研究者詳細 - 陣崎　雅弘

論文 - 陣崎　雅弘

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Can Angiomyolipomas be classified fully into three types?

陣崎雅弘

European Journal of Radiology （Elsevier） Epub ahead of print 2017年05月

研究論文（学術雑誌）

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Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement

Tetsuro Shimura, Masanori Yamamoto, Seiji Kano, Ai Kagase, Atsuko Kodama, Yutaka Koyama, Etsuo Tsuchikane, Takahiko Suzuki, Toshiaki Otsuka, Shun Kohsaka, Norio Tada, Futoshi Yamanaka, Toru Naganuma, Motoharu Araki, Shinichi Shirai, Yusuke Watanabe, Kentaro Hayashida, Fumiaki Yashima, Taku Inohara, Yuki Kakefuda, Takahide Arai, Ryo Yanagisawa, Makoto Tanaka, Takashi Kawakami, Yuichiro Maekawa, Kohno Takashi, Akihiro Yoshitake, Yasunori Iida, Masataka Yamazaki, Hideyuki Shimizu, Yoshitake Yamada, Masahiro Jinzaki, Hikaru Tsuruta, Yuji Itabashi, Mitsushige Murata, Michiyuki Kawakami, Shogo Fukui, Motoaki Sano, Keiichi Fukuda, Soh Hosoba, Hirotomo Sato, Tomohiko Teramoto, Masashi Kimura, Mitsuru Sago, Tatsuya Tsunaki, Shoko Watarai, Masanao Tsuzuki, Keisuke Irokawa, Kazuki Shimizu, Toshihiro Kobayashi, Yasuhide Okawa, Masaki Miyasaka, Yusuke Enta, Koki Shishido, Tomoki Ochiai, Tsuyoshi Yamabe, Kenichiro Noguchi, Shigeru Saito, Hiroyoshi Kawamoto, Hirokazu Onishi, Hiroto Yabushita, Satoru Mitomo, Sunao Nakamura, Masahiro Yamawaki, Yui Akatsu, Yosuke Honda, Takuro Takama, Akihito Isotani, Masaomi Hayashi, Norihiko Kamioka, Mizuki Miura, Takashi Morinaga, Tomohiro Kawaguchi, Mariko Yano, Michiya Hanyu, Yoshio Arai, Hideki Tsubota, Masafumi Kudo, Yuki Kuroda, Akihisa Kataoka, Hitofumi Hioki, Yugo Nara, Hideyuki Kawashima, Fukuko Nagura, Makoto Nakashima, Kazuya Sasaki, Junichi Nishikawa, Tomoki Shimokawa, Tadanori Harada, Ken Kozuma

Circulation （Ovid Technologies (Wolters Kluwer Health)） 135 （ 21 ） 2013 - 2024 2017年05月

ISSN 0009-7322

<jats:sec>
<jats:title>Background:</jats:title>
<jats:p>The semiquantitative Clinical Frailty Scale (CFS) is a simple tool to assess patients’ frailty and has been shown to correlate with mortality in elderly patients even when evaluated by nongeriatricians. The aim of the current study was to determine the prognostic value of CFS in patients who underwent transcatheter aortic valve replacement.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods:</jats:title>
<jats:p>We utilized the OCEAN (Optimized Catheter Valvular Intervention) Japanese multicenter registry to review data of 1215 patients who underwent transcatheter aortic valve replacement. Patients were categorized into 5 groups based on the CFS stages: CFS 1-3, CFS 4, CFS 5, CFS 6, and CFS ≥7. We subsequently evaluated the relationship between CFS grading and other indicators of frailty, including body mass index, serum albumin, gait speed, and mean hand grip. We also assessed differences in baseline characteristics, procedural outcomes, and early and midterm mortality among the 5 groups.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results:</jats:title>
<jats:p>
Patient distribution into the 5 CFS groups was as follows: 38.0% (CFS 1-3), 32.9% (CFS4), 15.1% (CFS 5), 10.0% (CFS 6), and 4.0% (CFS ≥7). The CFS grade showed significant correlation with body mass index (Spearman’s ρ=−0.077,
<jats:italic>P</jats:italic>
=0.007), albumin (ρ=−0.22,
<jats:italic>P</jats:italic>
<0.001), gait speed (ρ=−0.28,
<jats:italic>P</jats:italic>
<0.001), and grip strength (ρ=−0.26,
<jats:italic>P</jats:italic>
<0.001). Cumulative 1-year mortality increased with increasing CFS stage (7.2%, 8.6%. 15.7%, 16.9%, 44.1%,
<jats:italic>P</jats:italic>
<0.001). In a Cox regression multivariate analysis, the CFS (per 1 category increase) was an independent predictive factor of increased late cumulative mortality risk (hazard ratio, 1.28; 95% confidence interval, 1.10–1.49;
<jats:italic>P</jats:italic>
<0.001).
</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions:</jats:title>
<jats:p>In addition to reflecting the degree of frailty, the CFS was a useful marker for predicting late mortality in an elderly transcatheter aortic valve replacement cohort.</jats:p>
</jats:sec>

3D SPECT/CT fusion using image data projection of bone SPECT onto 3D volume-rendered CT images: feasibility and clinical impact in the diagnosis of bone metastasis

陣崎雅弘

Annals of Nuclear Medicine （Annals of Nuclear Medicine） 31 （ 4 ） 304 - 314 2017年05月

研究論文（学術雑誌）, 共著, ISSN 09147187

Purpose: We developed a method of image data projection of bone SPECT into 3D volume-rendered CT images for 3D SPECT/CT fusion. The aims of our study were to evaluate its feasibility and clinical usefulness. Methods: Whole-body bone scintigraphy (WB) and SPECT/CT scans were performed in 318 cancer patients using a dedicated SPECT/CT systems. Volume data of bone SPECT and CT were fused to obtain 2D SPECT/CT images. To generate our 3D SPECT/CT images, colored voxel data of bone SPECT were projected onto the corresponding location of the volume-rendered CT data after a semi-automatic bone extraction. Then, the resultant 3D images were blended with conventional volume-rendered CT images, allowing to grasp the three-dimensional relationship between bone metabolism and anatomy. WB and SPECT (WB + SPECT), 2D SPECT/CT fusion, and 3D SPECT/CT fusion were evaluated by two independent reviewers in the diagnosis of bone metastasis. The inter-observer variability and diagnostic accuracy in these three image sets were investigated using a four-point diagnostic scale. Results: Increased bone metabolism was found in 744 metastatic sites and 1002 benign changes. On a per-lesion basis, inter-observer agreements in the diagnosis of bone metastasis were 0.72 for WB + SPECT, 0.90 for 2D SPECT/CT, and 0.89 for 3D SPECT/CT. Receiver operating characteristic analyses for the diagnostic accuracy of bone metastasis showed that WB + SPECT, 2D SPECT/CT, and 3D SPECT/CT had an area under the curve of 0.800, 0.983, and 0.983 for reader 1, 0.865, 0.992, and 0.993 for reader 2, respectively (WB + SPECT vs. 2D or 3D SPECT/CT, p < 0.001; 2D vs. 3D SPECT/CT, n.s.). The durations of interpretation of WB + SPECT, 2D SPECT/CT, and 3D SPECT/CT images were 241 ± 75, 225 ± 73, and 182 ± 71 s for reader 1 and 207 ± 72, 190 ± 73, and 179 ± 73 s for reader 2, respectively. As a result, it took shorter time to read 3D SPECT/CT images than 2D SPECT/CT (p < 0.0001) or WB + SPECT images (p < 0.0001). Conclusions: 3D SPECT/CT fusion offers comparable diagnostic accuracy to 2D SPECT/CT fusion. The visual effect of 3D SPECT/CT fusion facilitates reduction of reading time compared to 2D SPECT/CT fusion.

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Spontaneous Regression of Possible Transcatheter Aortic Valve Thrombosis Without Additional Anticoagulant: Two-Year Follow-Up

Yanagisawa R., Hayashida K., Jinzaki M., Fukuda K.

Journal of Invasive Cardiology （Journal of Invasive Cardiology） 29 （ 5 ） E64 2017年05月

研究論文（学術雑誌）, 共著, ISSN 10423931

An 84-year-old man with symptomatic severe aortic stenosis received transcatheter aortic valve implantation (TAVI). Dual-antiplatelet therapy was continued for 6 months post TAVI, and aspirin alone was used thereafter. Four-dimensional multidetector computed tomography revealed a new hypoattenuated leaflet thickening (HALT) with reduced leaflet motion at 1 year, considered to indicate leaflet thrombosis. At the 2-year follow-up, leaflet mobility had improved, with spontaneous regression of HALT. This is the first report of confirmed spontaneous regression of possible transcatheter heart valve thrombosis and recovery of leaflet mobility without the need for additional anticoagulant.

Impact of cavity and infiltration on pulmonary function and health-related quality of life in pulmonary Mycobacterium avium complex disease: A 3-dimensional computed tomographic analysis

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

Respiratory Medicine （Respiratory Medicine） 126 9 - 16 2017年05月

研究論文（学術雑誌）, 共著, ISSN 09546111

Background and objectives Pulmonary Mycobacterium avium complex (pMAC) disease manifests as various types of lesions, such as infiltrates, nodules, cavities, and bronchiectasis. However, the important determinants for clinical parameters in lung involvement are poorly understood. The objective of this study was to obtain quantitative parameters by 3-dimensional CT, and investigate the relationship between these parameters and the pulmonary function tests (PFTs) and health-related quality of life. Material and methods Quantitative analysis using CT was performed in 67 pMAC patients. The relationship between new quantitative parameters for evaluating lung involvement using 3-dimensional CT and PFTs or St George's Respiratory Questionnaire (SGRQ) was evaluated. Results The ratio of infiltration to total lung volume showed significant correlation with the PFT results, especially the percent-predicted forced vital capacity (%FVC; ρ = −0.52), residual volume (ρ = −0.51), and total lung capacity (ρ = −0.59). The cavity volume was strongly correlated with the %FVC (ρ = −0.78) in the cavity group, while the ratio of infiltration to total lung volume was strongly correlated with the %FVC (ρ = −0.53) in the non-cavity group. The ratio of infiltration to total lung volume was significantly correlated with all SGRQ parameters (ρ = 0.41–0.52) in the non-cavity group. Conclusions Infiltration was an important parameter for the PFTs and SGRQ in pMAC patients according to the 3-dimensional CT analysis. Moreover, cavity volume was an important parameter of the PFTs in the cavity group. Therefore, infiltration and cavity volume are key features for the management of pMAC disease.

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Impact of Subclinical Vascular Complications Detected by Systematic Postprocedural Multidetector Computed Tomography After Transcatheter Aortic Valve Implantation Using Balloon-Expandable Edwards SAPIEN XT Heart Valve

Kakefuda Y., Hayashida K., Yamada Y., Yashima F., Inohara T., Yanagisawa R., Tanaka M., Arai T., Kawakami T., Maekawa Y., Tsuruta H., Itabashi Y., Murata M., Sano M., Okamoto K., Yoshitake A., Shimizu H., Jinzaki M., Fukuda K.

American Journal of Cardiology （American Journal of Cardiology） 119 （ 7 ） 1100 - 1105 2017年04月

研究論文（学術雑誌）, 共著, ISSN 00029149

Complications after transcatheter aortic valve implantation (TAVI) remain an important issue. This study aimed to evaluate the impact of systematic postprocedural multidetector computed tomography (MDCT) to detect subclinical complications after TAVI. From October 2013 to August 2015, a total of 135 patients who underwent transfemoral TAVI (n = 116) or transapical TAVI (n = 19) with Sapien XT and MDCT preprocedure and postprocedure were enrolled. Postprocedural MDCT findings were compared with the preprocedural MDCT findings. Cardiovascular complications were observed in 25.9% of patients, including 6 cases (4.5%) with major complications. Of those, clinically apparent major complications were reported in 2 cases including rupture of the sinus of Valsalva and iliac rupture. The complications in the remaining 4 cases (3.0%) included aortic dissection, aortic intramural hematoma, and left ventricular apical pseudoaneurysm, which were totally asymptomatic and only detected by MDCT. The apical pseudoaneurysm required surgical repair. Minor complications were observed in 21.5% of patients, 50% of which were subclinical. Only 1 case with femoral pseudoaneurysm required an additional procedure. Noncardiovascular findings were detected in 27.4% of patients; the most frequent were pleural effusions and atelectasis, which were predominantly observed in those treated through a transapical approach. Contrast-induced acute kidney injury after postprocedural MDCT was reported in 1 patient whose clinical course was complicated by sepsis. In conclusion, postprocedural MDCT was useful in detecting important subclinical complications that may affect the clinical course without deterioration of renal function.

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Impact of baseline visceral fat accumulation on prognosis in patients with metastatic renal cell carcinoma treated with systemic therapy

Mizuno R., Miyajima A., Hibi T., Masuda A., Shinojima T., Kikuchi E., Jinzaki M., Oya M.

Medical Oncology （Medical Oncology） 34 （ 4 ） 47 2017年04月

研究論文（学術雑誌）, 共著, ISSN 13570560

The aim of this study was to evaluate the clinical significance of visceral fat accumulation as a prognostic factor in patients with metastatic renal cell carcinoma (mRCC) treated with systemic therapies. A total of 114 patients were retrospectively reviewed. All patients received systemic therapy for mRCC at Keio University hospital in Japan. The intra-abdominal visceral fat area was determined by computed tomography at the umbilical level. The visceral fat accumulation was defined as ≥100 cm2. The mean visceral fat area was 107.4 ± 62.8 cm2. In the whole cohort, the median follow-up was 29 months. According to the Memorial Sloan Kettering Cancer Center (MSKCC) classification, 27.2% patients were favorable risk, 53.5% were intermediate risk, and 19.3% were poor risk. Visceral fat accumulation correlated with improved progression-free (P = 0.0070) and overall survival (P = 0.0001). On multivariate analysis, visceral fat accumulation (P = 0.0290) and MSKCC classification (P = 0.0085) were independent indices to predict progression-free survival in first-line treatment. In addition, visceral fat accumulation (P = 0.0007) and MSKCC classification (P = 0.0005) independently predicted overall survival. Prognostic grouping using visceral fat accumulation was identified as an independent prognostic marker in patients with mRCC. The addition of visceral fat accumulation improved the prognostic value of MSKCC classification alone in predicting overall survival in patients treated with systemic therapy for mRCC.

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Time-Resolved Quantitative Analysis of the Diaphragms During Tidal Breathing in a Standing Position Using Dynamic Chest Radiography with a Flat Panel Detector System (“Dynamic X-Ray Phrenicography”): Initial Experience in 172 Volunteers

Yamada Y., Ueyama M., Abe T., Araki T., Abe T., Nishino M., Jinzaki M., Hatabu H., Kudoh S.

Academic Radiology （Academic Radiology） 4 （ 4 ） 393 - 400 2017年04月

研究論文（学術雑誌）, 共著, ISSN 10766332

Rationale and Objectives Diaphragmatic motion in a standing position during tidal breathing remains unclear. The purpose of this observational study was to evaluate diaphragmatic motion during tidal breathing in a standing position in a health screening center cohort using dynamic chest radiography in association with participants’ demographic characteristics. Materials and Methods One hundred seventy-two subjects (103 men; aged 56.3 ± 9.8 years) underwent sequential chest radiographs during tidal breathing using dynamic chest radiography with a flat panel detector system. We evaluated the excursions of and peak motion speeds of the diaphragms. Associations between the excursions and participants’ demographics (gender, height, weight, body mass index [BMI], smoking history, tidal volume, vital capacity, and forced expiratory volume) were investigated. Results The average excursion of the left diaphragm (14.9 ± 4.6 mm, 95% CI 14.2–15.5 mm) was significantly larger than that of the right (11.0 ± 4.0 mm, 95% CI 10.4–11.6 mm) (P < 0.001). The peak motion speed of the left diaphragm (inspiratory, 16.6 ± 4.2 mm/s; expiratory, 13.7 ± 4.2 mm/s) was significantly faster than that of the right (inspiratory, 12.4 ± 4.4 mm/s; expiratory, 9.4 ± 3.8 mm/s) (both P < 0.001). Both simple and multiple regression models demonstrated that higher BMI and higher tidal volume were associated with increased excursions of the bilateral diaphragm (all P < 0.05). Conclusions The average excursions of the diaphragms are 11.0 mm (right) and 14.9 mm (left) during tidal breathing in a standing position. The diaphragmatic motion of the left is significantly larger and faster than that of the right. Higher BMI and tidal volume are associated with increased excursions of the bilateral diaphragm.

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特集 Q & Aでおさえるvascular imaging最重要ポイント大動脈　炎症性動脈瘤と感染性動脈瘤の違いを教えてください

奥田茂男, 田村全, 中塚誠之, 陣崎雅弘

臨床画像（(株)メジカルビュー社） 33 （ 3 ） 286 - 288 2017年03月

ISSN 0911-1069

Extremely low prevalence of amyloid positron emission tomography positivity in Parkinson's disease without dementia

陣崎雅弘

European Neurology （European Neurology） 77 （ (5-6) ） 231 - 237 2017年03月

研究論文（学術雑誌）, 共著, ISSN 00143022

Background: Most cases of dementia with Lewy bodies (DLB) show Alzheimer's disease pathology-like senile plaques and neurofibrillary tangles. Several studies have also revealed a high prevalence of positive amyloid imaging with positron emission tomography (PET) in DLB and moderate prevalence in Parkinson's disease (PD) with dementia. However, it remains unclear in PD without dementia as to when the brain β amyloid (Aβ) burden begins and progresses. Our study aimed to determine the prevalence of Aβ deposition in PD without dementia using amyloid PET. Methods: This was a cross-sectional study on 33 patients with PD without dementia, of whom 21 had normal cognition and 12 met the criteria for PD-mild cognitive impairment. All subjects underwent neuropsychological assessment and [18F] florbetaben (FBB) PET. Results: All subjects had Lewy body-related disorders, displaying a significantly reduced myocardial [123I] metaiodobenzylguanidine uptake. The cortical FBB-binding pattern in all subjects, including APOE e4 carriers, suggested negative Aβ deposition. Conclusion: Patients with PD without dementia exhibit an extremely low prevalence of Aβ positivity compared with those reported in cognitively normal elderly controls. Further longitudinal imaging studies and long-term follow-up are needed; however, our findings provide novel insights for understanding Aβ metabolism in PD.

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画像による病変の由来部位の診断第4章胸部　2. 肺・胸壁

杉浦弘明, 陣崎雅弘

画像診断（学研メディカル秀潤社） 37 （ 4 ） s118 - s131 2017年03月

ISSN 0285-0524

Analysis of the venous channel within the clivus using multidetector computed tomography digital subtraction venography

陣崎雅弘

Neuroradiology （Neuroradiology） 59 （ 3 ） 213 - 219 2017年03月

研究論文（学術雑誌）, 共著, ISSN 00283940

Purpose: Although neuroradiologists and skull base neurosurgeons are aware of the existence of veins within the clivus, such vessels have seldom been described in the literature. The aim of the present study is to elucidate the detailed venous structure of the clivus. Methods: Computed tomography digital subtraction venography (CT-DSV) images of 50 unruptured aneurysm cases were examined retrospectively. Results: Eighteen emissary veins were identified in 14 (28.0%) cases. A half of the emissary veins connected the inferior petrosal sinus with the inferior petro-occipital vein (IPOV) in the middle clivus. The clival diploic vein (CDV) was identified in 14.0% of cases, 42.9% of which had the clivus of the presellar type. The CDV was connected to the posterior intercavernous sinus or the rostral end of the basilar plexus superiorly, and was connected to the IPOV, anterior condylar vein, marginal sinus, or the anterior condylar confluence. Conclusion: The CDV provides collateral channels between the cavernous sinus and the internal jugular vein and the inferior petrosal sinus and the IPOV. Understanding of the emissary veins in the clivus and the CDV is valuable for skull base surgery, especially for endonasal endoscopic skull base procedures.

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特集次の25年の放射線治療の進歩を見据えて X線、超音波、CT、MRI

陣崎雅弘

臨床放射線（金原出版） 62 （ 2 ） 233 - 236 2017年02月

ISSN 0009-9252

Diagnosis of Renal Angiomyolipomas: Classic, Fat-Poor, and Epithelioid Types

陣崎雅弘

Seminars in Ultrasound, CT and MRI （Seminars in Ultrasound, CT and MRI） 38 （ 1 ） 37 - 46 2017年02月

研究論文（学術雑誌）, 共著, ISSN 08872171

With the increasing discovery of small renal masses with cross-sectional imaging, there has been the concomitant rise in their treatment. With the intent of early curative surgery for a presumed renal cell carcinoma, many renal masses are being resected at surgery without a confirmed diagnosis. Many of them are benign, and some are angiomyolipomas. The diagnosis of renal angiomyolipoma using imaging is, therefore, is as important as ever. Although most, if not all angiomyolipomas with abundant fat are diagnosed readily, some have too little fat to be detected with imaging. This article reviews the current classification, imaging pitfalls, and diagnosis of angiomyolipoma with an emphasis on the fat-poor types. Proper imaging technique, a thorough search for fat, and the appropriate use of percutanoeus biopsy are all needed to eliminate the unnecessary treatment of these benign neoplasms.

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Difference in diaphragmatic motion during tidal breathing in a standing position between COPD patients and normal subjects: Time-resolved quantitative evaluation using dynamic chest radiography with flat panel detector system (“dynamic X-ray phrenicography”)

Yamada Y., Ueyama M., Abe T., Araki T., Abe T., Nishino M., Jinzaki M., Hatabu H., Kudoh S.

European Journal of Radiology （European Journal of Radiology） 87 76 - 82 2017年02月

研究論文（学術雑誌）, 共著, ISSN 0720048X

Objectives To quantitatively compare diaphragmatic motion during tidal breathing in a standing position between chronic obstructive pulmonary disease (COPD) patients and normal subjects using dynamic chest radiography. Materials and methods Thirty-nine COPD patients (35 males; age, 71.3 ± 8.4 years) and 47 normal subjects (non-smoker healthy volunteers) (20 males; age, 54.8 ± 9.8 years) underwent sequential chest radiographs during tidal breathing using dynamic chest radiography with a flat panel detector system. We evaluated the excursions and peak motion speeds of the diaphragms. The results were analyzed using an unpaired t-test and a multiple linear regression model. Results The excursions of the diaphragms in COPD patients were significantly larger than those in normal subjects (right, 14.7 ± 5.5 mm vs. 10.2 ± 3.7 mm, respectively, P < 0.001; left, 17.2 ± 4.9 mm vs. 14.9 ± 4.2 mm, respectively, P = 0.022). Peak motion speeds in inspiratory phase were significantly faster in COPD patients compared to normal subjects (right, 16.3 ± 5.0 mm/s vs. 11.8 ± 4.2 mm/s, respectively, P < 0.001; left, 18.9 ± 4.9 mm/s vs. 16.7 ± 4.0 mm/s, respectively, P = 0.022). The multivariate analysis demonstrated that having COPD and higher body mass index were independently associated with increased excursions of the bilateral diaphragm (all P < 0.05), after adjusting for other clinical variables. Conclusions Time-resolved quantitative evaluation of the diaphragm using dynamic chest radiography demonstrated that the diaphragmatic motion during tidal breathing in a standing position is larger and faster in COPD patients than in normal subjects.

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q-Space Myelin Map imaging for longitudinal analysis of demyelination and remyelination in multiple sclerosis patients treated with fingolimod: A preliminary study

Tanikawa M., Nakahara J., Hata J., Suzuki S., Fujiyoshi K., Fujiwara H., Momoshima S., Jinzaki M., Nakamura M., Okano H., Takahashi S., Suzuki N.

Journal of the Neurological Sciences （Journal of the Neurological Sciences） 15 （ 373 ） 352 - 357 2017年02月

研究論文（学術雑誌）, 共著, ISSN 0022510X

Background Fingolimod (FTY) is an oral sphingosine-1-phosphate receptor modulator that reduces relapse and slows brain atrophy in multiple sclerosis (MS) patients. In addition, FTY has been shown to enhance remyelination in certain animal models. Objective To analyze feasibility of a novel q-space Myelin Map imaging to monitor demyelination and remyelination under FTY treatment in MS patients. Methods Treatment outcomes of 24 consecutive MS patients treated with FTY were analyzed. A longitudinal analysis of q-space Myelin Map imaging was performed in a subset of these patients. Results During the treatment course (average of 16.1 months), 10 patients (42%) exhibited improvement on the Expanded Disability Status Scale (EDSS) or maintained disability-free state (“optimal responders”). The average baseline age and EDSS score were significantly younger and milder in optimal responders compared to the rest of patients. A pilot longitudinal q-space Myelin Map study in 8 patients (including 4 optimal responders) showed that optimal responders tended to show signs of remyelination while exhibiting no newly evolved demyelinated lesions. Conclusion FTY may improve disability in younger patients with milder MS, and absence of demyelination activity and presence of remyelination activity may in part be associated with such improvement. q-Space Myelin Map imaging is a clinically feasible modality to monitor demyelination and remyelination in MS patients.

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Radiation exposure to operators performing pharmacologic stress testing in <sup>99M</sup>tc myocardial perfusion imaging: A prospective study

Nakahara T., Iwabuchi Y., Katagiri M., Matsusaka Y., Itoh K., Ogata Y., Jinzaki M.

Radiation Protection Dosimetry （Radiation Protection Dosimetry） 176 （ 3 ） 235 - 241 2017年01月

研究論文（学術雑誌）, 共著, ISSN 01448420

This prospective study investigated radiation exposure dose (RED) to main operator (MO) and supervisory operator (SO) performing dypiridamole stress testing in a 1-d rest/stress 99mTc tetrofosmin single-photon emission computed tomography (SPECT) of consecutive 42 patients. MO was instructed to be close to the patients during the entire procedures including the vasodilator and radiotracer injection. SO mainly recorded the data on the procedures apart from the patients. RED, procedure time (PT) and internal radioactivity (IR) of patients were measured before and after a secondary tracer injection for stress SPECT, respectively. RED was significantly greater to MO than to SO (6.2 ± 2.7 vs 2.5 ± 2.1 μSV per stress procedure, p < 0.0001). Multivariate analyses revealed that IR and PT were significantly independent factors to predict RED to both operators. Operators performing pharmacologic stress procedure should be aware that IR and PT are independent factors for RED in 99mTc myocardial perfusion imaging.

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Natural course of asymptomatic abnormal prostate findings incidentally detected by CT after intravesical BCG therapy

Matsushima M., Kikuchi E., Akita H., Miyajima A., Oya M., Jinzaki M.

International Journal of Clinical Oncology （International Journal of Clinical Oncology） 22 （ 3 ） 554 - 562 2017年01月

研究論文（学術雑誌）, 共著, ISSN 13419625

Background: Detailed information is not currently available on the incidence, natural course, and management of asymptomatic abnormal prostate findings incidentally detected by radiologic evaluations after BCG therapy for non-muscle-invasive bladder cancer patients. Methods: We identified 38 patients who were evaluated by contrast-enhanced CT scans before TUR-BT and after BCG therapy between 2006 and 2012. We evaluated the clinical courses of patients with abnormal radiologic findings of the prostate gland after BCG therapy. Results: Abnormal findings on CT scans were found in the prostate glands of 11 of the 38 patients examined (28.9%), none of whom exhibited any sign or symptom associated with prostatitis. Abnormal findings included a low attenuation area (n = 6, 15.8%), contrast enhancement (n = 3, 7.9%), and a low attenuation area and contrast enhancement in the prostate gland (n = 2, 5.3%). During the follow-up, abnormal prostate findings disappeared spontaneously in most cases without any anti-bacterial or anti-tuberculous drug treatments. No significant differences were observed in patient clinical backgrounds, with the exception of post-BCG prostate volumes, between patients with and without abnormal CT findings. Furthermore, no significant differences were noted in the incidence of the adverse effects of BCG therapy, tumor recurrence rates, or progression rates between patients with and without abnormal CT findings of the prostate gland after BCG therapy. Conclusions: Asymptomatic abnormal prostate findings incidentally detected by CT after BCG therapy are not rare, and these disappear over time during the follow-up period without any treatment.

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The learning curve of laparoendoscopic single-site adrenalectomy: an analysis of over 100 cases

Fukumoto K., Miyajima A., Hattori S., Matsumoto K., Abe T., Kurihara I., Jinzaki M., Kikuchi E., Oya M.

Surgical Endoscopy （Surgical Endoscopy） 31 （ 1 ） 170 - 177 2017年01月

研究論文（学術雑誌）, 共著, ISSN 09302794

Background: Recently, laparoendoscopic single-site adrenalectomy (LESS-A) has been developed as an alternative treatment for adrenal tumors. Although LESS-A is more technically complex than conventional laparoscopic adrenalectomy, its learning curve and the factors associated with poor surgical outcomes are poorly understood. We analyzed the learning curve of LESS-A and attempted to identify risk factors associated with worse surgical outcomes. Methods: We identified 103 patients who underwent LESS-A [performed by the same surgeon (A.M.)] from 2009 to 2015. The learning curve was analyzed using the moving average method (the 10-case moving average), and we assessed potential risk factors for a prolonged pneumoperitoneum time. Results: The learning curve stabilized at 30 cases. The cases were divided into two groups, the learning stage (LS) (cases 1–29) and master stage (MS) (cases 30–103) groups. The percentage of females and the frequency of previous abdominal surgery were higher in the LS group (p = 0.022 and 0.001, respectively). In the LS group, the mean pneumoperitoneum time was 92 ± 35 min, which was significantly longer than the equivalent value for the MS group (55 ± 18 min, p < 0.001). In the LS group, univariate analysis revealed that tumor size (≥50 mm) and the visceral fat area (VFA)/total fat area (TFA) ratio (≥0.49) were significantly associated with a prolonged pneumoperitoneum time (p = 0.046 and 0.046, respectively). In the multivariate analysis, tumor size and the VFA/TFA ratio were confirmed to be associated with a prolonged pneumoperitoneum time (p = 0.029 and 0.029, odds ratio 20.83 and 20.83, respectively). On the other hand, none of the examined factors were found to be associated with a prolonged pneumoperitoneum time in the MS group. Conclusions: LESS-A was performed safely in most cases. However, surgeons who are learning the LESS-A procedure need to pay attention to tumor size and visceral obesity.

Access to Document (DOI)

腎囊胞のCT 画像に生じるpseudoenhancement effect の抑制に関わる撮影条件の検討：連続X 線と仮想単色X 線，画像再構成法，およびビーム幅の違いにおけるファントム検証

杉澤浩一, 市川勝弘, 南島一也, 長谷川雅一, 山田祥岳, 陣崎雅弘

日本放射線技術学会雑誌（公益社団法人日本放射線技術学会） 73 （ 8 ） 636 - 645 2017年

研究論文（学術雑誌）, 共著, ISSN 0369-4305

PURPOSE:

The purpose of this study was to evaluate the effect of the virtual monochromatic spectral images (VMSI) and the model-based iterative reconstruction (MBIR) images, to evaluate the influence of the aperture size (40- and 20-mm beam) on renal pseudoenhancement (PE) compared with the filtered back projection (FBP) images.

METHODS:

The renal compartment-CT phantom was filled with iodinated contrast material diluted to the attenuation of 180 Hounsfield units (HU) at 120 kV. The water-filled spherical structures, which simulate cyst, were inserted into the renal compartment. Those diameters were 7, 15 and 25 mm. These were scanned by conventional mode (helical scan, 120 kV-FBP) and dual energy mode. 70 keV-VMSI were reconstructed from the dual energy mode, and MBIR images were reconstructed from conventional mode at 40- and 20-mm aperture. Additionally, the phantom was scanned using non-helical mode with 20-mm aperture, and FBP images were reconstructed. The CT value of the PE for cyst areas was measured for these images.

RESULTS:

The CT values of the cysts were 20.0-14.3 HU on the FBP images, 12.8-12.7 HU on the 70 keV-VMSI (PE-inhibition ratio was 36.0-11.2%) and 16.2-14.0 HU on the MBIR images (19.0-2.1%), respectively, at 40-mm aperture. The PE-inhibition ratio scanned by 20-mm aperture was improved by 28.0% with FBP, 32.8% with 70 keV-VMSI and 29.6% with MBIR compared with 40-mm aperture. One of the FBP images with non-helical mode was 11.6 HU.

CONCLUSIONS:

The best CT technique to minimize PE was the combination of 70 keV-VMSI and 20-mm aperture.

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陣崎　雅弘

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