Right Gastric Venous Drainage: Angiographic Analysis in 100 Patients

성낙종,정진욱,김효철,박재형,제환준,안상부,조백환 대한영상의학회 2012 Korean Journal of Radiology Vol.13 No.1

Objective: To evaluate the pattern of right gastric venous drainage by use of digital subtraction angiography. Materials and Methods: A series of 100 consecutive patients who underwent right gastric arteriography during transcatheter arterial chemoembolization for hepatocellular carcinoma were included in this study. Angiographic findings were retrospectively analyzed with respect to the presence or absence of the right and aberrant gastric veins, multiplicity of draining veins, aberrant right gastric venous drainage sites, and the termination pattern of aberrant right gastric veins (ARGVs). We also compared the relative size of the right and left gastric veins. Results: A total of 49 patients collectively had 66 ARGVs. The common drainage sites for the ARGVs included the hepatic segment IV (n = 35) and segment I (n = 15). The termination pattern of ARGV could be classified into 4 different types. The most common type was termination as a superficial parenchymal blush formation in small areas without demonstrable portal branches. A statistically significant difference was found for the dominancy of the right gastric vein in gastric venous drainage between the two groups with or without ARGV (p < 0.05, Fisher’s exact test). In the group of patients without ARGV (n = 51), the right gastric vein was equal to (n = 9) or larger than (n = 17) the left gastric vein in 26 patients (26 of 51, 51%). Conclusion: The incidence of ARGV is higher than expected with four distinct types in its termination pattern. The right gastric vein may play a dominant role in gastric venous drainage. Objective: To evaluate the pattern of right gastric venous drainage by use of digital subtraction angiography. Materials and Methods: A series of 100 consecutive patients who underwent right gastric arteriography during transcatheter arterial chemoembolization for hepatocellular carcinoma were included in this study. Angiographic findings were retrospectively analyzed with respect to the presence or absence of the right and aberrant gastric veins, multiplicity of draining veins, aberrant right gastric venous drainage sites, and the termination pattern of aberrant right gastric veins (ARGVs). We also compared the relative size of the right and left gastric veins. Results: A total of 49 patients collectively had 66 ARGVs. The common drainage sites for the ARGVs included the hepatic segment IV (n = 35) and segment I (n = 15). The termination pattern of ARGV could be classified into 4 different types. The most common type was termination as a superficial parenchymal blush formation in small areas without demonstrable portal branches. A statistically significant difference was found for the dominancy of the right gastric vein in gastric venous drainage between the two groups with or without ARGV (p < 0.05, Fisher’s exact test). In the group of patients without ARGV (n = 51), the right gastric vein was equal to (n = 9) or larger than (n = 17) the left gastric vein in 26 patients (26 of 51, 51%). Conclusion: The incidence of ARGV is higher than expected with four distinct types in its termination pattern. The right gastric vein may play a dominant role in gastric venous drainage.

Effects of Arsenic Trioxide on Radiofrequency Ablation of VX2 Liver Tumor: Intraarterial versus Intravenous Administration

성낙종,윤창진,강성권,정진욱,김효철,박재형 대한영상의학회 2012 Korean Journal of Radiology Vol.13 No.2

Objective: Arsenic trioxide (As2O3) can be used as a possible pharmaceutical alternative that augments radiofrequency (RF) ablation by reducing tumor blood flow. The aim of this study was to assess the effect of intraarterial and intravenous administration of As2O3 on RF-induced ablation in an experimentally induced liver tumor. Materials and Methods: VX2 carcinoma was grown in the livers of 30 rabbits. As2O3 (1 mg/kg) was administered through the hepatic artery (n = 10, group A) or ear vein (n = 10, group B), 30 minutes before RF ablation (125 mA ± 35; 90 ± 5°C). As a control group, 10 rabbits were treated with RF ablation alone (group C). RF was intentionally applied to the peripheral margin of the tumor so that ablation can cover the tumor and adjacent hepatic parenchyma. Ablation areas of the tumor and adjacent parenchymal changes among three groups were compared by the Kruskal-Wallis and Mann-Whitney U test. Results: The overall ablation areas were 156 ± 28.9 mm2 (group A), 119 ± 31.7 (group B), and 92 ± 17.4 (group C, p < 0.04). The ablation area of the tumor was significantly larger in group A (73 ± 19.7 mm2) than both group B (50 ± 19.4, p = 0.02) and group C (28 ± 2.2, p < 0.01). The ratios of the tumoral ablation area to the overall ablation area were larger in group A (47 ± 10.5%) than that of the other groups (42 ± 7.3% in group B and 32 ± 5.6% in group C) (p < 0.03). Conclusion: Radiofrequency-induced ablation area can be increased with intraarterial or intravenous administration of As2O3. The intraarterial administration of As2O3 seems to be helpful for the selective ablation of the tumor. Objective: Arsenic trioxide (As2O3) can be used as a possible pharmaceutical alternative that augments radiofrequency (RF) ablation by reducing tumor blood flow. The aim of this study was to assess the effect of intraarterial and intravenous administration of As2O3 on RF-induced ablation in an experimentally induced liver tumor. Materials and Methods: VX2 carcinoma was grown in the livers of 30 rabbits. As2O3 (1 mg/kg) was administered through the hepatic artery (n = 10, group A) or ear vein (n = 10, group B), 30 minutes before RF ablation (125 mA ± 35; 90 ± 5°C). As a control group, 10 rabbits were treated with RF ablation alone (group C). RF was intentionally applied to the peripheral margin of the tumor so that ablation can cover the tumor and adjacent hepatic parenchyma. Ablation areas of the tumor and adjacent parenchymal changes among three groups were compared by the Kruskal-Wallis and Mann-Whitney U test. Results: The overall ablation areas were 156 ± 28.9 mm2 (group A), 119 ± 31.7 (group B), and 92 ± 17.4 (group C, p < 0.04). The ablation area of the tumor was significantly larger in group A (73 ± 19.7 mm2) than both group B (50 ± 19.4, p = 0.02) and group C (28 ± 2.2, p < 0.01). The ratios of the tumoral ablation area to the overall ablation area were larger in group A (47 ± 10.5%) than that of the other groups (42 ± 7.3% in group B and 32 ± 5.6% in group C) (p < 0.03). Conclusion: Radiofrequency-induced ablation area can be increased with intraarterial or intravenous administration of As2O3. The intraarterial administration of As2O3 seems to be helpful for the selective ablation of the tumor.

종괴형 간담도암과 간농양의 감별: CT소견의 인공신경망 적용

성낙종,이정민,김세형,한준구,김영준,김지훈,이재영,박성호,최병인 대한영상의학회 2005 대한영상의학회지 Vol.53 No.5

목적: 간담도암과 간농양의 감별진단에 유용한 CT소견을 알아보고, 인공신경망이 진단방사선과 의사의 수행향상에 도움이 되는지를 알고자 하였다. 대상과 방법: 51명의 종괴형 간담도암 환자와 70명의 간농양 환자의 CT소견을 3명의 방사선과의사가 병변의 형태와 조영소견에 따라 분석하였다. 인공신경망은 이 분석으로 얻어진 유의한 소견을 이용하여 훈련되었으며 인공신경망 및 방사선과의사의 수행능력은 Receiver Operating Characteristic Analysis로 평가하였다. 결과: 테두리조영증강, 림프절종대, 피막수축, 국소담관확대, 고형성분등은 간담도암의 중요 소견이었으며 군집성모양, 다층조영증강, 뚜렷한 경계, 둥근 모양과 담도내공기등은 간농양의 중요소견이었다(p <0.05). 인공신경망(AZ=0.9673, 98.0%, 97.1%, and 97.5%)은 두 질환의 감별진단에 있어서 전공의(AZ=0.898, 78.4%, 81.4%, 80.2%)보다 좋은 수행능력을 보여주었다: (AZ, 민감도, 특이도, 정확성)(p<0.05) 그러나, 인공신경망과 전문의 사이에는 수행능력에 유의한 차이는 없었다. 결론: 몇가지 CT소견은 간담도암과 간농양의 감별에 유용하며 인공신경망은 진단방사선과 전공의들의 수행능력 향상에 도움을 준다. Purpose: To determine which CT findings are useful for differentiating cholangiocarcinomas (CC) from hepatic abscesses and also to determine whether artificial neural networks (ANNs) improve radiologists' performance. Materials and Methods: CT findings of 51 patients with mass-forming type CC and 70 patients with hepatic abscesses were analyzed with morphologic, enhancing and other ancillary findings by three radiologists with differing levels of expertise independently. ANNs were constructed using statistically significant CT findings derived from the analyses. The performances of the ANNs and the radiologists were evaluated using receiver operating characteristic analysis. Results: CT findings of rim-like enhancement, lymphadenopathy, capsular retraction, focal bile duct dilatation and a solid component were significant features of CC (p<0.05). Findings of a clustered sign, multilayered enhancement, sharp margin, round shape, and air-biliary gram were significant features of hepatic abscesses. The ANNs showed better performance (AZ=0.9673, 98.0%, 97.1%, and 97.5%, respectively) than the resident (AZ=0.898, 78.4%, 81.4%, 80.2%) (p<0.05) in differentiating between the two diseases: (AZ, sensitivities, specificities, and overall accuracies). However, there were no significant differences in the diagnostic performance of the ANNs and the two board-certified radiologists. Conclusion: Several CT findings are useful in differentiating CC from hepatic abscesses and ANNs may improve the performance of a radiologist with little experience.

Safety and Efficacy of Distal Perfusion Catheterization to Prevent Limb Ischemia after Common Femoral Artery Cannulation for Extracorporeal Membrane Oxygenation

전창호,성낙종,윤창진 대한영상의학회 2016 대한영상의학회지 Vol.74 No.6

Purpose: The extracorporeal membrane oxygenation (ECMO) cannula has the potential for obstructing flow to the lower limb, thus causing severe ischemia and possible limb loss. We evaluated the safety and clinical efficacy of percutaneous distal perfusion catheterization in preventing limb ischemia. Materials and Methods: Between March 2013 and February 2015, 28 patients with distal perfusion catheterization after ECMO were included in this retrospective study. The technical success was evaluated by Doppler ultrasound at the popliteal level after saline injection via distal perfusion catheter. Clinical success was assessed when at least one of the following conditions was met: restoration of continuous peripheral limb oximetry value or presence of distal arterial pulse on Doppler ultrasound evaluation or resolution of early ischemic sign after connecting the catheter with ECMO. Results: Twenty-six patients with early ischemia were successfully cannulated with a distal perfusion catheter (92.8%). Clinical success was achieved in 12/28 (42.8%) patients; 8/10 (80.0%) patients with survival duration exceeding 7 days and 4/18 (22.2%) patients with survival duration less than 7 days, respectively. Conclusion: A percutaneous distal perfusion catheter placement was a feasible tool with safety and efficacy in preventing lower limb ischemia for patients with prolonged common femoral arterial cannulation for ECMO.

Comparison of Combined Therapy Using Conventional Chemoembolization and Radiofrequency Ablation Versus Conventional Chemoembolization for Ultrasound-Invisible Early-Stage Hepatocellular Carcinoma (Barcelona Clinic Liver Cancer Stage 0 or A)

이혁준,윤창진,성낙종,Sook-Hyang Jeong,Jin-Wook Kim 대한영상의학회 2018 Korean Journal of Radiology Vol.19 No.6

Objective: To compare the therapeutic efficacy between conventional transarterial chemoembolization (cTACE) and combined therapy using cTACE and radiofrequency ablation (RFA) in ultrasound (US)-invisible early stage hepatocellular carcinoma (HCC). Materials and Methods: From January 2008 to June 2016, 167 patients with US-invisible early stage HCCs were treated with cTACE alone (cTACE group; n = 85) or cTACE followed by immediate fluoroscopy-guided RFA targeting intratumoral iodized oil retention (combined group; n = 82). Procedure-related complications, local tumor progression (LTP), time to progression (TTP), and overall survival (OS) were compared between the two groups. Multivariate analyses were performed to identify prognostic factors. Results: There was no major complication in either group. The cTACE group showed higher 1-, 3-, and 5-year LTP rates than the combined group; i.e., 12.5%, 31.7%, and 37.0%, respectively, in the cTACE group; compared to 7.3%, 16.5%, and 16.5%, respectively, in the combined group; p = 0.013. The median TTP was 18 months in the cTACE group and 24 months in the combined group (p = 0.037). Cumulative 1-, 3-, and 5-year OS rates were 100%, 93.2%, and 87.7%, respectively, in the cTACE group and 100%, 96.6%, and 87.4%, respectively, in the combined group (p = 0.686). Tumor diameter > 20 mm and cTACE monotherapy were independent risk factors for LTP and TTP. Conclusion: Combined therapy using cTACE followed by fluoroscopy-guided RFA is a safe and effective treatment in USinvisible early stage HCCs. It provides less LTP and longer TTP than cTACE alone.

Post-Operative Hemorrhage after Myomectomy: Safety and Efficacy of Transcatheter Uterine Artery Embolization

Alvin Yu-Hon Wan,신지훈,윤현기,고기영,박상익,성낙종,윤창진 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.3

Objective: To evaluate the safety and clinical efficacy of transcatheter uterine artery embolization (UAE) for postmyomectomy hemorrhage. Materials and Methods: We identified eight female patients (age ranged from 29 to 51 years and with a median age of 37) in two regional hospitals who suffered from post-myomectomy hemorrhage requiring UAE during the time period from 2004 to 2012. A retrospective review of the patients’ clinical data, uterine artery angiographic findings, embolization details, and clinical outcomes was conducted. Results: The pelvic angiography findings were as follows: hypervascular staining without bleeding focus (n = 5); active contrast extravasation from the uterine artery (n = 2); and pseudoaneurysm in the uterus (n = 1). Gelatin sponge particle was used in bilateral uterine arteries of all eight patients, acting as an empirical or therapeutic embolization agent for the various angiographic findings. N-butyl-2-cyanoacrylate was administered to the target bleeding uterine arteries in the two patients with active contrast extravasation. Technical and clinical success were achieved in all patients (100%) with bleeding cessation and no further related surgical intervention or embolization procedure was required for hemorrhage control. Uterine artery dissection occurred in one patient as a minor complication. Normal menstrual cycles were restored in all patients. Conclusion: Uterine artery embolization is a safe, minimally invasive, and effective management option for controlling post-myomectomy hemorrhage without the need for hysterectomy.