研究者詳細 - 陣崎　雅弘

論文 - 陣崎　雅弘

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コイル塞栓後に，瘤のネック近傍の再増大を認めた腎動脈瘤の1例

井上政則, 中塚誠之, 陣崎雅弘

日本インターベンショナルラジオロジー学会雑誌（一般社団法人日本インターベンショナルラジオロジー学会） 32 （ 3 ） 192 - 196 2017年

ISSN 1340-4520

Recently, endovascular treatment of visceral aneurysm has become popular. In most cases, recurrence following sac packing of visceral aneurysm is attributed to coil compaction; however aneurysm regrowth has also been proposed as a potential mechanism. We report a rare case of aneurysm regrowth after sack packing of renal artery aneurysm. After embolization, regrowth of aneurysm adjacent to the neck of the aneurysm occurred. Additional embolization of the parent artery as well as sack packing was performed.

精巣腫瘍と紛らわしい超音波所見を呈した結核性肉芽腫性精巣上体精巣炎の1例

成田啓一, 金田智, 陣崎雅弘

超音波医学（公益社団法人日本超音波医学会） 44 （ 3 ） 289 - 293 2017年

ISSN 1346-1176

症例は72歳男性で，1ヵ月前より陰嚢の無痛性腫大を自覚した．陰嚢超音波検査で右精巣上体頭部が腫大し不均一な低エコーを呈していた．低エコー域は右精巣に連続しており，精巣上体との境界が不明瞭であった．また，陰嚢内には結節状の低エコー域を散見した．中等量の陰嚢水腫，軽度の白膜肥厚や陰嚢壁の浮腫を伴っていた．カラードプラ上は精巣上体の辺縁にのみ血流信号を認めた．右精巣腫瘍を疑って，右高位精巣摘除術を実施した．病理組織診断で，膿瘍を伴う肉芽腫形成や炎症細胞浸潤を認めた．中心壊死やラングハンス巨細胞も見られたため，Ziehl-Neelsen染色を実施したが抗酸菌は検出できなかった．結核の既往歴はなく，術後の喀痰・尿培養検査ともに結核菌は検出されなかったが，インターフェロンγ放出試験陽性や胸部CTで陳旧性結核性胸膜炎を示唆する所見があり，最終的に結核性肉芽腫性精巣上体精巣炎と診断した．肉芽腫性精巣上体精巣炎と精巣腫瘍の鑑別は困難とされているが，自験例のように精巣上体の腫大や精巣内部に複数の低エコー結節，血流信号が辺縁のみで内部では乏しいことが診断に有用と考えられた．腫瘍よりも炎症性疾患を示唆する所見として，陰嚢壁肥厚，白膜肥厚，陰嚢水腫も参考になる．

Pylorus-Preserving Surgery Based on the Sentinel Node Concept in Early Gastric Cancer

Shimada A., Takeuchi H., Ono T., Kamiya S., Fukuda K., Nakamura R., Takahashi T., Wada N., Kawakubo H., Saikawa Y., Omori T., Nakahara T., Jinzaki M., Murakami K., Kitagawa Y.

Annals of Surgical Oncology （Annals of Surgical Oncology） 23 （ 13 ） 4247 - 4252 2016年12月

研究論文（学術雑誌）, 共著, ISSN 10689265

Background: In patients with early stage gastric cancer in the middle third of the stomach, pylorus-preserving gastrectomy (PPG) can be an option as function-preserving surgery, although its oncologic safety is not definitively defined. This issues may be overcome using the sentinel node (SN) concept. The aim of this study was to investigate the effectiveness of the SN concept in early gastric cancer patients who are candidates for PPG. Methods: One hundred fifty-six patients with middle-third location of cT1N0 gastric cancer (single lesion, <4 cm) underwent distal gastrectomy with SN mapping. As a tracer, technetium-99 tin colloid solution and blue dye were endoscopically injected into the submucosal layer surrounding the primary tumor. Results: SN detection rate was 100 % (156 of 156), and the accuracy of the nodal evaluation of metastasis was 99 % (155 of 156). Suprapyloric lymph node (LN; LN No. 5) and infrapyloric LN (LN No. 6) were detected as SNs in 6 and 14 % of the patients, respectively. We also found two cases with metastasis to LN No. 5 or LN No. 6. Discussion: When performing PPG, the possibility of LN metastasis, especially to LN No. 5 and LN No. 6, cannot be underestimated. SN mapping can play an important role to predict the possibility of metastasis to LN No. 5 and LN No. 6.

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Impact of underfilling and overfilling in balloon-expandable transcatheter aortic valve implantation assessed by multidetector computed tomography: Insights from the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) registry

Yashima F., Yamamoto M., Watanabe Y., Takagi K., Yamada Y., Inohara T., Yanagisawa R., Tanaka M., Arai T., Shimizu H., Jinzaki M., Kozuma K., Fukuda K., Suzuki T., Hayashida K.

International Journal of Cardiology （International Journal of Cardiology） 222 738 - 744 2016年11月

研究論文（学術雑誌）, 共著, ISSN 01675273

Background Underfilling or overfilling of balloon-expandable transcatheter heart valves (THVs) during transcatheter aortic valve implantation (TAVI) is commonly used to improve conformity to small or calcified annuli in order to avoid serious complications. However, little is known about this technique. This study assessed the effects of underfilling and overfilling of THVs. Methods and results Data from 213 consecutive TAVI patients treated with balloon-expandable THVs in 4 Japanese centers between October 2013 and December 2014 were prospectively analyzed; 23-mm and 26-mm THVs were implanted in 96 cases (56 underfilling, 22 nominal filling, and 18 overfilling) and 38 cases (23 underfilling and 15 nominal filling), respectively. Pre/postprocedural multidetector computed tomography (MDCT) and echocardiographic data were compared. MDCT revealed that the minimum area of the underfilled 23-mm THVs was significantly decreased compared to that of nominal filled and overfilled THVs (308.3 SD 26.1 vs. 333.9 SD 14.7 vs. 347.8 SD 21.3 mm2, respectively, p < 0.0001); analogous results were demonstrated for underfilled 26-mm THVs compared to nominal filled THVs (386.2 SD 34.6 vs. 423.6 SD 17.3 mm2, respectively, p = 0.0004). The postprocedural transvalvular gradient of underfilled 23-mm THVs was significantly higher than that of nominal filled and overfilled THVs, while there were no differences for 26-mm THVs. Conclusions Underfilling or overfilling of THVs is safe and feasible, conforming to the original annulus and covering a continuous range of annular sizes with limited THV size options. However, care should be taken when underfilling 23-mm THVs due to the potential for increased transvalvular gradient.

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Lymphatic intervention for various types of lymphorrhea: Access and treatment

Inoue M., Nakatsuka S., Yashiro H., Tamura M., Suyama Y., Tsukada J., Ito N., Oguro S., Jinzaki M.

Radiographics （Radiographics） 36 （ 7 ） 2199 - 2211 2016年11月

研究論文（学術雑誌）, 共著, ISSN 02715333

Traumatic lymphorrhea is a rare but potentially life-threatening complication. Postoperative lymphorrhea is the leading cause of traumatic lymphorrhea and can arise anywhere within the lymphatic system. Leaks arising from the aortoiliac region to the thoracic duct (TD) and from hepatic lymphatics can be identified with intranodal lymphangiography and transhepatic lymphangiography, respectively. Therefore, an appropriate lymphangiography technique is essential for identifying the sources of leaks. Chylothorax resulting from damage to the TD can be serious because the TD transports large amounts of lymphatic fluid from the gastrointestinal, hepatic, and aortoiliac regions. Percutaneous TD embolization—comprising access to the TD followed by embolization—has recently become a minimally invasive alternative to surgical TD ligation for high-output chylothorax. The selection of access routes to the TD depends on its anatomy. If the TD cannot be approached by such means, other options include TD needle interruption or drainage of lymphatic fluid adjacent to the leakage point followed by sclerotherapy. Most cases of abdominal lymphorrhea arise from the aorta-iliac lymphatic system, and lymphangiography alone or computed tomography–guided sclerotherapy might be useful. Rarely, leakage may arise from hepatic lymphatics due to a damaged gastroduodenal ligament and can be visualized and embolized transhepatically. This article comprehensively reviews clinically relevant anatomic TD variations, lymphangiography techniques and criteria for their selection, and treatment strategies for lymphorrhea.

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Single-energy metal artifact reduction in postimplant computed tomography for I-125 prostate brachytherapy: Impact on seed identification

Shiraishi Y., Yamada Y., Tanaka T., Eriguchi T., Nishimura S., Yoshida K., Hanada T., Ohashi T., Shigematsu N., Jinzaki M.

Brachytherapy （Brachytherapy） 15 （ 6 ） 768 - 773 2016年11月

研究論文（学術雑誌）, 共著, ISSN 15384721

Purpose To evaluate the effectiveness of the single-energy metal artifact reduction (SEMAR) technique for improving the accuracy of I-125 seed identification in postimplant computed tomography (CT) after prostate brachytherapy. Methods and Materials Postimplant CT images of 40 patients treated with I-125 prostate brachytherapy were acquired. For all patients, 2 data sets were reconstructed, 1 with SEMAR algorithms (SEMAR image), and the other without SEMAR algorithms (non-SEMAR image). Seed locations are automatically detected by the automatic seed finder tool, and their locations were compared between the SEMAR and non-SEMAR images. Dosimetric parameters using seed locations as detected were compared. Results The true-positive fraction of properly detected seeds on the SEMAR image as determined from a reference seed distribution defined by one investigator was significantly higher than the true-positive fraction on the non-SEMAR image (p = 0.011). The variabilities in D90 (p = 0.001), V100 (p = 0.007), and V150 (p = 0.007) were significantly reduced for seed location on the SEMAR image as compared with non-SEMAR image. Conclusions Prostate postimplant CT with SEMAR improved the accuracy of seed localization and postimplant dosimetric parameters.

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Postoperative Stroke after Debranching with Thoracic Endovascular Aortic Repair

Yoshitake A., Hachiya T., Okamoto K., Kitahara H., Kawaguchi S., Nakatsuka S., Inoue M., Jinzaki M., Shimizu H.

Annals of Vascular Surgery （Annals of Vascular Surgery） 36 132 - 138 2016年10月

研究論文（学術雑誌）, 共著, ISSN 08905096

Objectives This study aimed to analyze the perioperative stroke rate, stroke lesions, outcome, risk factors, and stroke prevention following debranching with thoracic endovascular aortic repair (TEVAR). Design Retrospective study. Methods Between February 2011 and February 2015, 74 consecutive patients underwent debranching with TEVAR at our institution. Of these, the TEVAR proximal landing zone was “zone 0” in 23 patients, “zone 1” in 28, and “zone 2” in 23. Left subclavian artery (LSA) occlusion with coil embolization, balloon occlusion, or vascular plugging was performed in 27 patients. Mean follow-up time was 19.2 months (range 2–52 months). Results The in-hospital mortality rate was 4.1%. Stroke developed in 7 patients (9.5%), zone 0 in 4 patients, zone 1 in 2, and zone 2 in 1. Six of these patients had stroke lesions arising from the vertebral/basilar artery. Univariate analysis revealed a significant increase in the risk of postoperative stroke in patients with intraluminal atheroma (P = 0.001), those who underwent prior percutaneous transluminal coronary angioplasty or coronary artery bypass graft (P = 0.002), and those with a long operative duration (P = 0.001). Additionally, LSA occlusion significantly decreased the incidence of stroke (P = 0.041). The postsurgical 1- and 2-year cumulative survival rates were 87.3% and 77.0%, respectively, in those without stroke, and 68.6% and 22.9%, respectively, in those with stroke (P = 0.012). Conclusions Stroke after debranching with TEVAR was associated with a high mortality. To prevent stroke, careful patient selection and protection of the vertebral artery are important. Prophylactic LSA occlusion at the time of stent-graft deployment might reduce the risk of perioperative stroke.

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Clinical significance of the anterosuperior lymph nodes along the common hepatic artery identified by sentinel node mapping in patients with gastric cancer

Shimada A., Takeuchi H., Kamiya S., Fukuda K., Nakamura R., Takahashi T., Wada N., Kawakubo H., Saikawa Y., Omori T., Nakahara T., Jinzaki M., Murakami K., Kitagawa Y.

Gastric Cancer （Gastric Cancer） 19 （ 4 ） 1088 - 1094 2016年10月

研究論文（学術雑誌）, 共著, ISSN 14363291

Background: The sentinel node (SN) concept is safely applied and validated in early gastric cancer. Gastric lymph nodes are divided into five basins with the main gastric arteries, and the anterosuperior lymph nodes with the common hepatic artery (No. 8a) are classified in the right gastric artery (r-GA) basin. Although No. 8a are considered to have lymphatic flow from the r-GA basin, there might be additional multiple lymphatic flows into No. 8a. The aim of this study is to analyze the lymphatic flows to No. 8a and to investigate the clinical significance of No. 8a as a sentinel node (SN No. 8a). Methods: Four hundred and twenty-nine patients with cT1N0 or cT2N0 gastric cancer underwent SN mapping. We used technetium-99 tin colloid solution and blue dye as a tracer. Results: We detected SN No. 8a in 35 (8.2 %) patients. In these patients, we detected SN No. 8a with SNs that belonged to the left gastric artery (l-GA) basin (66 %), right gastroepiploic artery (r-GEA) basin (54 %), and right gastric artery (r-GA) basin (46 %). In addition, celiac artery lymph nodes were detected as SNs significantly more frequently. Function-preserving surgery was performed significantly less often in patients with SN No. 8a (p =0.018). Conclusions: We found that SN No. 8a seemed to have lymphatic flow not only from the r-GA basin, but also from the l-GA basin or r-GEA basin. When SN No. 8a are detected, we should be careful to perform function-preserving surgery, even in SN-negative cases.

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Plasma fibrinogen level: an independent prognostic factor for disease-free survival and cancer-specific survival in patients with localised renal cell carcinoma

Obata J., Tanaka N., Mizuno R., Kanao K., Mikami S., Matsumoto K., Kosaka T., Kikuchi E., Jinzaki M., Oya M.

BJU International （BJU International） 118 （ 4 ） 598 - 603 2016年10月

研究論文（学術雑誌）, 共著, ISSN 14644096

Objectives: To investigate the impact of perioperative plasma fibrinogen level as a biomarker of oncological outcome in localised renal cell carcinoma (RCC). Patients and methods: We consecutively identified 601 patients with localised RCC who underwent curative surgery at a single institution. Subsequent disease recurrence and cancer-specific survival (CSS) were assessed using the Kaplan–Meier method. To evaluate the independent prognostic impact of plasma fibrinogen level, multivariate analysis was performed for these outcomes. Results: Using the defined threshold level of preoperative plasma fibrinogen of ≥420 mg/dL as elevated, we found 56 patients (9.3%) with an elevated plasma fibrinogen level preoperatively. In Kaplan–Meier analysis, there was a significant difference in disease-free survival and CSS rates between patients with and without preoperative plasma fibrinogen levels of ≥420 mg/dL. Multivariate analysis showed that elevated preoperative plasma fibrinogen level was an independent predictor of subsequent disease recurrence and cancer-specific mortality. In a subgroup analysis of the elevated preoperative plasma fibrinogen level group, postoperative normalisation of plasma fibrinogen level was significantly associated with CSS, showing that patients with non-normalised plasma fibrinogen levels tended to have a higher incidence of cancer-specific mortality after surgery. Conclusion: Patients with elevated preoperative plasma fibrinogen levels could be significantly predicted to have subsequent tumour metastasis and cancer-specific mortality, while there was a significant difference in CSS between patients in the normalised and non-normalised postoperative plasma fibrinogen groups. While these are hypothesis generating results, plasma fibrinogen levels may be a useful biomarker due to its low cost and ease of assessment.

Refresher Course 原発性アルドステロン症　診断から治療まで

小黒草太, 栗原勲, 宮下和季, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 12 ） 1206 - 1219 2016年09月

ISSN 0285-0524

軟部腫瘤の画像診断　−よくみる疾患から稀な疾患まで− 第5章腫瘍性病変　−平滑筋腫瘍　平滑筋肉腫

小黒草太, 村上康二, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 11 ） s152 - s153 2016年09月

ISSN 0285-0524

軟部腫瘤の画像診断　−よくみる疾患から稀な疾患まで− 第5章腫瘍性病変　−骨格筋腫瘍　横紋筋肉腫(胎児型、胞巣型、多形型)

小黒草太, 村上康二, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 11 ） s158 - s159 2016年09月

ISSN 0285-0524

軟部腫瘤の画像診断　−よくみる疾患から稀な疾患まで− 第5章腫瘍性病変　−血管周囲腫瘍　血管平滑筋腫

小黒草太, 村上康二, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 11 ） s156 - s157 2016年09月

ISSN 0285-0524

軟部腫瘤の画像診断　−よくみる疾患から稀な疾患まで− 第5章腫瘍性病変　−血管周囲腫瘍　グロムス腫瘍

小黒草太, 村上康二, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 11 ） s154 - s155 2016年09月

ISSN 0285-0524

軟部腫瘤の画像診断　−よくみる疾患から稀な疾患まで− 第5章腫瘍性病変　−脂肪性腫瘍　褐色脂肪腫

小黒草太, 村上康二, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 11 ） s116 - s117 2016年09月

ISSN 0285-0524

軟部腫瘤の画像診断　−よくみる疾患から稀な疾患まで− 第5章腫瘍性病変　−線維組織球性腫瘍　腱鞘巨細胞腫(限局型、びまん型)

小黒草太, 村上康二, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 11 ） s150 - s151 2016年09月

ISSN 0285-0524

Analysis of the Medial Opticocarotid Recess in Patients with Pituitary Macroadenoma Using Three-Dimensional Images

Kikuchi R., Toda M., Wakahara S., Fujiwara H., Jinzaki M., Yoshida K.

World Neurosurgery （World Neurosurgery） 93 139 - 143 2016年09月

研究論文（学術雑誌）, 共著, ISSN 18788750

Objective The medial opticocarotid recess (MOCR), which contains the lateral tubercular recess (LTR), is an important landmark for the cavernous internal carotid artery (ICA) and for accessing the parasellar and suprasellar regions. These microanatomic landmarks for endoscopic endonasal surgery can be observed using surgical simulation with three-dimensional images. The aim of this study was to analyze the MOCR in patients with pituitary macroadenoma using three-dimensional images. Methods We constructed three-dimensional computed tomography images of 20 patients with pituitary macroadenoma and 20 patients with unruptured aneurysms as a control. Using these images, we measured the distance between the left and right LTR, the midline and the unilateral LTR, and the left and right ICA. Results The distance between the left and right LTR was statistically longer in the pituitary adenoma group versus the control group. Tumor volumes were multivariate parameters for the distance between the left and right LTR, which was significantly longer in the group with tumor volumes >5 cm3 versus the other groups. This distance was also significantly correlated with the distance between the left and right ICA. Conclusions Pituitary macroadenomas expand the distance between the left and right MOCR together with the distance between the left and right ICA.

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特集非腫瘍性消化管疾患の画像診断　−beyond barium study and endoscopy− 炎症性腸疾患のCT診断

鈴木達也, 田村謙太郎, 陣崎雅弘, 白神伸之

画像診断（学研メディカル秀潤社） 36 （ 10 ） 1009 - 1018 2016年08月

ISSN 0285-0524

特集産婦人科病態への血管の診断と治療【診断編】総論 MRI、MRA

奥田茂男, 秋田大宇, 松本俊亮, 鈴木達也, 大堀訓明, 成田啓一, 陣崎雅弘

産婦人科の実際（金原出版） 65 （ 8 ） 895 - 901 2016年08月

ISSN 0558-4728

特集画像でみかける偶発的所見のマネジメント　−あなたならどう書く?− 序説

陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 9 ） 837 - 837 2016年07月

ISSN 0285-0524

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