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Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in patients with hepatocellular carcinoma (HCC) and was established as conventional TACE using Lipiodol in the 1980s. In the 2000s, drug-eluting beads were developed and applied clinically. Currently, TACE is a commonly used non-surgical treatment modality for patients with HCC who are unsuitable for curative treatment. Considering the vital role of TACE in the management of HCC, it is crucial to organize current knowledge and expert opinions regarding patient preparation, procedural techniques, and post-treatment care in TACE, which can enhance therapeutic efficacy and safety. A group of 12 experts in the fields of interventional radiology and hepatology, convened by the Research Committee of the Korean Liver Cancer Association (KLCA), has developed expert consensus-based practical recommendations in TACE. These recommendations have been endorsed by the Korean Society of Interventional Radiology and provide useful information and direction in performing TACE procedure as well as pre- and post- procedural patient care.
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Background@#In this study, we aimed to compare the long-term therapeutic outcomes of drug-eluting bead transarterial chemoembolization (DEB-TACE) with those of radiofrequency ablation (RFA) for the initial treatment of a single small (≤ 3 cm) hepatocellular carcinoma (HCC). @*Methods@#From January 2010 to December 2021, 259 consecutive patients who underwent DEB-TACE (67 patients) or RFA (192 patients) as a first-line treatment for a single small HCC were enrolled in this retrospective study. The therapeutic outcomes, including cumulative intrahepatic local tumor progression (LTP), progression-free survival (PFS), and longterm overall survival (OS) rates, were compared between the two groups before and after propensity score (PS) matching. Multivariate Cox proportional hazard models were used to evaluate the prognostic factors and differences in OS and PFS between the two groups for all 92 patients after PS matching. @*Results@#After PS matching, the 1-, 2-, 3-, and 5-year LTP rates were lower in the RFA group than those in the DEB-TACE group (P < 0.001), and the 1-, 2-, 3-, and 5-year PFS rates in the RFA group were higher than those in the DEB-TACE group (P = 0.007). However, the 1-, 2-, 3-, and 5-year OS rates were not significantly different between the RFA and DEB-TACE groups (P = 0.584).Moreover, the OS was not significantly different between the RFA and DEB-TACE groups in the univariate and multivariate analyses, with a hazard ratio (HR) of 0.81. The PFS was significantly higher in the RFA group than that in the DEB-TACE group in the univariate analyses, with a HR of 0.44 (P = 0.009). Multivariate Cox regression analysis showed that albumin (P = 0.019) was an independent prognostic factor for OS. Additionally, the major complication rates were not significantly different between the DEB-TACE and RFA groups (P = 1.000). @*Conclusion@#The LTP and PFS rates of RFA were superior to those of DEB-TACE in the initial treatment of single small HCC after PS matching. However, the OS rates were not significantly different between RFA and DEB-TACE. Therefore, DEB-TACE may be considered an efficient substitute for RFA in some patients with a single small HCC who are ineligible for RFA.
ABSTRACT
Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in patients with hepatocellular carcinoma (HCC) and was established as conventional TACE using Lipiodol in the 1980s. In the 2000s, drug-eluting beads were developed and applied clinically. Currently, TACE is a commonly used non-surgical treatment modality for patients with HCC who are unsuitable for curative treatment. Considering the vital role of TACE in the management of HCC, it is crucial to organize current knowledge and expert opinions regarding patient preparation, procedural techniques, and post-treatment care in TACE, which can enhance therapeutic efficacy and safety. A group of 12 experts in the fields of interventional radiology and hepatology, convened by the Research Committee of the Korean Liver Cancer Association (KLCA), has developed expert consensus-based practical recommendations in TACE. These recommendations have been endorsed by the Korean Society of Interventional Radiology and provide useful information and direction in performing TACE procedure as well as pre- and post- procedural patient care.
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Purpose@#To analyze the success and complication rates and factors associated with technical failure of the ultrasound (US)-guided percutaneous thrombin injection of femoral artery pseudoaneurysms caused by vascular access. @*Materials and Methods@#Records of 30 patients with post-catheterization femoral artery pseudoaneurysms who had been treated with US-guided percutaneous thrombin injections in the department of radiology between March 2009 and June 2019 were retrospectively analyzed.The lesion was diagnosed based on US or contrast-enhanced CT. The characteristics of the patients and their lesions were analyzed. @*Results@#The mean patient age was 67.8 years. The mean diameter of the pseudoaneurysmal sac was 20.88 mm (5–40 mm). Twenty patients (66.6%) obtained complete thrombosis after the primary injection, while 10 patients (33.3%) obtained partial thrombosis. The number of patients with a low platelet count (< 130 k/µL) was significantly higher in the partial thrombosis group than in the complete thrombosis group (p = 0.02). No substantial procedure-related complications were found in any patient. @*Conclusion@#The US-guided percutaneous thrombin injection is considered an initial treatment option for pseudoaneurysms caused by vascular access because of its safety and efficacy.
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Purpose@#To analyze the success and complication rates and factors associated with technical failure of the ultrasound (US)-guided percutaneous thrombin injection of femoral artery pseudoaneurysms caused by vascular access. @*Materials and Methods@#Records of 30 patients with post-catheterization femoral artery pseudoaneurysms who had been treated with US-guided percutaneous thrombin injections in the department of radiology between March 2009 and June 2019 were retrospectively analyzed.The lesion was diagnosed based on US or contrast-enhanced CT. The characteristics of the patients and their lesions were analyzed. @*Results@#The mean patient age was 67.8 years. The mean diameter of the pseudoaneurysmal sac was 20.88 mm (5–40 mm). Twenty patients (66.6%) obtained complete thrombosis after the primary injection, while 10 patients (33.3%) obtained partial thrombosis. The number of patients with a low platelet count (< 130 k/µL) was significantly higher in the partial thrombosis group than in the complete thrombosis group (p = 0.02). No substantial procedure-related complications were found in any patient. @*Conclusion@#The US-guided percutaneous thrombin injection is considered an initial treatment option for pseudoaneurysms caused by vascular access because of its safety and efficacy.
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Magnetic resonance imaging (MRI) has become a crucial tool for evaluating mediastinal masses considering that several lesions that appear indeterminate on computed tomography and radiography can be differentiated on MRI. Using a three-compartment model to localize the mass and employing a basic knowledge of MRI, radiologists can easily diagnose mediastinal masses. Here, we review the use of MRI in evaluating mediastinal masses and present the images of various mediastinal masses categorized using the International Thymic Malignancy Interest Group’s three-compartment classification system. These masses include thymic hyperplasia, thymic cyst, pericardial cyst, thymoma, mediastinal hemangioma, lymphoma, mature teratoma, bronchogenic cyst, esophageal duplication cyst, mediastinal thyroid carcinoma originating from ectopic thyroid tissue, mediastinal liposarcoma, mediastinal pancreatic pseudocyst, neurogenic tumor, meningocele, and plasmacytoma.
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Objective@#To compare the therapeutic efficacy of the bone marrow aspirate concentrate (BMAC)- platelet-rich plasma (PRP) complex with hyaluronic acid in patients with knee osteoarthritis. Method: Thirty-four patients with knee osteoarthritis participated in this study. Seventeen patients in the study group underwent BMAC and PRP extraction followed by intra-articular injection of BMAC-PRP complex within affected knee. Seventeen patients in the control group underwent intra-articular injection of hyaluronic acid. Knee injury, osteoarthritic outcome score (KOOS), and EuroQol-5D (EQ-5D) questionnaire were evaluated before, one month, three months, and six months after the injection. @*Results@#There were statistically significant temporal differences in total KOOS scores in both BMAC-PRP and HA groups. However, there were no significant group difference in the study period. In the Sports and Recreational Function Scale, there was statistically significant improvement in the BMAC-PRP group compared to the HA group at three months (p=0.041). There were no side effects or complications in both groups. @*Conclusion@#Intra-articular injection of BMAC-PRP showed better functional recovery in the OA at three months and this can be an alternative treatment in terms of functional recovery in the OA in addition to the decrease of pain.
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Objective@#To compare the therapeutic efficacy of the bone marrow aspirate concentrate (BMAC)- platelet-rich plasma (PRP) complex with hyaluronic acid in patients with knee osteoarthritis. Method: Thirty-four patients with knee osteoarthritis participated in this study. Seventeen patients in the study group underwent BMAC and PRP extraction followed by intra-articular injection of BMAC-PRP complex within affected knee. Seventeen patients in the control group underwent intra-articular injection of hyaluronic acid. Knee injury, osteoarthritic outcome score (KOOS), and EuroQol-5D (EQ-5D) questionnaire were evaluated before, one month, three months, and six months after the injection. @*Results@#There were statistically significant temporal differences in total KOOS scores in both BMAC-PRP and HA groups. However, there were no significant group difference in the study period. In the Sports and Recreational Function Scale, there was statistically significant improvement in the BMAC-PRP group compared to the HA group at three months (p=0.041). There were no side effects or complications in both groups. @*Conclusion@#Intra-articular injection of BMAC-PRP showed better functional recovery in the OA at three months and this can be an alternative treatment in terms of functional recovery in the OA in addition to the decrease of pain.
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BACKGROUND: In Asian countries, including Korea, lead poisoning caused by traditional herbal medicines is often observed in the clinic. However, there have been no reports thus far of lead poisoning caused by drugs that were approved by the Korea Food and Drug Administration (KFDA). Here, we describe seven patients who ingested a problematic natural product-derived drug (NPD). CASE PRESENTATION: In July 2018, seven patients visited a university hospital after ingesting an NPD, S. capsules. These patients complained of various symptoms, and their blood lead levels (BLLs) were elevated relative to those of the general population (arithmetic mean: 19.5 ± 11.6 µg/dL, range: 6.28–35.25 µg/dL). The total doses and BLLs were directly proportional to each other among the patients (r = 0.943, p = 0.001). After the patients discontinued drug intake, their BLLs decreased gradually. The capsule was confirmed to contain lead above the standard value (arithmetic mean: 2,547 ± 1,821.9 ppm). CONCLUSION: This incident highlights the need to strengthen standards for the management of NPD ingredients in Korea. NPDs are more likely to be contaminated than other drugs. Thorough management by the KFDA is essential to prevent a recurrence. Moreover, systematic health care is needed for many patients who have taken problematic NPDs.
Subject(s)
Humans , Asian People , Capsules , Delivery of Health Care , Korea , Lead Poisoning , Recurrence , United States Food and Drug AdministrationABSTRACT
Abdominal aortic aneurysm (AAA) can be defined as an abnormal, progressive dilatation of the abdominal aorta, carrying a substantial risk for fatal aneurysmal rupture. Endovascular aneurysmal repair (EVAR) for AAA is a minimally invasive endovascular procedure that involves the placement of a bifurcated or tubular stent-graft over the AAA to exclude the aneurysm from arterial circulation. In contrast to open surgical repair, EVAR only requires a stab incision, shorter procedure time, and early recovery. Although EVAR seems to be an attractive solution with many advantages for AAA repair, there are detailed requirements and many important aspects should be understood before the procedure. In this comprehensive review, fundamental information regarding AAA and EVAR is presented.
Subject(s)
Aneurysm , Aorta, Abdominal , Aortic Aneurysm, Abdominal , Dilatation , Endovascular Procedures , RuptureABSTRACT
OBJECTIVE: To compare the efficacy of epidural adhesiolysis with a single bolus steroid injection (EAS) and continuous steroid infusion (EAC).METHOD: Thirty-one patients were allocated to the EAS group (10 patients) and EAC group (21 patients). EAS received single bolus of 10 mg of dexamethasone. EAC received a total of 96 mL dexamethasone solution (20.0 mg of dexamethasone) for 48 hrs. Oswestry Disability Index (ODI) was evaluated before, one month after the procedure. Three months after the procedure, the Patient’s Global Impression of Change (PGIC) was evaluated.RESULTS: Pre-treatment ODI was 38.3 ± 3.1 in EAS and 46.40 ± 4.0 in EAC. One month later, ODI was decreased to 35.60 ± 3.33, 43.08 ± 6.96 in each group (p=0.174). Three months later, 2 patients in the EAS (20.0%) and 8 patients in EAC (38.1%) showed ‘much improvement’ in PGIC, 5 patients in EAS (50.0%) and 6 patients in EAC (38.1%) showed ‘slight improvement’, 3 patients in EAS (30.0%) and 7 patients in EAC (33.3%) showed ‘no improvement’ (χ2=1.588, p=0.510).CONCLUSION: Epidural adhesiolysis with continuous infusion did not show any superiority than single bolus injection.
Subject(s)
Humans , Dexamethasone , Methods , Spinal StenosisABSTRACT
PURPOSE: For evaluation of volume status in the emergency department, central venous pressure (CVP) measurement is a standard practice. However, this is an invasive method. Measuring inferior vena cava (IVC) size through ultrasound is promising as a non-invasive method. However, few studies have been reported in Korea. Therefore this study measured IVC size and collapsibility in order to examine the clinical usefulness. METHODS: In a prospective study setting, IVC size was measured with ultrasound for patients whose CVP was measured in the emergency department. IVC size of healthy applicants was measured. RESULTS: The healthy group included 100 people: 68 men and 32 women. The average IVC size of men was 1.8+/-0.4 cm and that of women was 1.8+/-0.3 cm. For collapsibility, men were 0.28+/-0.14 and women were 0.23+/-0.14, thus there was no statistical difference in size and collapsibility between men and women. The patient group included 51 people, average age was 59.9+/-18.5, and 28 (54.9%) were men. This group showed a significant negative correlation between CVP and collapsibility. IVC Max was 1.7+/-0.5 cm, IVC Min was 1.2+/-0.5 cm, median collapsibility was 0.26 (0.15-0.38), mean lactate was 6.4+/-4.4 mmol/L, and median CVP was 10.0 (1.0-14.5) cmH2O. CONCLUSION: IVC collapsibility can be used as a reference measure, or even instead of CVP in certain cases.
Subject(s)
Female , Humans , Male , Central Venous Pressure , Emergency Service, Hospital , Korea , Lactic Acid , Prospective Studies , Ultrasonography , Vena Cava, InferiorABSTRACT
Japanese-B viral encephalitis (JE) usually has a monophasic illness pattern. A 45-year-old woman in an altered mentality had improved over 1 month. About 1 week after the initial improvement, the patient became comatose with aggravated EEG and MRI findings. Assays of cerebrospinal fluid and serum were positive for the IgM antibody to Japanese-B virus. After intravenous immunoglobulin (IVIG) infusion, the patient recovered. We report a patient with JE who showed a biphasic illness pattern and recovered after IVIG therapy.
Subject(s)
Female , Humans , Middle Aged , Cerebrospinal Fluid , Coma , Electroencephalography , Encephalitis, Viral , Immunization, Passive , Immunoglobulin M , Immunoglobulins , Immunoglobulins, Intravenous , Magnetic Resonance ImagingABSTRACT
A 68-year-old man developed mild quadriparesis 1 month prior to presentation. At 4 days before presentation, he developed dysarthria and more severe quadriparesis, predominantly on the left side of the body. MRI revealed edematous lesions in the medulla and throughout the spinal cord. Angiography showed a right tentorial dural arteriovenous fistula (DAVF). Despite successful treatment achieved by endovascular embolization, there was no improvement in the weakness of either leg. Early diagnosis of tentorial DAVF is important to prevent neurological complications such as encephalomyelopathy and hemorrhage.
Subject(s)
Aged , Humans , Angiography , Central Nervous System Vascular Malformations , Dysarthria , Early Diagnosis , Hemorrhage , Leg , Magnetic Resonance Imaging , Quadriplegia , Spinal CordABSTRACT
Portal vein thrombosis (PVT) is commonly associated with liver cirrhosis, irrespective of the presence of hepatocellular carcinoma (HCC). Given that malignant PVT is a poor prognostic factor in patients with HCC, it is important to differentiate malignant PVT from benign PVT. Because malignant PVT has been reported to be contiguous with parenchymal HCC, in most cases, the presence of PVT alone indicates a benign entity. We report the case of a patient with rapid progression of malignant PVT mimicking benign PVT but without definite parenchymal HCC on imaging modalities.
Subject(s)
Humans , Carcinoma, Hepatocellular , Disease Progression , Liver Cirrhosis , Magnetic Resonance Imaging , Portal Vein , ThrombosisABSTRACT
PURPOSE: Diffusion-weighted magnetic resonance (MR) image (DWI) has advantages for the assessment of acute stroke. However, false negative DWI findings in acute ischemic stroke have been reported. Our purpose was to estimate the rate of initial false negative DWI studies in acute ischemic stroke patients and to identify characteristics of false negative DWI stroke patients. METHODS: In this retrospective study from January 2010 to June 2011, acute ischemic stroke patients (within 6 hours after stroke onset) were enrolled. A total of 56 patients were included in this study. Cases with negative initial DWI findings, with an ischemic lesion visible on follow-up MR studies, were analyzed for times between the onset of symptoms and initial DWI, National Institute of Health Stroke Scale (NIHSS), and the location of the ischemic stroke lesion. RESULTS: We found seven cases (12.5%) of false negative initial DWI studies. The initial false negative DWI group had a significantly shorter time from the onset of symptoms to the initial DWI compared to the initial positive DWI group (p=0.011). The false negative group had a lower NIHSS without significance (p=0.091). CONCLUSION: A false-negative DWI study is not uncommon in the assessment of acute ischemic stroke. Thus, patients suspected of having a stroke should not be ruled out on the basis of a negative DWI, especially a suspected low NIHSS, for an early onset of symptoms.
Subject(s)
Humans , Brain Stem , Cerebral Infarction , Follow-Up Studies , Magnetic Resonance Spectroscopy , Retrospective Studies , StrokeABSTRACT
PURPOSE: Whole body Positron Emission Tomography (PET) was used to evaluate the existence of cancer cells. However, PET had limitations in identifying thyroid cancer cells because of their slow progression, and evidence regarding its accuracy in finding thyroid cancer cells is insufficient. Therefore, we investigated the usefulness of PET for evaluation of patients with thyroid nodules by studying the relationships between PET and thyroid ultrasonography. METHODS: We evaluated 4,627 patients who had undergone PET from January 2007 to October 2011 and selected 370 patients who had undergone thyroid ultrasonography. We compared and analyzed the amount of thyroid SUVmax of PET, the pattern of glucose uptake, and findings of thyroid ultrasonography based on their size, shape, location, and FNAC. RESULTS: Of 370 patients, 197 (53.2%) subjects were found to have thyroid nodules, and 211 (57.0%) subjects had higher sugar metabolism, regardless of having thyroid nodules. No statistical correlations were observed among nodule size, nodule location,and higher sugar metabolism, however, noticeable relationships were observed between the shape of the cells on thyroid ultrasonography and FDG uptake of PET. In cases of papillary thyroid cancer, there was higher FDG uptake, compared to benign lesions in particular, SUVmax of the papillary thyroid cancer showed a significantly elevated level of FDG uptake. CONCLUSION: Despite its limited usefulness in identifying the characteristics of thyroid nodules being benign or malignant, PET is appropriate for evaluation of the malignancy of thyroid cells
Subject(s)
Humans , Diagnosis , Electrons , Glucose , Metabolism , Positron-Emission Tomography , Thyroid Gland , Thyroid Neoplasms , Thyroid Nodule , UltrasonographyABSTRACT
PURPOSE: The purpose of this study was to determine the accuracy of ultrasound guided vacuum-assisted Mammotome biopsy (UVAMB) for breast lesions. METHODS: Percutaneous biopsies of 564 breast lesions, in 489 patients, using UVAMB were performed between October 2000 and May 2002. The pathological findings of the UVAMB were compared with excisional biopsies, sonographic follow-ups and clinical follow-up findings. We evaluated the complication on immediate post-biopsy and 1 week later using ultrasound. RESULTS: Of the 564 lesions, 108 (19.1%) were diagnosed as malignant by UVAMB, and of 456 benign lesions, 63 were excised. On excision two of the benign lesions were found to be carcinomas. The false negative rate of the UVAMB was 2.7%, and 99 (17.5%) of the 564 biopsies were revealed as hematomas by ultrasound 1 week later. However, almost all of complications were well controlled by conservative management. CONCLUSION: Ultrasound guided vacuum-assisted Mammotome biopsies reduced the possibility of false-negatives and underestimated the disease. The complications of UVAMB were not serious, was proved to be a good biopsy method for small, non-palpable breast lesions.
Subject(s)
Humans , Biopsy , Breast , Follow-Up Studies , Hematoma , UltrasonographyABSTRACT
PURPOSE: To analyze the differences in mammographic and pathologic findings between palpable and non-palpable breast carcinoma. MATERIALS AND METHODS: Among 362 patients with surgically proven breast carcinoma, 317, whose chief com-plaint during preoperative evaluation was a palpable mass, Comprised group I, and 45 with no masses com-prised group II. We compared mammographic and pathologic findings between the two groups. RESULTS: As regards the pattern of mammographic presentation, mass alone accounted for 51.4 % of group I and 33.3 % of group II, while calcification alone was seen in 7.6 % of group I and 24.4 % of group II(p<0.05). In group I, 48.6 % of masses were of irregular shape, and in group II, 46.2 % were round. According to ACR-BIRADS, 47.6 % of group I was classified as category 5, and 51.1 % of group II as category 4 (p<0.05). On the other hand, the margin of the mass showed no statistical difference. Among the 362 patients, the mean age of group I was 48.1(range, 28 -79) years, while that of group II was 51. 7(range, 30 -73) years (p<0.05). Histologically, infiltrative ductal carcinoma was seen in 84.9% of group I, and DCIS in 8.5%, while for group II the respective figures were 62.2% and 28.9 % (p<0.05). For group I, mean lesional size was 3.01cm, with 4 7 .9 % lymph node metastasis in the axilla, while for group II the corresponding figures were 1.93 c m ( p < 0 . 0 5 ) and 28.2%(p<0.05). Differences were statistically significant. Under the TMN system, 30% of group I were at stage II, while 35.6 % of group II were at stage I (p<0.05). CONCLUSION: Palpable and non-palpable cancers showed statistically significant differences in mammographic findings such as mass shape and category, but not in the margin of the mass. There were also statistically sig-nificant differences with regard to age, histology, lesion size, axillary lymph node metastasis, and staging.