研究者詳細 - 冨田　晃司

論文 - 冨田　晃司

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Comparison of robotic versus manual needle insertion for CT-guided intervention: prospective randomized trial

Takao Hiraki, Yusuke Matsui, Jun Sakurai, Koji Tomita, Mayu Uka, Soichiro Kajita, Noriyuki Umakoshi, Toshihiro Iguchi, Michihiro Yoshida, Kota Sakamoto, Takayuki Matsuno, Tetsushi Kamegawa

Radiology Advances 2 ( 2 ) 2025年3月

掲載種別：研究論文（学術雑誌）出版者・発行元：Oxford University Press (OUP)

Abstract

Background

Robotic needle insertion under CT guidance has been developed, but data on comparison with manual insertion are still lacking.

Purpose

To compare robotic versus manual needle insertion for CT fluoroscopy-guided intervention, primarily in terms of insertion accuracy.

Materials and Methods

This was a prospective study between May 2020 and March 2023 at a single site. The cohort comprised 22 patients undergoing CT (Aquilion One or Aquilion CX; Canon Medical Systems) fluoroscopy-guided biopsy, who were randomly allocated to either the robotic or manual group. The robot used (Zerobot; Medicalnet Okayama) is not yet commercially available. A biopsy introducer needle was inserted by 1 of 3 physicians using a remote-control robot in the robotic group, versus by 1 of 3 different physicians by hand in the manual group. The primary endpoint was needle insertion accuracy, which was defined as the 3-dimensional Euclidean distance between a predetermined target point and the needle tip after insertion. The non-inferiority of robotic insertion to manual one was then tested. Adverse events were evaluated. Statistical comparisons were made between the 2 groups.

Results

Technical success and pathological findings were confirmed in all patients of the 2 groups. The mean and SD of needle insertion were 4.8 mm ± 2.6 in the robotic group and 7.0 mm ± 3.1 in the manual group (P &lt; .001). The mean difference in accuracy between the 2 groups (robotic minus manual group) was −2.1 mm (95% CI, −4.7 to 0.4). Effective dose to physicians was zero in all cases in the robotic group, while median dose was 1.0 µSv in the manual group (P &lt; .001). Dose length product to patients was not significantly different between the 2 groups (P = .100). No major adverse events were observed.

Conclusion

Robotic needle insertion was non-inferior to manual insertion in terms of accuracy, while it effectively eliminated radiation exposure to physicians.

Trial registration number

jRCT2062200013

DOI： 10.1093/radadv/umaf010

その他リンク： https://academic.oup.com/radadv/article-pdf/2/2/umaf010/62871840/umaf010.pdf

Evaluation of a novel central venous access port for direct catheter insertion without a peel-away sheath. 査読

Toshihiro Iguchi, Takahiro Kawabata, Yusuke Matsui, Koji Tomita, Mayu Uka, Noriyuki Umakoshi, Soichiro Okamoto, Kazuaki Munetomo, Takao Hiraki

Japanese journal of radiology 2024年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: This study retrospectively evaluated the feasibility and safety of implanting a newly developed central venous access port (CV-port) that allows catheter insertion into a vein without the use of a peel-away sheath, with a focus on its potential to minimize risks associated with conventional implantation methods. MATERIALS AND METHODS: All procedures were performed using a new device (P-U CelSite Port™ MS; Toray Medical, Tokyo, Japan) under ultrasound guidance. The primary endpoint was the implantation success rate. The secondary endpoints were the safety and risk factors for infection in the early postprocedural period (< 30 days). RESULTS: We assessed 523 CV-port implantations performed in a cumulative total of 523 patients (240 men and 283 women; mean age, 61.6 ± 13.1 years; range, 18-85 years). All implantations were successfully performed using an inner guide tube and over-the-wire technique through 522 internal jugular veins and one subclavian vein. The mean procedural time was 33.2 ± 10.9 min (range 15-112 min). Air embolism, rupture/perforation of the superior vena cava, or hemothorax did not occur during catheter insertion. Eleven (2.1%) intraprocedural complications occurred, including Grade I arrhythmia (n = 8) and subcutaneous bleeding (n = 1), Grade II arrhythmia (n = 1), and Grade IIIa pneumothorax (n = 1). Furthermore, 496 patients were followed up for ≥ 30 days. Six early postprocedural complications were encountered (1.1%), including Grade IIIa infection (n = 4), catheter occlusion (n = 1), and skin necrosis due to subcutaneous leakage of trabectedin (n = 1). These six CV-ports were withdrawn, and no significant risk factors for infection in the early postprocedural period were identified. CONCLUSION: The implantation of this CV-port device demonstrated comparable success and complication rates to conventional devices, with the added potential benefit of eliminating complications associated with the use of a peel-away sheath.

DOI： 10.1007/s11604-024-01658-5

Portal Venous Thrombosis after Percutaneous Cryoablation for Renal Cell Carcinoma 査読

Takahiro Kawabata, Toshihiro Iguchi, Yusuke Matsui, Koji Tomita, Mayu Uka, Noriyuki Umakoshi, Takao Hiraki

Journal of Kidney Cancer and VHL 11 ( 2 ) 39 - 42 2024年7月

掲載種別：研究論文（学術雑誌）出版者・発行元：Codon Publications

A 50-year-old man with von Hippel–Lindau disease underwent cryoablation (CRA) for two adjacent renal cell carcinomas in the upper pole of his right kidney. Although computed tomography (CT) immediately after CRA revealed involvement of part of the liver parenchyma in the ice-ball, the treatment was completed without complications. Contrast-enhanced CT on day 2 post-CRA revealed a thrombus in the portal vein of segment 6 near the ablated liver parenchyma, prompting the initiation of oral anticoagulation. The patient was discharged on day 4 after CRA without any sequelae, and a follow-up contrast-enhanced CT done 6 weeks later demonstrated resolution of the portal vein thrombus.

DOI： 10.15586/jkcvhl.v11i2.347

その他リンク： https://jkcvhl.com/index.php/jkcvhl/article/download/347/566

Mimicking Cryoprobe Fracture During Renal Cryoablation Due to Contrast Media Concentration: A Case Report with Verification. 査読国際誌

Kazuaki Munetomo, Koji Tomita, Toshihiro Iguchi, Yusuke Matsui, Mayu Uka, Takao Hiraki

Cardiovascular and interventional radiology 2024年5月

Is cryoablation a valid option for renal cell carcinomas in direct contact with critical organs? 査読国際誌

Shoma Nagata, Yusuke Matsui, Koji Tomita, Mayu Uka, Takahiro Kawabata, Noriyuki Umakoshi, Kazuaki Munetomo, Maria Kawada, Toshihiro Iguchi, Takao Hiraki

Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy 1 - 9 2024年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: This study aimed to assess the outcomes of percutaneous cryoablation (PCA) for renal cell carcinomas (RCCs) contacting critical organs without intervening fat tissue. MATERIAL AND METHODS: Twenty-three patients with 24 RCCs (mean size, 28.8 mm) contacting critical organs on preprocedural images were included. The organ displacement techniques, technical success, efficacy, and adverse events per Clavien-Dindo classification were retrospectively reviewed. RESULTS: The organs contacting the RCCs included the colon (n = 16), pancreas (n = 3), duodenum (n = 3), small intestine (n = 1), and stomach (n = 1). In all procedures, hydrodissection was conducted, and probe traction was additionally utilized in one to displace organs. Two procedures were terminated with an insufficient ice-ball margin (<6 mm) due to recurring proximity of the colon or thermal sink effect by renal hilar vessels, yielding a technical success rate of 91.6% (22/24). No severe adverse events were noted. All patients were alive without any metastases during a median follow-up of 34.4 months. The primary and secondary technical efficacy rates were 91.6% (22/24) and 95.8% (23/24) of tumors, respectively. CONCLUSION: PCA can be a valid option for RCCs contacting critical organs with a good safety profile and sufficient technical efficacy.

DOI： 10.1080/13645706.2024.2354332

Successful treatment for life threatening recurrent non-traumatic rectus sheath hematoma in a case with microscopic polyangiitis with rapidly progressive glomerulonephritis. 査読

Hiroyuki Nakanoh, Hidemi Takeuchi, Morimoto Shiho, Yuya Terajima, Shugo Okamoto, Yasuhiro Onishi, Keiko Tanaka, Takayuki Katsuyama, Kenji Tsuji, Yoshinori Matsumoto, Katsuyuki Tanabe, Hiroshi Morinaga, Mayu Uka, Koji Tomita, Haruhito A Uchida, Takao Hiraki, Jun Wada

Internal medicine (Tokyo, Japan) 2024年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

A 68-year-old woman was admitted to our hospital because of a rapid progression of renal dysfunction with positive myeloperoxidase antineutrophil cytoplasmic antibody and was diagnosed with rapidly progressive glomerulonephritis associated with microscopic polyangiitis (MPA). Severe right rectus sheath hematoma (RSH) bleeding from the inferior epigastric artery developed after starting hemodialysis, which required 4 transarterial embolizations due to recurrent bleeding. After additional treatment with methylprednisolone pulse therapy and rituximab, no rebleeding occurred. Although the giant hematoma reached the pelvis, it shrank spontaneously without any intervention. Nontraumatic RSH should therefore be considered when treating patients with multiple risk factors.

DOI： 10.2169/internalmedicine.3239-23

Ablation of Kidney Tumors in Patients with Substantial Kidney Impairment: Current Status. 査読国際誌

Toshihiro Iguchi, Yusuke Matsui, Koji Tomita, Mayu Uka, Noriyuki Umakoshi, Takahiro Kawabata, Hideo Gobara, Motoo Araki, Takao Hiraki

Current oncology reports 2024年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE OF REVIEW: To review the current status of kidney tumor ablation in patients with substantial kidney impairment. RECENT FINDINGS: Few reports of kidney tumor ablation in such patients have recently been published. The reported prevalence of patients with stage 4 or 5 chronic kidney disease (CKD) among patients undergoing ablation is 2.0%-10%. In patients with stage 4 or 5 CKD, local tumor control rates were 88%-100%. The effect of ablation on CKD stage is unclear, and the observed deteriorations in kidney function are consistent with both the effect of cryoablation and the natural course of advanced CKD. According to guidelines, active surveillance may be selected. The goals of treatment are complete tumor removal and maintenance of kidney function, both of which can be met by ablation. Given the limited treatment options, ablation may play a pivotal role in the management of patients with advanced CKD.

DOI： 10.1007/s11912-024-01533-6

Depiction rate of feeding arteries of renal cell carcinoma on four-dimensional computed tomography angiography. 査読

Kazuaki Munetomo, Yusuke Matsui, Koji Tomita, Mayu Uka, Noriyuki Umakoshi, Takahiro Kawabata, Yusuke Morimitsu, Toshihiro Iguchi, Takao Hiraki

Japanese journal of radiology 2024年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: To retrospectively evaluate the depiction rate of feeding arteries in biopsy-proven clear cell renal cell carcinoma (CCRCC) on four-dimensional computed tomography angiography (4D-CTA) images. MATERIALS AND METHODS: This study included 22 patients with 22 CCRCC and 30 feeding arteries treated with transcatheter renal artery embolization. The depiction rate of the feeding arteries on preprocedural 4D-CTA was evaluated. Images were acquired by 320-row multi-detector computed tomography (CT) 15‒36 s after starting to inject a contrast agent (600 mg/kg iodine) intravenously into patients at 2.1 s intervals (11 phases). Two board-certified radiologists retrospectively assessed the feeder depiction rate in all 11 phases with reference to the procedural images as the gold standard. Discrepancies were resolved by consultation with a third radiologist. RESULTS: Among the feeders, 11 (36.7%) were segmental or lobar, and 19 (63.3%) were interlobar or arcuate arteries. The feeder depiction rate was the highest (25 [83.3%] of 30) in the 5th phase (delay, 23.4 s) where the gap in contrast enhancement between the renal artery and cortex was the largest. This was followed by the 6th (23 [76.7%] of 30), 4th (22 [73.3%] of 30]), and 7th (21 [70.0%] of 30) phases. The overall rate of depicting feeding arteries in the 11 phases of 4D-CTA was 28 (93.3%) of 30. CONCLUSIONS: The depiction rate of CCRCC feeding arteries including lobar or smaller artery branches by 4D-CTA was favorable. The feeding arteries were optimally visualized during the phase with the largest contrast gap between the renal artery and cortex.

DOI： 10.1007/s11604-024-01538-y

Photon Counting CTが診断に有用であった肺動脈塞栓の1例

岡安和寛, 浅野雄大, 冨田晃司, 北山貴裕, 大川七子, 槙本怜子, 檜垣文代, 児島克英, 平木隆夫

Japanese Journal of Radiology 42 ( Suppl. ) 45 - 45 2024年2月

Arterial embolization via retrograde approach using steerable microcatheter and triaxial system. 査読国際誌

Takahiro Kawabata, Toshihiro Iguchi, Yusuke Matsui, Koji Tomita, Mayu Uka, Noriyuki Umakoshi, Shoma Nagata, Takao Hiraki

Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy 1 - 3 2024年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

We report a case of postoperative pseudoaneurysm, successfully treated with selective arterial embolization, using a steerable microcatheter and triaxial system via retrograde approach. A pseudoaneurysm was detected in the dorsal pancreatic artery, a severely narrow and steeply inverted branch of the superior mesenteric artery, making microcatheter insertion via the antegrade approach challenging. However, a steerable microcatheter was advanced beyond the orifice and the tip was reversed, changing the route to retrograde allowing for easy insertion of the microguidewire. Subsequently, a small microcatheter was advanced beyond the pseudoaneurysm into the dorsal pancreatic artery, and arterial embolization was successfully completed without complications.

DOI： 10.1080/13645706.2024.2302567

Clinical T1a Renal Cell Carcinoma with Solitary Diaphragmatic Metastasis in a Patient with von Hippel-Lindau Disease. 査読国際誌

Tadataka Hirai, Mayu Uka, Toshihiro Iguchi, Kazuya Yasui, Takahiro Kawabata, Noriyuki Umakoshi, Koji Tomita, Yusuke Matsui, Yasuyuki Kobayashi, Motoo Araki, Takao Hiraki

Journal of kidney cancer and VHL 11 ( 3 ) 23 - 26 2024年

記述言語：英語掲載種別：研究論文（学術雑誌）

We report the case of a 38-year-old man with two von Hippel-Lindau disease-associated T1a renal cell carcinomas (RCCs) (<2 cm in diameter) which developed into a 2.5-cm solitary diaphragmatic metastatic tumor. After diagnosis using percutaneous biopsy, the diaphragmatic metastasis and two RCCs were treated by laparoscopic resection and percutaneous cryoablation, respectively. One year after treatment, the patient survived without local recurrence or distant metastasis. This report describes a rare case of RCC metastasis in VHL disease and its treatment.

DOI： 10.15586/jkcvhl.v11i3.342

Omental Abscess after Laparoscopic Proximal Gastrectomy Successfully Treated with Percutaneous Drainage. 査読

Atsunobu Sakurai, Mayu Uka, Toshihiro Iguchi, Koji Tomita, Yusuke Matsui, Yoshihiko Kakiuchi, Shinji Kuroda, Toshiyoshi Fujiwara, Takao Hiraki

Acta medica Okayama 77 ( 6 ) 665 - 669 2023年12月

記述言語：英語

We report the case details of a 65-year-old Japanese man with an omental abscess that was discovered 43 days after he underwent a laparoscopic proximal gastrectomy for gastric cancer. His chief complaint was mild abdominal pain that had persisted for several days. The abscess was diagnosed as a rare postoperative complication. We hesitated to perform a reoperation given the invasiveness of general anesthesia and surgery, plus the possibility of postoperative adhesions and because the patient's general condition was stable and he had only mild abdominal pain. Percutaneous drainage using a 10.2-F catheter was performed with the patient under conscious sedation and computed tomography-fluoroscopy guidance, with no complications. After the procedure, the size of the abscess cavity was remarkably reduced, and 23 days later the catheter was withdrawn.

DOI： 10.18926/AMO/66160

Automated Feeder-Detection Software for Renal Cell Carcinoma Embolization: A Retrospective Evaluation of Detection Rate Using Transarterial Time-Resolved Computed Tomography Angiography. 査読国際誌

Yusuke Matsui, Koji Tomita, Mayu Uka, Noriyuki Umakoshi, Takahiro Kawabata, Kazuaki Munetomo, Shoma Nagata, Akira Kurozumi, Ayako Ujifuku, Toshihiro Iguchi, Takao Hiraki

Cardiovascular and interventional radiology 2023年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: To evaluate the detection rate of feeding arteries in renal cell carcinoma with automated feeder-detection software and determine the optimal imaging phase for accurate feeder detection with transarterial time-resolved computed tomography angiography. MATERIALS AND METHODS: The performance of automated feeder-detection software was retrospectively evaluated using transarterial renal time-resolved computed tomography angiography images of 15 renal cell carcinomas (mean size, 22.1 mm); the images were obtained via the renal artery using a hybrid angio-CT system with 320-row computed tomography, across nine phases with 0.5-s intervals over a contrast delay time of 1.0-5.0 s. Automated feeder-detection software was applied to each phase in all tumors (135 image series in total). The feeder-detection rate (i.e., sensitivity) in each phase was evaluated, and the number of false feeders demonstrated by the software was counted for each tumor. RESULTS: A total of 22 feeders were identified. The feeder-detection rate was the highest (95.5% [21/22]) at delay times of 1.5 s and 2.0 s and lower in later phases. At delay times of 1.0 s and 1.5 s, the software demonstrated no or only a few (≤ 3) false feeders in 93.3% (14/15) of the tumors. In later phases, however, many (≥ 4) false feeders were observed in > 50% of tumors. CONCLUSION: The automated feeder-detection software showed a favorable feeder-detection rate and may be useful in transarterial embolization for renal cell carcinoma. The optimal delay time to avoid the demonstration of false feeders and achieve a high detection accuracy was 1.5 s. LEVEL OF EVIDENCE IV: Case Series.

DOI： 10.1007/s00270-023-03611-x

Time course of complications after small renal mass biopsy: evaluation of initial follow-up images. 査読

Soichiro Kajita, Toshihiro Iguchi, Yusuke Matsui, Koji Tomita, Mayu Uka, Noriyuki Umakoshi, Takahiro Kawabata, Kazuaki Munetomo, Takao Hiraki

Japanese journal of radiology 2023年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: To retrospectively assess the time course of complications after image-guided small renal mass biopsy using initial follow-up imaging. MATERIALS AND METHODS: A total of 190 masses (mean, 2.1 ± 0.70 cm; range, 0.6-3.8 cm) were assessed using initial computed tomography (43 non-enhanced and 141 enhanced) or magnetic resonance imaging (five non-enhanced and one enhanced) after biopsy. Initial follow-up imaging was classified into two groups (i.e., with or without hematoma) and various factors were compared. RESULTS: The masses were histologically diagnosed in all patients except one. Post-procedural complications included 129 Grade I hematomas, 1 Grade I hemothorax, 9 Grade II hematomas, and 1 Grade IIIa pneumothorax. Residual 28 Grade I and 6 Grade II hematomas and 8 new complications (6 small hematomas, 1 pseudoaneurysm, and 1 arteriovenous fistula) were observed on the initial follow-up imaging obtained at a median of 21 days (3-90 days) after the biopsy. On the initial follow-up imaging, the groups with and without hematoma differed significantly in the following factors: age (P = 0.04), size (P = 0.02), guided images (P < 0.01), hematoma at the end of the procedure (P < 0.01), and days after biopsy (P < 0.01). Although three masses exhibited > 25% shrinkage, no significant change was observed in mass diameter on initial follow-up imaging (mean, 2.1 ± 0.71 cm; P = 0.90). CONCLUSION: Initial follow-up imaging after a biopsy revealed improvements in most of the complications, a few new complications, and an unchanged mass diameter.

DOI： 10.1007/s11604-023-01509-9

Prospective evaluation of core number of biopsy for renal tumor: are multiple cores preferable? 査読

Toshihiro Iguchi, Yusuke Matsui, Tomohiro Toji, Jun Sakurai, Koji Tomita, Mayu Uka, Noriyuki Umakoshi, Takahiro Kawabata, Kazuaki Munetomo, Toshiharu Mitsuhashi, Takao Hiraki

Japanese Journal of Radiology 82回 S160 - S160 2023年10月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Springer Science and Business Media LLC

Abstract

Purpose

This single-center, single-arm, prospective, open-label study was conducted to evaluate the optimal number of cores (single or multiple) in renal tumor biopsy.

Materials and methods

Forty-four biopsies of 44 tumors (mean diameter, 2.7 ± 1.0 cm; range, 1.6–5.0 cm) were included. Biopsy was performed under ultrasound or computed tomography fluoroscopy guidance using an 18-gauge cutting needle and the co-axial method. Two or more specimens were obtained, which were divided into first and subsequent specimens. “First specimen” and “all specimens” were histologically evaluated (i.e., appropriateness of specimen, histological diagnosis, subtype, and Fuhrman grade of renal cell carcinoma [RCC]) blindly and independently by two board-certified pathologists.

Results

Multiple specimens were successfully and safely obtained in all the biopsies. All tumors were histologically diagnosed; 40 malignancies included 39 RCCs and 1 solitary fibrous tumor, and 4 benign lesions included 2 angiomyolipomas, 1 oncocytoma, and 1 capillary hemangioma. In all RCCs, the subtype could be determined (32 clear cell RCCs, 4 chromophobe RCCs, and 3 papillary RCCs), and the Furman grade was determined in 38 RCCs. When only the first specimen was evaluated, 22.7% of the specimens were inappropriate for diagnosis, and 34 (77.3%) were histologically diagnosed. The diagnostic yield was significantly lower than that of all specimens (P = 0.0044). Univariate analysis revealed that smaller lesions were a significant predictor of diagnostic failure (P = 0.020).

Conclusion

Biopsy with multiple cores significantly improved diagnostic yield. Thus, operators should obtain multiple cores during renal tumor biopsy.

DOI： 10.1007/s11604-023-01496-x

その他リンク： https://link.springer.com/article/10.1007/s11604-023-01496-x/fulltext.html

Image-Guided Ablation Therapies for Extrahepatic Metastases from Hepatocellular Carcinoma: A Review 査読

Noriyuki Umakoshi, Yusuke Matsui, Koji Tomita, Mayu Uka, Takahiro Kawabata, Toshihiro Iguchi, Takao Hiraki

Cancers 15 ( 14 ) 3665 - 3665 2023年7月

掲載種別：研究論文（学術雑誌）出版者・発行元：MDPI AG

The most common sites of extrahepatic metastases from hepatocellular carcinoma (HCC) are the lungs, intra-abdominal lymph nodes, bones, and adrenal glands, in that order. Although systemic therapies are a common treatment for patients with extrahepatic metastases, local ablative therapies for the extrahepatic metastatic lesions can be performed in selected patients. In this article, the literature on image-guided thermal ablation for metastasis to each organ was reviewed to summarize the current evidence. Radiofrequency ablation was the most commonly evaluated technique, and microwave ablation, cryoablation, and percutaneous ethanol injection were also utilized. The local control rate of thermal ablation therapy was relatively favorable, at approximately 70–90% in various organs. The survival outcomes varied among the studies, and several studies reported that the absence of viable intrahepatic lesions was associated with improved survival rates. Since only retrospective data from relatively small studies has been available thus far, more robust studies with prospective designs and larger cohorts are desired to prove the usefulness of thermal ablation for extrahepatic metastases from HCC.

DOI： 10.3390/cancers15143665

Robotic systems in interventional oncology: a narrative review of the current status 査読

Yusuke Matsui, Tetsushi Kamegawa, Koji Tomita, Mayu Uka, Noriyuki Umakoshi, Takahiro Kawabata, Kazuaki Munetomo, Toshihiro Iguchi, Takayuki Matsuno, Takao Hiraki

International Journal of Clinical Oncology 2023年4月

Renal cryoablation combined with prior transcatheter arterial embolization in non-dialysis patients with stage 4 or 5 chronic kidney disease: a retrospective study 査読

Noriyuki Umakoshi, Toshihiro Iguchi, Yusuke Matsui, Koji Tomita, Mayu Uka, Takahiro Kawabata, Kazuaki Munetomo, Shoma Nagata, Hideo Gobara, Motoo Araki, Takao Hiraki

Japanese Journal of Radiology 2023年4月

掲載種別：研究論文（学術雑誌）出版者・発行元：Springer Science and Business Media LLC

Abstract

Purpose

To retrospectively evaluate cryoablation combined with prior transcatheter arterial embolization (TAE) for renal cell carcinoma (RCC) in non-dialysis patients with stage 4 or 5 chronic kidney disease (CKD).

Materials and methods

Patients with stage 4 or 5 CKD undergoing TAE and cryoablation for RCC between May 2012 and October 2021 were included. TAE was selectively performed using iodized oil with absolute ethanol or gelatin sponge 1–14 days before cryoablation. Local efficacy, safety, and changes in renal function were evaluated.

Results

Nine patients (seven men and two women; median age, 64 years; range 52–88 years) with nine RCCs (mean diameter, 3.0 ± 1.0 cm; range 1.7–4.7 cm) were included. The mean pre-treatment estimated glomerular filtration rate (eGFR) was 24.2 ± 5.6 ml/min/1.73 m² (range 10.4–29.2 ml/min/1.73 m²). The mean amount of contrast medium used in TAE was 58 ± 29 ml (range 40–128 ml). Except in one patient (grade 3 pyelonephritis), no grade ≥ 3 complications occurred. During the follow-up period (median, 18 months; range 7–54 months), no local tumor progression occurred. In two patients with pre-treatment eGFR of < 20 ml/min/1.73 m², hemodialysis was initiated at 3 and 19 months after cryoablation. At their last follow-up, the remaining seven patients showed a decrease of 6.2 ± 5.3 ml/min/1.73 m² (range 0.7–17.2 ml/min/1.73 m²) in their eGFR.

Conclusion

Cryoablation combined with TAE for RCC in non-dialysis patients with stage 4 or 5 CKD was effective and safe, with an acceptable impact on renal function.

DOI： 10.1007/s11604-023-01416-z

その他リンク： https://link.springer.com/article/10.1007/s11604-023-01416-z/fulltext.html

Complications of Percutaneous Cryoablation for Renal Tumors and Methods for Avoiding Them. 査読

Toshihiro Iguchi, Yusuke Matsui, Koji Tomita, Mayu Uka, Noriyuki Umakoshi, Takahiro Kawabata, Kazuaki Munetomo, Shoma Nagata, Motoo Araki, Takao Hiraki

Acta medica Okayama 77 ( 2 ) 121 - 129 2023年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Percutaneous cryoablation of renal tumors is widely used because of its high efficacy and safety. This high safety can be attributed, at least in part, to the visibility of the ablated area as an "ice ball". This therapy has fewer complications (incidence, 0-7.2%) and is less invasive than surgery. Minor bleeding is inevitable in most kidney-related procedures, and indeed the most common complication of this therapy is bleeding (hematoma and hematuria). However, patients require treatment such as transfusion or transarterial embolization in only 0-4% of bleeding cases. Various other complications such as ureteral or collecting system injury, bowel injury, nerve injury, skin injury, infection, pneumothorax, and tract seeding also occur, but they are usually minor and asymptomatic. However, operators should know and avoid the various complications associated with this therapy. This study aimed to summarize the complications of percutaneous cryoablation for renal tumors and provide some techniques for achieving safe procedures.

DOI： 10.18926/AMO/65141

Navicular Bone Fracture after Radiofrequency Ablation in a Patient with Osteoid Osteoma.

Koji Tomita, Toshihiro Iguchi, Yusuke Matsui, Mayu Uka, Eiji Nakata, Takao Hiraki

Acta medica Okayama 77 ( 1 ) 81 - 84 2023年2月

記述言語：英語

Osteoid osteoma (OO) is a benign bone tumor that presents with nocturnal pain. Computed tomography (CT)- guided radiofrequency ablation (RFA) has been widely performed for OO, and major adverse events post-RFA are rare. We report a case of OO in the left navicular bone of a 15-year-old male. He underwent RFA for OO, and the pain improved temporarily. At the 1-month follow-up, the patient complained of left foot pain, and a CT examination revealed a fracture of the ablated navicular bone. Fractures are rare but must be taken into account after bone RFA.

DOI： 10.18926/AMO/64366

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