expected to replace PTBD because of its many advantages over PTBD.

Key words

  • EUS
  • Biliary drainage
  • ESBD

Original Article

Adverse Events and Therapeutic Efficacy Associated with TACE for Hepatocellular Carcinoma with a Miriplatin-Lipiodol Suspension in Comparison with a Cisplatin-Lipiodol Suspension

Department of Radiology, University of Yamanashi
Araki Takuji, Okada Taiki, Kimura Kazufumi, Sawada Eiichi, Sano Katushiro, Araki Tsutomu

Purpose: The aim of this study was to evaluate the short-term adverse events and therapeutic efficacy of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with a miriplatin-lipiodol suspension in comparison with a cisplatin-lipiodol suspension.
Materials and Methods: Of patients who underwent TACE for unresectable HCCs in 2009 and 2010, twenty-nine and twenty-seven patients underwent TACE using cisplatin-lipiodol suspension (C-LS) and miriplatin-lipiodol suspension (M-LS), respectively. Adverse events of fever, pain, nausea, anorexia, elevation of aspartate aminotransferase (AST), total bilirubin, creatinine and a decrease in platelet count were evaluated by the National Cancer Institute Common Toxicity Criteria Ver.4. to compare the C-LS and M-LS groups. The short-term therapeutic efficacy of both groups was evaluated by the treatment effect (TE) on the CT images three months after TACE according to the General Rules for the Clinical and Pathological Study of Primary Liver Cancer (the 5th edition, Revised Version).
Results: With regard to the adverse events, the M-LS group had significantly less fever and anorexia than the C-LS group. No critical adverse events were observed in either group. The therapeutic efficacy was not significantly different between the groups.
Conclusion: TACE with M-LS had fewer adverse events than TACE with C-LS, but neither TACE led to any critical adverse events. The short-term therapeutic efficacy of TACE with M-LS was equivalent to that of TACE with C-LS.

Key words

  • Cisplatin
  • Miriplatin
  • Lipiodol-suspension
  • TACE
  • HCC


Palliative Interventional Radiology for Malignant Pleural Effusion
-The Efficacy of Pleurodesis Using CT Guided Drainage-

Department of Radiology, Tottori Prefectural Central Hospital
Kazuhiko Nakamura, Eiji Matsusue, Yoshio Fujiwara
Department of Radiology, Tottori University School of Medicine
Akira Adachi

Fourteen patients with malignant pleural effusion were treated by pleurodesis after CT-guided effusion drainage.CT guidance was used for accurate chest tube (20 Fr.) placement, and chemical pleurodeses were performed with cisplatin and OK-432 in all cases.The pleurodesis was successful in thirteen of the fourteen patients. After the treatments, dyspnea improved and numeric rating scales dropped from 4 to 1 points (p<0.01). Also, hypoxemia improved and percutaneous oxygen saturation increased from 94% to 97% (p<0.05). In caring for patients with a poor prognosis, palliative interventional radiologic procedure is recommended to improve their patients’ quality of life. Also, it seems to be very important to predict the prognosis in patients with advanced cancer by using indices such as palliative prognostic index (PPI), because interventional radiologic procedure is invasive to patients with poor prognosis. In conclusion, following CT guided drainage, pleurodesis effectively eliminates malignant pleural effusion.

Key words

  • Malignant pleurisy
  • Pleurodesis
  • CT guided drainage

Case Report

Use of Gadolinium Contrast Material for Visualization of the Extravasation and Transarterial Embolization for Acute Duodenal Bleeding in a Patient with a History of Anaphylaxis to Iodinated Contrast Material: A Case Report

Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
Kaishu Tanaka, Masahisa Nakamura, Tetsuro Nakazawa, Hiroki Higashihara
Noboru Maeda, Keigo Osuga, Tonsok Kim, Noriyuki Tomiyama
Department of Radiology, Kinki University School of Medicine
Nobuo Kashiwagi
Department of Radiology, Osaka Rosai Hospital
Isao Tsukaguchi
Department of Radiology, National Cerebral and Cardiovascular Center Hospital
Kentaro Kishimoto

A man in his 70s presented with acute duodenal bleeding refractory to endoscopic management. On the day before, he had had an event of anaphylactic reaction to iodinated contrast material during coronary angiography. To control the bleeding, we performed transarterial embolization (TAE) using gadolinium contrast material. As the gastroduodenal arteriogram revealed extravasation from the posterior superior pancreaticoduodenal artery (PSPDA), gelatin particles were selectively injected into PSPDA. Hemostasis was confirmed by gastrointestinal endoscopy, and the clinical course was uneventful. Our experience suggests that gadolinium contrast material can be used as an alternative to iodinated contrast material for the angiographic survey of bleeding source and the subsequent embolization procedure for acute gastrointestinal bleeding.

Key words

  • Duodenal bleeding
  • TAE
  • Gadolinium

Technical Note

Initial Experience Using Three-Dimensional CT Angiography Reconstructed with CT during Hepatic Arteriography on the Planning of Chemoembolization Treatment of Hepatocellular Carcinoma

Department of Radiology, Hamamatsu University School of Medicine
Hatsuko Nasu, Yohei Ito, Yusuke Kanoko, Takasuke Ushio
Shuhei Yamashita, Mika Kamiya, Harumi Sakahara
Radiology Department, Hamamatsu University School of Medicine, University Hospital
Takayuki Nomura, Michihiro Fukuoka, Yasutaka Takei, Yasuo Takehara

This is a brief report about our two cases using three-dimensional CT angiography reconstructed with CT during hepatic arteriography (CTHA). Three-dimensional CT angiography reconstructed with CTHA was conducted by an angiographic technologist using the IVR-Multi-Detector-Row CT (IVR-MDCT) system (Infinix Celeve-i, Toshiba Medical Systems, Tochigi, JAPAN) and a three-dimensional workstation (ZIO STATION, Amin, Tokyo, JAPAN). In the transcatheter arterial chemoembolization (TACE) procedure for hepatocellular carcinoma, it is important to recognize tumor stains and tumor-feeding arteries, but two-dimensional DSA is often insufficient because of overlapping arteries. Using three-dimensional CT angiography reconstructed with CTHA, tumor stains and tumor-feeding arteries were clearly visualized with high contrast resolution and multi-angle observation. Three-dimensional CT angiography reconstructed with CTHA may contribute to a speedy and effective TACE procedure providing optimal working angles for the visualization of tumor stains and tumor-feeding arteries.

Key words

  • TACE
  • CTHA
  • Three-dimensional CT angiography

Special Contribution

Clinical behavioral survey of trainees before and after the Japanese Society of Interventional Radiology 8th Academic Summer Seminar

Department of Radiology, Kansai Medical University
Atsushi Komemushi, et al*

PURPOSE : The purpose of this study was to report clinical behavioral survey of trainees before and after the Japanese Society of Interventional Radiology 8th Academic Summer Seminar.
MATERIALS AND METOODS : 27 trainees participated in the seminar. 26 trainees included in this study. The seminar consisted of a total of 5 hours of lectures on B-RTO and NBCA embolization, and following three types of practical training conducted for 120 minutes each: venous embolization and NBCA Embolization using swine 1, venous embolization and NBCA Embolization using swine 2 and a simulated B-RTO procedure using a venous vascular model. We surveyed to trainees clinical behavior about B-RTO and NBCA embolization of six months before and after the seminar.
RESULT : The number of trainees who had already experienced the procedures as operator of B-RTO and NBCA embolization at the time of the seminar were 15 and 13, respectively.
No trainees newly experienced operator and assistant of B-RTO in six months after the seminar. One and 2 trainees newly experienced operator and assistant of NBCA embolization in six months after the seminar, respectively.
CONCLUSION : We reported clinical behavioral survey of trainees before and after the Japanese Society of Interventional Radiology 8th Academic Summer Seminar.

Key words

  • Hands-on seminar
  • Clinical behavioral survey
  • B-RTO
  • NBCA