• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.3
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• pp.188-193
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• 2019

Transarterial chemoembolization (TACE) is a commonly used and rapidly evolving non-invasive treatment for hepatocellular carcinoma (HCC). It is important that understanding individual anatomical variants and planning for tumor-feeding artery access to acquire adequate treatment effectiveness. In this study, we will report acquired arteriovenous malformation which interferes with TACE for HCC. A 72-year-old man with persistent abdominal pain for 2 days visited our hospital. The patient was chronic hepatitis B carrier and had a history of HCC treated with conventional TACE 10 years ago. Hypervascular nodular HCC in the liver segment 8 and aberrant right hepatic artery from the superior mesenteric artery were detected on computed tomography (CT). When first TACE was performed, the tumor-feeding artery originating from the left hepatic artery was found and embolized. There was no tumor-feeding artery from the right hepatic artery but arteriovenous malformation was found. After a month, follow up CT showed necrotic lesion and residual HCC and we performed secondary TACE. On secondary TACE, we selected the right hepatic artery and passed through arteriovenous malformation. Superselective-angiogram showed remnant tumoral staining and remnant tumor was embolized using drug-eluting bead and Adriamycin. Final angiogram showed no remnant tumoral staining and the patient was discharged without complication. We found the rare case of arteriovenous malformation adjacent to HCC, and we performed superselective TACE beyond arteriovenous malformation to treat HCC.

• Radiation Oncology Journal
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• v.28 no.2
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• pp.106-110
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• 2010

Reactivation of the hepatitis B virus (HBV) is a well-recognized complication in patients with chronic HBV infection who receive cytotoxic or other immunosuppressive therapy. In cases of patients treated by radiotherapy however, only a few of such reports exist and most of these include the patients previously treated by chemotherapy or transarterial chemoembolization. The results of this study point to a case of a patient with reactivation of HBV after radiotherapy alone. This study shows the possibility of HBV reactivation by partial hepatic irradiation alone hence, special attention should be paid to patients with HBV disease.

• Journal of Chest Surgery
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• v.29 no.9
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• pp.1023-1027
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• 1996

The carotid body is derived from both mesoderm and elements of the third branchial arch and neural crest ectoderm. It is located within the advaptitial layer of the posteromedial aspe t of the common carotid bifurcation. Tumors arising from this body were originally termed chemodectomas, but they actually arise from the paraganglionic cells and thereby should be classified as paragangliomas. Carotid body. tumors present as a painless, palpable mass over the carotid bifurcation region of the neck. The definitive study for diagnosis of carotid body tumors is selective bilateral cerebral arteriography. Current treatment of ca- rotid body tumors is primarily operative excision of the tumor with maintenance of the Integrity of carotid flow. Recently, the authors experienced two cases of carotid body tumor which were successfully treated by surgical excision. We report these cases with brief review of the literature.

• Journal of Digestive Cancer Research
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• v.4 no.1
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• pp.21-28
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• 2016

Hepatocellular carcinoma (HCC) is rather unique. Most of HCC patients have underlying chronic liver diseases with or without cirrhosis and the prognosis of HCC depends on the liver function, as well as the tumor extent. Non-invasive diagnosis of HCC can be made with certain risk factors and specific imaging findings (e.g. hypervascularity). Patients with HCC can receive surgical resection, radiotherapy, and systemic chemotherapy as other solid malignancies. HCC has more treatment options such as liver transplantation, transarterial chemoembolization (TACE) and radiofrequency ablation (RFA). A variety of practice guidelines for HCC has been published by many academic societies. Different healthcare systems and availability of resources also affect the practice guidelines; therefore, practice guidelines have similarities and dissimilarities. Herein, we review the current status of practice guidelines for HCC and future perspectives for the improvement of guidelines are also discussed.

• Journal of radiological science and technology
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• v.40 no.1
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• pp.27-34
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• 2017

The author investigated interventional radiology patient doses in several other countries, assessed accuracy of DAP meters embedded in intervention equipments in domestic country, conducted measurement of patient doses for 13 major interventional procedures with use of Dose Area Product(DAP) meters from 23 hospitals in Korea, and referred to 8,415 cases of domestic data related to interventional procedures by radiation exposure after evaluation the actual effectives of dose reduction variables through phantom test. Finally, dose reference level for major interventional procedures was suggested. In this study, guidelines for patient doses were $237.7Gy{\cdot}cm^2$ in TACE, $17.3Gy{\cdot}cm^2$ in AVF, $114.1Gy{\cdot}cm^2$ in LE PTA & STENT, $188.5Gy{\cdot}cm^2$ in TFCA, $383.5Gy{\cdot}cm^2$ in Aneurysm Coil, $64.6Gy{\cdot}cm^2$ in PTBD, $64.6Gy{\cdot}cm^2$ in Biliary Stent, $22.4Gy{\cdot}cm^2$ in PCN, $4.3Gy{\cdot}cm^2$ in Hickman, $2.8Gy{\cdot}cm^2$ in Chemo-port, $4.4Gy{\cdot}cm^2$ in Perm-Cather, $17.1Gy{\cdot}cm^2$ in PCD, and $357.9Gy{\cdot}cm^2$ in Vis, EMB. Dose referenece level acquired in this study is considered to be able to use as minimal guidelines for reducing patient dose in the interventional radiology procedures. For the changes and advances of materials and development of equipments and procedures in the interventional radiology procedures, further studies and monitorings are needed on dose reference level Korean DAP dose conversion factor for the domestic procedures.

• Journal of the Korean Society of Radiology
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• v.79 no.6
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• pp.340-347
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• 2018

Purpose: To evaluate value of image subtraction for identifying hepatocellular carcinoma (HCC) capsule on gadoxetic acid-enhanced MR images. Materials and Methods: This study involved 108 patients at risk of HCC preoperatively examined using gadoxetic acid-enhanced MRI with hepatic resection between May 2015 and February 2017. We evaluated qualities of subtraction images and presence of capsular appearance on portal venous or transitional phases conventional and subtraction images. We assessed effect of capsular appearance on subtraction images on HCC. Results: After excluding 1 patient who had treated by transarterial chemoembolization prior to surgery and 33 patients with unsatisfactory subtraction image qualities, 82 focal hepatic lesions (73 HCC, 5 non-HCC malignancies, and 4 benign) from 74 patients were analyzed. Regarding detection of capsules, sensitivity, accuracy, and area under the receiver operating characteristic curve (AUC) on subtraction images were significantly higher than those on conventional images (95.4%, 89.0%, and 0.80, respectively; p < 0.001), though specificities were same (64.7%). For diagnosis of HCC, sensitivity, accuracy, and AUC on subtraction images were significantly higher than on conventional images (82.2%, 79.3%, and 0.69, respectively; p = 0.011), though specificities were identical (55.6%). Conclusion: Portal venous or transitional phase gadoxetic acid-enhanced MRI subtraction images could improve detection of HCC capsule.

• Radiation Oncology Journal
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• v.20 no.2
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• pp.123-129
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• 2002

Purpose : The purpose of this study 띤as to determine the potential role of three-dimensional conformal radiotherapy (3D-CRT) in the treatment of primary unresectable hepatocellular carcinoma. The preliminary results on the efficacy and the toxicity of 3D-CRT are reported. Materials and Methods : Seventeen patients were enrolled in this study, which was conducted prospectively from January 1995 to June 1997. The exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Child-Pugh classification C, tumors occupying more than two thirds of the entire liver, and a performance status of more than 3 on the ECOG scale. Two patients were treated with radiotherapy only while the remaining 15 were treated with combined transcatheter arterial chemoembolization. Radiotherapy was given to the field including the tumor plus a 1.5 cm margin using a 3D-CRT technique. The radiation dose ranged from $36\~60\;Gy$ (median; 59.4 Gy). Tumor response was based on a radiological examination such as the CT scan, MR imaging, and hepatic artery angiography at $4\~8$ weeks following the completion of treatment. The acute and subacute toxicities were monitored. Results : An objective response was observed in 11 out of 17 patients, giving a response rate of $64.7\%$. The actuarial survival rate at 2 years was $21.2\%$ from the start of radiotherapy (median survival; 19 months). Six patients developed a distant metastasis consisting of a lung metastasis in 5 patients and bone metastasis in one. The complications related to 30-CRT were gastro-duodenitis $(\geq\;grade\;2)$ in 2 patients. There were no treatment related deaths and radiation induced hepatitis. Conclusion : The preliminary results show that 3D-CRT is a reliable and effective treatment modality for primary unresectable hepatocellular carcinoma compared to other conventional modalities. Further studies to evaluate the definitive role of the 3D-CRT technique in the treatment of primary unresectable hepatocellular carcinoma are needed.