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

Magnetic Resonance Imaging Guidance for Percutaneous Needle Intervention

Mayu Uka, Yusuke Matsui, Toshihiro Iguchi, Toshi Matsushita, Koji Tomita, Noriyuki Umakoshi, Takahiro Kawabata, Masanori Yamada, Takao Hiraki

Interventional Radiology 2023年

Correction to: Correlation between renal ablation zone in contrast‑enhanced CT and non‑enhanced MRI during the early period following percutaneous cryoablation.

Noriyuki Umakoshi, Toshihiro Iguchi, Takao Hiraki, Yusuke Matsui, Koji Tomita, Mayu Uka, Soichiro Kajita, Motoo Araki, Toshiharu Mitsuhashi, Hideo Gobara, Susumu Kanazawa

Japanese journal of radiology 40 ( 12 ) 1316 - 1316 2022年12月

Evidence on percutaneous radiofrequency and microwave ablation for liver metastases over the last decade

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

Japanese Journal of Radiology 40 ( 10 ) 1035 - 1045 2022年9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

This review aimed to summarize the treatment outcomes of percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) for metastatic liver tumors based on the findings of published studies over the last decade.

Materials and methods

Literature describing the survival outcomes of ablation therapy for liver metastases was explored using the PubMed database on April 26, 2022, and articles published in 2012 or later were selected. The included studies met the following criteria: (i) English literature, (ii) original clinical studies, and (iii) literature describing overall survival (OS) of thermal ablation for metastatic liver tumors. All case reports and cohort studies with fewer than 20 patients and those that evaluated ablation for palliative purposes were excluded.

Results

RFA was the most commonly used method for ablation, while MWA was used in several recent studies. RFA and MWA for liver metastases from various primary tumors have been reported; however, majority of the studies focused on colorectal cancer. The local control rate by RFA and MWA varied widely among the studies, ranging approximately 50–90%. Five-year survival rates of 20–60% have been reported following ablation for colorectal liver metastases by a number of studies, and several reports of 10-year survival rates were also noted.

Conclusion

Comparative studies of local therapies for colorectal liver metastases demonstrated that RFA provides comparable survival outcomes to surgical metastasectomy and stereotactic body radiation therapy.

DOI： 10.1007/s11604-022-01335-5

その他リンク： https://link.springer.com/article/10.1007/s11604-022-01335-5/fulltext.html

Percutaneous cryoablation combined with prior transcatheter arterial embolization for renal cell carcinomas of 3 cm or larger: a prospective study

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

International Journal of Clinical Oncology 27 ( 10 ) 1589 - 1595 2022年8月

植込み型除細動器(ICD)リード交換後に生じた内胸動脈-腕頭静脈シャント塞栓術の1例

馬越紀行, 宇賀麻由, 宗友一晃, 小牧稔幸, 冨田晃司, 松井裕輔, 櫻井淳, 生口俊浩, 郷原英夫, 平木隆夫, 金澤右

日本インターベンショナルラジオロジー学会雑誌 36 ( 3 ) 320 - 320 2022年8月

CTガイド下心生検にて診断しえたMALTリンパ腫の1例

西垣貴美子, 宇賀麻由, 宗友一晃, 小牧稔幸, 馬越紀行, 冨田晃司, 松井裕輔, 櫻井淳, 生口俊浩, 平木隆夫, 郷原英夫, 片岡仁美, 金澤右

日本インターベンショナルラジオロジー学会雑誌 36 ( 3 ) 322 - 322 2022年8月

コイル塞栓術を施行した左心房近傍の巨大複雑型肺動静脈奇形の1例

宗友一晃, 松井裕輔, 平木隆夫, 生口俊浩, 冨田晃司, 宇賀麻由, 馬越紀行, 小牧稔幸, 郷原英夫, 金澤右

日本インターベンショナルラジオロジー学会雑誌 36 ( 3 ) 320 - 320 2022年8月

Balloon dissectionを併用し尿管損傷を回避し得た腎凍結療法の1例

河村俊一, 冨田晃司, 小牧稔幸, 馬越紀行, 宇賀麻由, 松井裕輔, 櫻井淳, 生口俊浩, 郷原英夫, 平木隆夫

日本インターベンショナルラジオロジー学会雑誌 36 ( 3 ) 322 - 322 2022年8月

CTガイド下心生検にて診断しえたMALTリンパ腫の1例

西垣貴美子, 宇賀麻由, 宗友一晃, 小牧稔幸, 馬越紀行, 冨田晃司, 松井裕輔, 櫻井淳, 生口俊浩, 平木隆夫, 郷原英夫, 片岡仁美, 金澤右

日本インターベンショナルラジオロジー学会雑誌 36 ( 3 ) 322 - 322 2022年8月

Balloon dissectionを併用し尿管損傷を回避し得た腎凍結療法の1例

河村俊一, 冨田晃司, 小牧稔幸, 馬越紀行, 宇賀麻由, 松井裕輔, 櫻井淳, 生口俊浩, 郷原英夫, 平木隆夫

日本インターベンショナルラジオロジー学会雑誌 36 ( 3 ) 322 - 322 2022年8月

植込み型除細動器(ICD)リード交換後に生じた内胸動脈-腕頭静脈シャント塞栓術の1例

馬越紀行, 宇賀麻由, 宗友一晃, 小牧稔幸, 冨田晃司, 松井裕輔, 櫻井淳, 生口俊浩, 郷原英夫, 平木隆夫, 金澤右

日本インターベンショナルラジオロジー学会雑誌 36 ( 3 ) 320 - 320 2022年8月

コイル塞栓術を施行した左心房近傍の巨大複雑型肺動静脈奇形の1例

宗友一晃, 松井裕輔, 平木隆夫, 生口俊浩, 冨田晃司, 宇賀麻由, 馬越紀行, 小牧稔幸, 郷原英夫, 金澤右

日本インターベンショナルラジオロジー学会雑誌 36 ( 3 ) 320 - 320 2022年8月

Up-to-date evidence on image-guided thermal ablation for metastatic lung tumors: a review

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

Japanese Journal of Radiology 40 ( 10 ) 1024 - 1034 2022年7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

The aim of this review was to summarize the latest evidence on image-guided thermal ablation therapies for lung metastases. PubMed was used to search for relevant articles that reported the oncological outcomes of thermal ablation for metastatic lung tumors, and those published in 2010 or later were selected for review. Ablative therapies were applied for lung metastases from various types of primary tumors, but most commonly colorectal ones. Radiofrequency ablation (RFA) was the most evaluated technique, followed by microwave ablation (MWA). The local control rates of ablative therapies were generally favorable, approximately 80–90% in many studies. Representative studies demonstrated promising overall survival rates of approximately 50% or higher 5 years after ablation for lung metastases from colorectal cancer or mixed types of primary tumors. Nevertheless, the survival outcomes varied depending on the type of primary tumor and background factors of patients such as other metastases and comorbidities. Several studies had aimed to compare the outcomes of various ablative therapies such as RFA, MWA, and cryoablation; however, conclusive data are not yet available to determine the most appropriate ablation modality for lung metastases. Further data accumulation is needed, especially for long-term outcomes and comparisons with other therapies.

DOI： 10.1007/s11604-022-01302-0

その他リンク： https://link.springer.com/article/10.1007/s11604-022-01302-0/fulltext.html

Percutaneous cryoablation for clinical T3a renal cell carcinoma (< 7 cm) with segmental vein involvement or perinephric fat invasion based on preoperative evaluation of high-resolution multidetector computed tomography scan

Mayu Uka, Toshihiro Iguchi, Nanako Okawa, Yusuke Matsui, Koji Tomita, Noriyuki Umakoshi, Kazuaki Munetomo, Hideo Gobara, Motoo Araki, Takao Hiraki

Japanese Journal of Radiology 40 ( 11 ) 1201 - 1209 2022年6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 assess the feasibility, safety, renal function, technique efficacy rate, and survival of patients with clinical T3a renal cell carcinoma (RCC).

Materials and methods

Sixteen cryoablation sessions were performed in 14 patients (10 men; mean age, 69.8 ± 10.5 years; range, 49–90 years) with 14 clear cell T3a RCCs (mean, 3.3 ± 0.9 cm; range, 1.9–5.2 cm). One patient was on dialysis. Transcatheter arterial embolization was performed before cryoablation in 15 sessions. The primary endpoint was the technique efficacy rate. The secondary endpoints included feasibility, safety, renal function, and survival.

Results

Cryoablation was technically successful in all RCC cases. In two RCCs, cryoablation was performed twice because of local tumor progression. No major adverse events were observed. All patients were alive without metastases, with a median follow-up of 45 months (6−93 months). Complete response was achieved by cryoablation in 11 RCCs (78.6%). The primary and secondary technique efficacy rates were 77.1% and 84.4% at 1 year, 57.9% and 73.9% at 3 years, and 57.9% and 73.9% at 5 years, respectively. One patient underwent dialysis given a total contralateral nephrectomy due to another RCC 1 month after initial cryoablation and a total ipsilateral nephrectomy 46 months after initial cryoablation due to local progression. Except for two dialysis patients, of the 12 patients with a median follow-up of 41 months (6–93 months), none were on dialysis.

Conclusion

Cryoablation was safe and effective in T3a RCC, which mainly involved the renal venous branches and may represent an alternative treatment for inoperable patients.

DOI： 10.1007/s11604-022-01297-8

その他リンク： https://link.springer.com/article/10.1007/s11604-022-01297-8/fulltext.html

Early enlarging cavitation after percutaneous radiofrequency ablation of lung tumors: Incidence, risk factors and outcome. 国際誌

Koji Tomita, Toshihiro Iguchi, Yusuke Matsui, Mayu Uka, Noriyuki Umakoshi, Toshiharu Mitsuhashi, Jun Sakurai, Hideo Gobara, Susumu Kanazawa, Takao Hiraki

Diagnostic and interventional imaging 103 ( 10 ) 464 - 471 2022年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: The purpose of this study was to retrospectively determine the incidence of early enlarging cavitation after percutaneous radiofrequency ablation (RFA) of lung tumor and identify risk factors associated with their occurrence. PATIENTS AND METHODS: A total of 245 patients (140 men, 105 women; mean age, 62.7 ± 11.8 [SD] years; age range: 31-87 years) with 605 lung tumors who were treated using 401 RFA sessions from April 2010 to March 2020 were included. Of which, 31 patients with 38 early enlarging cavitation and control group (151 patients with 228 tumors) were analyzed. Early enlarging cavitation was defined as cavities with an enlarged size (>3 cm) occurring on ablated lesions within seven days after RFA. Incidence of cavitation, risk and post-procedural factors of occurrence, major adverse events (AEs) that occurred in RFA sessions with cavitation, and course of cavitation were evaluated. AEs were classified using the CIRSE classification system for complications. RESULTS: Thirty-eight cavities (6.3%, 38/605 tumors) in 31 patients occurred in an average of 3.1 ± 1.7 days (range, 1-7 days) after 32 RFA sessions. Distance from pleura ≥ 20 mm, contact with vessel ≥ 3 mm, multitined expandable electrode ≥ 3 cm, and bronchus ≥ 2 mm encompassed in the ablation zone were independent risk factors of occurrence. Fever ≥ 38.5 °C, white blood cell count ≥ 10,000/μl one day after RFA, and steroid therapy were independent post-procedural factors of occurrence. Twenty-four Grade 3 and two Grade 6 AEs occurred. Twenty-nine cavities disappeared within a mean duration of 111.9 ± 64.9 (SD) days (range: 44-274 days) and four remained with a mean follow-up of 279.2 ± 174 (SD) days; five patients were lost to follow-up. CONCLUSIONS: Early enlarging cavitation occurs in 6.3% of lung tumors treated with RFA and are associated with 26 major AEs in 32 sessions. Aforementioned procedural factors and post-procedural inflammation were significant risk factors of occurrence.

DOI： 10.1016/j.diii.2022.05.004

Correlation between renal ablation zone in contrast-enhanced CT and non-enhanced MRI during the early period following percutaneous cryoablation.

Noriyuki Umakoshi, Toshihiro Iguchi, Takao Hiraki, Yusuke Matsui, Koji Tomita, Mayu Uka, Soichiro Kajita, Motoo Araki, Toshiharu Mitsuhashi, Hideo Gobara, Susumu Kanazawa

Japanese journal of radiology 40 ( 10 ) 1087 - 1095 2022年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: To retrospectively evaluate and correlate the contrast-enhanced computed tomography (CECT) and non-enhanced magnetic resonance imaging (MRI) during the early period following renal cryoablation. MATERIALS AND METHODS: Both dynamic CECT and non-enhanced MRI were performed within 4 days following cryoablation in 34 renal tumors in 33 patients. The renal volumes of the unenhanced regions on dynamic CECT (nephrogenic phase, 4 mm thickness) and the regions with signal intensity changes on non-enhanced MRI (fat-suppressed T2-weighted image, 4 mm thickness) were evaluated. Fusion images of the axial, coronal, and sagittal sections of CECT and MRI images were created from the maximum cross-section of the renal tumor, and the match score of each image was visually evaluated on a 5-point scale. RESULTS: The mean renal volume of the unenhanced regions on CECT and those with signal intensity changes on non-enhanced MRI following cryoablation were 29.5 ± 19.9 cm3 (range, 4.3-97.4 cm3) and 30.7 ± 19.8 cm3 (range, 6.7-94.0 cm3), respectively; the difference between them was -1.17 cm3 (95% confidence interval [CI] -2.74, 0.40, P = 0.139). The Pearson's product-moment correlation coefficient (r = 0.975; 95% CI, 0.951, 0.988; P < 0.0001) showed a strong correlation between the volumes. The average match score between CECT and non-enhanced MRI was as high as 4.5 ± 0.5 points (radiologist 1, 4.3 ± 0.5; radiologist 2, 4.7 ± 0.5). Local tumor control rate was 94.1% (32/34 tumors) and recurrence-free survival rate was 82.0% (95% CI: 64.2%, 91.5%) at 5 years. CONCLUSIONS: The region with signal intensity changes on non-enhanced MRI was strongly correlated with the unenhanced region on CECT during the early period following renal cryoablation.

DOI： 10.1007/s11604-022-01285-y

Kidney cyst infection through a fistula between bladder and retroperitoneal abscess in a polycystic kidney disease patient. 国際誌

Takato Nakadoi, Kenji Tsuji, Takehiro Iwata, Eriko Eto, Hisashi Masuyama, Koji Tomita, Takao Hiraki, Shinji Kitamura, Hitoshi Sugiyama, Jun Wada

Nephrology (Carlton, Vic.) 27 ( 4 ) 383 - 384 2022年4月

経過中に難治性高血圧症を合併した血管型Ehlers-Danlos症候群の1例

長谷川功, 田中秀一, 山本紘一郎, 中野靖浩, 本多寛之, 萩谷英大, 冨田晃司, 戸田洋伸, 内田治仁, 平沢晃, 大塚文男

日本内分泌学会雑誌 98 ( 1 ) 322 - 322 2022年4月

経過中に難治性高血圧症を合併した血管型Ehlers-Danlos症候群の1例

長谷川功, 田中秀一, 山本紘一郎, 中野靖浩, 本多寛之, 萩谷英大, 冨田晃司, 戸田洋伸, 内田治仁, 平沢晃, 大塚文男

日本内分泌学会雑誌 98 ( 1 ) 322 - 322 2022年4月

Hemothorax and bloody ascites caused by vascular Ehlers-Danlos syndrome. 国際誌

Shuichi Tanaka, Hiroyuki Honda, Kou Hasegawa, Koji Tomita, Reimi Sogawa, Hideki Yamamoto, Takao Hiraki, Akira Hirasawa, Fumio Otsuka

The American journal of medicine 135 ( 7 ) e210-e211 2022年3月

Catecholamine Crisis Due to Cryoinjury of the Adrenal Gland during Renal Cryoablation. 国際誌

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

Journal of vascular and interventional radiology : JVIR 33 ( 3 ) 350 - 352 2022年3月

CT fluoroscopy-guided biopsy of pulmonary lesions contacting the interlobar fissure: An analysis of 72 biopsies. 国際誌

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

Diagnostic and interventional imaging 103 ( 6 ) 302 - 309 2022年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: The purpose of this study was to evaluate retrospectively the safety and diagnostic yield of computed tomography (CT) fluoroscopy-guided biopsy for pulmonary lesions with interlobar fissure contact. MATERIALS AND METHODS: Seventy-two lesions showing interlobar fissure contact (mean size, 15.2 ± 5.3 [SD] mm [range: 5.3-27.0 mm]; mean length of interlobar fissure contact, 8.9 ± 3.6 [SD] mm [range: 2.6-17.5 mm] in 72 patients (33 men, 39 women; mean age, 69.7 ± 10.3 [SD] years; age range: 37-91 years) were evaluated. Multiple variables were assessed to determine the risk factors for diagnostic failure and pneumothorax. Additionally, these variables were compared between these 72 lesions and randomly selected controls (i.e., non-contact lesions). RESULTS: All biopsies were technically successful using the transfissural (n = 14) or conventional routes (the route into the lung lobe with the target) with (n = 35) or without (n = 23) possible risk of needle insertion into the interlobar fissure after penetrating the target lesion. Sixty-eight (94.4%) procedures succeeded diagnostically and four (5.6%) failed. There were 27 grade I pneumothorax (37.5%), one (1.4%) grade II bleeding, and five (6.9%) grade IIIa pneumothorax requiring chest tube placement. Groups with and without pneumothorax did not differ significantly in patient-, lesion-, or procedure-related variables. Diagnostic yields and pneumothorax occurrence showed no significant differences between lesions with interlobar fissure contact and controls. CONCLUSION: CT fluoroscopy-guided biopsy of pulmonary lesions with interlobar fissure contact is a safe procedure with a high diagnostic yield. Furthermore, because of potential complications, the transfissural route should be used only when a safer route is not possible.

DOI： 10.1016/j.diii.2022.01.008

In Vivo Microwave Ablation of Normal Swine Lung at High-power, Short-duration Settings.

Toshihiro Iguchi, Takao Hiraki, Yusuke Matsui, Tomohiro Toji, Mayu Uka, Koji Tomita, Toshiyuki Komaki, Noriyuki Umakoshi, Toshiharu Mitsuhashi, Susumu Kanazawa

Acta medica Okayama 76 ( 1 ) 57 - 62 2022年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

To evaluate the volume and heat-sink effects of microwave ablation (MWA) in the ablation zone of the normal swine lung. MWA at 100 W was performed for 1, 2, and 3 min in 7, 5, and 5 lung zones, respectively. We assessed the histopathology in the ablation zones and other outcome measures: namely, length of the longest long and short axes, sphericity, ellipsoid area, and ellipsoid volume. The mean long- and short-axis diameters were 22.0 and 14.1 mm in the 1-min ablation zone, 27.6 and 20.2 mm in the 2-min ablation zone; and 29.2 and 21.2 mm in the 3-min ablation zone, respectively. All measures, except sphericity, were significantly less with 1-min ablation than with either 2- or 3-min ablation. There were no significant differences between the 2- and 3-min ablation zones, but all measures except sphericity were larger with 3-min ablation. Although there were no blood vessels that resulted in a heat-sink effect within the ablation zones, the presence of bronchi nearby in 5 lung ablation zones resulted in reduced ablation size. In high-power, short-duration MWA, the lung ablation volume was affected by ablation time. Some ablations showed that a heat-sink effect by a neighboring bronchus might occur.

DOI： 10.18926/AMO/63212

腎腫瘍生検後の出血に対し腎動脈塞栓術を施行した1例

宗友一晃, 生口俊浩, 郷原英夫, 松井裕輔, 冨田晃司, 宇賀麻由, 馬越紀行, 小牧稔幸, 平木隆夫, 金澤右

Japanese Journal of Radiology 40 ( Suppl. ) 44 - 44 2022年2月

CTガイド下生検で診断された腎capillary hemangiomaの1例

白石明日香, 松井裕輔, 宗友一晃, 平木隆夫, 生口俊浩, 冨田晃司, 宇賀麻由, 馬越紀行, 小牧稔幸, 金澤右

Japanese Journal of Radiology 40 ( Suppl. ) 44 - 44 2022年2月

上大静脈症候群に対するコスモテックステント留置の1例

馬越紀行, 冨田晃司, 平木隆夫, 生口俊浩, 松井裕輔, 宇賀麻由, 小牧稔幸, 宗友一晃, 郷原英夫, 金澤右

Japanese Journal of Radiology 40 ( Suppl. ) 45 - 45 2022年2月

胆管チューブステントを経皮的に体外抜去した1例

河村俊一, 馬越紀行, 松井裕輔, 宗友一晃, 小牧稔幸, 宇賀麻由, 冨田晃司, 櫻井淳, 生口俊浩, 郷原英夫, 平木隆夫

Japanese Journal of Radiology 40 ( Suppl. ) 50 - 50 2022年2月

マルチモダリティロードマップを用いて経頸静脈的肝内門脈大循環短期術(TIPS)を行った1例

白石明日香, 冨田晃司, 宗友一晃, 平木隆夫, 生口俊浩, 松井裕輔, 宇賀麻由, 馬越紀行, 小牧稔幸, 金澤右

Japanese Journal of Radiology 40 ( Suppl. ) 50 - 50 2022年2月

骨盤内動静脈奇形に対し経静脈的アプローチにて塞栓術を施行した2例

櫻井淳暢, 宇賀麻由, 松井裕輔, 宗友一晃, 生口俊浩, 小牧稔幸, 馬越紀行, 富田晃司, 櫻井淳, 郷原英夫, 平木隆夫

Japanese Journal of Radiology 40 ( Suppl. ) 51 - 51 2022年2月

Pneumodissection during percutaneous renal cryoablation resulting in massive subcutaneous and mediastinal emphysema. 国際誌

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

Diagnostic and interventional imaging 103 ( 4 ) 231 - 232 2022年1月

A single-center, single-arm, prospective, open-label trial to evaluate the efficacy and safety of percutaneous sclerotherapy with polidocanol for painful venous malformations (SCIRO-2001): study protocol 査読

Mayu Uka, Jun Sakurai, Yusuke Matsui, Toshihiro Iguchi, Koji Tomita, Noriyuki Umakoshi, Kazuaki Munetomo, Toshiharu Mitsuhashi, Hideo Gobara, Takao Hiraki

Nagoya J. Med. Sci. 84. 746–751, 2022 2021年12月

Percutaneous needle biopsy under 1.2 Tesla open MRI guidance.

Yusuke Matsui, Takao Hiraki, Jun Sakurai, Soichiro Okamoto, Toshihiro Iguchi, Koji Tomita, Mayu Uka, Takatsugu Yamauchi, Hideo Gobara, Susumu Kanazawa

Japanese journal of radiology 40 ( 4 ) 430 - 438 2021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 feasibility of percutaneous needle biopsy using a 1.2 Tesla open magnetic resonance imaging (MRI) system, which has the highest field strength among the currently available open MRI systems. MATERIALS AND METHODS: This single-center prospective study included 10 patients. The primary endpoint was the feasibility of biopsy needle insertion into a target lesion under 1.2 Tesla open MRI guidance. The secondary endpoints included adverse events, device failures, and success of tissue specimen acquisition. Biopsy was performed for targets in various organs using an MRI-compatible coaxial needle system consisting of a 16G introducer needle and 18G semi-automatic biopsy needle. A newly developed body coil with a suitable design for intervention was used for intraprocedural imaging. RESULTS: Biopsy procedures were performed for six musculoskeletal masses, two retroperitoneal masses, one renal mass, and one liver mass. The median diameter of the targets was 4.9 cm (range 2.1-22.8 cm). MRI-guided biopsy needle insertion was feasible in all 10 patients. In total, four grade 1 adverse events (as per Common Terminology Criteria for Adverse Events version 4.0) occurred in three patients. Adequate biopsy specimens for pathological diagnosis were successfully obtained from all 10 patients. CONCLUSION: Percutaneous needle biopsy using a 1.2 Tesla open MRI system was feasible for relatively large targets, especially in the musculoskeletal region.

DOI： 10.1007/s11604-021-01211-8

良性腫瘍に対する低侵襲治療類骨骨種に対するRFA

冨田晃司, 馬越紀行, 宇賀麻由, 藤原智洋, 松井裕輔, 中田英二, 生口俊浩, 国定俊之, 平木隆夫, 尾崎敏文

日本小児整形外科学会雑誌 30 ( 3 ) S39 - S39 2021年11月

【泌尿器科領域のIVR】腎癌に対するアブレーション治療

生口俊浩, 平木隆夫, 松井裕輔, 冨田晃司, 宇賀麻由, 郷原英夫, 金澤右

日本インターベンショナルラジオロジー学会雑誌 36 ( 1 ) 2 - 6 2021年9月

記述言語：日本語出版者・発行元：(一社)日本インターベンショナルラジオロジー学会

日本では2011年に小径腎細胞癌に対する凍結療法(CA)が保険収載となり、低侵襲、安全、高い局所制御率を有するアブレーション治療の施行件数は増加傾向にある。アブレーション治療として施行例の多いCAとラジオ波焼灼術(RFA)について、その原理と特徴、適応、治療の流れとアブレーション手技、治療成績と合併症、費用などについて概説した。

精巣静脈が排血路となった腸間膜静脈瘤に対する塞栓術の1例

馬越紀行, 冨田晃司, 平木隆夫, 生口俊浩, 松井裕輔, 宇賀麻由, 小牧稔幸, 宗友一晃, 櫻井淳, 郷原英夫, 金澤右

日本門脈圧亢進症学会雑誌 27 ( 3 ) 136 - 136 2021年8月

CT evaluation of patent artery after percutaneous cryoablation of renal cell carcinoma. 国際誌

Soichiro Kajita, Toshihiro Iguchi, Takao Hiraki, Yusuke Matsui, Koji Tomita, Mayu Uka, Takashi Tanaka, Motoo Araki, Hideo Gobara, Susumu Kanazawa

Diagnostic and interventional imaging 102 ( 12 ) 753 - 758 2021年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: The purpose of this retrospective study was to determine the incidence of persistent patent artery after percutaneous cryoablation of renal cell carcinoma (RCC) and the relationship between patent arteries one month after cryoablation and early tumor progression. MATERIALS AND METHODS: One hundred and fifty-nine patients (112 men, 47 women; mean age, 63.6±14.6 [SD] years; age range: 21-91 years) who underwent percutaneous cryoablation for 186 RCCs (mean diameter, 1.9±0.6 [SD] cm; range: 0.7-4.0cm) were retrospectively included. After cryoablation, patients underwent contrast-enhanced computed tomography (CT) with ≤2-mm slice thickness within one week from cryoablation, and at one, three, and six months. The time course of patent artery in the ablated renal parenchyma after cryoablation was the primary endpoint. The relationships between patent arteries one month after cryoablation and treatment effectiveness, tumor vascularity, tumor enhancement one month after cryoablation, tumor subtype, and renal function changes were evaluated as secondary endpoints. RESULTS: CT showed patent arteries in the ablated renal parenchyma within one week in 166 RCCs (89.2%), at one month in 54 RCCs (29.0%), at three months in 8 RCCs (4.3%), and at six months in 2 RCCs (1.1%). The presence of patent artery one month after cryoablation was significantly associated with tumor enhancement at the same time point (P=0.015). There was no association between patent arteries one month after cryoablation and treatment effectiveness (P=0.693). CONCLUSION: Patent arteries in the ablated renal parenchyma are commonly observed on CT examination after percutaneous cryoablation of RCC. However, they gradually disappear and do not require specific treatment.

DOI： 10.1016/j.diii.2021.06.001

Percutaneous Cryoablation of Lower Limb Soft-Tissue Venous Malformations: Preliminary Results of Long-Term Efficacy. 国際誌

Hiroyasu Fujiwara, Takao Hiraki, Yusuke Matsui, Mayu Uka, Koji Tomita, Toshihiro Iguchi, Jun Sakurai, Takao Soshi, Hideo Gobara, Susumu Kanazawa

Cardiovascular and interventional radiology 44 ( 9 ) 1485 - 1490 2021年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: To retrospectively evaluate long-term efficacy of percutaneous cryoablation for lower limb soft-tissue venous malformations. MATERIALS AND METHODS: Nine patients (mean age, 36.6 years) with lower limb soft-tissue venous malformations were included. Cryoablation was performed percutaneously using an argon-based system. Adverse events (AE) using the Common Terminology Criteria for AEs version 4.0 were evaluated. The visual analog scale (VAS) scores and lesion volumes measured on magnetic resonance imaging were also evaluated at 12 months and 5-6 years. RESULTS: Technical success (i.e., complete coverage of the lesion by an iceball) was achieved in eight of the nine patients. All patients developed a total of 14 grade 1 or 2 adverse events. The mean (± standard deviation) VAS score was 6.0 (± 1.7) before therapy, whereas it was 0.14 (± 0.27) at 12 months and 0.97 (± 1.3) at 5-6 years (58-78 months). Complete pain relief was obtained in 6 and 5 patients at 12 months and 5-6 years, respectively. The median lesion volume was 2.49 mL before therapy, whereas it was 0.26 mL at 12 months and 0.35 mL at 5-6 years. CONCLUSION: Percutaneous cryoablation of lower limb soft-tissue venous malformations achieved considerable pain relief and lesion shrinkage for 5-6 years in this small preliminary study. LEVEL OF EVIDENCE: Level 4, Case Series.

DOI： 10.1007/s00270-021-02876-4

CT-guided biopsy of lung nodules with pleural contact: Comparison of two puncture routes. 国際誌

Toshihiro Iguchi, Takao Hiraki, Yusuke Matsui, Koji Tomita, Mayu Uka, Takashi Tanaka, Kazuaki Munetomo, Hideo Gobara, Susumu Kanazawa

Diagnostic and interventional imaging 102 ( 9 ) 539 - 544 2021年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: The purpose of this study was to retrospectively compare two puncture routes (transpleural vs. transpulmonary) for computed tomography (CT) fluoroscopy-guided cutting needle biopsy of lung nodules with pleural contact. PATIENTS AND METHODS: A total of 102 patients (72 men; mean age, 71.1±9.5 [SD] years) were included and 102 biopsies of 102 lung nodules (mean size, 16.7±5.9 [SD] mm; range, 6.0-29.4mm; mean length of pleural contact, 10.1±4.2 [SD] mm; range, 2.8-19.6mm) were analyzed. All procedures were classified as biopsies via the direct transpleural route or the transpulmonary route. The patient-, lesion-, and biopsy-related variables, diagnostic yields, and incidence of complications were compared between the two routes. RESULTS: Biopsy was performed via the direct transpleural route (n=59; 57.8%) and transpulmonary route (n=43; 42.2%). In the transpulmonary route group, the mean distance of the intrapulmonary pathway was 17.7±9.4 [SD] mm (range: 4.1-47.6mm; P<0.001) and the introducer needle trajectory angle of<45° was significantly observed (8.5% [5/59] vs. 60.5% [26/43]; P<0.001). There was no significant difference in diagnostic accuracy between the direct transpleural and transpulmonary routes (93.2% [55/59] vs. 90.7% [39/43]; P=0.718). The frequencies of all complications (64.4% [38/59] vs. 97.7% [42/43]; P<0.001), pneumothorax (33.9% [20/59] vs. 65.1% [28/43]; P=0.003), pneumothorax with chest tube placement (3.4% [2/59] vs. 18.6% [8/43]; P=0.016), and pulmonary hemorrhage (47.5% [28/59] vs. 76.7% [33/43]; P=0.004) were significantly lower in the direct transpleural group. CONCLUSION: Direct transpleural route is recommended for CT fluoroscopy-guided biopsy of lung nodules with pleural contact because it is safer and yields similar diagnostic accuracy than transpulmonary route.

DOI： 10.1016/j.diii.2021.05.005

Needle artifact characteristics and insertion accuracy using a 1.2T open MRI scanner: A phantom study. 国際誌

Soichiro Okamoto, Yusuke Matsui, Takao Hiraki, Toshihiro Iguchi, Toshiyuki Komaki, Takatsugu Yamauchi, Mayu Uka, Koji Tomita, Jun Sakurai, Hideo Gobara, Susumu Kanazawa

Diagnostic and interventional imaging 102 ( 6 ) 363 - 370 2021年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: To evaluate the characteristics of needle artifacts and the accuracy of needle insertion using a 1.2 Tesla open magnetic resonance imaging (MRI) system in a phantom. MATERIALS AND METHODS: First, the apparent width of the needle on the MRI and the needle tip position error of 16- and 18-gauge MRI-compatible introducer needles and a 17-gauge cryoneedle were examined with different needle angles (0°, 30°, 45°, 60°, and 90°) to the main magnetic field (B0), sequence types (balanced steady-state acquisition with rewound gradient echo [BASG] and T2-weighted fast spin echo [FSE] sequence), and frequency encoding directions. Second, the accuracy of needle insertion was evaluated after 10 MRI fluoroscopy-guided insertions in a phantom. RESULTS: The apparent needle widths was larger when the angle of the needle axis relative to B0 was larger. The needles appeared larger on BASG than on T2-weighted FSE images, with the largest apparent widths of 16-, 17-, and 18-gauge needles of 14.3, 11.6, and 11.0mm, respectively. The apparent needle tip position was always more distal than the actual position on BASG images, with the largest longitudinal error of 4.0mm. Meanwhile, the 16- and 18-gauge needle tips appeared more proximal on T2-weighted FSE images with right-to-left frequency encoding direction. The mean accuracy of MRI fluoroscopy-guided needle insertion was 3.1mm. CONCLUSION: These experiments clarify the characteristics of needle artifacts in a 1.2 Tesla open MRI. With this system, the MRI fluoroscopy-guided needle insertion demonstrated an acceptable accuracy for clinical use.

DOI： 10.1016/j.diii.2020.12.007

Contrast examination of central venous access port implanted through internal jugular vein for evaluation of suspected complications.

Toshihiro Iguchi, Takao Hiraki, Yusuke Matsui, Koji Tomita, Mayu Uka, Noriyuki Umakoshi, Soichiro Kajita, Toshiyuki Komaki, Hideo Gobara, Susumu Kanazawa

Japanese journal of radiology 39 ( 11 ) 1103 - 1110 2021年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: We summarized the findings, diagnosis, and outcomes of cases for which contrast examination of central venous access ports (CV-ports) were attempted to detect complications. MATERIALS AND METHODS: Fifty-seven contrast examinations were attempted for 45 patients with 46 CV-ports (median, 162 days after implantation). Contrast examination was performed due to three suspicion catheter fractures or 54 CV-port dysfunctions (combinations of an absence of blood reflux on aspiration and 9 sufficient, 21 insufficient, or 24 impossible drip infusions). RESULTS: Contrast examination was successfully performed in 52 cases and revealed 45 normal findings, 5 pericatheter fibrin sheath formations, and 2 partial catheter fractures. In 23 of 45 cases with normal findings, the resistance to injection was initially mild or moderate but resolved after the CV-port was flushed slowly with heparinized saline solution. Subsequent contrast examination demonstrated normal findings. All fibrin sheath formations disappeared after thrombolytic therapy. Five cases could not undergo contrast examination due to high resistance. After contrast examination, nine of 46 CV-ports were removed or exchanged, while the use of the remaining 37 continued. CONCLUSION: Contrast examination of CV-port allowed the assessment of suspected complications and early treatment.

DOI： 10.1007/s11604-021-01142-4

皮膚直下のタイプII動静脈奇形に対してポリドカノールフォームを用いて硬化療法を施行した一例

松井裕輔, 宇賀麻由, 平木隆夫, 生口俊浩, 冨田晃司, 馬越紀行, 小牧稔幸, 宗友一晃, 金澤右

日本インターベンショナルラジオロジー学会雑誌 36 ( Suppl. ) 242 - 242 2021年4月

腎凍結療法における低線量CTプロトコルの後方視的検討

小牧稔幸, 松井裕輔, 梶田聡一郎, 馬越紀行, 冨田晃司, 宇賀麻由, 生口俊浩, 櫻井淳, 平木隆夫, 郷原英夫, 金澤右

日本インターベンショナルラジオロジー学会雑誌 36 ( Suppl. ) 145 - 145 2021年4月

肺動静脈奇形コイル塞栓術の再開通評価におけるTime-resolved MR Angiographyの有用性

宗友一晃, 冨田晃司, 郷原英夫, 平木隆夫, 生口俊浩, 松井裕輔, 宇賀麻由, 梶田聡一朗, 小牧稔幸, 馬越紀行, 金澤右

日本インターベンショナルラジオロジー学会雑誌 36 ( Suppl. ) 166 - 166 2021年4月

胸膜に接する肺結節に対するCT透視ガイド下生検の穿刺経路の比較(CT fluoroscopy-guided biopsy for lung nodules with pleural contact: Comparison with puncture routes)

生口俊浩, 平木隆夫, 松井裕輔, 冨田晃司, 宇賀麻由, 馬越紀行, 梶田聡一郎, 小牧稔幸, 宗友一晃, 郷原英夫, 金澤右

日本インターベンショナルラジオロジー学会雑誌 36 ( Suppl. ) 149 - 149 2021年4月

当院におけるT3a腎癌に対する経皮的凍結療法成績の検討(Percutaneous cryoablation outcome for clinical T3a renal cell carcinoma at our institution)

宇賀麻由, 大川七子, 宗友一晃, 馬越紀行, 小牧稔幸, 梶田聡一郎, 冨田晃司, 松井裕輔, 櫻井淳, 生口俊浩, 郷原英夫, 平木隆夫, 金澤右

日本インターベンショナルラジオロジー学会雑誌 36 ( Suppl. ) 182 - 182 2021年4月

腎癌凍結療法後の造影CTと単純MRI画像の関係性の検討

馬越紀行, 生口俊浩, 平木隆夫, 松井裕輔, 冨田晃司, 宇賀麻由, 梶田聡一郎, 小牧稔幸, 宗友一晃, 櫻井淳, 郷原英夫, 金澤右

日本インターベンショナルラジオロジー学会雑誌 36 ( Suppl. ) 181 - 181 2021年4月

Oncologic outcomes and safety of percutaneous cryoablation for biopsy-proven renal cell carcinoma up to 4 cm in diameter: a prospective observational study.

Hideo Gobara, Takao Hiraki, Toshihiro Iguchi, Yusuke Matsui, Jun Sakurai, Mayu Uka, Koji Tomita, Toshiyuki Komaki, Yasuyuki Kobayasi, Motoo Araki, Toyohiko Watanabe, Susumu Kanazawa

International journal of clinical oncology 26 ( 3 ) 562 - 568 2021年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Percutaneous cryoablation is widely used for the treatment of renal cell carcinoma. We prospectively evaluated the oncologic outcomes and safety of percutaneous cryoablation for the treatment of tumors ≤ 4 cm in diameter. METHODS: We included patients aged ≥ 20 years, who had histologically proven renal cell carcinoma, tumor diameter ≤ 4 cm, a performance status of ≤ 1, acceptable laboratory parameters, were inoperable or refused to undergo surgery, and had signed a written informed consent. The primary endpoint was the cause-specific survival rate. The secondary endpoints were overall and progression-free survival, and adverse event frequency and grade. All procedures were percutaneously performed under computed tomography fluoroscopy guidance. RESULTS: From October 2013 to October 2015, 33 patients (mean age: 68 ± 14 years; sex: six women, 27 men) were enrolled. The mean tumor diameter was 2.1 ± 0.6 (range 1.0-3.4) cm. The median follow-up period was 60.1 (range 18.4-76.6) months. One patient died of non-renal cell carcinoma-related disease 46 months after percutaneous cryoablation. The cause-specific and overall survival rates were 100% and 96.8% at 3 years, and 100% and 96.8% at 5 years, respectively. There was no local tumor progression or distant metastasis. The incidence of severe urological (urinary fistula and perinephric infection) and non-urological adverse events (increased creatine kinase and skin ulceration) was 6% each. CONCLUSION: Percutaneous cryoablation for renal cell carcinoma ≤ 4 cm in diameter achieved good tumor control with a low complication frequency.

DOI： 10.1007/s10147-020-01825-4

Needle Tract Ablation in Liver Tissue Using a Cryoprobe Combined with an Electrosurgical Device: Influence of ex vivo and in vivo Animal Models.

Hideo Gobara, Akira Yamamoto, Toshiyuki Komaki, Toshiaki Kitayama, Jun Sakurai, Toshihiro Iguchi, Yusuke Matsui, Mayu Uka, Koji Tomita, Takao Hiraki, Susumu Kanazawa

Acta medica Okayama 75 ( 1 ) 9 - 14 2021年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

To assess the feasibility of needle tract ablation in liver tissue in ex vivo and in vivo animal models using a cryo-probe and electrosurgical device. The experimental device is made by inserting a cryoprobe through an intro-ducer sheath for insulation, with 2-cm of probe tip projecting out. A beagle liver was punctured by the device, and electric current was applied at 30-W with the electrosurgical knife touching the non-insulated device base. The discolored area of cut surface along the device was evaluated in 5 application-time groups (5 , 10 , 15 , 20, or 25 seconds). An ex vivo experiment was performed to determine an ablation algorithm with an appropriate application time by comparison with radiofrequency ablation (RFA) results. Thereafter, an in vivo experiment was performed to verify the algorithm's feasibility. In the ex vivo model, the cut surface demonstrated different amounts of discolored area according to the application time. The total discolored area in the 20-seconds group was similar to that by RFA. In the in vivo model, the liver did not bleed, the total discolored area was similar to that ex vivo, and coagulation necrosis was confirmed by photomicrograph. Needle tract ablation can be per-formed using the experimental device and electrosurgical device.

DOI： 10.18926/AMO/61428

Computed Tomography-guided Core Needle Biopsy for Renal Tumors: A Review

Toshihiro Iguchi, Yusuke Matsui, Koji Tomita, Mayu Uka, Toshiyuki Komaki, Soichiro Kajita, Noriyuki Umakoshi, Kazuaki Munetomo, Hideo Gobara, Susumu Kanazawa

Interventional Radiology 6 ( 3 ) 69 - 74 2021年

Image-guided core biopsy of 2-cm or smaller renal tumors 査読

T. Iguchi, T. Hiraki, Y. Matsui, K. Tomita, M. Uka, T. Tanaka, T. Komaki, T. Toji, H. Gobara, S. Kanazawa

Diagnostic and Interventional Imaging 101 ( 11 ) 715 - 720 2020年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

Purpose: The purpose of this study was to retrospectively evaluate diagnostic yield, risk factors for diagnostic failure, and safety of image-guided core biopsy of renal tumors ≤ 2 cm. Materials and methods: Eighty-four biopsies of 84 renal tumors (mean size, 1.5 ± 0.4 [SD] cm; range, 0.6–2.0 cm) from 84 patients (53 men, 31 women; mean age, 61.7 ± 12.7 [SD] years; age range, 34–87 years) were included. All adverse events (AEs) were evaluated based on the CIRSE classification. The 84 procedures were classified as diagnostic or nondiagnostic. Multiple variables related to the patients, tumors, and procedures were assessed to identify variables associated with diagnostic failure. Results: All 84 biopsies (100%) were technically successful, defined as penetration of the target and acquisition of some specimens. Eighty (80/84; 95.2%) biopsy procedures were diagnostic and four (4/84; 4.8%) procedures were nondiagnostic. Among 80 diagnosed renal tumors, 71/80 (88.8%) tumors were malignant (49 clear cell renal cell carcinomas [RCCs], 14 papillary RCCs, 3 chromophobe RCCs, 3 metastatic renal cancers, 1 lymphoma, and 1 unclassified RCC) and 9/80 (11.2%) lesions were benign (5 angiomyolipomas, 3 oncocytomas, and 1 inflammatory lesion). No significant differences existed in any variables between the two groups. A total of 57 (57/84; 67.9%) procedures resulted in 56 Grade 1, 2 Grade 2, and 1 Grade 3 AEs. Conclusion: Image-guided biopsy of renal tumors ≤ 2 cm is safe and has a high diagnostic yield.

DOI： 10.1016/j.diii.2020.07.002

肺がん診断と治療の最前線 CTガイド下肺アブレーション

松井裕輔, 平木隆夫, 生口俊浩, 冨田晃司, 宇賀麻由, 金澤右

肺癌 60 ( 6 ) 474 - 474 2020年10月

【泌尿器がんに対するfocal therapyの現状と展望】小径腎がんに対する経皮的ラジオ波焼灼療法の現状と展望

平木隆夫, 宇賀麻由, 冨田晃司, 松井裕輔, 生口俊浩, 金澤右, 荒木元朗, 小林泰之, 渡邉豊彦, 郷原英夫

泌尿器科 12 ( 3 ) 233 - 240 2020年9月

Difference in specimen weights with semi-automatic cutting biopsy needles.

Toshihiro Iguchi, Takao Hiraki, Yusuke Matsui, Toshiharu Mitsuhashi, Toshiyuki Komaki, Soichiro Okamoto, Shogo Fukuma, Koji Tomita, Mayu Uka, Susumu Kanazawa

Japanese journal of radiology 38 ( 6 ) 579 - 586 2020年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: To assess specimen weight difference of six types of semi-automatic cutting biopsy needles. MATERIALS AND METHODS: We compared 18- and 20-gauge needles, one aspiration-type (STARCUT® aspiration-type, TSK Laboratory, Tochigi, Japan) and five non-aspiration-type (MISSION®, BARD, AZ; SuperCore™, Argon Medical Devices, TX; Temno Evolution®, Care Fusion, IL; FINE CORE®, Toray Medical, Tokyo, Japan; Quick-Core®, Cook, IN) needles. Four biopsies were performed with each needle with the longest throw length on an excised bovine liver. The biopsies were repeated with new needles, four times with four different livers. STARCUT® was used both with and without aspiration. RESULTS: Sixteen specimens were obtained with each needle. In needles of gauges, STARCUT® with aspiration provided the heaviest specimen and significantly heavier specimens were obtained with STARCUT® with aspiration (P < 0.05) than five non-aspiration-type needles. The specimen weight differed significantly (P < 0.001) among all 18- and 20-gauge needles. The specimen weights did not differ significantly between aspiration and non-aspiration biopsies with STARCUT® (6.32 vs. 5.97 mg with 18-gauge needle, P = 0.342; 1.95 vs. 1.92 mg with 20-gauge needle, P = 0.886). CONCLUSION: Although STARCUT® with aspiration provided the heaviest specimen, specimen weights were not significantly different between aspiration and non-aspiration biopsies. We assessed the specimen weight difference of six types of semi-automatic cutting biopsy needles. Significantly heavier specimens were obtained with STARCUT® with aspiration than the other needles. The specimen weight differed significantly among all 18- and 20-gauge needles but did not differ significantly between aspiration and non-aspiration biopsies with STARCUT®.

DOI： 10.1007/s11604-020-00935-3

Computed tomography fluoroscopy-guided cutting needle biopsy of pulmonary nodules ≤8 mm: A retrospective study including 117 nodules. 国際誌

Yanqing Zhao, Yusuke Matsui, Takao Hiraki, Toshihiro Iguchi, Koji Tomita, Mayu Uka, Hideo Gobara, Shinichi Toyooka, Susumu Kanazawa

European journal of radiology 125 108903 - 108903 2020年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: To evaluate the diagnostic yield and safety of computed tomography (CT) fluoroscopy-guided cutting needle biopsy (CNB) for pulmonary nodules ≤ 8 mm. METHOD: Data of CT fluoroscopy-guided CNB for pulmonary nodules ≤ 8 mm performed in a single institution were retrospectively analyzed. One hundred and seventeen biopsy procedures for 117 pulmonary nodules (mean size, 7.4 mm) in 114 patients were included in the study. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated. Univariate analyses were performed to elucidate the risk factors for diagnostic failure (i.e., non-diagnostic, false-positive, or false-negative results). Complications were graded per the Clavien-Dindo Classification. RESULTS: One (0.9 %) non-diagnostic biopsy result was found. The diagnostic accuracy was 95.7 % (112/117). The sensitivity and specificity were 95.8 % (91/95) and 95.5 % (21/22), respectively. PPV and NPV were 98.9 % (91/92) and 87.5 % (21/24), respectively. Univariate analyses showed that nodules in the lower lobes (p = 0.006) and prone biopsy position (p = 0.021) were the significant risk factors for diagnostic failure. The incidence of pneumothorax requiring chest tube placement (Grade IIIa) was 6.8 % (8/117). No Grade IIIb or higher complications were observed. CONCLUSION: CT fluoroscopy-guided CNB for pulmonary nodules ≤ 8 mm showed a high diagnostic yield without severe complications.

DOI： 10.1016/j.ejrad.2020.108903

Percutaneous Gastrojejunostomy Catheter Placement Using a Slow-Leak Balloon through the Reconstructed Gastric Tube after Esophagectomy. 国際誌

Shinichi Morita, Yasuaki Arai, Shunsuke Sugawara, Miyuki Sone, Koji Tomita, Hiroaki Ishii, Shuji Terai

Journal of vascular and interventional radiology : JVIR 31 ( 3 ) 478 - 481 2020年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

Twelve patients who had undergone esophageal reconstruction because of cancer and in whom conventional percutaneous radiologic or endoscopic gastrostomy was considered difficult are reported. These patients underwent placement of a percutaneous gastrojejunostomy catheter through the reconstructed gastric tube using a slow-leak balloon that had been developed for percutaneous transesophageal gastrotubing. Retrospective evaluation showed successful outcomes without severe complications in all patients. Eight (66.6%) were able to resume oral intake, which allowed gastrojejunostomy catheter withdrawal in 3 (25%). This technique is feasible with acceptable clinical outcomes for patients who have undergone gastric tube reconstruction after esophagectomy.

DOI： 10.1016/j.jvir.2019.09.009

Robotic needle insertion during computed tomography fluoroscopy-guided biopsy: prospective first-in-human feasibility trial. 国際誌

Takao Hiraki, Tetsushi Kamegawa, Takayuki Matsuno, Jun Sakurai, Toshiyuki Komaki, Takuya Yamaguchi, Koji Tomita, Mayu Uka, Yusuke Matsui, Toshihiro Iguchi, Hideo Gobara, Susumu Kanazawa

European radiology 30 ( 2 ) 927 - 933 2020年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: This was a prospective, first-in-human trial to evaluate the feasibility and safety of insertion of biopsy introducer needles with our robot during CT fluoroscopy-guided biopsy in humans. MATERIALS AND METHODS: Eligible patients were adults with a lesion ≥ 10 mm in an extremity or the trunk requiring pathological diagnosis with CT fluoroscopy-guided biopsy. Patients in whom at-risk structures were located within 10 mm of the scheduled needle tract were excluded. Ten patients (4 females and 6 males; mean [range] age, 72 [52-87] years) with lesions (mean [range] maximum diameter, 28 [14-52] mm) in the kidney (n = 4), lung (n = 3), mediastinum (n = 1), adrenal gland (n = 1), and muscle (n = 1) were enrolled. The biopsy procedure involved robotic insertion of a biopsy introducer needle followed by manual acquisition of specimens using a biopsy needle. The patients were followed up for 14 days. Feasibility was defined as the distance of ≤ 10 mm between needle tip after insertion and the nearest lesion edge on the CT fluoroscopic images. The safety of robotic insertion was evaluated on the basis of machine-related troubles and adverse events according to the Clavien-Dindo classification. RESULTS: Robotic insertion of the introducer needle was feasible in all patients, enabling pathological diagnosis. There was no machine-related trouble. A total of 11 adverse events occurred in 8 patients, including 10 grade I events and 1 grade IIIa event. CONCLUSION: Insertion of biopsy introducer needles with our robot was feasible at several locations in the human body. KEY POINTS: • Insertion of biopsy introducer needles with our robot during CT fluoroscopy-guided biopsy was feasible at several locations in the human body.

DOI： 10.1007/s00330-019-06409-z

Radiofrequency Ablation for Stage I Non-Small Cell Lung Cancer: An Updated Review of Literature from the Last Decade

Yusuke Matsui, Toshihiro Iguchi, Koji Tomita, Mayu Uka, Jun Sakurai, Hideo Gobara, Susumu Kanazawa

Interventional Radiology 5 ( 2 ) 43 - 49 2020年

Recurring Local Tumor Progression After Cryoablation of Renal Cell Carcinoma

Soichiro Okamoto, Yusuke Matsui, Takao Hiraki, Toshihiro Iguchi, Koji Tomita, Mayu Uka, Hideo Gobara, Susumu Kanazawa

Interventional Radiology 5 ( 2 ) 77 - 81 2020年

Computed Tomography Fluoroscopy-guided Core Needle Biopsy of Abdominal Para-aortic Lesions: A Retrospective Evaluation of the Diagnostic Yield and Safety

Koji Tomita, Toshihiro Iguchi, Takao Hiraki, Yusuke Matsui, Mayu Uka, Toshiyuki Komaki, Hideo Gobara, Susumu Kanazawa

Interventional Radiology 5 ( 3 ) 128 - 133 2020年

Percutaneous thermal ablation for renal cell carcinoma in patients with Birt–Hogg–Dubé syndrome

Y. Matsui, T. Hiraki, H. Gobara, T. Iguchi, K. Tomita, M. Uka, M. Araki, Y. Nasu, M. Furuya, S. Kanazawa

Diagnostic and Interventional Imaging 100 ( 11 ) 671 - 677 2019年11月

掲載種別：研究論文（学術雑誌）

Purpose: The purpose of this study was to analyze the outcome of patients with Birt–Hogg–Dubé (BHD) syndrome who underwent percutaneous thermal ablation of renal cell carcinoma (RCC). Materials and methods: Six patients with genetically proven BHD syndrome who underwent one or more sessions of percutaneous thermal ablation for the treatment of RCC were included. There were 4 men and 2 women, with a mean age of 57.3 ± 7.5 [SD] years (range: 44–67 years). A total of 29 RCCs (1–16 tumors per patient) were treated during 20 thermal ablation sessions (7 with radiofrequency ablation and 13 with cryoablation). Outcomes of thermal ablation therapy were assessed, including technical success, adverse events, local tumor progression, development of metastases, survival after thermal ablation, and changes in renal function. Results: Technical success was achieved in all ablation sessions (success rate, 100%). No grade 4 or 5 adverse events were observed. All patients were alive with no distant metastasis during a median follow-up period of 54 months (range: 6–173 months). No local tumor progression was found. The mean decrease in estimated glomerular filtration rate during follow-up was 10.7 mL/min/1.73 m2. No patients required dialysis or renal transplantation. Conclusion: Radiofrequency ablation and cryoablation show promising results for the treatment of RCCs associated with BHD syndrome. Percutaneous thermal ablation may be a useful treatment option for this rare hereditary condition.

DOI： 10.1016/j.diii.2019.06.009

MRI-guided percutaneous needle biopsy with 1.2T open MRI: study protocol for a prospective feasibility study (SCIRO-1701).

Yusuke Matsui, Jun Sakurai, Takao Hiraki, Soichiro Okamoto, Toshihiro Iguchi, Koji Tomita, Mayu Uka, Hideo Gobara, Susumu Kanazawa

Nagoya journal of medical science 81 ( 3 ) 463 - 468 2019年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

There has been growing interest in magnetic resonance imaging (MRI)-guided interventional procedures such as percutaneous needle biopsy. Although open MRI is preferable for MRI-guided procedures in terms of patient accessibility, its inferior imaging capability due to lower field strength is a substantial limitation. In this situation, the high-field (1.2T) open MRI has recently become available. This novel MRI system is expected to provide excellent image quality as well as good patient accessibility, potentially contributing to safe and accurate device manipulation. This trial is designed to investigate the feasibility of MRI-guided percutaneous needle biopsy with this system. Patients with lesions needing percutaneous needle biopsy for pathological diagnosis are included. The enrollment of ten patients is intended. The primary endpoint of this study is the feasibility of biopsy needle insertion under real-time MR-fluoroscopy guidance based on the presence of the notch of the biopsy needle within the target lesion. The secondary endpoints are adverse events, device failures, and success of specimen acquisition. Once the feasibility of MRI-guided biopsy with 1.2T open MRI is validated by this study, it may potentially encourage widespread use of MRI-guidance for biopsy procedures. Furthermore, it may lead to development of the other MRI-guided interventional procedures using this MRI system.

DOI： 10.18999/nagjms.81.3.463

CT透視ガイド下腎凍結療法における患者被曝の検討

松井裕輔, 平木隆夫, 生口俊浩, 冨田晃司, 宇賀麻由, 趙彦清, 山口卓也, 山内崇嗣, 市川大樹, 郷原英夫, 金澤右

日本インターベンショナルラジオロジー学会雑誌 34 ( Suppl. ) 243 - 243 2019年5月

Simultaneous biopsy and radiofrequency ablation of T1a renal cell carcinoma 査読

T. Iguchi, T. Hiraki, K. Tomita, H. Gobara, H. Fujiwara, J. Sakurai, Y. Matsui, S. Kanazawa

DIAGNOSTIC AND INTERVENTIONAL IMAGING 97 ( 11 ) 1159 - 1164 2016年11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：ELSEVIER MASSON

Objective: The goal of this study was to retrospectively evaluate the outcome, including feasibility, safety, diagnostic yield, and factors affecting the success of computed tomography fluoroscopy-guided biopsy when performed during the same procedure than radiofrequency ablation (RFA) in renal tumors strongly suspected of being T1a renal cell carcinoma (RCC).
Materials and methods: Nineteen patients (13 men, 6 women; mean age, 66.7 years) with a total of 19 suspected renal tumors (mean diameter, 1.8 cm) underwent computed tomography fluoroscopy-guided biopsy during (n = 6) or immediately after (n = 13) RFA. All patients were strongly suspected of having RCC on the basis of patient's medical histories and/or the results of imaging investigations. All procedures were divided into diagnostic and non-diagnostic biopsies. Various variables were compared between the 2 groups using univariate analysis.
Results: In all tumors, biopsy procedures were technically feasible. No major complications were observed, except for 8 minor post-procedural bleedings. All but one tumor was completely ablated. Local recurrence in the ablation zone as well as tumor seeding in retroperitoneal fat occurred in 1 patient 8.5 months after the procedure and were successfully treated with further percutaneous cryoablation. Thirteen tumors were diagnosed as RCC, whereas 6 were ultimately found to contain normal renal tissue (n = 5) or connective tissue (n = 1). Univariate analysis revealed that none of the variables were significantly different between the diagnostic and non-diagnostic biopsies.
Conclusion: The performance of renal tumor biopsy and RFA in the same session is feasible and safe. Although pre-treatment pathological diagnosis would be generally desirable, simultaneous biopsy with RFA can be an option for the patients who are not amenable to pre-treatment biopsy. (C) 2016 Editions francaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

DOI： 10.1016/j.diii.2016.05.001

Angio-CT-Assisted Balloon Dissection: Protection of the Adjacent Intestine during Cryoablation for Patients with Renal Cancer. 国際誌

Miyuki Sone, Yasuaki Arai, Shunsuke Sugawara, Koji Tomita, Keishi Fujiwara, Hiroaki Ishii, Shinichi Morita

Journal of vascular and interventional radiology : JVIR 27 ( 9 ) 1414 - 1419 2016年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

The present study describes the technical feasibility of a combined-modality angiography/computed tomography (angio-CT)-assisted balloon dissection technique for bowel protection during renal cryoablation in six procedures in five patients. A retrospective review was performed to evaluate balloon dissection using the angio-CT system. Mean bowel-to-tumor distances before and after balloon dissection were 0.9 mm (range, 0-3 mm) and 13.0 mm (range, 11-17 mm), respectively. No bowel injury was observed during the mean follow-up period of 19 months (range, 7-44 mo). Our preliminary experience suggests that balloon dissection using the angio-CT system for bowel protection during renal cryoablation may be feasible and effective.

DOI： 10.1016/j.jvir.2016.02.028

Evaluation of Lung Radiofrequency Ablation With Dual-Energy Computed Tomography: Analysis of Tumor Composition and Lung Perfusion

Koji Tomita, Takao Hiraki, Hideo Gobara, Hiroyasu Fujiwara, Toshihiro Iguchi, Yusuke Matsui, Susumu Kanazawa

JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY 40 ( 5 ) 752 - 756 2016年9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：LIPPINCOTT WILLIAMS & WILKINS

Objective The aim of this study was to evaluate radiofrequency ablation (RFA) of lung tumors with dual-energy computed tomography while focusing on tumor composition and lung perfusion.Methods The 36 tumors in 25 patients were included. Dual-energy computed tomography was performed before RFA and at 2 days and 1, 3, and 6 months thereafter. The effective atomic number (Z(eff)) of the tumors before RFA was compared with the Z(eff) at each follow-up using the paired t test. Lung perfusion was evaluated by iodine map images. When decreased perfusion was suspected after RFA, lung perfusion scintigraphy was performed.Results The mean Z(eff) of the tumors significantly (P < 0.001) decreased at each follow-up, compared with that before RFA. Lung perfusion in the parenchyma peripheral to the tumors appeared to decrease at 2 days in 9 tumors, which was confirmed by scintigraphy in 7 tumors.Conclusions Dual-energy computed tomography was useful by providing additional information on tumor composition and lung perfusion.

DOI： 10.1097/RCT.0000000000000422

Hepatic Intracystic Organizing Hematoma Mimicking Biliary Cystadenocarcinoma in a Patient with Polycystic Liver Disease.

Takashi Tanaka, Hideo Gobara, Koji Tomita, Takao Hiraki, Takehiro Tanaka, Susumu Kanazawa

Internal medicine (Tokyo, Japan) 54 ( 16 ) 2001 - 5 2015年

記述言語：英語掲載種別：研究論文（学術雑誌）

Hepatic intracystic hemorrhage is a rare complication of polycystic liver diseases, such as autosomal dominant polycystic kidney disease (ADPKD). A hepatic cyst with mural nodules and septation may suggest the presence of a cystic malignancy, such as biliary cystadenocarcinoma. We herein report a case of hepatic intracystic hematoma with a mural nodule mimicking biliary cystadenocarcinoma in a patient with ADPKD. Hepatic intracystic hemorrhage with a mural nodule is a very rare occurrence. A fat-saturated T1-weighted magnetic resonance image may be useful for making an accurate diagnosis of intracystic hematoma.

DOI： 10.2169/internalmedicine.54.4218

Lung cancer ablation: complications. 国際誌

Takao Hiraki, Hideo Gobara, Hiroyasu Fujiwara, Hiroaki Ishii, Koji Tomita, Mayu Uka, Satoko Makimoto, Susumu Kanazawa

Seminars in interventional radiology 30 ( 2 ) 169 - 75 2013年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

Although radiofrequency ablation for lung cancer is generally safe (with a mortality rate <1%), it may cause various complications. Common complications include pneumothorax, pleural effusion, and parenchymal hemorrhage. Although most complications can be treated conservatively or with minimal therapy, physicians should be aware of rare but serious complications. Potentially fatal complications include massive hemorrhage, intractable pneumothorax due to bronchopleural fistula, pulmonary artery pseudoaneurysm, systemic air embolism, and pneumonitis. Other serious complications include injury to the nearby tissues (e.g., brachial nerve plexus, phrenic nerve, diaphragm, and chest wall), needle tract seeding, lung abscess, empyema, and skin burn. Although cavitation of the ablation zone is usually insignificant clinically, such a cavity occasionally ruptures, leading to pneumothorax and bleeding. Cavities may also serve as a scaffold for fungal colonization. Precautions to minimize risk should be taken whenever possible. Nevertheless, serious complications may occur, and thus physicians should be aware of the appropriate treatments for these complications. This article reviews complications associated with lung cancer ablation.

DOI： 10.1055/s-0033-1342958

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