論文 - 陣崎　雅弘

Bone SPECT-based segmented attenuation correction for quantitative analysis of bone metastasis (B-SAC): comparison with CT-based attenuation correction

Nakahara T., Owaki Y., Shindou T., Nakajima K., Jinzaki M.

EJNMMI Research （EJNMMI Research）  9 2019年

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© 2019, The Author(s). Background: Evidence has shown the clinical usefulness of measuring the metastatic tumor burden of bone for prognostic assessment especially in prostate cancer; quantitative evaluation by dedicated SPECT is difficult due to the lack of attenuation correction (AC) method. We developed a novel method for attenuation correction using bone SPECT emission data (bone SPECT-based segmented attenuation correction; B-SAC) where emission data were virtually segmented into three tissues (i.e., bone, soft tissue, and air). Then, the pixel values in SPECT were replaced by 50 for the virtual soft tissue, and − 1000 for the virtual air. The replaced pixel values for the virtual bone were based on the averaged CT values of the normal vertebrae (B-SACN) or the metastatic bones (B-SACM). Subsequently, the processed SPECT data (i.e., SPECT value) were supposed to realize CT data (i.e., CT value) that were used for B-SAC. The standardized uptake values (SUVs) of 112 metastatic bone tumors in 15 patients with prostate cancer were compared between CTAC with scatter correction (SC) and resolution recovery (RR) and the following reconstruction conditions: B-SACN (+)SC(+)RR(+), B-SACM (+)SC(+)RR(+), uniform AC(UAC)(+)SC(+)RR(+), AC(−)SC(+)RR(+), and no correction (NC). Results: The SUVs in the five reconstruction conditions were all correlated with those in CTAC(+)SC(+)RR(+) (p < 0.01), and the correlations between B-SACN or B-SACM and CTAC images were excellent (r > 0.94). Bland-Altman analysis showed that the mean SUV differences between CTAC (+)SC(+)RR(+) and the other five reconstructions were 0.85 ± 2.25 for B-SACN (+)SC(+)RR(+), 1.61 ± 2.36 for B-SACM (+)SC(+)RR(+), 1.54 ± 3.84 for UAC(+)SC(+)RR(+), − 3.12 ± 4.97 for AC(−)SC(+)RR(+), and − 5.96 ± 4.59 for NC. Compared to CTAC(+)SC(+)RR(+), B-SACN (+)SC(+)RR(+) showed a slight but constant overestimation (approximately 17%) of the metastatic tumor burden of bone when the same threshold of metabolic tumor volume was used. Conclusions: The results of this preliminary study suggest the potential for B-SAC to improve the quantitation of bone metastases in bone SPECT when X-ray CT or transmission CT data are not available. Considering the small but unignorable differences of lesional SUVs between CTAC and B-SAC, SUVs obtained with the current version of B-SAC seem difficult to be directly compared with those obtained with CTAC.

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A rare case of unroofed coronary sinus with a secundum atrial septal defect incidentally detected by computed tomography

Shoji S., Kanazawa H., Yamada Y., Jinzaki M., Fukuda K.

Journal of Cardiovascular Computed Tomography （Journal of Cardiovascular Computed Tomography）  14 （ 6 ） e105 - e106 2019年

ISSN  19345925

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Impact of a combination of quantitative indices representing uptake intensity, shape, and asymmetry in DAT SPECT using machine learning: comparison of different volume of interest settings

Iwabuchi Y., Nakahara T., Kameyama M., Yamada Y., Hashimoto M., Matsusaka Y., Osada T., Ito D., Tabuchi H., Jinzaki M.

EJNMMI Research （EJNMMI Research）  9 2019年

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© 2019, The Author(s). Background: We sought to assess the machine learning-based combined diagnostic accuracy of three types of quantitative indices obtained using dopamine transporter single-photon emission computed tomography (DAT SPECT)—specific binding ratio (SBR), putamen-to-caudate ratio (PCR)/fractal dimension (FD), and asymmetry index (AI)—for parkinsonian syndrome (PS). We also aimed to compare the effect of two different types of volume of interest (VOI) settings from commercially available software packages DaTQUANT (Q) and DaTView (V) on diagnostic accuracy. Methods: Seventy-one patients with PS and 40 without PS (NPS) were enrolled. Using SPECT images obtained from these patients, three quantitative indices were calculated at two different VOI settings each. SBR-Q, PCR-Q, and AI-Q were derived using the VOI settings from DaTQUANT, whereas SBR-V, FD-V, and AI-V were derived using those from DaTView. We compared the diagnostic value of these six indices for PS. We incorporated a support vector machine (SVM) classifier for assessing the combined accuracy of the three indices (SVM-Q: combination of SBR-Q, PCR-Q, and AI-Q; SVM-V: combination of SBR-V, FD-V, and AI-V). A Mann-Whitney U test and receiver-operating characteristics (ROC) analysis were used for statistical analyses. Results: ROC analyses demonstrated that the areas under the curve (AUC) for SBR-Q, PCR-Q, AI-Q, SBR-V, FD-V, and AI-V were 0.978, 0.837, 0.802, 0.906, 0.972, and 0.829, respectively. On comparing the corresponding quantitative indices between the two types of VOI settings, SBR-Q performed better than SBR-V (p = 0.006), whereas FD-V performed better than PCR-Q (p = 0.0003). No significant difference was observed between AI-Q and AI-V (p = 0.56). The AUCs for SVM-Q and SVM-V were 0.988 and 0.994, respectively; the two different VOI settings displayed no significant differences in terms of diagnostic accuracy (p = 0.48). Conclusion: The combination of the three indices obtained using the SVM classifier improved the diagnostic performance for PS; this performance did not differ based on the VOI settings and software used.

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Temporal relationship between ¹⁸F-sodium fluoride uptake in the abdominal aorta and evolution of CT-verified vascular calcification

Nakahara T., Narula J., Fox J.J., Jinzaki M., Strauss H.W.

Journal of Nuclear Cardiology （Journal of Nuclear Cardiology）  28 （ 5 ） 1936 - 1945 2019年

ISSN  10713581

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© 2019, American Society of Nuclear Cardiology. Background: Fluoride-18 sodium fluoride (18F-NaF) localizes in microcalcifications in atheroma. The microcalcifications may aggregate, passing the resolution threshold to visualize on computed tomography (CT). We evaluated serial NaF positron emission tomography (PET)-CT scans to determine the temporal relationship between vascular NaF uptake and CT evident calcification in the abdominal aorta. Methods: Prostate cancer patients who had at least 3 NaF PET-CT scans over at least 1.5 years were retrospectively enrolled. Regions of interest were traced in the abdominal aorta on both PET and CT images, excluding skeletal NaF activity. The maximum standardized uptake value (SUVmax) of NaF and the density and volume of calcium (exceeding 130 HU) were summed and divided by the number of slices to produce the SUVmax/slice and the mm3·slice−1 of calcium. Results: Of 437 patients, 45 patients met criteria. NaF uptake waxed and waned between scans, while the calcium volume plateaued or increased over time. NaF uptake correlated with calcium volume on the baseline scan (P =.60, <.0001†) and calcium volume increment, especially from 1.0 to 1.5 years (r =.79, P <.0001†). Patients with persistently high NaF uptake showed a higher calcium volume increment (0-1.5 years) than patients with low or transiently high NaF uptake. Conclusions: Abdominal aortic NaF uptake varied over time. NaF uptake on the baseline scans and high NaF uptake on the serial scans preceded an increase in calcium volume, especially by 1.0-1.5 years. Persistently high NaF uptake was associated with a greater increment in calcium volume than patients with transiently elevated or persistently low fluoride uptake.

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Previously implanted mitral surgical prosthesis in patients undergoing transcatheter aortic valve implantation: Procedural outcome and morphologic assessment using multidetector computed tomography

Tanaka M., Yanagisawa R., Yashima F., Arai T., Jinzaki M., Shimizu H., Fukuda K., Watanabe Y., Naganuma T., Shirai S., Araki M., Tada N., Yamanaka F., Higashimori A., Takagi K., Ueno H., Tabata M., Mizutani K., Yamamoto M., Hayashida K., Hayashida K., Yamamoto M., Shimura T., Adachi Y., Yamaguchi R., Sago M., Tsunaki T., Hosoba S., Koyama Y., Kagase A., Tokuda T., Kobayashi T., Shibata K., Watanabe Y., Hioki H., Kataoka A., Yamamoto H., Kawashima H., Nakashima M., Nara Y., Nagura F., Ito M., Sasaki K., Ishibashi R., Yukimitsu N., Takamura S., Nomura T., Naganuma T., Mitomo S., Onishi H., Kawamoto H., Amano T., Arai Y., Isotani A., Hayashi M., Kawaguchi T., Ito S., Takiguchi H., Yano M., Taniguchi T., Ishizu K., Mori S., Fujioka S., Araki M., Yamawaki M., Honda Y., Makino K., Akatsu Y., Hata M., Miyasaka M., Ishii K., Inoue A., Nakashima M., Saigan M., Ootomo T., Munehisa Y., Sakurai M., Toki Y., Sakamoto Y., Shishido K., Ochiai T., Mizuno S., Moriyama N., Takagi K., Yoshioka N., Ueno H., Sobajima M., Onoda H., Kuwahara H., Ueno Y., Tabata M., Ito J., Morimura H., Hibino M., Watanabe S., Obunai K.

PLoS ONE （PLoS ONE）  14 （ 12 ）  2019年

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© 2019 Tanaka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Transcatheter aortic valve implantation (TAVI) in the presence of a preexisting mitral prosthesis is challenging and its influence on the morphology of mitral prosthesis and the positioning of transcatheter heart valve (THV) is unknown. We assessed the feasibility of TAVI for patients with preexisting mitral prostheses, its influence on mitral prosthesis morphology, and the positional interaction between a newly implanted THV and mitral prosthesis using serial multidetector computed tomography (MDCT). Thirty-one patients with preexisting mitral prosthesis undergoing TAVI were included. MDCT was performed before and after TAVI. Thirty patients successfully underwent TAVI without interference from preexisting mitral prosthesis. Although opening disturbance of the mechanical mitral prosthesis by the THV edge was observed in 1 patient, the patient was managed conservatively. No THV embolization occurred. THV shift during deployment occurred in 9 patients and was predicted by a larger aortic annulus area (odds ratio: 1.24 per 10 mm2, 1.03-1.49, p = 0.02), possibly because of large THVs. The mitral mean pressure gradient was slightly higher after TAVI (3.7 vs. 4.3 mmHg, p = 0.002), whereas the mitral regurgitation grade was similar. MDCT showed that the size of the mitral prosthesis housing was unchanged after TAVI. The median distance between the mitral prosthesis and THV was 2.6 mm. The postprocedural angle between the mitral prosthesis and THV was larger than the preprocedural angle between the mitral prosthesis and the left ventricular outflow tract (64° vs. 61°, p = 0.03). Thus, TAVI is feasible in the case of preexisting mitral prosthesis. Serial MDCT demonstrated favorable THV positioning and unchanged mitral prosthesis morphology after TAVI.

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Magnetic resonance imaging texture analyses in lower-grade gliomas with a commercially available software: correlation of apparent diffusion coefficient and T2 skewness with 1p/19q codeletion

Kanazawa T., Minami Y., Takahashi H., Fujiwara H., Toda M., Jinzaki M., Yoshida K., Sasaki H.

Neurosurgical Review （Neurosurgical Review）  43 （ 4 ） 1211 - 1219 2019年

ISSN  03445607

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© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Preoperative prediction of molecular information of lower-grade gliomas (LrGGs) helps to determine the overall treatment strategy as well as the initial surgical strategy. This study aimed to detect magnetic resonance imaging (MRI) texture parameters to predict the molecular signature of LrGGs using a commercially available software and routine MR images. Forty-three patients treated at Keio University Hospital who had World Health Organization grade II or III gliomas were included. All patients having preoperative T1- and T2-weighted, fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted (DW) images were also included. Texture analyses of T2, FLAIR, and apparent diffusion coefficient (ADC) histograms were performed using a commercially available software. Texture parameters including kurtosis, skewness, and entropy were investigated to determine any correlation with the presence or absence of isocitrate dehydrogenase (IDH) mutations, 1p/19q codeletion, and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation. ADC skewness and T2 skewness were significantly associated with 1p/19q codeletion status. ADC skewness of ≥ 0.25 predicted 1p/19q codeletion with a sensitivity and specificity of 80% and 65.2%, respectively (AUC = 0.728). T2 skewness of ≥ − 0.11 predicted 1p/19q codeletion with a sensitivity and specificity of 80% and 91.3%, respectively, (AUC = 0.866). None of the texture parameters were associated with IDH mutation and MGMT promoter methylation. MRI texture analysis using a commercially available software demonstrated that T2 skewness could predict 1p/19q codeletion with high sensitivity and specificity, suggesting a clinical utility.

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Impact of the cerebrospinal fluid-mask algorithm on the diagnostic performance of ¹²³I-Ioflupane SPECT: an investigation of parkinsonian syndromes

Iwabuchi Y., Nakahara T., Kameyama M., Matsusaka Y., Minami Y., Ito D., Tabuchi H., Yamada Y., Jinzaki M.

EJNMMI Research （EJNMMI Research）  9 （ 1 ）  2019年

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© 2019, The Author(s). Background: A cerebrospinal fluid (CSF)-mask algorithm has been developed to reduce the adverse influence of CSF-low-counts on the diagnostic utility of the specific binding ratio (SBR) index calculated with Southampton method. We assessed the effect of the CSF-mask algorithm on the diagnostic performance of the SBR index for parkinsonian syndromes (PS), including Parkinson’s disease, and the influence of cerebral ventricle dilatation on the CSF-mask algorithm. Methods: We enrolled 163 and 158 patients with and without PS, respectively. Both the conventional SBR (non-CSF-mask) and SBR corrected with the CSF-mask algorithm (CSF-mask) were calculated from 123I-Ioflupane single-photon emission computed tomography (SPECT) images of these patients. We compared the diagnostic performance of the corresponding indices and evaluated whether the effect of the CSF-mask algorithm varied according to the extent of ventricle dilatation, as assessed with the Evans index (EI). A receiver-operating characteristics (ROC) analysis was used for statistical analyses. Results: ROC analyses demonstrated that the CSF-mask algorithm performed better than the non-CSF-mask (no correction, area under the curve [AUC] = 0.917 [95% confidence interval (CI) 0.887–0.947] vs. 0.895 [95% CI 0.861–0.929], p < 0.001; attenuation correction, AUC = 0.930 [95% CI 0.902–0.957] vs. 0.903 [95% CI 0.870–0.936], p < 0.001). When not corrected for attenuation, no significant difference in the AUC was observed in the low EI group between the non-CSF-mask and CSF-mask algorithms (0.927 [95% CI 0.877–0.978] vs. 0.942 [95% CI 0.898–0.986], p = 0.11); in the middle and high EI groups, the CSF-mask algorithm performed better than the non-CSF-mask algorithm (middle EI group, AUC = 0.894 [95% CI 0.825–0.963] vs. 0.872 [95% CI 0.798–0.947], p < 0.05; high EI group, AUC = 0.931 [95% CI 0.883–0.978] vs. 0.900 [95% CI 0.840–0.961], p < 0.01). When corrected for attenuation, significant differences in the AUC were observed in all three EI groups (low EI group, AUC = 0.961 [95% CI 0.924–0.998] vs. 0.942 [95% CI 0.895–0.988], p < 0.05; middle EI group, AUC = 0.905 [95% CI 0.843–0.968] vs. 0.872 [95% CI 0.800–0.944], p < 0.005; high EI group, AUC = 0.954 [95% CI 0.917–0.991] vs. 0.917 [95% CI 0.862–0.973], p < 0.005). Conclusion: The CSF-mask algorithm improved the performance of the SBR index in informing the diagnosis of PS, especially in cases with ventricle dilatation.

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Relationship between pneumatization of lateral recess in the sphenoid sinus and removal of cavernous sinus invasion in pituitary adenomas by endoscopic endonasal surgery

Kosugi K., Tamura R., Mase T., Tamura H., Jinzaki M., Yoshida K., Toda M.

Surgical Neurology International （Surgical Neurology International）  10 2019年

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Background: Endoscopic endonasal transsphenoidal surgery (EES) is the gold standard for pituitary adenoma (PA) resection. The sphenoid sinus (SS), a highly variable anatomic structure, is located in the center of the cranial base. It has previously been reported that poor pneumatization of the lateral recess of the SS (LRSS) increases the difficulty level of the surgery and the risk of neural and vascular injury. However, to date no studies have evaluated the association between LRSS volume and PAs removal rate by EES. Methods: The present study analyzed 23 consecutive patients with new-onset PAs categorized as Knosp Grades 3 and 4 who underwent EES. A retrospective radiographic analysis was conducted on patients undergoing magnetic resonance imaging and high-resolution computed tomography scans. Results: Among PA cases categorized as Knosp 3 and 4, no significant association was found between the whole tumor's resection rate and LRSS volume (R = 0.08, P = 0.70). However, a significant association was found between cavernous sinus (CS) tumors' removal rate and LRSS volume (R = 0.52, P = 0.011). The same results were achieved in PAs with a Knosp Grade 4, with a stronger correlation (R = 0.60, P = 0.014). Conclusion: The development of LRSS pneumatization affects the removal rate of CS tumors in PAs. Preoperative analysis of LRSS development should be considered when planning EES against PA with CS invasion.

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新生児CT検査における逐次近似応用再構成法のdisplay field of view依存性

南島 一也, 杉澤 浩一, 木津 啓介, 益田 翔太, 大脇 由樹, 陣崎 雅弘

日本CT技術学会雑誌 （(NPO)日本CT技術学会）  7 （ 2 ） 1 - 5 2019年

ISSN  2434-2769

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逐次近似応用再構成法(HIR)では、display field of view(DFOV)や画像ノイズなどによって非線形な挙動を示すことが報告されており、特に小児は体格に合わせて再構成することからDFOVの影響を受けると考えられる。しかし、小児患者の線量低減割合や参考プロトコルを公表しているImage Gentlyや日本のCT撮影ガイドラン(GALACTIC)には詳細なデータによる報告や具体的な撮影条件の検討に関する報告はなされていない。そこで、HIRのDFOV依存に着目し、GALACTICの撮影条件に準拠した成人と新生児のCT検査を対象として、HIRによる線量低減率が成人と新生児でどのように異なるか検討した。方法は、成人および新生児ファントムを撮影し、それぞれstandard deviationが10となる画像を基準画像とした。また、基準画像に対して撮影線量を低減しHIRで再構成した画像を低線量画像とした。そして各画像にて、noise power spectrum(NPS)、task transfer function(TTF)、システム性能関数(SP)を測定し、HIRにより低減可能な線量を算出した。NPS解析の結果、同一線量低減率下の比較において新生児は成人よりもノイズ量が2.0倍程度多かった。TTF解析の結果、低線量画像の10%TTFは基準画像に比べて低下し、低下の程度は新生児が成人よりも小さかった。SP解析の結果、成人では50%、新生児では37.5%の線量低減が可能であった。これらの結果から、新生児CTにおけるHIRの使用には、DFOV依存を考慮した撮影プロトコルの設定が必要と考えられた。

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腎・上部尿路の画像診断－適切なマネージメントにつなげるためのminimum essence－

秋田 大宇, 陣崎 雅弘

画像診断 39   61 - 75 2019年

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特集 画像診断においてピットフォールに陥らないために 腎・上部尿路−適切なマネージメントにつなげるためのminimum essence−

秋田 大宇, 陣崎 雅弘

画像診断 （学研メディカル秀潤社）  39 （ 1 ） 61 - 75 2018年12月

ISSN  0285-0524

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Preoperative Prediction of Solitary Fibrous Tumor/Hemangiopericytoma and Angiomatous Meningioma Using Magnetic Resonance Imaging Texture Analysis

Kanazawa T., Minami Y., Jinzaki M., Toda M., Yoshida K., Sasaki H.

World Neurosurgery （World Neurosurgery）  120   e1208 - e1216 2018年12月

ISSN  18788750

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© 2018 Elsevier Inc. Background: Solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is radiologically difficult to distinguish from meningioma, especially angiomatous meningioma. This study aimed to detect texture parameters to distinguish SFT/HPC from angiomatous meningioma using magnetic resonance imaging texture analysis with commercially available software. Methods: We retrospectively investigated textural parameters in 43 newly diagnosed SFTs/HPCs, angiomatous meningiomas, and other World Health Organization (WHO) grade I meningiomas treated at Keio University Hospital. For T1 contrast-enhanced, T2, and apparent diffusion coefficient (ADC) images, texture analyses were performed. Regions of interest were drawn manually with reference to the greater signal on contrast-enhanced T1-weighted images. ADC values and texture parameters, including kurtosis, skewness, and entropy, were evaluated and compared between these 3 groups. Results: The mean ADC value was significantly high in angiomatous meningioma, compared with SFT/HPC and other WHO grade I meningioma. ADC entropy was highest in SFT/HPC, followed by angiomatous and other WHO grade I meningioma. T2 skewness was significantly high in SFT/HPC, compared with angiomatous and other WHO grade I meningioma. T1 contrast-enhanced skewness was significantly low in angiomatous meningioma, compared with other WHO grade I meningioma. Mean ADC value distinguished SFT/HPC from angiomatous meningioma with a positive predictive value (PPV) of 62.5% and specificity of 62.5%. ADC entropy distinguished SFT/HPC from angiomatous meningioma with a PPV of 100% and specificity of 100%. ADC skewness distinguished SFT/HPC from angiomatous meningioma with a PPV of 66.7% and specificity of 71.4%. Conclusions: This study demonstrated that magnetic resonance imaging texture analysis was useful for distinguishing SFT/HPC from meningioma, especially angiomatous meningioma.

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Quantitative assessment of erector spinae muscles in patients with Mycobacterium avium complex lung disease

Asakura T., Yamada Y., Suzuki S., Namkoong H., Okamori S., Kusumoto T., Niijima Y., Ozaki A., Hashimoto M., Yagi K., Kamata H., Funatsu Y., Ishii M., Jinzaki M., Betsuyaku T., Hasegawa N.

Respiratory Medicine （Respiratory Medicine）  145   66 - 72 2018年12月

ISSN  09546111

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© 2018 Elsevier Ltd Background and objective: No reports exist regarding skeletal muscle involvement in patients with Mycobacterium avium complex lung disease (MAC-LD). The cross-sectional area of the erector spinae muscles (ESMCSA) reflects physical activity and can be assessed by computed tomography (CT). We investigated the relationship between ESMCSA and physiological parameters and prognosis in MAC-LD patients. Material and methods: In this prospective observational study, the ESMCSA was measured on single-slice axial CT images. MAC-LD patients and sex- and age-matched controls (non-MAC-LD participants) were evaluated. We evaluated the relationship between the ESMCSA and physiological parameters and prognosis. Results: A total of 260 patients (209 female; median age, 69 years; 190 with nodular/bronchiectatic disease; 74 with cavitary lesions) were enrolled. The ESMCSA was not different between MAC-LD patients and controls. In MAC-LD patients, the ESMCSA was significantly associated with age, body mass index (BMI), pulmonary function, CT severity, and health-related quality of life (HRQL). Multivariate Cox proportional hazards analyses revealed that an ESMCSA < −1 standard derivation (hazards ratio [HR], 2.76; P = 0.047) was significantly associated with all-cause mortality, along with BMI < 18.5 kg/m2 (HR, 3.67; P = 0.02) and presence of cavitary lesions (HR, 5.84; P = 0.001). However, the ESMCSA was not significantly associated with all-cause mortality when current treatment status, % predicted functional vital capacity, and forced expiratory volume in 1 s were added to the analyses. Conclusions: Although the prognostic impact was limited, ESMCSA was significantly associated with HRQL and prognostic physiological parameters, such as BMI and pulmonary function.

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Evaluation of pancreatic fibrosis with acoustic radiation force impulse imaging and automated quantification of pancreatic tissue components

Fujita Y., Kitago M., Abe T., Itano O., Shinoda M., Abe Y., Yagi H., Hibi T., Ishii M., Nakano Y., Okuma K., Hashimoto M., Takeuchi A., Masugi Y., Jinzaki M., Sakamoto M., Kitagawa Y.

Pancreas （Pancreas）  47 （ 10 ） 1277 - 1282 2018年11月

ISSN  08853177

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© 2018 Wolters Kluwer Health, Inc. All rights reserved. Objectives The aim of this study was to determine whether computer-assisted digital analysis and acoustic radiation force impulse (ARFI) imaging were useful for assessing pancreatic fibrosis, and if ARFI imaging predicted postoperative pancreatic fistula (POPF). Methods Seventy-eight patients scheduled to undergo pancreatic resection were enrolled. Shear wave velocity (SWV) at the pancreatic neck was measured preoperatively using ARFI imaging. Pancreatic tissue components on a whole slide image were quantified using an automatic image processing software. The relationship between SWV, fibrotic tissue content, and POPF incidence and clinical severity was analyzed. Results The median collagen fiber, fatty tissue, and acinar cell contents were 11.6%, 8.5%, and 61.3%, respectively. Unlike fatty tissue, collagen fiber content and acinar cells were correlated with SWV (ρ = 0.440, P < 0.001 and ρ =-0.428, P < 0.001, respectively). Although collagen fiber content and SWV were associated with the overall incidence of POPF (P = 0.004 and 0.001, respectively), collagen fiber content and SWV had no statistical correlation with clinically relevant POPF (P = 0.268 and 0.052, respectively). Conclusions We objectively quantified the pancreatic tissue components using an automatic image processing software. Shear wave velocity was significantly related to collagen fiber content and suggests that ARFI imaging can be useful for evaluating pancreatic fibrosis.

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Performance of diffusion-weighted MRI post-CT urography for the diagnosis of upper tract urothelial carcinoma: Comparison with selective urine cytology sampling

Akita H., Kikuchi E., Hayakawa N., Mikami S., Sugiura H., Oya M., Jinzaki M.

Clinical Imaging （Clinical Imaging）  52   208 - 215 2018年11月

ISSN  08997071

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© 2018 Objectives: To evaluate the usefulness of adding diffusion-weighted MRI (DW-MRI) to CT urography (CTU) for diagnosing upper tract urothelial carcinoma (UTUC). Materials and methods: We retrospectively evaluated 102 high-risk patients with UTUC who underwent both CTU and DW-MRI. The diagnostic performance of CTU and DW-MRI was evaluated in all the patients. Then, the diagnostic performance of DW-MRI in the patients with positive CTU findings was assessed based on the types of CTU findings (mass formation, wall thickening, and small filling defects). The diagnostic performance of DW-MRI and selective urine cytology sampling in these patients was also compared. Results: The sensitivity of DW-MRI (92%) was less than that of CTU (98%) (P = 0.25), since DW-MRI could not detect any small papillary tumors. The specificity of DW-MRI (91%) was greater than that of CTU (78%) (P = 0.065), since DW-MRI could discriminate some benign conditions from UTUC. Among the 59 positive CTU lesions, DW-MRI correctly diagnosed all 41 mass-forming lesions and improved the accuracy from 36% using CTU alone to 79% for 14 wall-thickening lesions but could not add any additional information for 4 small filling-defect lesions. Among the 44 patients with positive CTU findings who underwent selective urine cytology sampling, the sensitivity of DW-MRI (95%) was significantly greater than that of selective urine cytology sampling (56%) (P < 0.001). Conclusions: The addition of DW-MRI would be useful for both mass-forming and wall-thickening lesions. DW-MRI has the potential to reduce the frequency of selective urine cytology sampling for such lesions.

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特集 知っておきたいリンパ系の画像診断 リンパ漏病変に対するIVR

井上 政則, 中塚 誠之, 御須 学, 長谷 学, 鳥飼 秀幸, 田村 全, 塚田 実郎, 伊東 伸剛, 陣崎 雅弘

画像診断 （学研メディカル秀潤社）  38 （ 12 ） 1173 - 1180 2018年09月

ISSN  0285-0524

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特集 知っておきたいリンパ系の画像診断 序説

陣崎 雅弘

画像診断 （学研メディカル秀潤社）  38 （ 12 ） 1109 - 1109 2018年09月

ISSN  0285-0524

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Evaluation of prostate‑specific antigen density in the diagnosis of prostate cancer combined with magnetic resonance imaging before biopsy in men aged 70�years and older with elevated PSA

Yoshinori Yanai, Takeo Kosaka, Hiroshi Hongo, Kazuhiro Matsumoto, Toshiaki Shinojima, Eiji Kikuchi, Akira Miyajima, Ryuichi Mizuno, Shuji Mikami, Masahiro Jinzaki, Mototsugu Oya

Molecular and Clinical Oncology （Spandidos Publications）  2018年09月

ISSN  2049-9450

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押さえておきたい臨床・画像分類 序文

青木 茂樹, 陣崎 雅弘

画像診断 （学研メディカル秀潤社）  38 （ 11 ） A3 - A3 2018年09月

ISSN  0285-0524

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押さえておきたい臨床・画像分類 第5章 腹部・骨盤　5. Budd-Chiari症候群

田村 全, 中塚 誠之, 陣崎 雅弘

画像診断 （学研メディカル秀潤社）  38 （ 11 ） A186 - A189 2018年09月

ISSN  0285-0524

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