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Radiofrequency ablation in a porcine liver model:Effects of transcatheter arterial embolization with iodized oil on ablation time,maximum output,and coagulation diameter as well as angiographic characteristics

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World Journal of Gastroenterology 2007年第20期13卷 2841-2845页

作者： Motoki Nakai Morio Sato shinya sahara Nobuyuki Kawai Hirohiko Tanihata Masashi Kimura Masaki Terada Department of Radiology Hidaka General Hospi-tal116-2 SonoGobo ShiWakayama 644-8655Japan Department of Radiol-ogy Wakayama Medical University 811-1KimiideraWakayama ShiWakayama 641-8510Japan

AIM:To evaluate the effects of combined radiofrequen-cy ablation and transcatheter arterial embolization with iodized oil on ablation time,maximum output,coagula-tion diameter,and portal angiography in a porcine liver model. METHODS: Radiofrequency ablation (RFA) was applied to in vivo livers of 10 normal pigs using a 17-gauge 3.0 cm expandable LeVeen RF needle electrode with or with-out transcatheter arterial embolization (TAE) with iodized oil (n = 5). In each animal,2 areas in the liver were ab-lated. Direct portography was performed before and af-ter RFA. Ablation was initiated at an output of 30 W,and continued with an increase of 10 W per minute until roll-off occurred. Ablation time and maximum output until roll-off,and coagulated tissue diameter were compared between the 2 groups. Angiographic changes on portog-raphy before and after ablation were also reviewed. RESULTS: For groups with and without TAE with iodized oil,the ablation times until roll-off were 320.6 ± 30.9 seconds and 445.1 ± 35.9 seconds,respectively,maxi-mum outputs were 69.0 ± 7.38 W and 87.0 ± 4.83 W and maximal diameters of coagulation were 41.7 ± 3.85 mm and 33.2 ± 2.28 mm. Significant reductions of abla-tion time and maximum output,and significantly larger coagulation diameter were obtained with RFA following TAE with iodized oil compared to RFA alone. Portography after RFA following TAE with iodized oil revealed more occlusion of the larger portal branches than with RFA alone. CONCLUSION: RFA following TAE with iodized oil can increase the volume of coagulation necrosis with lower output and shorter ablation time than RFA alone in nor-mal pig liver tissue.

关键词： Liver Radiofrequency ablation Transcatheter arterial embolization Iodized oil Angiography Hepatocellular carcinoma

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Ruptured high flow gastric varices with an intratumoral arterioportal shunt treated with balloon-occluded retrograde transvenous obliteration during temporary balloon occlusion of a hepatic artery

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World Journal of Gastroenterology 2006年第33期12卷 5404-5407页

作者： Motoki Nakai Morio Sato Hirohiko Tanihata Tetsuo Sonomura shinya sahara Nobuyuki Kawai Masashi Kimura Masaki Terada Department of Radiology Hidaka General Hospital 116-2 Sono Gobo Shi Wakayama 644-8655 Japan Department of Radiology Wakayama Medical University 811-1 Kimiidera Wakayama Shi Wakayama 641-8510 Japan

A patient presented with hematemesis due to gastric variceal bleeding with an intratumoral arterioportal shunt. Contrast-enhanced CT revealed gastric varices and hepatocellular carcinoma with tumor thrombi in the right portal vein. Angiography and angio-CT revealed a marked intratumoral arterioportal shunt accompanied with reflux into the main portal vein and gastric varices. Balloon-occluded retrograde venography from the gastro-renal shunt showed no visualization of gastric varices due to rapid blood flow through the intratumoral arterioportal shunt. The hepatic artery was temporarily occluded with a balloon catheter to reduce the blood flow through the arterioportal shunt, and then concurrent balloon-occluded retrograde transvenous obliteration （BRTO） was achieved. Vital signs stabilized immediately thereafter, and contrast-enhanced CT revealed thrombosed gastric varices. Worsening of hepatic function was not recognized. BRTO combined with temporary occlusion of the hepatic artery is a feasible interventional procedure for ruptured high flow gastric varices with an intratumoral arterioportal shunt.

关键词： Gastric varices Hepatocellular carcinoma Arterioportal shunt Balloon-occluded retrogradeobliteration Hematemesis

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Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolization in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt

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World Journal of Gastroenterology 2006年第31期12卷 5071-5074页

作者： Motoki Nakai Morio Sato shinya sahara Nobuyuki Kawai Masashi Kimura Yoshimasa Maeda Yumiko Ibata Katsuhiko Higashi Department of RadiologyWakayama Medical University 811-1KimiideraWakayama ShiWakayama 641-8510Japan the First Department of Internal MedicineHidaka General Hospital 116-2 SonoGobo ShiWakayama 644-8655Japan

A 66-year-old woman underwent partial splenic embolization （PSE） for hypersplenisrn with idiopathic portal hypertension （IPH）. One week later, contrast-enhanced CT revealed extensive portal vein thrombosis （PVT） and dilated portosystemic shunts. The PVT was not dissolved by the intravenous administration of urokinase. The right portal vein was canulated via the percutaneous transhepatic route under ultrasonic guidance and a 4 Fr. straight catheter was advanced into the portal vein through the thrombus. Transhepatic catheter-directed thrombolysis was performed to dissolve the PVT and a splenorenal shunt was concurrently occluded to increase portal blood flow, using balloon-occluded retrograde transvenous obliteration （BRTO） technique. Subsequent contrast-enhanced CT showed good patency of the portal vein and thrombosed splenorenal shunt. Transhepatic catheter-directed thrombolysis combined with BRTO is feasible and effective for PVT with portosystemic shunts.

关键词： Portal vein thrombosis Idiopathic portal hypertension Partial splenic embolization Portosystemic shunts Transhepatic catheter-directed thrombolysis Balloon-occluded retrograde transvenous obliteration

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Three benefits of microcatheters for retrograde transvenous obliteration of gastric varices

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World Journal of Gastroenterology 2012年第12期18卷 1373-1378页

AIM： To evaluate the usefulness of the microcatheter techniques in balloon-occluded retrograde transvenous obliteration （BRTO） of gastric varices.METHODS： Fifty-six patients with gastric varices underwent BRTOs using microcatheters. A balloon catheter was inserted into gastrorenal or gastrocaval shunts. A microcatheter was navigated close to the varices, and sclerosant was injected into the varices through the microcatheter during balloon occlusion. The next morning, thrombosis of the varices was evaluated by contrast enhanced computed tomography （CE-CT）. In patients with incomplete thrombosis of the varices, a second BRTO was performed the following day. Patients were followed up with CE-CT and endoscopy.RESULTS： In all 56 patients, sclerosant was selectively injected through the microcatheter close to the varices. In 9 patients, microcoil embolization of collateral veinswas performed using a microcatheter. In 12 patients with incomplete thrombosis of the varices, additional injection of sclerosant was performed through the microcatheter that remained inserted overnight. Complete thrombosis of the varices was achieved in 51 of 56 patients, and the remaining 5 patients showed incomplete thrombosis of the varices. No recurrence of the varices was found in the successful 51 patients after a median follow up time of 10.5 too. We experienced one case of liver necrosis, and the other complications were transient.CONCLUSION： The microcatheter techniques are very effective methods for achieving a higher success rate of BRTO procedures,

关键词： Balloon-occluded retrograde transvenousobliteration Gastric varices Microcatheter Portal hyper-tension Ethanolamine oleate

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Reactive lymphoid hyperplasia of the liver:Perinodular enhancement on contrast-enhanced computed tomography and magnetic resonance imaging

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World Journal of Gastroenterology 2015年第21期21卷 6759-6763页

作者： Tetsuo Sonomura Shinpei Anami Taizo Takeuchi Motoki Nakai shinya sahara Hirohiko Tanihata Kazuki Sakamoto Morio Sato Department of Radiology Wakayama Medical University Department of Radiology Kishiwada Tokushukai Hospital Department of Surgery Kishiwada Tokushukai Hospital

We report the case of a 69-year-old woman with reactive lymphoid hyperplasia(RLH) of the *** underwent partial hepatectomy under a preoperative diagnosis of hepatocellular carcinoma; however,histopathological analysis revealed *** liver nodule showed the imaging feature of perinodular enhancement in the arterial dominant phase on contrast-enhanced computed tomography and magnetic resonance imaging,which could be a useful clue for identifying RLH in the ***,the perinodular enhancement was compatible with prominent sinusoidal dilatation surrounding the liver nodule.

关键词： Reactive lymphoid hyperplasia Liver Perinodular enhancement Computed tomography Magnetic resonance imaging

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Balloon-occluded retrograde transvenous obliteration for gastric varices via the intercostal vein

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World Journal of Radiology 2012年第3期4卷 121-125页

作者： Hiroki Minamiguchi Nobuyuki Kawai Morio Sato Akira Ikoma Munehisa Sawa Tetsuo Sonomura shinya sahara Kouhei Nakata Isao Takasaka Motoki Nakai Department of Radiology Wakayama Medical University 811-1 KimiideraWakayama ShiWakayama 641-8510Japan

Gastric varices are usually associated with a gastrorenal(G-R) ***,the gastric varices described in this case report were not associated with a G-R *** inflow vessel was the posterior gastric vein and the outflow vessels were the narrow inferior phrenic vein and the dilated cardio-phrenic ***,percutaneous transhepatic obliteration of the posterior gastric vein was performed,but the gastric varices remained ***,micro-balloon catheterization of the subphrenic vein was carried out via the jugular vein,pericardial vein and cardio-phrenic vein,however,micro-balloon-occluded inferior phrenic venography followed by micro-coil embolization of the cardio-phrenic vein revealed no delineation of gastric varices resulting in no further ***,as a gastrosubphrenic-intercostal vein shunt developed,a microballoon catheter was advanced to the gastric varices via the intercostal vein and balloon-occluded retrograde transvenous obliteration(BRTO) was performed resulting in the eradication of gastric *** for gastric varices via the intercostal vein has not previously been documented.

关键词： Balloon-occluded retrograde transvenous obliteration Gastric varices Gastro-subphrenic-intercostal vein shunt Hepatocellular carcinoma Intercostal vein

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Emergency balloon-occluded retrograde transvenous obliteration of ruptured gastric varices

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World Journal of Gastroenterology 2013年第31期19卷 5125-5130页

作者： Tetsuo Sonomura Wataru Ono Morio Sato shinya sahara Kouhei Nakata Hiroki Sanda Nobuyuki Kawai Hiroki Minamiguchi Motoki Nakai Kazushi Kishi Department of Radiology Wakayama Medical University Wakayama 641-8510 Japan Department of Gastroenterology Kishiwada Tokushukai Hospital Kishiwada 596-8522 Japan Department of Radiology Kishiwada Tokushukai Hospital Kishiwada 596-8522 Japan

AIM: To evaluate the effectiveness and safety of emergency balloon-occluded retrograde transvenous obliteration(BRTO) for ruptured gastric ***: Emergency BRTO was performed in 17 patients with gastric varices and gastrorenal or gastrocaval shunts within 24 h of hematemesis and/or tarry *** gastric varices were confirmed by endoscopy,and the gastrorenal or gastrocaval shunts were identified by contrast-enhanced computed tomography(CE-CT).A 6-Fr balloon catheter(Cobra type) was inserted into the gastrorenal shunt via the right internal jugular vein,or into the gastrocaval shunt via the right femoral vein,depending on the varices drainage *** sclerosant,5% ethanolamine oleate iopamidol,was injected into the gastric varices through the catheter during balloon *** patients with incom plete thrombosis of the varices after the first BRTO,a second BRTO was performed the following *** were followed up by endoscopy and CE-CT at 1 d,1 wk,and 1,3 and 6 mo after the procedure,and every 6 mo ***: Complete thrombosis of the gastric varices was not achieved with the first BRTO in 7/17 patients because of large gastric *** patients underwent a second BRTO on the next day,and additional sclerosant was injected through the *** thrombosis which led to disappearance of the varices was achieved in 16/17 patients,while the remaining patient had incomplete thrombosis of the *** of the patients experienced rebleeding or recurrence of the gastric varices after a median follow-up of 1130 d(range 8-2739 d).No major complications occurred after the ***,esophageal varices worsened in 5/17 patients after a mean follow-up of 8.6 ***: Emergency BRTO is an effective and safe treatment for ruptured gastric varices.

关键词： Emergency balloon-occluded retrograde transvenous obliteration Gastric varices Bleeding Portal hypertension Ethanolamine oleate

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