IVR 会誌 Jpn J Intervent Radiol Vol.20 No.1 2005

State of the Art

1.Multi-Institutional Clinical Study of Interventional Radiology in Oncology Field
-JIVROSG (Japan Interventional Radiology in Oncology Study Group) -
Department of Diagnostic Radiology, National Cancer Center
Yasuaki Arai

To establish interventional radiology as the standard therapeutic modality in the oncology field, evidence to reveal the scientific merit must be shown by clinical studies. JIVROSG(Japan Interventional Radiology in Oncology Study Group) involving 33 active institutions was organized in 2002. The formation of this study group was modeled on the Japan clinical Oncology Group, and the study design was also modeled on that of medical oncology. Now, 10 clinical studies are ongoing and 2 studies are being planning.
The financial and social backgrounds of these clinical studies have not been adequeat, and the Japan Society of Angiography and Interventional Radiology must perform the great roles to improve this situation. However, by the great efforts of young interventional radiologists, much evidence of interventional radiology in the oncology field will be reported from this country in the near future.

Key words
● Interventional radiology
● Clinical study
● Oncology

2.A Multi-Institutional Trial of Transcatheter Arterial Infusion Therapy as a Method of Chemoradiotherapy for Uterine Cervical Cancer
Department of Therapeutic Radiology & Oncology, Kyoto University
Yasushi Nagata, Norio Araki, Takashi Sakamoto, Michihide Mitsumori, Masahiro Hiraoka
Department of Radiology, Fukui Redcross Hospital
Yoshiharu Negoro, Masato Noguchi
Department of Radiology, Otsu Redcross Hospital
Keizo Akuta
Department of Radiology, Nara Social Insurance Hospital
Tadashi Kawamura

Purpose : To evaluate the clinical feasibility of the multi-institutional trial for the transcatheter arterial infusion (TAI) therapy as a method of chemoradiotherapy for uterine cervical cancer.
Materials and Methods : The trial was performed in four institutions. Twenty cases were enrolled in this study between May 1999 and February 2003. More than 66Gy was administered with intracavitary radiotherapy in 17 cases. TAI was performed within 2 weeks after the start of radiotherapy. CDDP alone in 7 cases and CDDP with THP-ADR was administered in 13 cases.
Results : TAI could be performed as a method of chemoradiotherapy in all cases. Local control rate (CR+PR/all) was 100%. The three-year local control rate and three-year cumulative survival rate were 83% and 85%, respectively. During the follow-up of 6~54 months (median 36), the complication of Grade 2 rectal bleeding was very low.
Coclusion : The initial result of the transcatheter arterial infusion (TAI) therapy as a method of chemoradiotherapy for uterine cervical cancer seems promising. A further study comparing systemic therapy and TAI therapy is warranted.

Key words
● Transcatheter arterial infusion
● Uterine cervical cancer
● Cisplatin

3.Multidisciplinary Research Using Internet Technology : Online-Database System
Department of Radiology, Yamaguchi University School of Medicine
Naofumi Matsunaga

Online submission of case data is required for making a strong evidence of interventional radiology (IVR). FileMakerPro is convenient for construction and analysis of database of IVR. Online submission of data via the internet is now mandatory to accumulate the data among the groups using the web-based version of FileMakerPro (unlimited version). Setting strict criteria for the selection of the cases in the committee is important for accumulation of reliable data. UMIN (University Hospital Medical Information Network) is useful for large-scale online-database system.

Key words
● Evidence-based medicine
● Interventional radiology
● Internet technology
● Online-database system

4.Intellectual Property Rights Especially a Patent, and Its Industrialization in Multi-Institution Joint Research
Department of Radiology, St. Marianna University Yokohama Seibu Hospital
Eigoro Yamanouchi, Yukihisa Ogawa, Shingo Hamaguchi
Takayuki Hattori, Reiko Kumano, Tohru Fukushima

This paper is based on the presentation about intellectual property rights especially a patent, and its industrialization in multi-institution joint research at the symposium of the general meeting last Spring. Some portions have been retouched and corrected for the written version. It seems that intellectual property rights including a patent continue to increase in various fields, and medicine is not an exception.
In industrializing the result of multi-institution joint research, problems are that the study group is not a organization which exchanges contracts, and a corporation.
Moreover, many of results of IVR studies in Japan are following foreign papers, and there is actually almost nothing in this field.
Therefore, new research, which is producing patents, based on the new way of thinking will not be served by the present system or conservative way.

Key words
● Patent
● Intellectual property rights
● Multi-institution joint research

Original Article
CT Guided Aspiration of Ganglion Cysts, Experience of 10 Cases
Diagnostic Radiology and Nuclear Medicine, Gunma University Hospital
Department of Radiology, Ota General Hospital*
Eri Ito*, Yoshinori Koyama, Ayako Taketomi, Akihiro Ishibashi
Hiromi Hirasawa, Sachiko Awata, Yuko Matsuyama, Keigo Endo
Department of Radiology, Gunma General Hospital
Jun Aoki

Purpose :
To report the results of CT guided fine needle aspiration of symptomatic ganglion cysts.
Materials and Methods : Aspirations were performed on twelve ganglion cysts in ten patients (five men and five women). Under local anesthesia and using CT guidance, ganglion cysts were punctured and aspirated with an 18G needle. As necessary, injection of ethanol and busting of the cyst with normal saline were performed in addition to aspiration. The average patient age was 35.3 years old, ranging from 16 to 73 years. The maximum diameters of the ganglion cysts ranged from 1.0 to 2.0b, averaging 2.0b. The distance from the skin surface to the ganglion cyst ranged from 1.3 to 9.0a, averaging 53.1a. Follow up periods ranged from zero to 14 months, with an average of three and a half months.
Results : Eleven ganglion cysts were sucessfully aspirated. The clinical symptoms were completely resolved in five cases, improved in two cases, and recurred in four cases. No serious complications were seen.
Conclusion : CT guided percutaneous ganglion cyst aspiration is safe, relatively easy to perform and is effective in treating symptomatic ganglion cysts.

Key words

Original Article
Safety Considerations in the Power Injection of Contrast Medium via a Totally Implantable Central Venous Access System
Department of Radiology, Asahikawa Kosei General Hospital
Syuhei Takeuchi, Hiroya Saitoh, Kazuhide Hiramatsu
Hirofumi Hokotate, Akio Takamura, Ta-chen Chang

The aim of this study is to assess the maximal pressure of a totally implantable central venous access system using an auto power injector system, and to direct a safety model to use the power injector of contrast media via a totally implantable central venous access system during computed tomography.
In-line pressures were measured in an experimental model, consisting of eight different types of catheters, ports and the power injector. The catheters were infused with a contrast medium at each flow rate of 3.0p/w, 1.5p/w, and below the pressure limit 15o/f.
The experimental pressures were safe at rates of 3.0p/second for 20b catheter tubing. All totally implantable central venous access systems had measured pressures with no dislodgement or dislocation.
This study suggests that power injection of contrast medium via a totally implantable central venous access system during CT is a safe procedure. This study was an in vitro study, and experimental cases were not complete. We need to continue to investigate.

Key words
 ●Central venous access
 ●Computed tomography
 ●Power injection

Case Report
Preoperative Transcatheter Arterial Embolization(TAE) for
Graves’Disease with a Large Diffuse Goiter : Report on Two Cases
Department of Medical Imagings, Hiroshima General Hospital
Keizo Tanitame, Noriaki Matsuura, Ryoichiro Hata, Takayuki Suzuki, Koichi Fujikawa
Hiroshima Thyroid Medical Clinic
Nobuo Takeichi

In Graves’disease, a subtotal thyroidectomy is performed on patients who are unable to tolerate or accept antithyroid drugs and/or radioactive iodine. When operating on extremely large goiters, unexpected massive bleeding is a serious complication and inevitably requires long skin incisions, which are cosmetically unappealing. In order to resolve this problem, we performed preoperative transcatheter arterial embolization (TAE) in two young female patients, who had Graves’disease with large goiters. In each case, several series of selective angiographies were performed to identify the arteries supplying the upper half of the goiter. After vascular mapping, the superior thyroid arteries and some related arteries were occluded using microcoils. In each case, subtotal thyroidectomy was completed with less bleeding and a shorter skin incision than expected. No remarkable complications due to TAE were identified except for transient throat pain in one patient. Preoperative TAE of the superior thyroid arteries is useful for decreasing intraoperative blood loss and the extent of skin incisions.

Key words
●Transcatheter arterial embolization
●Thyroid artery

Case Report
A Case of Bone Metastasis from Hepatocellular Carcinoma with Persistent Clinical Remission Four Years After Percutaneous Bone Cement Injection Therapy
Department of Radiology, Asahikawa Kosei General Hospital
Syuhei Takeuchi, Hiroya Saitoh, Kazuhide Hiramatsu
Akio Takamura, Masakazu Hasegawa

A 65-year-old male, who had undergone hepatic arterial infusion chemotherapy for hepatocellular carcinoma(HCC), complained of local pain of the right hip joint. Imaging modalities revealed metastatic HCC in his right iliac bone.
The first percutaneous bone cement injection therapy was attempted under computed tomography(CT) guidance with 60 Gray radiation therapy. The additional second procedure was performed for residual tumor two months after the initial procedure. No other distant metastases or local recurrences occurred during the follow-up period of four years.
In conclusion, percutaneous bone cement injection therapy is thought to be very useful in the treatment of bone metastasis of HCC with severe local pain.

Key words
●Interventional radiology
●Bone metastasis
●Percutaneous osteoplasty
●Bone cement

Case Report
Clinical Experience of Osteoject (Bone Cement Injection Tool) for Percutaneous Vertebroplasty
Department of Radiology, Kanazawa University Hospital
Takeshi Kobayashi, Tsuyoshi Takanaka, Junichiro Sanada, Noboru Terayama
Satoshi Kobayashi, Hiroko Kawashima, Osamu Matsui

Percutaneous vertebroplasty is widely used as an effective treatment option for patients with intractable pain related to compression fractures of the spine. Although this procedure has been established, the consistency of polymethylmetaclyrate(PMMA) bone cements remains a major problem. Osteoject is a specific tool for the injection of bone cement in this procedure. Osteoject is composed 0 of a 10p pressure-resistant syringe, 27b pressure-resistant tube and reusable powerful screw compressor. The screw compressor is able to yield 0.25p/half-rotation. We described initial experiences of using this tool and evaluated the injection time with and without it. We used this tool for four vertebral compression fractures in three patients. Using this tool, the injection time can be prolonged to over 3 minutes compared with conventional methods and ease of control of good delivery distributions. According to employment of the long tube, the irradiation dose to the operator of this procedure is considered to be significantly decreased. This injection tool will bring the operator both longer treatment time and less irradiation dose. We suggest that Osteoject will be a standard tool for injection of bone cements for percutaneous vertebroplasty under X-ray and CT fluoroscopic guidance.

Key words
 ●Percutaneous vertebroplasty
 ●CT fluoroscopy