論文 - 陣崎　雅弘

Incidence, Predictors, and Mid-Term Outcomes of Possible Leaflet Thrombosis After TAVR

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

JACC: Cardiovascular Imaging （JACC: Cardiovascular Imaging）  Epub ahead of print （ 1 ） 1 - 11 2016年

研究論文（学術雑誌）, 共著,  ISSN  1936878X

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Objectives This study sought to clarify the incidence and predictors of hypoattenuated leaflet thickening (HALT) and mid-term outcomes after transcatheter aortic valve replacement. Background HALT detected on multidetector computed tomography (MDCT) scanning raised concerns about possible subclinical leaflet thrombosis. Methods We studied 70 of 100 consecutive patients from a single-center registry who underwent implantation with the Edwards SAPIEN-XT device. MDCT results, echocardiographic data, and laboratory findings obtained at the 6-month and 1-year follow-ups were analyzed. Results Of 70 patients, MDCT scans revealed HALT in 1 patient (1.4%) at discharge, 7 (10.0%) at 6 months, and 10 (14.3%) at 1 year post–transcatheter aortic valve replacement cumulatively. The degree of leaflet immobility correlated with the HALT area on 4-dimensional MDCT (r = 0.68) on the basis of data from 10 patients. HALT was associated with male sex (70% vs. 25%; p = 0.008) and larger sinus of Valsalva (31.0 ± 2.0 mm vs. 28.6 ± 2.6 mm; p = 0.005). HALT was found in 3 of 49 patients with a 23-mm bioprosthesis and in 7 of 21 patients with a 26-mm bioprosthesis (6.1% vs. 33.3%; p = 0.006). D-dimer levels were significantly increased in the HALT group at the 6-month (2.3 μg/ml [interquartile range (IQR): 2.1 to 6.1 μg/ml] vs. 1.1 μg/ml [IQR: 0.8 to 2.2 μg/ml]; p = 0.002) and 1-year (2.7 μg/ml [IQR: 1.7 to 4.8 μg/ml] vs. 1.2 μg/ml [IQR: 0.9 to 2.1 μg/ml]; p = 0.006) follow-ups, despite no differences at discharge. The pressure gradient was decreased in the HALT group at the 1-year follow-up (8.3 ± 0.8 mm Hg vs. 11.1 ± 4.9 mm Hg; p = 0.005). After detecting HALT, additional anticoagulation therapy was not administered. Clinical outcomes, including all-cause mortality (0% vs. 1.7%; p = 1.00) and stroke (0% vs. 0%; p = 1.00), were similar between the groups. Conclusions HALT with reduced leaflet motion was not rare but usually subclinical. Valve hemodynamics and mid-term outcomes were uneventful even without additional anticoagulant therapy in our limited number of cases. Male sex, larger sinus and bioprosthesis size, and elevated D-dimer levels during follow-up were associated with this phenomenon.

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Feasibility of a Sheathless Arterial Access Using a 4-F Catheter and a Triaxial System for Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

Oguro Sota, Nakatsuka Seishi, Inoue Masanori, Yashiro Hideki, Tamura Masashi, Jinzaki Masahiro

Interventional Radiology （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）  1 （ 2 ） 39 - 44 2016年

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<p>Purpose: This study evaluated the feasibility of sheathless access using the combination of a 4-F catheter and a triaxial system for transcatheter arterial chemoembolization (TACE).</p><p>Materials and Methods: A total of 35 of 53 patients were selected to undergo TACE of hepatocellular carcinoma (HCC) using a triaxial system that included a 4-F shepherd hook catheter, a 2.7-2.9-F high-flow microcatheter, and a 1.7-1.9-F microcatheter without using a sheath introducer. Feasibility was defined as successful completion of the procedure without using another microcatheter or switching to another system. The duration of manual compression after catheter removal was set to 10 minutes. Two hours and 1 hour of bed rest after the procedure were prescribed for 24 and 11 patients, respectively.</p><p>Results: TACE using a triaxial system without a sheath introducer was feasible in 34/35 cases (97%). A small amount of bleeding around the catheter at the puncture site was observed during the procedure in 3 cases. No other hemorrhagic complications were observed 5 days after the procedure.</p><p>Conclusion: Sheathless arterial access using the combination of a 4-F catheter and a triaxial system for TACE of HCC was shown to be both feasible and safe. Additionally, using the triaxial system resulted in hemostasis within 1-2 hours of bed rest after catheter removal.</p>

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機械学習を用いた読影レポート解読手法の構築

田中 佑岳, 橋本 正弘, 伊藤 詩乃, 奧田 茂男, 陣崎 雅弘, 榊原 康文

人工知能学会全国大会論文集 （一般社団法人 人工知能学会）  JSAI2016 （ 0 ） 2C4OS21a2 - 2C4OS21a2 2016年

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Visceral to total obesity ratio and severe hydronephrosis are independently associated with prolonged pneumoperitoneum operative time in patients undergoing laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma

Shigeta K., Kikuchi E., Hagiwara M., Hattori S., Kaneko G., Hasegawa M., Takeda T., Jinzaki M., Akita H., Miyajima A., Nakagawa K., Oya M.

SpringerPlus （SpringerPlus）  4 （ 1 ）  2015年12月

研究論文（学術雑誌）, 共著

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Background: Our aim was to evaluate the effect of visceral obesity and impact of severe hydronephrosis on surgical complexity in patients undergoing laparoscopic radical nephroureterectomy (LRNU). Methods: From January 2000 to December 2013, 169 patients underwent radical nephroureterectomy at our institution. We retrospectively reviewed the medical records of 70 patients who underwent LRNU. We measured total fat area (TFA) and visceral fat area (VFA) at the level of the umbilicus using computed tomography. We defined accumulated visceral fat distribution as a VFA/TFA ratio ≥0.45. Ipsilateral hydronephrosis was graded from 0 to 4 by two uro-radiologists blinded to the clinical outcomes. Results: Among the 70 patients, VFA/TFA ratio was ≥0.45 in 40 patients (57.1%) and 28 (40.0%) had severe hydronephrosis (grade 3 or greater). Patients with a VFA/TFA ratio ≥0.45 had significantly longer pneumoperitoneum and total operation times compared to their counterparts (p = 0.047 and p = 0.002, respectively). Patients with severe hydronephrosis had significantly longer pneumoperitoneum and total operative times compared to their counterparts (p = 0.006 and p = 0.002, respectively). Multivariate logistic regression analysis showed that a high VFA/TFA and severe hydronephrosis were independent predictive factors for prolonged pneumoperitoneum (p = 0.048, HR = 2.90; p = 0.015, HR = 3.82, respectively) and total operative times (p < 0.001, HR = 18.7; p = 0.003, HR = 10.7; respectively). Other pre-clinical factors such as age, gender, BMI, clinical stage, tumor size, location, laterality, degree of perinephric stranding, and surgical procedure did not affect the operation times. Conclusion: The present data indicated that the visceral type of adipose accumulation and presence of severe hydronephrosis could provide preoperative information on the degree of technical difficulty associated with LRNU.

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Novel MR imaging method - MAVRIC - for metal artifact suppression after joint replacement in musculoskeletal tumor patients

Susa M., Oguro S., Kikuta K., Nishimoto K., Horiuchi K., Jinzaki M., Nakamura M., Matsumoto M., Chiba K., Morioka H.

BMC Musculoskeletal Disorders （BMC Musculoskeletal Disorders）  4 （ 16 ） 377 2015年12月

研究論文（学術雑誌）, 共著

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Background: Standard imaging modality for the follow-up after prosthetic replacements for musculoskeletal tumor patients has been conventional radiography. This technique is effective in detecting subtle changes in bone adjacent to metal implants, but in many cases, radiographs do not lead to definitive diagnosis of postoperative adverse events such as acute infection, local recurrence of soft tissue tumor or soft tissue local recurrence of osseous sarcoma. Conventional MRI sequences have not been effective due to metal artifacts. In this study, we tried to elucidate the effectiveness of metal artifact suppression using novel sequence, multiacquisition variable-resonance image combination (MAVRIC), after musculoskeletal tumor surgeries. Methods: We retrospectively analyzed 5 cases of malignant bone and soft tissue sarcoma patients who were reconstructed with metal prosthesis after wide resection of tumors. Images obtained using MAVRIC and short tau inversion recovery (STIR) were compared side by side. The paired MAVRIC and STIR images were qualitatively compared independently by two specialists for 4 parameters: visualization of bone - implant interface, visualization of surrounding soft tissues, image blurring, and overall image quality. Quantitatively, paired images were reviewed to identify the slice where the metal artifact was maximal, and a region of interest encompassing the implant and surrounding artifact was drawn using Advantage Workstation (GE Healthcare, Japan). Results: There were no local recurrences that were detected. By utilizing MAVRIC, visualization of the bone - implant interface and visualization of the surrounding soft tissue were significantly improved in MAVRIC compared to STIR. Although blurring was worse on the MAVRIC acquisitions, the overall image quality was still better on MAVRIC. Quantitatively, the area of metal artifact measured using MAVRIC was markedly less compared to STIR (61.4 cm2 vs 135.9 cm2). Conclusion: Despite the relatively small number of cases in the present study, our observation strongly suggests that MAVRIC is able to improve the quality of images by decreasing the artifact caused by endoprosthesis, frequently utilized in reconstruction of musculoskeletal tumor patients. Further installments of conventional imaging sequences with the addition of gadolinium - enhancement will enable increased accuracy in diagnosing local recurrences of sarcoma patients.

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Advance in cardiac CT

Yamada Y., Matsumoto S., Suzuki T., Hashimoto M., Okamura T., Sugiura H., Jinzaki M., Yamada M.

Respiration and Circulation （Respiration and Circulation）  63 （ 12 ） 1199 - 1207 2015年12月

ISSN  04523458

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Impact of CT-guided balloon pulmonary angioplasty with identification of pulmonary arterial structures distal to target lesions.

Kawakami T, Kataoka M, Yamada Y, Takei M, Yamada M, Jinzaki M, Fukuda K.

EuroIntervention 11 （ 7 ） e1 - e2 2015年11月

研究論文（学術雑誌）, 共著

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Effects of Liraglutide Monotherapy on Beta Cell Function and Pancreatic Enzymes Compared with Metformin in Japanese Overweight/Obese Patients with Type 2 Diabetes Mellitus: A Subpopulation Analysis of the KIND-LM Randomized Trial

Tanaka K., Saisho Y., Manesso E., Tanaka M., Meguro S., Irie J., Sugiura H., Kawai T., Jinzaki M., Cobelli C., Itoh H.

Clinical Drug Investigation （Clinical Drug Investigation）  35 （ 10 ） 675 - 684 2015年10月

研究論文（学術雑誌）, 共著,  ISSN  1173-2563

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Background and Objective: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are becoming one of the major therapeutic options for the treatment of type 2 diabetes mellitus (T2DM). This study was conducted as an exploratory analysis to clarify the effects of liraglutide, a GLP-1RA, on beta cell function, fat distribution and pancreas volume compared with metformin in Japanese overweight/obese patients with T2DM. Methods: A subpopulation of the Keio study for Initial treatment of type 2 Diabetes with Liraglutide versus Metformin (KIND-LM) study participants (n = 20, 10 in oral metformin group and 10 in subcutaneous liraglutide group) who were enrolled at Keio University Hospital and underwent frequently sampled mixed meal tolerance test (MTT) and abdominal computed tomography (CT) at weeks 0 and 24 were included in this analysis. The patients were treated with either metformin or liraglutide throughout the 24-week study period. Results: Changes in glycemic parameters such as glycated hemoglobulin (HbA1c), glycated albumin and 1,5-anhydroglucitol at week 24 were comparable between the groups. An oral minimal model based on MTT revealed that static-phase beta cell responsiveness (Φs) and static-phase disposition index were significantly increased at week 24 in the liraglutide group but not in the metformin group. There was no significant change in fat distribution as well as body weight at week 24 in either group. Serum amylase and lipase levels modestly but significantly increased in the liraglutide group during the study; however, there was no incidence of pancreatitis and pancreas volume was not changed in the liraglutide group. Conclusion: Liraglutide monotherapy for 24 weeks improved beta cell responsiveness with no change in either body weight or fat distribution. Further investigation is needed to clarify the mechanism by which liraglutide increases serum pancreatic enzymes. Trial Registration: The University Hospital Medical Information Network (UMIN) Clinical Trials Registry (http://www.umin.ac.jp/ctr/); UMIN000004243.

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"Protruding Myocardium" as a Target for Percutaneous Transluminal Septal Myocardial Ablation in a Case of Hypertrophic Obstructive Cardiomyopathy

Maekawa Y., Akita K., Tsuruta H., Yashima F., Kimura M., Yamada Y., Kawakami T., Kanazawa H., Hayashida K., Yuasa S., Murata M., Jinzaki M., Fukuda K.

JACC: Cardiovascular Interventions （JACC: Cardiovascular Interventions）  8 （ 12 ） e201 - e202 2015年10月

研究論文（学術雑誌）, 共著,  ISSN  19368798

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Usefulness of 3D SPECT/CT fusion image in CTEPH.

陣崎 雅弘

International Journal of Cardiology （Elsevier）   （ 194 ） 39 - 40 2015年09月

研究論文（学術雑誌）, 共著

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Three-dimensional cardiac cine imaging using the kat ARC acceleration: Initial experience in clinical adult patients at 3T

Okuda S., Yamada Y., Tanimoto A., Fujita J., Sano M., Fukuda K., Kuribayashi S., Jinzaki M., Nozaki A., Lai P.

Magnetic Resonance Imaging （Magnetic Resonance Imaging）  33 （ 7 ） 911 - 917 2015年09月

研究論文（学術雑誌）, 共著,  ISSN  0730-725X

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Objective: Three-dimensional cardiac cine imaging has demonstrated promising clinical 1.5-Tesla results; however, its application to 3. T scanners has been limited because of the higher sensitivity to off-resonance artifacts. The aim of this study was to apply 3D cardiac cine imaging during a single breath hold in clinical patients on a 3. T scanner using the kat ARC (k- and adaptive-t auto-calibrating reconstruction for Cartesian sampling) technique and to evaluate the interchangeability between 2D and 3D cine imaging for cardiac functional analysis and detection of abnormalities in regional wall motion. Methods: Following institutional review board approval, we obtained 2D cine images with an acceleration factor of two during multiple breath holds and 3D cine images with a net scan acceleration factor of 7.7 during a single breath hold in 20 patients using a 3. T unit. Two readers independently evaluated the wall motion of the left ventricle (LV) using a 5-point scale, and the consistency in the detection of regional wall motion abnormality between 2D and 3D cine was analyzed by Cohen's kappa test. The LV volume was calculated at end-diastole and end-systole (LVEDV, LVESV); the ejection fraction (LVEF) and myocardial weight (LVmass) were also calculated. The relationship between functional parameters calculated for 2D and 3D cine images was analyzed using Pearson's correlation analysis. The bias and 95% limit of agreement (LA) were calculated using Bland-Altman plots. In addition, a qualitative evaluation of image quality was performed with regard to the myocardium-blood contrast, noise level and boundary definition. Results: Despite slight degradation in image quality for 3D cine, excellent agreement was obtained for the detection of wall motion abnormalities between 2D and 3D cine images (κ. = 0.84 and 0.94 for each reader). Excellent correlations between the two imaging methods were shown for the evaluation of functional parameters (r. >. 0.97). Slight differences in LVEDV, LVESV, LVEF and LVmass were observed, with average values of 1.6. ±. 8.9. mL, - 0.6. ±. 5.9. mL, 1.4. ±. 3.6%, and 1.3. ±. 8.7. g, respectively. Conclusions: Images obtained using the kat ARC 3D and conventional 2D cine techniques were equivalent in the detection of regional wall motion abnormalities and the evaluation of cardiac functional parameters.

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Impact of Combined Use of Blood-based Inflammatory Markers on Patients with Upper Tract Urothelial Carcinoma Following Radical Nephroureterectomy: Proposal of a Cumulative Marker Score as a Novel Predictive Tool for Prognosis

Tanaka N., Kikuchi E., Kanao K., Matsumoto K., Shirotake S., Miyazaki Y., Kobayashi H., Kaneko G., Hagiwara M., Ide H., Obata J., Hoshino K., Hayakawa N., Kosaka T., Hara S., Nakagawa K., Jinzaki M., Oya M.

European Urology Focus （European Urology Focus）  1 （ 1 ） 54 - 63 2015年08月

研究論文（学術雑誌）, 共著

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Background: Previous studies showed the prognostic impact of preoperative levels of neutrophil-to-lymphocyte ratio (NLR), plasma fibrinogen, and serum C-reactive protein (CRP) in surgically treated upper tract urothelial carcinoma; however, few papers have discussed the proper use of these indices. Objective: To investigate whether combinations of these three markers, as a cumulative marker score (CMS), improve the accuracy of prognostic models following radical nephroureterectomy (RNU). Design, setting, and participants: A total of 394 patients from multiple institutions were included. Median follow-up was 30 mo. Intervention: All patients underwent RNU without neoadjuvant chemotherapy. Outcome measurements and statistical analysis: Associated outcomes were assessed using multivariate analysis. The CMS was defined as the number of elevated levels of preoperative NLR, plasma fibrinogen, and serum CRP. Results and limitations: Multivariate analyses revealed that an increasing CMS was independently associated with high rates of disease recurrence, cancer-specific mortality, and all-cause mortality following RNU. Addition of the CMS to a model that included standard clinicopathologic predictors significantly improved predictive accuracy by 2.7% for disease recurrence, 3.9% for cancer-specific mortality, and 4.0% for all-cause mortality, which were the highest among other prognostic models using each marker alone or combinations of two. The study is limited by its retrospective nature. Conclusions: Although the use of each inflammatory marker alone may be as predictive as clinicopathologic indices for prognosis, combinations like CMS can provide more accurate prognostic models following RNU. Patient summary: Elevation of blood-based inflammatory markers may be useful for predicting prognosis because of their low cost and accessibility. Among blood-based indices, we examined the efficacy of preoperative neutrophil-to-lymphocyte ratio, plasma fibrinogen, and serum C-reactive protein levels. Although use of each marker alone provides additional prognostic information, the combination of all three markers would be more predictive than any single marker or combinations of two.

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Retroperitoneal low-flow vascular malformations: characteristic MRI findings correlated with histopathological findings.

Akita H, Yamada Y, Ito Y, Mikami S, Sugiura H, Okuda S, Jinzaki M.

Abdominal Imaging 40 （ 6 ） 1713 - 1720 2015年08月

研究論文（学術雑誌）, 共著

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PURPOSE:

To evaluate the MRI findings of retroperitoneal low-flow vascular malformations (RLVMs) correlated with histopathological findings.

METHODS:

Two radiologists reviewed the MRI findings of 4 RLVMs (3 with capillary malformations and 1 with a venous malformation). First, they evaluated the visibility, signal intensities, and signal homogeneity of each lesion on non-fat-suppressed breath-hold T2-weighted single-shot fast spin-echo (non-FS SSFSE) images and fat-suppressed T2-weighted fast spin-echo (FS T2-weighted FSE) images. Second, the kinetic patterns and the internal enhancement patterns were analyzed for each lesion on multi-phasic contrast-enhanced (CE) images. After these image analyses, the MRI findings were correlated with the histopathological findings.

RESULT:

Histopathologically, the 4 RLVMs did not exhibit remarkable degeneration and were present in the retroperitoneal fat tissue without clear capsules. On the non-FS SSFSE images, 3 of the 4 RLVMs could not be discriminated from the surrounding retroperitoneal fat tissue (invisible), and the remaining lesion was barely visible with an indistinct margin. On the FS T2-weighted FSE images, however, all the RLVMs were clearly visualized as homogeneous high-signal intensities. On the multi-phasic CE images, all the capillary malformations exhibited fast enhancement, while a venous malformation showed slow enhancement. Furthermore, the RLVMs tended to exhibit a centripetal filling pattern.

CONCLUSION:

The RLVMs blended in with the surrounding retroperitoneal fat tissue on non-FS SSFSE images, like phantoms, whereas they were clearly visualized on FS T2-weighted FSE images. On multi-phasic CE images, the RLVMs tended to exhibit a centripetal filling pattern. These imaging features may be useful diagnostic clues for RLVMs.

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特集 知っておきたい循環器疾患のCT・MRI(2)─胸部・腹部・末梢血管疾患Case Review─ 腹部　Leriche症候群

奥田 茂男, 中塚 誠之, 陣崎 雅弘

画像診断 （学研メディカル秀潤社）  35 （ 9 ） 1098 - 1099 2015年07月

ISSN  0285-0524

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特集 知っておきたい循環器疾患のCT・MRI(2)─胸部・腹部・末梢血管疾患Case Review─ 腹部　腹部限局性大動脈解離

塚田 実郎, 奥田 茂男, 中塚 誠之, 陣崎 雅弘

画像診断 （学研メディカル秀潤社）  35 （ 9 ） 1096 - 1097 2015年07月

ISSN  0285-0524

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特集 知っておきたい循環器疾患のCT・MRI(2)─胸部・腹部・末梢血管疾患Case Review─ 腹部　腹部大動脈瘤

田村 全, 奥田 茂男, 中塚 誠之, 陣崎 雅弘

画像診断 （学研メディカル秀潤社）  35 （ 9 ） 1086 - 1087 2015年07月

ISSN  0285-0524

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特集 知っておきたい循環器疾患のCT・MRI(2)─胸部・腹部・末梢血管疾患Case Review─ 腹部　破裂腹部大動脈瘤

田村 全, 奥田 茂男, 中塚 誠之, 陣崎 雅弘

画像診断 （学研メディカル秀潤社）  35 （ 9 ） 1088 - 1089 2015年07月

ISSN  0285-0524

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特集 知っておきたい循環器疾患のCT・MRI(2)─胸部・腹部・末梢血管疾患Case Review─ 腹部　炎症性大動脈瘤

須山 陽介, 奥田 茂男, 中塚 誠之, 陣崎 雅弘

画像診断 （学研メディカル秀潤社）  35 （ 9 ） 1090 - 1091 2015年07月

ISSN  0285-0524

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特集 知っておきたい循環器疾患のCT・MRI(2)─胸部・腹部・末梢血管疾患Case Review─ 腹部　感染性大動脈瘤

須山 陽介, 奥田 茂男, 中塚 誠之, 陣崎 雅弘

画像診断 （学研メディカル秀潤社）  35 （ 9 ） 1092 - 1093 2015年07月

ISSN  0285-0524

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特集 知っておきたい循環器疾患のCT・MRI(2)─胸部・腹部・末梢血管疾患Case Review─ 腹部　内臓動脈瘤

塚田 実郎, 奥田 茂男, 中塚 誠之, 陣崎 雅弘

画像診断 （学研メディカル秀潤社）  35 （ 9 ） 1094 - 1095 2015年07月

ISSN  0285-0524

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