| IVR 会誌 Jpn J Intervent Radiol Vol.17
No.1 2002 |
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State of the Art
Interventional Procedures Bone and Joint
Radiology
Percutaneous Bone Biopsy
Department of Radiology, Mitsui Memorial Hospital
Kenji Ibukuro, Hozumi Fukuda, Koichi Mori, Yoshihiro Inoue,
Department of Radiology, Futyu Keijinkai General Hospital
Toshitaka Tsukiyama
Abstract
Most bone lesions can be diagnosed by various imaging modalities
and clinical information. However some bone lesions are radiologically
atypical, therefore, it is difficult to differentiate metastatic
bone tumor from primary bone disease. Percutaneous bone biopsy
enables us to diagnose such lesions or primary disease, so that
proper therapy can be performed. We performed 29 percutaneous
bone biopsies under CT guidance, especially to confirm metastatic
bone lesions. Overall accuracy of bone biopsy is 86％.
Since the needle tract is confirmed before biopsy to avoid neurovascular
complications, bone biopsy under CT guidance is considered to
be safer then that performed under fluoroscopy. Destroyed cortex
of bone can be penetrated by an 18G needle and an adequate sample
is obtained ; however, a 14G biopsy needle is sometimes necessary
to penetrate the cortex. Semi-automatic 20G biopsy needle is
useful to obtain adequate tissue materials for pathologic diagnosis.
To rule out infectious disease, it is necessary to send the aspirated
sample for culture. It is reported that aspiration and core biopsy
are complementary with the accuracy of bone biopsy 80～90％.
Percutaneous bone biopsy technique is also utilized for vertebroplasty,
steroid injection therapy for Langerhans’ cell histiocytosis,
and percutaneous resection or ablation for osteoid osteoma.
Key words
● Bone
● Biopsy
● CT guidance
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CT Guided Percutaneous
Laser Disk Decompression for Cervical and Lumbar Disk Herniation
Departments of Radiology, and Neurosurgery1),
Jikei University
Michiko Dohi, Junta Harada, Kunihiko Fukuda,
Tsutomu Koyama1), Hiromichi Nakazaki1), Toshiaki Abe1)
Abstract
Percutaneous laser disk decompression(PLDD) is simplicity, minimal
invasiveness and effective method for disk herniation. Proper
patient selection and correct needle placement are needed to
perform successful PLDD. From this point of view, we chose CT,
which has a good spatial and temporal resolution, to guide and
monitor this procedure. All procedure for 158 lumbar and 7 cervical
disk herniations were safely and accurately performed without
any major complication by the aid of CT images that allow visualizing
the vaporized gas and bony structure around disk, occasionally
a nerve root. CT-guided technique provides safe and accurate
PLDD. PLDD shows promise in the management of radiculalgia.
Key words
● CT guidance
● Laser ablation
● Disk herniation
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Practice of Percutaneous
Vertebroplasty
Department of Radiology, Kanazawa University
Takeshi Kobayashi, Tsuyoshi Takanaka, Osamu Matsu
Abstract
Percutaneous vertebroplasty is a minimally invasive procedure
that offers a marked therapeutic option for patients suffering
from osteoporotic or tumor-related vertebral fractures and pain.
This technique consists of the percutaneous injection of a bone-cement,
most commonly polymethylmethacrylate(PMMA), into an affected
vertebral body under imaging guidance. This procedure was introduced
for tumor-related vertebral fractures and pain in Europe in 1987,
but now is mainly used to treat pain following osteoporotic compression
fractures in the United States. In Japan, we developed this procedure
under CT-fluoroscopic guidance in 1997. We described the practical
aspects of this technique, such as its indications, techniques
and effects.
Key words
● Percutaneous vertebroplasty
● CT-fluoroscopic guidance
● Malignant vertebral tumor
● Osteoporosis
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Interventional MRI
Department of Radiology, Nagoya University
School of Medicine
Hiroshi Fukatsu
Abstract
MR guided interventional procedures have become useful clinical
tools recently. In this article the authors discuss the usefulness
and problems of MR-guided needle biopsy and MR-guided laser induced
thermotherapy(LITT) for clinical cases. MR enabled optimal plane
monitoring with desired image contrast during the procedure without
X-ray irradiation for puncture and tissue sampling. Also only
MR could non-invasively provide interstitial temperature information
during laser ablation. Bone and soft tissue lesions are likely
to be candidates for MR interventions because they are free from
any physiological motions. and radiologists should compare MR-guidance
with CT- or US guidance for individual cases in order to achieve
a less invasive diagnosis or treatment.
Key words
● MR fluoroscopy
● Needle biopsy
● Laser induced thermotherapy
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Original Article
The Efficacy of Percutaneous
Injection Therapy for Pelvic Bone Metastases Using Surgical Bone
Cement
Department of Radiology, Oita Red Cross Hospital
Shinichiro Ueno
Department of Radiology, Oita Medical University
Norio Hongo, Kunihiro Asai, Rieko Shuto,Fumika Nakano, Shunro
Matsumoto, Hiromu Mori
Abstract
Purpose : To evaluate the usefulness of the percutaneous injection
of acrylic surgical cement for treatment of pelvic bone metastases.
Materials and Methods : Acrylic surgical cement was injected
percutaneously 8 times in 7 patients with malignant pelvic bone
metastases under the guidance of CT fluoroscopy. It was administered
in combination with transcatheter arterial embolization and/or
radiotherapy. We evaluated the number of punctures, total dose
of bone cement, procedure time, relief from pain, percentage
of cement accumulation within the lesion, bone stabilization
and any complications that occurred. The mean follow - up period
was 4.8 months(range : 24 days to 9 months).
Results : The mean number of punctures was 3. The mean amount
of filling cement used was 15.3p. All of the patients reported
relief from pain within 7days. There was no correlation between
the degree of cement accumulation within the lesion and the analgesic
response. No fractures occurred after the cement injection. We
experienced 3 leakages. Of the 7 patients studied,
two had transient ischialgia, probably due to the heat of polymerization.
Conclusions : Percutaneous injection of acrylic surgical cement
is an effective therapy for pelvic bone metastases, as it promotes
rapid pain relief and bone stabilization.
Key words
● Percutaneous acetabuloplasty
● Interventional radiology
● Bone metastasis
● Acrylic surgical cement
● CT fluoroscopy
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Original Article
The Complications of
Central Venous Port Access System
Department of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University
*Present) Department of Radiology, National Kyushu Canter Center
Toshiro Kuroiwa*, Hiroshi Honda, Kengo Yoshimitsu, Hiroyuki Irie,
Hitoshi Aibe, Kenji Shinozaki, Kouji Masuda
Abstract
We performed placements of central venous port access system(intravenous
hyperalimentation port, IVH port) for 10 patients and the complications
were assessed. 6 patients had malignant tumors, 3 had Crohn’s
disease, and 1 had necrotizing pancreatitis. The main purpose
of IVH port was to administer systemic chemotherapy in 6 patients
with malignant liver tumors and home total parenteral nutrition(HTPN)
in 4 patients with benign diseases. Technical approach was performed
using an ultrasound-guided puncture of a subclavian vein in 3
cases, and another was catheter exchange method for IVH catheter,
which was previously placed through a subclavian vein. The catheter
tip was placed in the superior vena cava in each case. The catheter
was connected to a port implanted subcutaneously in the subclavicular
region. There was no complication during the procedure. The observation
period after placement ranged from 11 to 588 days(mean : 207
days).
The complications after placement were observed in 4 cases. These
included partial exposure of the IVH ports in 2 cases, occlusion
of the indwelling catheter in 1, and dislocation of the catheter
tip to the jugular vein in 1. Catheter-port access systems were
replaced on the contralateral side in 2 cases, and it was removed
in 1 case. In the case of the dislocation of the catheter tip
to the right jugular vein, a 5 Fr. pig-tail catheter was introduced
via the femoral vein, and the dislocated catheter tip was corrected
in the superior vena cava by entangling the 5 Fr. pig-tail catheter.
The central venous catheter-port access system makes it possible
for patients unable to eat oral diets to receive HTPN thereby
improving their quality of life. However, some complications
may occur and guidance for self-management of their IVH port
might be necessary during their admission to hospital.
Key words
● Implantable port
● Intravenous hyperalimentation
● Home total parenteral nutrition
● Complication
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Case Report
Two Cases of Bilateral
Renal Cancer that Were Treated with Resection of One Kidney and
Selective Transarterial Embolization of the Other Kidney Using
a Mixture of Absolute
Ethanol and Iodized Oil : One and a half years’follow-up
Department of Radiology, Kameda Medical Center
Nobumaro Ihara, Naobumi Yashiro, Takahiro Kinoshita, Jun Yoshigi
Abstract
We report 2 cases of renal cell carcinoma in solitary kidney
treated with selective transarterial embolization with the mixture
of absolute ethanol and iodized oil(Lipiodol). In both cases,
radical nephrectomy of contralateral kidneys had been performed
due to renal cell carcinomas.
No recurrences or renal failure was were found during the follow-up
period of one and a half years. Our method can be an option for
the treatment for the patients with bilateral renal cell carcinoma.
Key words
● Transarterial embolization
● Bilateral renal cell carcinoma
● Absolute ethanol
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Case Report
Transcatheter Arterial
Embolization to Control Severe Bleeding in Advanced Breast Cancer
－Report of Two Cases－
Department of Radiation Technology, College
of Medical Technology, Hokkaido University
Yutaka Morita
Department of Surgery, Otaru Kyokai Hospital
Kazuhiko Naoe, Takeshi Kawamura, Toshimichi Asano,
Yoshitaka Nakakubo, Tomoo Okushiba, Fujio Watanabe, Tomoyoshi
Atsuta
Abstract
Two cases of successful transcatheter arterial embolization(TAE)
for uncontrollable hemorrhage of advanced breast cancer are presented.
The vasculo-anatomical characteristics of the breast consist
of multiple arterial blood supply and complicated anastomoses.
The detailed vascular anatomy of the breast is discussed in relation
to the multiplicity of the arterial blood supply and the variety
of arterial anastomoses. According to these vascular characteristics
and our experience of two cases, a suitable procedure for TAE
is embolization from the distal and proximal ends of the bleeding
artery using a coaxial microcatheter system and microcoils. Controversial
problems with TAE for bleeding of advanced breast cancer are
as follows :
1) Identification of the bleeding artery is difficult.
2) There are no difinite standards of limited area of embolization
because of the variety of arterial anostomoses.
3) It is possible to obliterate the approach for arterial infusion
chemotherapy.
Key words
● Breast cancer
● Transcatheter arterial embolization
● Coaxial microcatheter system
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Technical Note
Marking of Peripheral
Small Lesion of Lung, Using Color Collagen before Resection on
VATS(video-associated thoracoscopic system)
Departments of Radiology and Thoracic surgery1),
Yokosuka Kyousai Hospital
Megumi Nakamura, Yasuhiko Fujita, Satoru Kuroda, Youji Tsuchie,
Takao Moroboshi1)
Abstract
In the present study, small peripheral lesions in the lung were
marked with color collagen under CT in 11 patients, prior to
thoracoscopic resection. Marking could be accomplished in all
patients without induction of any complications. The marked lesions
were very easily identified and distinguished from the surrounding
pulmonary parenchyma. Marking with color collagen was an easy
and useful method of facilitating thoracoscopic pulmonary resection
for peripheral lung tumors indicating the possible contribution
of this marking method to the early treatment of primary lung
cancer.
Key words
● Color collagen
● CT guided marking
● Small lung lesion
● VATS
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