Radial Artery Approach for Transcatheter Arterial Chemoembolization in Patients with Hepatocellular Carcinoma

PURPOSE: To evaluate the feasibility and usefulness of the transradial approach for intra-arterial chemoembolization therapy in patients with hepatocellular carcinomas. MATERIALS AND METHODS: Twenty-nine patients with hepatocellular carcinoma who underwent intra-arterial chemoembolization via the radial artery approach were involved in this study. All underwent Allen's test to check ulnar arterial patency. In all cases, we used the radial approach hepatic artery (RHA) catheter designed by ourselves, evaluating the selection ability of the hepatic artery using an RHA cathter, the number of punctures, the procedure time, and compression time at the puncture site as well as complications occurring during and after the procedure. RESULTS: Except for three in which puncture failure, brachial artery variation or hepatic artery variation occurred, all procedures were successful. The mean number of punctures was 3.5, and the average duration of the whole procedure was one and half hours. This gradually decreased as the number of procedures increased. The average duration at a compression of puncture site was 12 minutes. There were no major complications. Minor complications included minimal intimal dissection of the radial artery (3.8%), reversible vasospasm of the radial artery (7.7%), hematoma at a puncture site (7.7%) and transient neurologic deficit (3.8%). CONCLUSION: The transradial approach using an RHA catheter for intra-arterial chemoembolization therapy in patients with hepatocellular carcinomas was technically feasible, with acceptable levels of safety. It may be a good alternative to absolute bed rest with a sand bag after the femoral approach.

The Usefulness of Enhanced 3D-TOF MR Angiography in the Patients with Cerebral Infarction: Comparison with Conventional Angiography

PURPOSE: The aim of this study was to compare the usefulness of enhanced 3D-TOF MR angiography with that of the conventional kind in patients with cerebral ischemic symptoms and to determine the difference between radiologists who have interpreted MR angiograms for less than one year and for more than five years. MATERIALS AND METHODS: Seventy-three patients with clinical symptoms of cerebral ischemic infarction who had undergone conventional angiography MR imaging and MR angiography were involved in this study. On the basis of divisions of the internal carotid artery, three groups were designated: Group I, from the bifurcation of the common carotid artery to the bifurcation of the internal carotid; Group II, from the bifurcation of the internal carotid to the bifurcation of the anterior and middle cerebral artery; Group III, the anterior and middle cerebral artery segments distal to their branching. Two radiologists, one who had interpreted MR angiographic findings for less than one year, and the other for more than 5 years, retrospectively reviewed the findings and graded them according to the degree of vascular stenosis. k statistics were used to measure agreement between the two readers and to compare their techniques. Sensitivity and specificity were calculated only if there were abnormal vascular findings. RESULTS: A total of 438 arteries, 146 in each group, were available. In Group I, agreement between CA and MRA was high; k was 0.538 in reader A and 0.687 in reader B and there was close agreement between the readers(K=0.621). For reader A, sensitivity was 82.4% and specificity was 77.7%, while for reader B, the figures were 88.2% and 87.2%, respectively. In Group II, agreement between CA and MRA was high; k was 0.508 for reader A and 0.566 for reader B and again there was close agreement between the two readers(k=0.622). Reader A showed a sensitivity of 88.2% and a specificity of 73.7%, while for reader B, the corresponding figures were 68.2% and 81.8%. In Group III, agreement between CA and MRA was high; k was 0.508 in reader A and 0.566 in reader B and there was close agreement between (k=0.622). For reader A, sensitivity was 50.0% and specificity was 77.6%, while for reader B, the corresponding figures were 40% and 89.7%. Overall, in total of 438 ar-teries, there was good agreement between each reader (k=0.662). Reader A showed a sensitivity of 81.1% and a specificity of 76.4%, and for reader B, the figures were 83.2% and 86.4%, respectively. CONCLUSIONS: For the evaluation of intracranial vascular disease, e3D-TOF MRA is faster and less invasive than conventional angiography. Regardless of the reader's experience, it shows high sensitivity and there is close agreement between the readers involved. It is thus a useful method for the evaluation of steno-occlusive lesions in patients with cerebral infarction.

Brachial Artery Approach for Outpatient Arteriography

PURPOSE: To evaluate the diagnostic usefulness of brachial approach arteriography for outpatients, withparticular regard to safety and image quality. MATERIALS AND METHODS: The angiographic findings and follow-upmedical records of 131 brachial approach arteriographies in 121 outpatients were retrospectively analysed. 5 Fpigtail catheters were used in 125 cases, and 5-F OCU-A catheters were used in three cases of renal arteriography,and three of upper extremity arteriography without catheter. RESULTS: Except for three cases of brachial arterypuncture failure, all procedures were performed successfully. One hundred and fifteen of 119 lower extremityarteriographies were visualized down to the level of the tibioperoneal artery. The non-visualized cases were threein which there was multiple obstruction at the distal common iliac artery and one with insufficient contrastamount due to renal failure. In four cases there were complications : two involved arterial thrombosis, one was anintramuscular hematoma, and one an A-V fistula. CONCLUSION: For outpatients, brachial approach arteriography canreplace the femoral approach. Its image quality is excellent, there are time-cost benefits, and the rate ofcomplications is relatively low.

Assessment of Spacial Distortion in Digital Subtraction Angiogra phy for Stereotactic Radiosurge ry: An Experimental Study with Phantom

PURPOSE: In stereotactic radiosurgery, awareness of the precise localization and volumetry of tumors and of critical organs, and the planning of the treatment field are important. The purpose of this study was to determine the degree of distortion in images obtained by digital subtraction angiography(DSA) and to assess whether DSA is a suitable may substitute for MRI in the planning of stereotactic radiosurgery. MATERIALS AND METHODS: After designing DSA phantoms we obtained images under variable conditions and analyzed image distortion using an image analysis program. RESULT: DSA imaging distortion increased as intensifying tube size became greater and the distance between tube and object decreased. CONCLUSION: Images obtained by DSA imaging were very distorted, and in the planning of stereotactic radio-surgery DSA is not, therefore, a suitable substitute for MRI.

Double Uncture fo Single Common Femoral Artery for CT Hepatic Arteriography and CT Arterial Portography

PURPOSE: To evaluate the safety and efficacy of double puncture of a single common femoral artery for CThepatic arteriography(CTHA) and CT arterial portography(CTAP) in patients with hepatocellular carcinoma. MATERIAL AND METHODS: Between October and December 1995, 35 patients with hepatocellular carcinoma underwent doublepuncture of a single common femoral artery for combined CTHA and CTAP. Preangiographic laboratory data were asfollows : platelet count from 28,000 to 250,000/mm3 (average, 124,500/mm3) ; prothrombin time from 45.8% to100%(average, 85.3%). In the inguinal area, a pair of 21G puncture needles were used unilaterally for the firsttwo femoral punctures, at a distance of 5-7mm ; a 0.018" guidewire for the insertion of a 4-F sheath in a coaxialmicropuncure introducer set ; and a 0.035" guidewire and 4 F check-flo sheath for the insertion of 4-F catheters.After being moved to the CT room, patients then underwent spiral CTHA and CTAP for further detection ofhepatocellular carcinoma nodules. Transarterial chemoembolization followed, and the punctured site was thencompressed by the usual finger compression method. After initial compression and one day later, we observed thepuncture site for complications such as hematoma formation, thromboembolization or arteriovenous fistula ; ect. RESULTS: Except for the formation of two mild hematomas, no remarkable severe complications were noted. Fifteenpatients who had previously undergone combined spiral CTHA and CTAP using the bilateral femoral puncture method(with a 5-F check-flo sheath) felt more comfortable than when an earlier method was used. CONCLUSION: For combinedCTHA and CTAP, double puncture of a single common femoral artery is safer and more comfortable than the bilateralfemoral puncture method.

Diagnostic Efficacy of Gastric Air Filling in Hepatic Arteriography of the Left Lobe

PURPOSE: To evaluate the diagnostic efficacy of gastric air filling during DSA-hepatic arteriography of the left lobe in overcoming the pitfalls caused by accessory left gastric artery and left hepatic artery from left gastric artery. MATERIALS AND METHODS: In a prospective study, standard hepatic arteriogram and hepatic arteriogram after ingestion of an effervescent agent were performed in 22 patients with anatomic variation of the celiac axis. The anatomic variations were accessory left gastric artery in 15 patients and left hepatic arteryfrom left gastric artery in seven. RESULTS: Hepatic arteriogram after ingestion of an effervescent agent was excellent in differentiating nodular stomach staining from hepatic tumor staining in the left hepatic lobe in patients with accessory left gastric artery, and for evaluation of the left hepatic lobe when this was obscured by stomach staining. CONCLUSION: Hepatic arteriogram after ingestion of an effervescent agent is a simple and safe method for overcoming angiographic pitfalls due to anatomic variation.

Artifacts on CT Angiography

PURPOSE: To demonstrate various artifacts on CT angiography (CTA) and by analysing their frequency and causeto improve diagnostic accuracy and CTA image. MATERIALS AND METHODS: CTA was performed with spiral CT in 21 patients with suspected cerebrovascular diseases. Original spiral CT images were obtained with 120ml nonionic contrast material, 3.0 ml/sec injection rate, 20-23 sec. Scan delay, 1mm collimation, 2mm/sec table feeds and 1mm reconstruction interval. MIP and SSD images of CTA were reconstructed with editing by using a standard processing algorithm of volume rendering technique and 3D techniques including Grow, ROI and Paint techniques. Artifacts onCTA were analyzed, and compared with original spiral CT images, conventional angiography and operative results. RESULTS: Artifacts on CTA were classified as follows : arising from CTA reconstruction, spiral CT scanning, physical properties of CT and patient. During CTA reconstruction, background inhomogeneity developed through slabediting(n=21), blurring along the longitudinal axis(n=21), contour artifact(n=21), tapering-off(n=18) and saccularfusion(n=1) developing because of improper threshold and window level, break-off or blurring through missing some source images(n=13) and incorrect scaling due to computer error(n=2). During spiral CT scanning, stair-step artifacts(n=21) developed through the effect of by rotation and aliasing, and inhomogeneity(n=21) through profile decrease. Artifacts related to physical property included those related by the partial volume effect(n=1) and thebeam hardening effect(n=1). Patient-related artifacts included metal artifacts(n=2), caused by a surgical clip, and motion artifacts(n=4). CONCLUSION: An analysis of the variety, frequency and cause of artifacts on CTA, canlead to better imaging and provide basic information for more exact diagnosis.