Inoue, Masanori

写真a

Affiliation

School of Medicine, Department of Radiology (Diagnostic Radiology) Diagnostic Radiology (Shinanomachi)

Position

Assistant Professor/Senior Assistant Professor

Academic Background 【 Display / hide

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    Keio University, School of Medicine

    University

Academic Degrees 【 Display / hide

  • Percutaneous Cryoablation of Lung Tumors: Feasibility and Safety, Keio University

    Percutaneous Cryoablation of Lung Tumors: Feasibility and Safety

 

Papers 【 Display / hide

  • Vessel Occlusion using Hydrogel-Coated versus Nonhydrogel Embolization Coils in Peripheral Arterial Applications: A Prospective, Multicenter, Randomized Trial

    Hongo N., Kiyosue H., Ota S., Nitta N., Koganemaru M., Inoue M., Nakatsuka S., Osuga K., Anai H., Yasumoto T., Tanoue S., Maruno M., Kamei N., Kichikawa K., Abe T., Hasebe T., Asayama Y.

    Journal of Vascular and Interventional Radiology (Journal of Vascular and Interventional Radiology)  32 ( 4 ) 602 - 609.e1 2021.04

    ISSN  10510443

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    Purpose: To evaluate the safety and effectiveness of hydrogel-coated coils for vessel occlusion in the body trunk. Materials and Methods: A total of 77 patients with various peripheral vascular lesions, treatable by embolization with coils, were randomized (hydrogel group, n = 38; nonhydrogel group, n = 39). In the hydrogel group, embolization of the target vessel was conducted using 0.018-inch hydrogel-coated coils (AZUR 18; Terumo Medical Corporation, Tokyo, Japan) with or without bare platinum coils. The nonhydrogel group received both bare platinum coils and fibered coils without the use of hydrogel-coated coils. Results: Complete target vessel occlusion was accomplished in 36 patients in the hydrogel group and 37 patients in the nonhydrogel group. No major adverse events were observed in either group. The median number of coils/vessel diameter and the median total coil length/vessel diameter were significantly larger in the nonhydrogel group than in the hydrogel group (P =.005 and P =.004, respectively). The median embolization length was significantly longer in the nonhydrogel group (31.95 mm) than in the hydrogel group (23.43 mm) (P =.002). If no expansion was assumed, the median packing density in the hydrogel group was 44.9%, which was similar to that in the nonhydrogel group (46.5%) (P =.79). With full expansion assumed, the median packing density in the hydrogel group was 125.7%. Conclusions: Hydrogel-coated coils can be safely used for peripheral vascular coil embolization, and hydrogel-coated and conventional coils in combination allow for a shorter embolization segment and shorter coil length.

  • Development of human hepatocellular carcinoma in X-linked severe combined immunodeficient pigs: An orthotopic xenograft model

    Mishima K., Itano O., Matsuda S., Suzuki S., Onishi A., Tamura M., Inoue M., Abe Y., Yagi H., Hibi T., Kitago M., Shinoda M., Kitagawa Y.

    PLoS ONE (PLoS ONE)  16 ( 3 March ) e0248352 2021.03

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    Hepatocellular carcinoma (HCC) is the fifth most common primary tumor and the third leading cause of cancer-related deaths worldwide. Rodent models of HCC have contributed to the advancement of studies investigating liver carcinogenesis, tumor-host interactions, and drug screening. However, their small size renders them unsuitable for surgical or clinical imaging studies, necessitating the development of larger-size HCC models. Here, we developed a xenograft model of human HCC in X-linked interleukin-2 receptor gamma chain gene (Il2rg)-targeted severe combined immunodeficient (SCID) pigs. HepG2 cell suspension in serum-free medium containing 50% membrane matrix was directly injected into the liver parenchyma of eight X-linked Il2rg-targeted SCID pigs (6.6-15.6 kg) via ultrasonography- guided percutaneous puncture. Tumor engraftment was evaluated weekly using ultrasonography, and cone-beam computed tomography was performed during arterial portography (CTAP) and hepatic arteriography (CTHA) to evaluate the hemodynamics of engrafted tumors. The engrafted tumors were histologically analyzed following necropsy and assessed for pathological similarities to human HCCs. Macroscopic tumor formation was observed in seven of the eight pigs (simple nodular tumors in three and multinodular tumors in four). Engrafted tumors were identified as low-echoic upon ultrasonography and as perfusion-defect nodules on the CTAP images. Meanwhile, CTHA showed that the tumors were hyperattenuating. Further, histopathological findings of the engrafted tumors were consistent with those of human HCC. In conclusion, the porcine model of human HCC, successfully generated herein, might help develop more effective therapeutic strategies for HCC.

  • Embolization of congenital hemangioma with severe hemorrhage

    Kamata M., Aramaki-Hattori N., Okabe K., Sakai S., Nakatsuka S., Jinzaki M., Kishi K., Inoue M.

    Journal of Pediatric Surgery Case Reports (Journal of Pediatric Surgery Case Reports)  65 2021.02

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    Congenital hemangioma is a rare vascular lesion in children. Although most cases are asymptomatic, severe complications can arise, including severe bleeding. We describe the case of a female infant who was born with a congenital hemangioma on her right thigh. Ulceration appeared at the center of the tumor and gradually progressed over the following weeks. One month after birth, the lesion started hemorrhaging severely. Transfusions were required. The bleeding recurred repeatedly despite compression therapy. Embolization was performed urgently and succeeded in arresting the hemorrhage. Bleeding did not recur and the lesion involuted completely over the next few months. A literature review revealed that this is the eighth case where embolization was used to arrest severe hemorrhage of a congenital hemangioma. In the previous cases, embolization permanently (five cases) or temporarily (two cases) arrested the bleeding. In one of the latter cases, selective hemostatic surgery successfully arrested bleeding recurrence after embolization. In the other, the patient had Von Willebrand's Disease; while embolization arrested the hemorrhaging for several years, it restarted at the age of 18 years and the lesion had to be resected to manage the bleeding. Thus, embolization can be a first choice to arrest massive bleeding of congenital hemangioma.

  • Treatment effect prediction using CT after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

    Tsukada J., Yamada Y., Kawakami T., Matsumoto S., Inoue M., Nakatsuka S., Okada M., Fukuda K., Jinzaki M.

    European Radiology (European Radiology)   2021

    ISSN  09387994

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    Objective: To evaluate whether the change in computed tomography pulmonary angiography (CTPA) metrics after balloon pulmonary angioplasty (BPA) can predict treatment effect in chronic thromboembolic pulmonary hypertension (CTEPH) patients. Methods: This study included 82 CTEPH patients who underwent both CTPA and right heart catheterization (RHC) before and at the scheduled time of 6 months after BPA. The diameters of the main pulmonary artery (dPA), ascending aorta (dAA), right atrium (dRA), right ventricular free wall thickness (dRVW), and right and left ventricles (dRV, dLV) were measured on CTPA. The correlation of the New York Heart Association functional class (NYHA FC), 6-minute walking distance (6MWD), brain natriuretic peptide (BNP) level, and calculated CT metrics with a decrease in mean pulmonary artery pressure (ΔmPAP) using RHC (used as the reference for BPA effect) was investigated. Using multiple regression analysis, independent variables were also identified. Results: In univariate analysis, clinical indicators (NYHA FC, 6MWD, and BNP level) improved significantly after BPA and were significantly correlated with ΔmPAP (p < 0.01). In the univariate analysis of CTPA parameters, dPA, dRA, dPA/dAA ratio, dRVW, and dRV/dLV ratio decreased significantly and were significantly correlated with ΔmPAP (p < 0.01). Multivariate analysis demonstrated that decreased dPA (p = 0.001) and decreased dRA (p = 0.039) on CTPA were independent predictive factors of ΔmPAP. Conclusions: Decreased dPA and dRA on CTPA could predict a decrease in mPAP after BPA, thus potentially eliminating unnecessary invasive catheterization. Key Points: • The reduction in mean pulmonary artery pressure after balloon pulmonary angioplasty in CTEPH patients was significantly correlated with the clinical indices improvement and CTPA parameter decrease. • The decreased diameter of the main pulmonary artery and the decreased diameter of the right atrium on CTPA were independent predictors of mean pulmonary artery pressure reduction.

  • Arteriovenous malformation on the sole of the foot treated successfully by embolization

    Yuzaki I., Aramaki-Hattori N., Tamura M., Torikai H., Okabe K., Sakai S., Nakatsuka S., Jinzaki M., Kishi K., Inoue M.

    Radiology Case Reports (Radiology Case Reports)  15 ( 12 ) 2621 - 2626 2020.12

     View Summary

    Arteriovenous malformations of the sole of the foot are rare and can cause disturbances in normal living activities. We report a case of a plantar arteriovenous malformation in a 24-year-old male with pain and difficulty in walking. The arteriovenous malformation was complex, with a large and poorly marginated nidus, so we considered that with surgical resection, walking disabilities would be inevitable. When surgical removal of vascular mass is difficult, embolization alone can be effective. Therefore, he was treated with 4 therapeutic embolization procedures. Transvenous approaches to the venous sac and direct punctures of the nidus was performed. The nidus was successfully eradicated by embolization using alcohol, resulting in the disappearance of associated symptoms. Appropriate imaging is essential for diagnosis and evaluation of treatment. We were successful in achieving improved quality of life and satisfaction for a rare and difficult case by percutaneous embolization and sclerotherapy.

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Papers, etc., Registered in KOARA 【 Display / hide

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Reviews, Commentaries, etc. 【 Display / hide

Presentations 【 Display / hide

  • EVAR後Type1aエンドリークからDICを呈した症例

    細川 恭佑, 松原 健太郎, 鳥崎 友紀子, 菊池 直哉, 神谷 悠紀, 井上 政則, 尾原 秀明, 北川 雄光

    血管外科, 2020.11, 血管外科症例検討会

  • リンパ系画像診断とIVR

    井上 政則, 曽我 茂義, 中塚 誠之, 陣崎 雅弘

    日本医学放射線学会秋季臨床大会抄録集, 2020.10, (公社)日本医学放射線学会

  • 腹部のリンパ管解剖とリンパ漏に対するIVR

    井上 政則

    日本門脈圧亢進症学会雑誌, 2020.10, (一社)日本門脈圧亢進症学会

  • 脈管としてのリンパ管の再考-リンパ学の基礎と臨床- リンパ漏のIVR治療

    井上 政則

    脈管学, 2020.10, (一社)日本脈管学会

  • 内臓動脈瘤の治療戦略:直達手術と血管内治療の適応と限界 内臓動脈瘤に対する血管内治療 基本から応用まで

    井上 政則

    日本臨床外科学会雑誌, 2020.10, 日本臨床外科学会

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Research Projects of Competitive Funds, etc. 【 Display / hide

  • 免疫不全豚を用いた結節型肝癌実験モデル作成と血流動態-病理相関の検討

    2019.04
    -
    2022.03

    MEXT,JSPS, Grant-in-Aid for Scientific Research, 井上 政則, 淵本 大一郎, 中塚 誠之, 上野 彰久, 板野 理, 鈴木 俊一, 松田 祐子, Grant-in-Aid for Scientific Research (C), Principal Investigator

     View Summary

    現在の癌治療の進歩において動物モデルを用いた基礎実験は重要である.特に肝癌の低侵襲治療である,ラジオ波,マイクロ波,さらには今後臨床応用が期待されるエレクトロポレーションや凍結治療開発において,担癌動物モデルを用いた,臨床研究前の安全性,有効性の検討は重要なステップである.現在大型動物の肝癌モデルは存在しない.すでに我々は重度免疫不全ブタ(Il2rg-KO)へのヒト肝細胞癌下株移植によるびまん性肝癌モデルの作成に成功している.しかし前述の局所治療の効果判定においては結節型肝癌モデルの作成が重要である.本研究では様々な肝癌株の移植方法を用いて,結節型肝癌のモデルの作成を行う.
    本研究では免疫不全豚であるIl2rg-KOブタを用いた肝癌大動物実験モデル作成を行う予定であった.国立研究開発法人農業・食品産業技術総合研究機構の協力の下,免疫不全豚を茨城県から慶應義塾大学に搬送して全身麻酔下にIl2rg-KOブタ肝臓内に細胞株を複数の方法(以下,方法1,方法2)にて移植を行う..
    方法1:18ゲージ/16ゲージPTBD針を用いて,冷却して細胞株懸濁液とマトリゲルを混和した後に粘稠度をあげるために,常温に近い状態に戻して肝実質内に注入する.
    方法2:豚腹部に小切開をいれ,肝実質を露出する.肝実質に剪刀にて切開をいれ,そこに常温で個体に近い状態にした細胞株懸濁液とマトリゲルの塊を植え込む.1, 2の実験後に超音波にて,腫瘤形成の有無を経時的に確認する.生着しなければ,細胞株濃度を変えて,さらに追加の実験を行う.
    その後,血管造影下CTやダイナミックCTにて血流動態検討を行う予定出会った.しかし2019年に本邦で豚コレラの感染が見られた.このため豚コレラのワクチン接種地域に、茨城,東京,千葉も加わる事が決定した.基本的には全頭で例外は哺乳豚のみであるが,免疫不全ブタ(IL2RGヘテロKO、RAG2ホモKO)も哺乳中は例外となるが,離乳後には接種対象となる.このため食品産業技術総合研究機構から東京への移送が制限をされる可能性があるため,本年度は研究を行うことができなかった.
    実験準備は進めたが,豚コレラが本邦で蔓延し,その対策のため、食品産業技術総合研究機構がある茨城県でも2019年2月以降にワクチンの接種を行うことになった。組換えブタもその対象となるが,豚コレラワクチンは、生ワクチンであり免疫不全ブタへの接種は効果がないだけでなく、ウイルス血症を引き起こす可能性もある.また接種後はブタの移動が制限されることになっため,実験が進められなかった.
    既に茨城,東京もワクチン接種推奨地域に指定されているため,ワクチン接種以前のブタの移動をする際にはブタ出荷時点ではワクチン接種しないが,東京都下のブタは全頭接種が原則のため東京にてワクチン接種をする必要があり.例外となるには、慶應義塾大学医学部の飼育施設が高度な隔離・監視下にある施設として確認を受けている必要があるため、今後確認を行って,実験の方向性を検討する.

  • Evaluation of radiation dose of interventionist to the eyes using small dosimeters attached to the both surfaces of radiation protection glasses

    2018.04
    -
    2021.03

    Teikyo University, 近藤 浩史, 井上 政則, 山本 真由, 古井 滋, 清末 一路, 下平 政史, 五島 聡, 棚橋 裕吉, Grant-in-Aid for Scientific Research (C)

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    我が国においては放射線業務従事者の受ける眼の水晶体の等価線量限度を1年間につき150 mSvと規定されている.一方,2011年の国際放射線防護委員会(International Commission on Radiological Protection: 以下ICRP)は,眼の水晶体の等価線量限度を,これまでよりも低い5年間平均で1年当たり20mSv(年最大50 mSv)と示された.一般的に水晶体被ばく量は頚部に付けた個人線量計から推定して行われ,目の近傍での実測に関する情報は乏しい.当院では過去に数人のIVR医,脳外科医,循環器内科医が装着している放射線防護眼鏡左レンズの内外面に小線量計(nanoDot)を固定して実測を行ってきた.測定には1センチ角の小さな線量計(nano Dot TM,長瀬ランダウア)を使用し,鉛当量0.07mPbのアクリルレンズを付けた放射線防護眼鏡(パノラマシールド,東レ・メディカル)の左レンズ外側部の外面(表)と内面(裏)に線量計を1つずつ固定した.この眼鏡を装着して全てのIVR手技を行い,1ヶ月毎に線量計を回収,レンズ外面の3mm線量当量(dose of outside surface:Do)とレンズ内面の3mm線量当量(dose of inside surface:Di)を測定した.2名でDoが1.7msv/月を上回る,つまり,20mSv/年を超える可能性が示唆された.サンプル数を増やす目的で今回はさらに全国の多施設で複数のIVR医を対象にデータ集積を行い我が国での現状を調査することとした.
    当院での倫理委員会の承認を得た後,2019年7月にすべての協力施設の承認が得られた.そのため, 2019年6月から全国調査を開始している.1施設で倫理委員会の承認が遅れたため,全ての参加施設のデータが揃うには2019年8月からのデータである.現在まで8ヶ月のデータを得ることができた.さらにデータを収集しながら解析を同時に進めていく予定である.
    倫理委員会の承認に予想以上に時間を要したために数ヶ月の遅れがでている.さらに,新型コロナウィルス感染症の影響でIVR手技が減少している施設も散見される.
    今後もデータの収集は継続していく.最短で2020年7月にデータ収集が完了する.その後,データ解析を行っていく予定である.

  • 穿刺針先端圧解析による実質臓器の末梢胆管・脈管穿刺アプローチ技術の確立と普遍化

    2017.04
    -
    2021.03

    Keio University, 中塚 誠之, 井上 政則, 鳥飼 秀幸, 小黒 草太, 田村 全, 屋代 英樹, Grant-in-Aid for Scientific Research (C)

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    1. 一定圧での生体豚肝臓の実質離開確率の計測
    全身麻酔下に開腹し、豚肝臓を露出。22Gチバ針(PTBD針)を穿刺して、事前に用意してある点滴ボトル(造影剤)に接続。この際、三方向活栓につないで点滴圧を一定(30、40、50、60、70mmHg)として、それぞれ10か所にて実質離開が生じる確率を観察した。なお、管腔構造(胆管、門脈、肝静脈、リンパ管)が描出された場合は判定を除外した。
    その結果、30mmHgでは0/10、40mmHgでは0/10、50mmHgで3/10、60mmHgで5/10、70mmHgで6/10の確率で実質離開を生じた。このことから、昨年の実験に引き続いて40mmHgに注入圧を設定すれば、肝実質では離開を生じないと考えられた。
    2. 一定圧での生体豚脾臓、腎臓の実質離開確率の計測
    引き続いて1と同様の実験を脾臓、腎臓で行った。なお、脾臓での一定圧は30、40、50mmHg、腎臓では40、50、60、70mmHgとし、それぞれ10か所にて実質離開が生じる確率を観察した。なお、管腔構造(脾臓では門脈、腎臓では腎静脈、腎盂腎杯)が描出された場合は判定を除外した。
    その結果、脾臓では30mmHgでは2/8(2点はのちの判断で除外)、40mmHgでは0/10、50mmHgで3/7(3点はのちの判断で除外)で実質離開を生じた。このことから、実質の離開圧の判断は保留することとした。脾臓の類洞が早期に描出されたのち門脈が早期に描出されたことが理由である。腎臓では40mmHgでは1/10、50mmHgでは0/10、60mmHgで4/10、70mmHgで4/10の確率で実質離開を生じた。このことから、50mmHgに注入圧を設定すれば、腎実質では離開を生じにくいと考えられた。
    当初今年度で研究を終わることができるようになっていた。
    Covid-19の影響で発表ができなくなったという影響があるが、この期間で追加の実験を行うこととできる。
    1. 一定圧での生体豚肝臓、腎臓、脾臓の実質離開確率の計測
    同様の手法で、肝臓、脾臓、腎臓で実質離開確率を計測する。
    2.臨床応用
    同手法(点滴法)によるPTBDについての倫理申請書を作成提出し、倫理委員会承認が得られたのち、臨床例に応用する。なお、点滴圧は40mmHgに設定する。おもに安全性を検討し、副次項目として有用性(成功率)を観察する。

  • Fundamental study on percutaneous thoracic duct embolization for chylothorax: Establishment of animal model and evaluation of safety

    2015.04
    -
    2018.03

    MEXT,JSPS, Grant-in-Aid for Scientific Research, INOUE Masanori, 小野澤 志郎, 中塚 誠之, 陣崎 雅弘, 米虫 敦, 屋代 英樹, Grant-in-Aid for Scientific Research (C), Principal Investigator

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    We have established animal model of chylothorax associated with thoracic duct injury. Using this model, we embolized thoracic duct using metallic coils or NBCA. Five days after thoracic duct embolization, we performed lymphangiography again and confirmed that thoracic duct is completely embolized in both embolic materials. A part of jejunum and ileum was removed and a pathological specimen was prepared. Pathological examination confirmed the safely of thoracic duct embolization.

  • Study of Modified Coaxial Needles Aimed at Expansion of Freezing Ranges.

    2014.04
    -
    2018.03

    Keio University, Yashiro Hideki, 中塚 誠之, 井上 政則, 小黒 草太, 塚田 実郎, 須山 陽介, 田村 全, 伊東 伸剛, Grant-in-Aid for Scientific Research (C)

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    The purpose of this study is to introduce umbrella-shaped thermally conductive coaxial needles and directional thermally conductive coaxial needles and verify their effectiveness in order to obtain an expansion of freezing range during cryotherapy.
    A stainless steel coaxial needle with six branches of 0.28 mm diameter was prepared as an umbrella-shaped thermally conductive coaxial needle, but it exhibited no practical function. A directional heat conducting coaxial needle consisting of side branches containing 0.8 mm diameter copper wires in 1.2 mm diameter Nitinol tubes with a shape memory property at its tip was prepared. It punctured lung and liver tissue safely during in vivo experiments and in the phantom experiment, the side branch showed a 33% expansion of the freezing range.

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Awards 【 Display / hide

  • Best Paper Award

    9. Inoue M, Nakatsuka S, Yashiro H. et al., 2012, 日本IVR学会, Percutaneous cryoablation of lung tumors: feasibility and safety

    Type of Award: International Academic Awards.  Country: 日本

  • Certificate of Merit

    8. Inoue M, Nakatsuka S, Yashiro H, Kawamura M, Izumi Y, Kuribayashi S, 2008.09, Cardiovascular and Interventional Radiological Society of Europe, Complications of percutaneous cryoablation for pulmonary malignancies.

    Type of Award: Awards of International Conference, Council and Symposium