Scintigraphic assessment of therapeutic success in aldosteronomas treated by transcatheter arterial embolization using absolute ethanol.

UNLABELLED: Adrenocortical scintigraphy was examined as an indicator of therapeutic success in aldosteronomas treated by transcatheter arterial embolization (TAE) with absolute ethanol (AE). METHODS: Adrenocortical scintigraphy was performed 7 days after intravenous injection of 37 MBq 131I-6-beta-iodomethyl-19-norcholesterol before and after TAE. Complete or incomplete therapeutic success was determined by periodic measurements of the levels of plasma aldosterone and correlated with the scintigraphic results. RESULTS: The aldosteronoma was visualized as a hot nodule in nine patients and a warm nodule in one patient before TAE. Scintigraphy showed a hot, residual hot or warm nodule on seven occasions (six occasions after the first TAE and one occasion after the second TAE) when the techniques were incompletely successful and disappearance on seven occasions when success was achieved (three occasions after the first TAE and one occasion after the second TAE). Of the seven occasions when TAE was unsuccessful, four patients received the second or third TAE to result in complete destruction of the aldosteronoma; three patients underwent unilateral adrenalectomy. CONCLUSION: Adrenocortical scintigraphy can correctly predict the effect of TAE on aldosteronomas and is a valuable indicator for decisions on the necessity of repeated TAE or adrenalectomy.

Transcatheter arterial renal and adrenal embolization with iohexol-ethanol solutions. Animal experimental study and clinical application.

RATIONALE AND OBJECTIVES: The authors compared the embolic effect of radiolucent absolute ethanol (AE) with that of a radiopaque iohexol-ethanol (IES) solution for renal ablation in dogs and for the destruction of human aldosteronomas by the technique of transcatheter arterial embolization (TAE) to test whether IES can be an alternative to AE. METHODS: The embolic agents were infused through a balloon catheter into the renal arteries of 17 dogs (9 infused with 0.3 mL/kg AE; 8 infused with IES). The immediate and parenchyma were compared between the two groups. Transcatheter arterial embolization with IES also was performed in three humans with unilateral aldosteronoma. RESULTS: The IES was visualized faintly under fluoroscopy in all dogs. There were no significant differences in embolic effects between the AE and IES. Three patients with aldosteronoma were treated successfully by TAE with IES. CONCLUSIONS: The IES can be used as a "visible ethanol" to improve the safety and ease of ethanol embolization.

Non-surgical therapy of primary aldosteronism: transcatheter arterial infusion of ethanol into an aldosteronoma.

Primary aldosteronism due to an adrenocortical adenoma can be cured by ablation of the adenoma, which produces an excess of aldosterone (aldosteronoma). This has traditionally been performed by surgical removal of the adenoma. However, some patients with aldosteronomas refuse surgical removal. Therefore, we developed a therapeutic method to ablate an aldosteronoma by transcatheter arterial infusion of ethanol. This method ablated the aldosteronoma in 27 (82%) of 33 treated cases and produced no serious complications, and may be one of the therapeutic choices for aldosteronomas.

A case of renal juxtaglomerular cell tumor: usefulness of segmental sampling to prove autonomic secretion of the tumor.

A 27-year-old female patient had been treated for hypertension with conventional therapy for years, because renal vein renin levels failed to show lateralization in renal venous samplings and a renal juxtaglomerular cell tumor (RJGCT) had gone undiagnosed. Abdominal computed tomography revealed a mass at the middle of the right kidney. The right renal venogram demonstrated distinct segmental veins from the upper pole and from the middle and lower poles in the right kidney. On segmental renin sampling from each renal vein, the plasma renin concentration (PRC) of the segmental veins from the middle and lower poles was higher than that from other sites. We diagnosed RJGCT of the right kidney and performed right-sided nephrectomy. After the resection, the PRC rapidly decreased. Immunohistochemical studies using antihuman renin antibodies revealed positive staining of the tumor cells. It is an important strategy to make a segmental sampling at the site as close as possible to the RJGCT.

A comparison of hepatocellular carcinoma associated with HBV or HCV infection.

BACKGROUND/AIMS: Close relationships between hepatocellular carcinoma (HCC) and hepatitis virus infection have been elucidated. However, clinical differences between HBV- and HCV-associated HCC remain unclear. METHODOLOGY: Four hundred and sixteen patients with HCC were examined for both HBsAg and HCV-Ab. Sixty-nine of the 416 patients (16.6%) were positive for HBsAg and negative for HCV-Ab (B-HCC), while 290 patients (69.7%) were negative for HBsAg and positive for HCV-Ab (C-HCC). Various comparisons were made between the 2 groups. RESULTS: B-HCC patients were younger in age (p < 0.0001), and had significantly better liver function than C-HCC patients. The motivation of HCC detection was different between the 2 groups (p < 0.0001), and the tumor size of B-HCC was significantly larger when comparing groups with regard to symptoms (p < 0.05). Although B-HCC demonstrated better survival in Stage I/II treated by surgery (p < 0.05), it was associated with poorer survival in Stage III/IV receiving hepatic arterial infusion chemotherapy when compared to C-HCC (p < 0.01). CONCLUSIONS: These results suggest that clinical differences between B-HCC and C-HCC may depend upon the difference of the natural course between HBV and HCV infection, and B-HCC may be more resistant to treatment than C-HCC in the advanced stage. This also illustrates the need for early tumor detection in B-HCC.

MR imaging during arterial-portography (MR-AP) in the detection of hepatic tumor: comparison with CT-AP.

This study was undertaken to compare the detection rate of hepatic space occupying lesion (SOL)s between computed tomography during arterial portography (CT-AP) and magnetic resonance imaging during arterial portography (MR-AP) and the differences in time intensity curve on MR-AP between HCC, metastatic tumor, FNH, and hemangioma. We performed CT-AP and MR-AP in 17 patients including 14 cases of HCC and one each of metastasis, FNH, and hemangioma. MR-AP was performed by Turbo-FLASH sequence. There was no statistically significant difference between CT-AP and MR-AP in detecting satellite lesions in terms of smallest diameter and number of flow defects (p > 0.05). Hemangioma showed rapid enhancement after the first pass and, consequently, the same enhancement as the hepatic parenchyma. MR-AP was comparable to CT-AP in the detection of hepatic SOLs. Hemangioma showed an enhancement pattern different from those of HCC, metastatic tumor, and FNH, which showed patterns similar to each other.

A case with Cushing's syndrome treated with arterial ablation of adrenal gland by absolute ethanol.

Adrenal arterial embolization with absolute ethanol was performed for the treatment of Cushing's syndrome. A 55-year-old woman was admitted to our hospital with complaints of obesity, hypertension, and back pain caused by left adrenal hyperplasia after surgical resection of the right adrenal gland. Therapeutic adrenal arterial embolization was performed by the coaxial technique using absolute ethanol (AE) as an embolic material. No severe complications were encountered during the procedure, and the patient was discharged without symptoms or abnormalities on laboratory tests.

A case of sclerosing hemangioma of the lung: correlation of MR images with pathological findings.

The authors present a case of sclerosing hemangioma of the lung in which MRI was performed. The tumor had areas of various signal intensities on both T1- and T2-weighted images, including high-intensity areas and isointensity areas relative to muscle. We compared the signal intensity of the tumor with its pathological findings. The relatively high signal intensity of the tumor on T1-weighted images was thought to be a reflection of lipids of clear cells, and the isointensity relative to muscle on T1-weighted images to be a reflection of fibrosis. Hyperintensity was also seen on both T1- and T2-weighted images, and was intralesional hemorrhage. Use of Gd-DTPA strongly enhanced the tumor. This enhancement was thought to be abundant blood cavities, since not many capillaries were seen in the specimen. The signal intensity of the tumor corresponded closely to the pathognomonic findings, and it is thought that MRI may be helpful in diagnosing sclerosing hemangioma of the lung because of its high contrast resolution.

Primary hepatic neuroendocrine carcinoma with multiple metastases: a case report.

We report a rare case of primary hepatic neuroendocrine cell carcinoma with multiple metastases to the liver, lung, diaphragm, bone, and pancreas. The patient was a 45-year-old man with jaundice and a large hepatic tumor measuring 12 x 16 cm at autopsy. Located in the right lobe, it was hyperechoic and inhomogeneous on US, a diffusely low density mass that contained capsule- and septum-like structures enhanced by contrast medium on CT, an inhomogeneously low intensity mass with much lower intensity foci on T1-weighted MRI, and a diffusely high intensity mass containing small higher and lower intensity foci on T2-weighted MRI. These findings are similar to those of a few previously reported cases, but are not specific to this tumor.

Estimation of the kinetics of iodized oil injected into the feeding artery of hepatocellular carcinoma using dynamic computed tomography.

The distribution of iodized oil (Lipiodol) after its injection in hepatocellular carcinoma (HCC) was evaluated by dynamic computed tomography (CT) in 10 patients. Following the injection of Lipiodol into the hepatic artery, two patterns were observed. In type I (4/10 tumors) Lipiodol retention began at the tumor periphery and then spread contiguously towards the central portion. In type II (6/10 tumors), the accumulation began at the periphery, but then skipped directly to the central portion of the tumor. Hypervascular tumors were predominantly type I, and avascular or hypovascular tumors were all type II. This difference in Lipiodol kinetics suggests that lipid-based intra-arterial (i.a.) chemoembolization should precede the i.a. infusion of water-soluble chemotherapeutic agents or injection of solid embolic materials in hypervascular tumors.

Successful therapeutic embolization of aldosteronoma using absolute ethanol.

Adrenal arterial infusion of absolute ethanol (AE) was successfully performed to treat a hyperfunctioning aldosteronoma. One milliliter of AE was infused into the branches of the inferior adrenal artery using a microcatheter with coaxial technique. No severe complications occurred during the procedure. The patient has experienced no recurrence of symptoms, and laboratory values have remained normal for eight months after therapy.

[Anticancer effect and side effect of arterial chemoembolization using cis-diamine-dichloroplatinum (II)/4-0-tetrahydropyranyl-adriamycin-lipiodol (CTL) suspension on hepatocellular carcinoma].

Seventeen patients with hepatocellular carcinoma were treated by intraarterial injection of CTL suspension. The doses of CTL suspension, CDDP and THP(mean +/- SD)/injection were 4.1 +/- 1.6 ml, 81.9 +/- 31.6 mg and 13.5 +/- 5.2 mg, respectively. The therapy was given once in 10 patients, twice in 6 and 4 times in one. Over 50 per cent reduction in tumor size was obtained in 5 patients (30%). Fifty or more % decrease in serum alpha-feto-protein (AFP) levels was observed in 3 of 7 patients (43%) with the initial serum AFP level of more than 200 ng/ml, Fever, abdominal pain, nausea and vomiting were noted in most cases. However, they disappeared within 2 weeks after therapy was completed. No severe complications were encountered except one case of a liver abscess which healed by administration of antibiotics. No severe changes in laboratory data were observed. This study suggests that a new method of intraarterial injection must be developed to enhance the therapeutic effect even more, in addition to an increased injection dose of CDDP/THP-LPD and higher concentration of CDDP and THP in LPD.

[Hepatocellular carcinoma treated by intraarterial injection of adriamycin/mitomycin C oil suspension alone or combined with cis-diaminodichloroplatinum].

One hundred thirty-five patients with hepatocellular carcinoma (HCC) were treated by intraarterial injection of adriamycin/mitomycin C oil suspension (ADMOS) alone (59 cases) and ADMOS plus cis-diaminodichloroplatinum (CDDP) (76 cases). Tumor size was reduced by over 25% in 13 of 38 patients (35%) in the ADMOS alone group and in 39 of 76 patients (50%) in the ADMOS plus CDDP group. Serum alpha-fetoprotein (AFP) levels decreased by more than 50% in 7/17 (59%) in the ADMOS alone group and in 23/32 (70%) in the ADMOS plus CDDP group. The overall 1- and 2-year survival rates were 68% and 41% by the Kaplan-Meier method. However, no significant difference in the survival rates was observed between the two groups.

[Anticancer and side effect of arterial subsegmental chemoembolization using cisplatinum/pirarubicin lipiodol suspension (CTLS) for hepatocellular carcinoma].

Twenty patients with unresectable hepatocellular carcinoma were treated by intra-arterial subsegmental injection of Cisplatin/4-0-Tetrahydro-Pyranyl-adriamycin Lipiodol suspension (CTLS). The mean single doses of Lipiodol, cisplatin and THP were 2.3 ml, 85 mg and 8.9 mg, respectively. The therapy was given once in 10 patients, twice in 8 and 3 times in two. Over 25% reduction in tumor size was recognized in 12 patients (60%). Fifty or more % decrease of alfa-feto-protein (AFP) was observed in all of 7 patients (100%) with the initial serum AFP level of more than 200 ng/ml. Although transitional and mild symptoms, such as fever, abdominal pain and vomiting were recognized in some cases, no severe complications were encountered. This method is promising as an excellent procedure for unresectable hepatocellular carcinoma.

[Three cases of alveolar soft part sarcoma and MRI findings].

Three cases of alveolar soft part sarcoma were reported with characteristic MRI findings. On MRI findings, slightly higher signal intensity than muscles on T1 weighted image and remarkably high signal intensity on T2 weighted image were thought to be characteristic of alveolar soft part sarcoma.

Retrograde visualization of the portal venous system using CO2 intraarterial digital subtraction angiography.

Carbon dioxide (CO2) intraarterial digital subtraction angiography (IADSA) provides retrograde visualization of the portal vein via a peripheral segmental hepatic artery. IADSA was performed in 12 patients with known hepatic diseases by injecting a peripheral hepatic artery with both CO2 gas and an iodinated contrast medium. The portal vein was constantly visualized only with CO2 IADSA in all patients. The injected CO2 may flow back into the portal vein through an anastomotic system known as the peribiliary or periportal plexus. This new method is safe and useful to image the portal venous system in patients with hepatic malignancy.

Transcatheter arterial ablation of aldosteronomas with high-concentration ethanol: preliminary and long-term results.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of transcatheter arterial ablation (TAA) of aldosteronomas with high-concentration ethanol (HCE). MATERIALS AND METHODS: From August 1992 to August 1995, 18 patients with unilateral aldosteronoma, three men and 15 women, 28-65 years old, were treated by TAA with HCE. A single dose (0.2-7.0 ml) of HCE was selectively infused into the feeding arterial branches of the aldosteronoma using a microcatheter and the coaxial technique. The 18 patients underwent 31 TAA procedures. RESULTS: Ablation of the aldosteronoma was monitored by measuring plasma levels of aldosterone and was successful in 15 (83%) of 18 patients. The remaining three patients underwent surgery because results of TAA were insufficient. The destructive effect of ablation by HCE has persisted for 7-38 months (mean, 20 months) in 14 patients. Although one patient had recurrence of symptoms 15 months after the initial TAA, normalization of plasma levels of aldosterone continued for 3 months after TAA was repeated. No severe complications occurred in any of the 18 patients. However, back pain (18 of 18), slight fever (nine of 18), pleural effusion (two of 18), and labile changes in blood pressure (one of 18) were noted in patients 1-7 days after the procedure. CONCLUSION: TAA of aldosteronoma with HCE is an alternative to open adrenalectomy.

[Evaluation of anastomosis between intrahepatic or extrahepatic vessels by intra-arterial digital subtraction angiography using carbon dioxide].

Carbon dioxide (CO2) intraarterial subtraction angiography (IADSA) was performed in 31 patients with various hepatobiliary diseases. The injection sites of CO2 were proper hepatic artery (10/31; group A), segmental hepatic artery (18/31; group B), and peripheral inferior phrenic artery (3/31; group C), respectively. In group A, only the third order branches of the portal venous system were visualized anterogradely in 8 of 10 patients. In group B, the microcatheter was placed coaxially through a 5 French guiding catheter at the main arterial supply of the tumor in 7 patients and at the peripheral segmental branch of the hepatic artery in 11 patients. The portal venous system was visualized retrogradely in all of the patients regardless of the injection site. The injected CO2 may flow back into the portal vein through the anastomosis known as the peribiliary or periportal plexus. In group C, not only the portal vein but also the pulmonary artery or pericardial vein were visualized by this method. CO2-IADSA was useful to image the minute communications between the various vessels, which have been not hitherto visualized by iodinated contrast medium.

Visualization of left bronchial-to-coronary artery communication after distal bronchial artery embolization for bronchiectasis.

We present a 44-year-old woman in whom a bronchial-to-coronary artery communication via the conus branch was discovered after distal bronchial artery embolization with gelatin sponge for hemoptysis. If this bronchial-to-coronary artery anastomosis, not visible prior to embolization, had been inadvertently embolized, the patient could have developed a myocardial infarction. To reduce the likelihood of a serious complication, the possibility of this anastomosis should be kept in mind and angiography should be repeated before attempting proximal bronchial artery embolization.

Transcatheter arterial chemoembolization therapy using iodized oil for patients with unresectable hepatocellular carcinoma: evaluation of three kinds of regimens and analysis of prognostic factors.

BACKGROUND: The current study was conducted to evaluate retrospectively the effects of three kinds of regimens used in transcatheter arterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC) and patients' prognosis, and to analyze their prognostic factors. METHODS: The study population was comprised of 152 patients who were treated by TACE alone. Three kinds of regimens were used successively: doxorubicin hydrochloride (ADM) and mitomycin C mixed with iodized oil in 26 patients (ADMOS group), a combination of cisplatin (CDDP) solution and ADMOS in 70 patients (CDDP-ADMOS group), and CDDP powder and pirarubicin hydrochloride mixed with iodized oil in 56 patients (CTLS group). The CTLS group was comprised of patients with significantly worse background factors than the other two groups. RESULTS: The initial tumor response rate with a > 50% reduction was 12%, 23%, and 30%, respectively, in the ADMOS, CDDP-ADMOS, and CTLS groups. CTLS was significantly more effective than ADMOS (P < 0.05), and slightly but not significantly better than CDDP-ADMOS (P <0.1). The cumulative survival rates for the ADMOS, CDDP-ADMOS, and CTLS groups were 59.0%, 70.1%, and 72.0%, respectively, at 1 year; 0%, 16. 3%, and 29.8%, respectively, at 3 years; and 0%, 4.1%, and 16.8%, respectively, at 5 years, with median survival times of 448 days, 574 days, and 758 days, respectively. The CTLS group showed a slightly but not significantly better survival than the ADMOS and CDDP-ADMOS groups (P <0.1). Multivariate analysis indicated that the significantly important prognostic factors (in order) were extrahepatic metastasis followed by the TACE regimen, serum alpha-fetoprotein levels, and portal vein involvement and that CTLS was the best of the three regimens. CONCLUSIONS: Although TACE, using an effective regimen, improves clinical results, tumor factors appear to be more important when determining prognosis.