佐々木 康二 | ![]() |
ササキ コウジ | |
医学部附属病院 放射線診断・IVR科 | |
助教 | |
医学 |
PURPOSE: The purpose is to investigate the major and minor complications of the pancreas after transcatheter arterial embolization (TAE) using n-butyl-2-cyanoacrylate (NBCA) for bleeding from pancreatic arteries. MATERIALS AND METHODS: Thirty-three patients who underwent TAE using NBCA for acute bleeding from pancreatic arteries and their parent arteries followed by contrast-enhanced computed tomography (CE-CT) were evaluated retrospectively. Complications and risk factors were assessed using Mann-Whitney U test or Fisher's exact test for the univariate analysis. Patients' characteristic, embolized artery, procedure details, and clinical outcomes were examined as possible risk factors. RESULTS: TAE was performed successfully in all patients. Minor pancreatic complications occurred in 10 patients (30%), including acute mild pancreatitis (n = 4) and focal lack of pancreatic parenchymal enhancement on CE-CT without pancreatitis (n = 6). No cases of major pancreatic complications, such as moderate/severe pancreatitis, were reported. Embolized artery was the only significant risk factor. The rate of complications per embolized artery were 15% (three out of 20 patients) in the arteries of the pancreatic head and 54% (seven out of 13 patients) in the arteries of pancreatic body and tail (p = 0.025). CONCLUSION: TAE using NBCA for acute bleeding from pancreatic arteries is efficacious and safe. Mild pancreatic complications were observed more frequently in case of embolization of the pancreatic body and tail region than the pancreatic head.
2021年10月06日, Japanese journal of radiology, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
BACKGROUND: Preoperative prediction of thromboembolic complications using magnetic resonance imaging (MRI) in coronary arteries and carotid arteries has been established. However, the technique has not been applied in peripheral arteries. This study aimed to assess the relationship between thromboembolic complications during endovascular treatment (EVT) for iliac artery occlusion and signal intensity on MRI. METHODS: This single-institution study included 52 iliac artery occlusions in 51 patients (mean age, 70.4 years) who underwent successful EVT between January 2010 and March 2018. MRI using an inversion recovery-prepared, steady-state free precession technique was performed preoperatively. Thromboembolic complications were defined as distal embolization and in-stent protrusion greater than 25% of the stent cross-sectional area confirmed by angiography and intravascular ultrasonography, regardless of symptoms. The highest signal intensity of iliac artery occlusion divided by the signal intensity of adjacent iliopsoas muscle (target-to-muscle ratio, TMR) was measured on MR images. Multivariate analysis was performed to clarify the predictors of thromboembolic complications during EVT. RESULTS: Thromboembolic complications observed in 11 vessels (21.2%) from 11 patients comprised distal embolization (n = 4) and in-stent protrusion (n = 7). A TMR cutoff value > 2.57 had a sensitivity of 90.9%, specificity of 78.0%, positive predictive value of 52.6%, and negative predictive value of 97.0% for detecting thromboembolic complications during EVT. In the multivariate analysis, TMR >2.57 was the only independent factor associated with thromboembolic complications (odds ratio, 30.10; 95% confidence interval, 3.26-278.00; P = 0.003). CONCLUSIONS: The presence of higher signal intensity in iliac artery occlusion on MRI is useful for predicting thromboembolic complications during EVT.
2021年05月, Annals of vascular surgery, 73, 211 - 221, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
Carbon dioxide (CO2) treatment is reported to have an antitumor effect owing to the improvement in intratumoral hypoxia. Previous studies were based on histological analysis alone. In the present study, the improvement in intratumoral hypoxia by percutaneous CO2 treatment in vivo was determined using 18F-fluoromisonidazole positron emission tomography-computed tomography (18F-FMISO PET-CT) images. Twelve Japanese nude mice underwent implantation of LM8 tumor cells in the dorsal subcutaneous area 2 weeks before percutaneous CO2 treatment and 18F-FMISO PET-CT scans. Immediately after intravenous injection of 18F-FMISO, CO2 and room air were administered transcutaneously in the CO2-treated group (n=6) and a control group (n=6), respectively; each treatment was performed for 10 minutes. PET-CT was performed 2 h after administration of 18F-FMISO. 18F-FMISO tumor uptake was quantitatively evaluated using the maximum standardized uptake value (SUVmax), tumor-to-liver ratio (TLR), tumor-to-muscle ratio (TMR), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Mean ± standard error of the mean (SEM) of the tumor volume was not significantly different between the two groups (CO2-treated group, 1.178±0.450 cm3; control group, 1.368±0.295 cm3; P=0.485). Mean ± SEM of SUVmax, TLR, MTV (cm3) and TLG were significantly lower in the CO2-treated group compared with the control group (0.880±0.095 vs. 1.253±0.071, P=0.015; 1.063±0.147361 vs. 1.455±0.078, P=0.041; 0.353±0.139 vs. 1.569±0.438, P=0.015; 0.182±0.070 vs. 1.028±0.338, P=0.015), respectively. TMR was not significantly different between the two groups (4.520±0.503 vs. 5.504±0.310; P=0.240). In conclusion, 18F-FMISO PET revealed that percutaneous CO2 treatment improved intratumoral hypoxia in vivo. This technique enables assessment of the therapeutic effect in CO2 treatment by imaging, and may contribute to its clinical application.
2021年03月, Oncology letters, 21 (3), 207 - 207, 英語, 国際誌研究論文(学術雑誌)
PURPOSE: To assess the utility of whole-aorta CT angiography (CTA) with 15 mL contrast material (CM) on time-resolved imaging for endovascular abdominal aortic repair (EVAR). METHODS: Twenty-six patients with a high-risk of post-contrast acute kidney injury (PC-AKI) underwent CTA with 15 mL CM using temporal maximum intensity projection (tMIP-CTA) generated from time-resolved imaging. The aortoiliac CT values were measured. Two observers measured the arterial diameters in unenhanced CT and tMIP-CTA images, and image quality was evaluated on a 5-point scale. The presence of the accessory renal artery, inferior mesenteric artery (IMA) occlusion, and instructions for use (IFU) of EVAR were evaluated. RESULTS: CT examinations were successfully performed, and no patients developed PC-AKI. The mean CT values of the whole aorta were 267.5 ± 51.4 HU, which gradually decreased according to the distal levels of the aorta. Bland-Altman analysis revealed excellent agreement for the external arterial diameter measurements between unenhanced CT and tMIP-CTA. Excellent interobserver agreement was achieved for the measurements of the external (ICCs, 0.910-0.992) and internal arterial diameters (ICCs, 0.895-0.993). Excellent or good overall image quality was achieved in 24 (92 %) patients. The presence of the accessory renal artery, IMA occlusion and the assessment of IFU were in 100 % agreement. Multivariate analysis revealed aortic volume as the most significant independent factor associated with strong aortic enhancement (p = 0.004). CONCLUSIONS: Whole-aorta tMIP-CTA on time-resolved imaging is useful for maintaining contrast enhancement and image quality for EVAR planning, and can substantially reduce the amount of CM.
2020年05月, European journal of radiology, 126, 108861 - 108861, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
PURPOSE: To evaluate the mid-term outcomes of transarterial embolization (TAE) for type II endoleak after endovascular abdominal aortic aneurysm repair (EVAR) and investigate the predictors of sac enlargement after embolization. MATERIALS AND METHODS: We conducted a retrospective analysis of 55 patients [48 men and 7 women, median age 79.0 (interquartile ranges 74-82) years] who underwent TAE for type II endoleak from 2010 to 2018. The aneurysmal sac enlargement, endoleaks, aneurysm-related adverse event rate, and reintervention rate were evaluated. Patients' characteristics and clinical factors were evaluated for their association with sac enlargement. RESULTS: Fifty-five patients underwent TAE with technical success and were subsequently followed for a median of 636 (interquartile ranges 446-1292) days. The freedom from sac enlargement rates at 1, 3, and 5 years was 73.2%, 32.0%, and 26.7%, respectively. After initial TAE, the recurrent type II, delayed type I, and occult type III endoleak were identified in 39 (71%), 5 (9%), and 3 (5%) patients, respectively. Although a patient had aorto-duodenal fistula, there was no aneurysm-related death. The freedom from reintervention rates was 84.6%, 35.7%, and 17.0%, respectively. In the multivariate analysis, sac diameter > 55 mm at initial TAE (hazard ratios, 3.23; 95% confidence intervals, 1.22-8.58; P < 0.05) was a significant predictor of sac enlargement. CONCLUSION: TAE for type II endoleak was not effective in preventing sac enlargement, and reinterventions were required among the mid-term follow-up. The sac diameter > 55 mm at initial TAE was a significant predictor of sac enlargement.
2020年05月, Cardiovascular and interventional radiology, 43 (5), 696 - 705, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
OBJECTIVE: The aim of this study was to assess the utility of 70-kilovoltage-peak (kVp) contrast-enhanced computed tomography (CECT) for visualization and identification of the right adrenal vein (RAV) in comparison with that of conventional 120-kVp CECT. METHODS: This retrospective study included patients who underwent adrenal venous sampling with concurrent biphasic 120-kVp (120-kVp group, n = 43) or 70-kVp (70-kVp group, n = 47) CECT. Signal-to-noise ratios, contrast-to-noise ratios, longitudinal lengths, conspicuity scores, RAV detection rates, and size-specific dose estimates were compared between the 2 groups. RESULTS: In comparison with the 120-kVp group, the 70-kVp group had significantly higher signal-to-noise and contrast-to-noise ratios (P < 0.001-P = 0.033), greater longitudinal lengths (P < 0.001-P = 0.002), superior conspicuity scores for the RAV (P < 0.001), higher RAV detection rates (P = 0.015-P = 0.033), and lower size-specific dose estimates (P < 0.001). CONCLUSIONS: Seventy-kilovoltage-peak CECT has advantages over conventional 120-kVp CECT and is potentially useful for noninvasive assessment of the precise anatomy of the RAV.
2020年01月, J Comput Assist Tomogr., 44 (1), 153 - 159, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
[査読有り]
[査読有り]
[査読有り]
PURPOSE: To assess the safety and efficacy of transarterial embolization (TAE) and to evaluate the utility of contrast-enhanced computed tomography (CE-CT) for life-threatening spontaneous retroperitoneal hemorrhage (SRH). METHODS: Nineteen patients underwent TAE following CE-CT for life-threatening SRH. CE-CT and angiographic findings, technical successes, and clinical successes were evaluated. The diagnostic performance of CE-CT for the detection of active bleeding arteries was also assessed by two independent readers. RESULTS: Active extravasation of contrast material was accurately observed in 78.9‒84.2% of the patients on CE-CT. Angiograms revealed active extravasation in 37 arteries of 15 patients (78.9%), and 4 patients showed no sign of active bleeding. Sensitivity, positive predictive value, and accuracy rate of CE-CT for the detection of active bleeding vessels was 59.5%, 62.9‒71.0% and 55.6‒60.0% respectively. The successful embolization of 48 intended arteries was achieved in all the patients, including empirical TAE in four patients. Hemodynamic stabilization was achieved in 17 patients (89.5%) with a significant decrease in transfusion (p < 0.001). CONCLUSION: TAE is a technically safe and clinically effective treatment method for life-threatening SRH. CE-CT has moderate capability for accurate identification of active bleeding arteries. TAE including arteries that potentially distribute anatomic territory of the hematoma is essential.
2019年04月, Japanese journal of radiology, 37 (4), 328 - 335, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
PURPOSE: To evaluate the advantages of intraprocedural CT during adrenal venous sampling (AVS) to confirm accurate catheterization of the right adrenal vein (RAV). MATERIALS AND METHODS: This single-institution study included 106 patients (mean age 52.4 years; range 28-74 years) with primary aldosteronism who performed contrast-enhanced CT (CECT) before AVS following AVS between January 2011 and March 2018. After catheterization of the RAV under fluoroscopic guidance, unenhanced CT images were obtained to confirm catheter position on unified CT angiography system. Catheter repositioning was performed when the catheter was inaccurately positioned. Venography findings were classified into two groups: (1) presumably cannulated in the RAV (presumed RAV group) and (2) obscured visualization of the RAV because of collateral vessels (obscured RAV group). Success rates of AVS were compared using Fisher's exact test. RESULTS: The overall success of AVS was achieved in 104 patients (98.1%). Catheter was deviated into the IVC during intraprocedural CT in four patients. Fourteen patients (14.0%) required catheter repositioning by intraprocedural CT images, and accurate catheterization in the RAV was eventually accomplished. The success rate of AVS was significantly higher in the presumed RAV group (90.1% [73/81]) than that in the obscured RAV group (68.4% [13/19]) (p = 0.024). If intraprocedural CT was not acquired during AVS, the success rate of AVS would have been significantly lower (84.9% [90/106]) compared with that use of intraprocedural CT (98.1% [104/106]) (p < 0.001). CONCLUSIONS: Intraprocedural unenhanced CT by referring to the preprocedural CECT before AVS enables the confirmation of accurate catheterization of the RAV. LEVEL OF EVIDENCE: Level 4, case series.
2019年04月, Cardiovascular and interventional radiology, 42 (4), 542 - 551, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
OBJECTIVE: To evaluate the impact of white matter changes on neurologic outcomes after total arch replacement using antegrade cerebral perfusion. METHODS: White matter changes were assessed using a visual Fazekas scale on preoperative magnetic resonance images. From October 1999 to December 2016, 359 patients who had demonstrated changes on preoperative magnetic resonance imaging underwent elective total arch replacement using antegrade cerebral perfusion. Patients were classified into 3 severity groups: mild (100 patients), moderate (158 patients), and severe (101 patients). Mean follow-up time was 4.8 ± 3.6 years. Multivariate logistic regression methods were used to evaluate for an independent association between white matter changes and postoperative neurological outcomes. RESULTS: Hospital mortality was 2.8% (10/359), and no significant differences were found across the 3 groups (P = .604). Multivariate analysis demonstrated that the severity of white matter change was significantly associated with both postoperative permanent neurologic deficit (odds ratio, 5.77; 95% confidence interval, 1.58-38.4, P = .005) and transient neurologic deficit (odds ratio, 2.46; 95% confidence interval, 1.45-4.37, P < .001). CONCLUSIONS: White matter changes, defined using the visual Fazekas scale on preoperative magnetic resonance imaging, were significantly associated with significant postoperative adverse neurologic outcomes after total arch replacement using antegrade cerebral perfusion.
2019年04月, The Journal of thoracic and cardiovascular surgery, 157 (4), 1350 - 1357, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
研究論文(学術雑誌)
Following up patients after coil embolization with non-invasive imaging such as CT or MRI is important to evaluate recanalization, surrounding and distal organ ischemia and complications, but can be difficult due to metal artifact or other factors. In this article, the characteristics of X-ray, CT and MRI to assess post-embolization state were addressed. The recent trend including dual energy CT, metal artifact reduction algorithm on CT, and sequences for MR angiography were summarized with some clinical cases.
一般社団法人日本インターベンショナルラジオロジー学会, 2018年, 日本インターベンショナルラジオロジー学会雑誌, 33 (2), 137 - 143, 日本語[査読有り]
研究論文(学術雑誌)
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
外傷性・医原性血管損傷に対するバイアバーンステントグラフト留置後の抗血栓療法には定まった見解はなく、治療担当医の判断に委ねられている。浅大腿動脈の閉塞性疾患に対するバイアバーン留置後の抗血栓療法に準じた治療が行われることが多いが、治療血管の部位や再出血のリスクなどを鑑みて調整する必要がある。腹部分枝では、血管の蛇行や血管周囲の炎症や感染など、グラフト閉塞の原因となり得る因子がある一方で、必ずしも長期開存が求められない場合もある。腸骨動脈では、グラフト閉塞の可能性は基本的に低いと思われるため、場合によっては抗血栓療法を行わないのも一つの選択肢である。反対に、鎖骨下動脈では確実な開存性を担保したい場合が多く、抗血栓療法は必須と考える。外傷性・医原性出血に対するバイアバーンステントグラフトの長期成績はいまだ不明であり、さらなるエビデンスの構築が望まれる。(著者抄録)
(一社)日本血管内治療学会, 2021年, 日本血管内治療学会誌, 22 (1), 50 - 53, 日本語1999年10月〜2016年12月に弓部全置換術を施行した350例を、術前MRIのFLAIR像を用いて大脳白質病変(WMC)をFazekasスケールにより3群(Mild 100例、Moderate 158例、Severe 101例)に分け、早期・長期成績に及ぼす影響について検討した。全体の30日死亡率と院内死亡率はそれぞれ1.4%、2.8%であり、Severe群は1年死亡の有意な危険因子であった。恒久的脳障害(PND)と一過性脳障害(TND)はそれぞれ2.2%、7.8%で生じ、いずれもWMC重症度と有意に相関した。多変量解析では、PND発生の有意な危険因子としてatherothrombotic aorta、Severe WMC、人工心肺時間が挙げられ、TND発生の有意な危険因子としてatherothrombotic aorta、Severe WMC、頸動脈狭窄があげられた。平均観察期間4.8年で97例の遠隔死亡を認め、5年生存率はWMCの重症度と相関して有意に減少し、心大血管・脳血管関連死亡回避率もWMCの重症度と相関して有意に低下した。
(NPO)日本心臓血管外科学会, 2018年07月, 日本心臓血管外科学会雑誌, 47 (4号), vii - xii, 日本語[査読有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
ポスター発表
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
急性腸管膜虚血症(Acute Mesenteric Ischemia:以下、AMI)は、循環器疾患との合併も多く、近年増加傾向にある。近年、血管内治療による血行再建術に続き、試験開腹術を行って、非可逆的な壊死腸管のみを切除して可能な限り腸管を温存する治療戦略が普及しつつあるが、虚血腸管の評価、切除適応、範囲の決定には主観的な腸管の肉眼所見に依存する部分が大きく、過不足なく壊死腸管のみを切除することは難しい。客観的な検査としては造影CTや血管造影といった評価法があるが、確実な腸管血流評価は難しいとされ、新たな検査法の開発が課題である。そこで本研究では、AMIにおける試験開腹時の新たな腸管血流評価法として、上腸間膜動脈からの選択的インドシアニングリーン(indocyanine green:以下、ICG)投与による蛍光ナビゲーションの確立を目的とし、ウサギ腸管虚血モデルを用いた基礎的実験を行った後に、多施設共同研究による臨床試験の立案までを行う。令和元年度現在、動物実験計画書を作成し、倫理委員会に申請中である。