• Asian Pacific Journal of Cancer Prevention
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• v.16 no.14
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• pp.6159-6162
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• 2015

Purpose: To evaluate efficacy of transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in treatment of patients with hepatocellular carcinoma. Materials and Methods: During January 2009 to March 2012, 80 patients with hepatocellular carcinoma underwent TACE, with or without RFA. Alfafetoprotein (AFP) was checked before and after procedure. CT scans were obtained one month after TACE or RFA for all patients to evaluate tumor changes. Complete response+partial response+stable disease (CR+PR+SD)/n were used to assess the disease control rate (DCR). Survival at 3, 6 and 12 months was compared in both groups. Results: AFP levels in TACE + RFA group dropped rapidly, becoming obviously lower than that of the TACE group. In the TACE + RFA group DCR was 93.8%, while only 76.8% in the TACE group. The treatment effect between the two groups was statistically significant (P<0.05) by Ridit analysis. 1 year survival rate in the TACE + RFA group was 92.5%, significantly higher than that of the TACE group at 77.5% (P<0.05). Conclusions: TACE and RFA as combined therapy method for patients with middle and terminal stage HCC gives full play to synergy between the two and improves the therapeutic effect.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.12
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• pp.5101-5106
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• 2015

Background: This systemic analysis was conducted to evaluate tumor recurrence rate and one-year survival rate for patients with liver metastases received radiofrequency ablation after transarterial chemoembolization and introduce a new method of radiofrequency ablation by puncture navigation technology for single liver metastases after transarterial chemoembolization. Materials and Methods: Clinical studies evaluating tumor recurrence rate and one-year survival rate. Appling the innova trackvision software to process one liver metastases received transarterial chemoembolization and using radiofrequency ablation by puncture navigation technology to treat the liver metastases. Results: 3 clinical studies which including 235 patients with liver metastases after transaeterial chemoembolization were considered eligible for inclusion. Systemic analysis suggested that tumor recurrence rate was 23% (54/235), one-year survival rate was 76% (178/235). The new procedure was performed successfully and the patient received a good prognosis. Conclusions: This systemic analysis suggests that radiofrequency ablation is a good method for liver metastases after transarterial chemoembolization and could receive a relatively good prognosis.

• Clinical Endoscopy
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• v.56 no.1
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• pp.100-106
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• 2023

Background/Aims: Endoscopic ultrasound (EUS) has become an essential diagnostic and therapeutic tool. EUS was introduced in 2013 in Indonesia and is considered relatively new. This study aimed to describe the current role of interventional EUS at our hospital as a part of the Indonesian tertiary health center experience. Methods: This retrospective study included all patients who underwent interventional EUS (n=94) at our center between January 2015 and December 2020. Patient characteristics, technical success, clinical success, and adverse events associated with each type of interventional EUS procedure were evaluated. Results: Altogether, 94 interventional EUS procedures were performed at our center between 2015 and 2020 including 75 cases of EUS-guided biliary drainage (EUS-BD), 14 cases of EUS-guided pancreatic fluid drainage, and 5 cases of EUS-guided celiac plexus neurolysis. The technical and clinical success rates of EUS-BD were 98.6% and 52%, respectively. The technical success rate was 100% for both EUS-guided pancreatic fluid drainage and EUS-guided celiac plexus neurolysis. The adverse event rates were 10.6% and 7.1% for EUS-BD and EUS-guided pancreatic fluid drainage, respectively. Conclusions: EUS is an effective and safe tool for the treatment of gastrointestinal and biliary diseases. It has a low rate of adverse events, even in developing countries.

• Korean Journal of Radiology
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• v.23 no.9
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• pp.901-910
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• 2022

Objective: This study aimed to assess the technical feasibility, efficacy, and safety of the safe triangular working zone (STWZ) approach applied in percutaneous vertebroplasty (PV) for spinal metastases involving the posterior part of the vertebral body. Materials and Methods: We prospectively enrolled 87 patients who underwent PV for spinal metastasis involving the posterior part of the vertebral body, with or without the STWZ approach, from January 2019 to April 2022. Forty-nine patients (27 females and 22 males; mean age ± standard deviation [SD], 57.2 ± 11.6 years; age range, 31-76 years) were included in group A (with STWZ approach), accounting for 54 vertebrae. Thirty-eight patients (18 females and 20 males; 59.1 ± 10.9 years; 29-81 years) were included in group B (without STWZ approach), accounting for 57 vertebrae. Patient demographics, procedure-related variables, and pain relief as assessed using the visual analog scale (VAS) were collected at different time points. Tumor recurrence in the vertebrae after PV was analyzed using Kaplan-Meier curves. Results: The STWZ approach was successful from T1 to L5 without severe complications. Cement filling was satisfactory in 47/54 (87.0%) and 25/57 (43.9%) vertebrae in groups A and B, respectively (p < 0.001). Cement leakage was not significantly different between groups A and B (p = 1.000). Mean VAS score ± SD before and 1 week and 1, 3, 6, 9, and 12 months after PV were 7.6 ± 1.8, 4.2 ± 2.0, 2.7 ± 1.9, 1.9 ± 1.5, 1.7 ± 1.4, 1.7 ± 1.1, and 1.6 ± 1.3, respectively, in group A and 7.2 ± 1.7, 4.0 ± 1.3, 3.4 ± 1.6, 2.4 ± 1.2, 1.8 ± 1.0, 1.4 ± 0.5, and 1.7 ± 0.9, respectively, in group B. Kaplan-Meier analysis showed a lower tumor recurrence rate in group A than in group B (p = 0.001). Conclusion: The STWZ approach may represent a new, safe, alternative/auxiliary approach to target the posterior part of the vertebral body in the PV for spinal metastases.

• Journal of Korean Neurosurgical Society
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• v.48 no.1
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• pp.88-90
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• 2010

Retroperitoneal hematoma (RH) due to radiologic intervention for an intracranial lesion is relatively rare, difficult to diagnose, and can be lifethreatening. We report a case of RH that developed in a patient on anticoagulant therapy following endovascular coiling of a ruptured anterior communicating artery (AcoA) aneurysm. An 82-year-old man presented with a 12-day history of headache. Computed tomography (CT) on admission demonstrated slight subarachnoid hemorrhage, and left carotid angiography revealed an AcoA aneurysm. The next day, the aneurysm was occluded with coils via the femoral approach under general anesthesia. The patient received a bolus of 5,000 units of heparin immediately following the procedure, and an infusion rate of 10,000 units/day was initiated. The patient gradually became hypotensive 25 hours after coiling. Abdominal CT showed a huge, high-density soft-tissue mass filling the right side of the retroperitoneum space. The patient eventually died of multiple organ failure five days after coiling. RH after interventional radiology for neurological disease is relatively rare and can be difficult to diagnose if consciousness is disturbed. This case demonstrates the importance of performing routine physical examinations, sequentially measuring the hematocrit and closely monitoring systemic blood pressures following interventional radiologic procedures in patients with abnormal mental status.

• Journal of radiological science and technology
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• v.43 no.3
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• pp.169-176
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• 2020

Interventional radiology is performed under real-time fluoroscopy, and patients are exposed to a wide range of exposures for a long period of time depending on the examination and procedure. However, studies on radiation protection for patients during an intervention are insufficient. This study aims to evaluate the doses exposed during the intervention and the applicability of 3D printing materials. The organ dose for each intervention site was evaluated using a monte carlo simulatio. Also, the dose reduction effect of the critical organs was calculated when using a shielding device using 3D printing materials. As a result, the organ dose distribution for each intervention site showed a lower dose distribution for organs located far from the x-ray tube. It was analyzed that the influence of scattered rays was higher in the superficial organs of the back of the human body where x-rays were incident. The dose reduction effect on the critical organ using the 3D printing shield showed the highest testis among the gonads, and in the case of other organs, the dose reduction effect gradually decreased in the order of the eye, thyroid, breast, and ovary. Accordingly, it is judged that the 3D printed shield will be sufficiently usable as a shielding device for the radiation protection of critical organs.

• Journal of the Korean Society of Radiology
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• v.6 no.1
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• pp.11-17
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• 2012

The purpose of this study is to measure and evaluate radiation dose on patients in interventional radiological(IVR) procedures classified by each procedure, and aid as data for safety management. Fluroscopy time(F-time), dose area product(DAP) and number of acquired images from each kind of procedure was checked. Non-vascular procedures showed low value, and vascular procedure showed high value in all procedures except in IVC filter. F-time was longest in EVAR, which showed also the highest DAP value of all procedures. DAP-rate showed high value in TACE. By this result, we attempt to establish standard guideline of radiation dose on patients in IVR procedure.

• Progress in Medical Physics
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• v.30 no.4
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• pp.75-88
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• 2019

Diagnostic reference level (DRL) is employed to optimize the radiation doses of patients. The objective of this study is to review the DRLs for interventional procedures in Korea and abroad. Literature review was performed to investigate radiation dose index and measurement methodology commonly used in DRL determination. Dose area product (DAP) and fluoroscopy time within each major procedure category were systematically abstracted and analyzed. A wide variation was found in the radiation dose. The DAP values and fluoroscopy times ranged 0.01-3,081 Gy·㎠ and 2-16,878 seconds for all the interventional procedures, 8.5-1,679 Gy·㎠ and 32-5,775 seconds for the transcatheter arterial chemoembolization (TACE), and 0.1-686 Gy·㎠ and 16-6,636 seconds for the transfemoral cerebral angiography (TFCA), respectively. The DRL values of the DAP and fluoroscopy time were 238 Gy·㎠ and 1,224 seconds for the TACE and 189 Gy·㎠ and 686 seconds for the TFCA, respectively. Generally, the DRLs of Korea were lower than those of other developed countries, except for the percutaneous transluminal angioplasty with stent in arteries of the lower extremity (LE PTA and stent), aneurysm coil embolization, and Hickman insertion procedures. The wide variation in the radiation doses of the different procedures suggests that more attention must be paid to reduce unnecessary radiation exposure from medical imaging. Furthermore, periodic nationwide survey of medical radiation exposures is necessary to optimize the patient dose for radiation protection, which will ultimately contribute to patient dose reduction and radiological safety.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.3
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• pp.307-312
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• 2023

Hepatic arterioportal fistulae are abnormal communications between the hepatic artery and portal vein. They are reported to be congenital or acquired secondary to trauma, iatrogenic procedures, hepatic cirrhosis, and hepatocellular carcinoma, but less likely to occur spontaneously. Extrahepatic portal venous obstruction (EHPVO) can lead to pre-hepatic portal hypertension. A spontaneous superimposed hepatic arterioportal fistula can lead to pre-sinusoidal portal hypertension, further exacerbating its physiology. This report describes a young woman with long-standing EHPVO presenting with repeated upper gastrointestinal variceal bleeding and symptomatic hypersplenism. Computed tomography scan demonstrated a cavernous transformation of the portal vein and a macroscopic hepatic arterioportal fistula between the left hepatic artery and portal vein collateral in the central liver. The hepatic arterioportal fistula was associated with a flow-related left hepatic artery aneurysm and a portal venous collateral aneurysm proximal and distal to the fistula, respectively. Endovascular coiling was performed for the hepatic arterioportal fistula, followed by proximal splenorenal shunt procedure. This case illustrates an uncommon association of a spontaneous hepatic arterioportal fistula with EHPVO and the utility of a combined endovascular and surgical approach for managing multifactorial non-cirrhotic portal hypertension in such patients.

• Korean Journal of Radiology
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• v.2 no.3
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• pp.151-158
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• 2001

Objective: To determine the ability of MR imaging to detect the pathological changes occurring in radiofrequency (RF) thermal lesions and to assess its accuracy in revealing the extent of tissue necrosis. Materials and Methods: Using an RF electrode, thermal lesions were created in the livers of 18 rabbits. The procedure involved three phases. In the acute phase, six animals were killed the day after performing thermal ablation with RF energy, and two on day 3. In the subacute and chronic phases, eight rabbits underwent percutaneous hepatic RF ablation. After performing MR imaging, two animals were sacrificed at 1, 2, 4, and 7 weeks after the procedure, and MRpathologic correlation was performed. Results: In the acute phase, the thermal ablation lesions appeared at gross examination as well-circumscribed, necrotic areas, representing early change in the coagulative necrosis seen at microscopic examination. They were hypointense on T2-weighted images, and hyperintense on T1-weighted images. Gadolinium-enhanced MR imaging showed that a thin hyperemic rim surrounded the central coagulative necrosis. In the subacute phase, ablated lesions also showed extensive coagulative necrosis and marked inflammation at microscopic examination. Beyond two weeks, the lesions showed gradual resorption of the necrotic area, with a peripheral fibrovascular rim. The size of lesions measured by MR imaging correlated well with the findings at gross pathologic examination. Conclusion: MR imaging effectively demonstrates the histopathological tissue change occurring after thermal ablation, and accurately determines the extent of the target area.