Details of a Researcher - Jinzaki, Masahiro

Papers - Jinzaki, Masahiro

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The time-adjusted gradual replacement injection method enables better visualization of the right heart

Nakahara Takehiro, Jinzaki Masahiro, Niwamae Nogiku, Saito Yuuichirou, Arai Masashi, Tsushima Yoshito, Kuribayashi Sachio, Kurabayashi Masahiko

Journal of Cardiovascular Computed Tomography (Journal of Cardiovascular Computed Tomography) 8 ( 2 ) 158 - 165 2014

Research paper (scientific journal), Joint Work, ISSN 1934-5925

Background: Despite the improvement of cardiac CT, right heart visualization remains challenging. Objective: We herein describe a new method, called the time-adjusted gradual replacement injection protocol. The aim of this study was to compare this protocol with the split-bolus injection protocol. Methods: Fifty-two patients who had undergone dual-source cardiac CT were retrospectively recruited. Twenty-six patients were injected by using the split-bolus injection protocol, and 26 patients were injected by using the time-adjusted gradual replacement injection protocol. For this method, we injected contrast medium for 10seconds at a flow rate of 0.07× body weight mL/s, then gradually replaced the contrast material with saline until 2 seconds before finishing the scans. The CT attenuation was measured in 4 chambers, the aorta, and the coronary arteries. The visualization of the anatomic structures and the occurrence and severity of streak artifacts were scored for the cardiac structures in the heart. For the analyses, either Welch t-test or Student t-test was performed. Results: In the right heart, the CT values and visualization scores were significantly higher in the time-adjusted replacement injection group than in the split-bolus injection group, whereas the artifact scores were comparable between the 2 groups. The CT values, visualization scores, and artifact scores of the left heart were not significantly different between the 2 groups. Conclusions: In this study, the time-adjusted gradual replacement injection protocol provided excellent attenuation for visualization of the right heart. This method may help toaccurately evaluate the right cardiac anatomy and thereby identify any potential diseases. © 2014 Society of Cardiovascular Computed Tomography.

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Surgical anatomy imaging associated with cervical cancer treatment

Nakamura Masaru, Fujii Takuma, Imanishi Nobuaki, Jinzaki Masahiro, Yamada Minoru, Kuribayashi Sachio, Aoki Daisuke

Clinical Anatomy (Clinical Anatomy) 27 ( 3 ) 503 - 510 2014

Research paper (scientific journal), Joint Work, ISSN 0897-3806

The objectives of this study were to visualize the surgical anatomical structures in the female pelvis by computed tomography and to investigate the components of the parametrium for anatomical education, radiological diagnosis, and surgical simulation. We surgically dissected fresh female cadavers maintained in precise surgical anatomic positions and examined the anatomical structures using experimental fine cell detector multislice computed tomography (FDCT) with a slice thickness of 0.3125 mm. In addition, we established a three-dimensional (3D) reconstruction model for precise observation of the surgical anatomy using Materialise's Interactive Medical Image Control System (Mimics). We evaluated two-dimensional (2D) images of the surgical anatomical structures in combination with the 3D reconstruction model. The 3D model was reconstructed from 430 serial axial pelvic CT images of a cadaver. The cardinal ligament, uterosacral ligament, paravesical space, and pararectal space were visualized on the CT images obtained from the surgically dissected part. The parametrium components were clearly distinguished on the surgically dissected side. Based on the information from the dissected side, these components on the undissected side could be distinguished as well. We recognized the parametrium components in the area extirpated during radical hysterectomy. The approach using cadavers, experimental FDCT, and 3D software provided excellent visualization of pelvic structures. High-quality images of surgical anatomical structures provide new insight regarding precise surgical anatomy in the female pelvis. The radiological information has practical usefulness for radiotherapeutic planning and surgical simulation. Copyright © 2013 Wiley Periodicals, Inc.

Renal angiomyolipoma

Jinzaki Masahiro, Silverman Stuart G., Akita Hirotaka, Nagashima Yoji, Mikami Shuji, Oya Mototsugu

Abdominal Imaging (Abdominal Imaging) 39 ( 3 ) 588 - 604 2014

Research paper (scientific journal), Joint Work, ISSN 0942-8925

Angiomyolipoma is the most common benign solid renal neoplasm observed in clinical practice. Once thought to be a hamartoma and almost always diagnosed by the imaged-based detection of fat, angiomyolipomas are now known to consist of a heterogeneous group of neoplasms. Although all are considered perivascular epithelioid cell tumors, many display different pathology, imaging features, and clinical behavior. The importance of understanding this group of neoplasms is emphasized by the fact that many types of angiomyolipoma contain little to no fat, and despite being benign, sometimes escape a pre-operative diagnosis. These types of angiomyolipomas can all be considered when encountering a renal mass that is both hyperattenuating relative to renal parenchyma on unenhanced CT and T2-hypointense, features that reflect their predominant smooth muscle component. We review recent developments and provide a radiological classification of angiomyolipomas that helps physicians understand the various types and learn how to both diagnose and manage them. © 2014 The Author(s).

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Three-dimensional image fusion of volume rendering SPECT/CT images for evaluation of pulmonary lobe function

Nakahara T., Koga S., Katagiri M., Ogata T., Iwabuchi Y., Matsuzaka Y., Murakami K., Jinzaki M.

Japanese Journal of Clinical Radiology (Japanese Journal of Clinical Radiology) 59 ( 13 ) 1821 - 1827 2014

Research paper (scientific journal), Joint Work, ISSN 0009-9252

Evaluating pulmonary regional function using pulmonary perfusion scintigraphy is so easy that it is used in daily clinical practice. However, this may not seem suitable for prediction of post-lobectomy lung function because it is difficult to divide lobar radioactive counts from pulmonary radioactivity on planar scintigraphic images. On the other hand, pulmonary perfusion SPECT with attenuation and scatter correction may help calculate lobar perfusion of the lung. We developed a new method for assessing pulmonary lobe function using three-dimensional (3D) image fusion of volume rendering SPECT/CT images. Our study showed that lobe-to-entire lung perfusion ratio with this 3D method (%lobe3D) was reproducible between 2 observers (rs = 0.97, ICC = 0.98). In addition, there was a high correlation between %lobe3D and lobe-to-entire lung perfusion ratio with 2D method (rs=0.98-0.99). In conclusion, our proposed method provides an accurate assessment for pulmonary lobar perfusion.

Prognostic value of preoperative multiparametric magnetic resonance imaging (MRI) for predicting biochemical recurrence after radical prostatectomy

Hattori Seiya, Kosaka Takeo, Mizuno Ryuichi, Kanao Kent, Miyajima Akira, Yasumizu Yota, Yazawa Satoshi, Nagata Hirohiko, Kikuchi Eiji, Mikami Shuji, Jinzaki Masahiro, Nakagawa Ken, Tanimoto Akihiro, Oya Mototsugu

BJU International (BJU International) 113 ( 5 ) 741 - 747 2014

Research paper (scientific journal), Joint Work, ISSN 1464-4096

Objective To evaluate the suitability of preoperative multiparametric magnetic resonance imaging (MRI) positivity as a predictor of biochemical recurrence after radical prostatectomy (RP). Patients and Methods We reviewed the clinical records of patients who underwent either standard RP or laparoscopic RP between January 2005 and December 2009 at our institution. Patients who received radiotherapy or androgen deprivation therapy before surgery were excluded. A total of 314 patients met the study inclusion criteria. Cox proportional hazard regression models were used for analyses. In accordance with the criteria in the established guidelines, a radiologist scored the probability of the presence of prostate cancer using a five-point scale of diagnostic confidence level. The highest confidence level of any pulse sequence was considered as the evaluation result. Results MRI positivity was significantly associated with a high clinical stage (cT ≥ 2; P = 0.039), a high positive biopsy core rate (≥0.2; P < 0.001), a high biopsy Gleason score ([GS] ≥8; P < 0.001) and a high pathological GS (≥8; P = 0.005). Univariate analysis and multivariate analysis showed that MRI positivity was a prognostic indicator in the analysis that included only preoperative variables and also in the analysis including preoperative and pathological variables. Conclusion Multiparametric MRI positivity can independently predict biochemical recurrence after RP. © 2013 The Authors. BJU International © 2013 BJU International.

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Relationship between body mass index and pancreas volume in japanese adults

Kou Kinsei, Saisho Yoshifumi, Jinzaki Masahiro, Itoh Hiroshi

Journal of the Pancreas (Journal of the Pancreas) 15 ( 6 ) 626 - 627 2014

Research paper (scientific journal), Joint Work, ISSN 1590-8577

Context The volume of the pancreas increases with obesity.Objective This study was aimed to explore the relationship between body mass index (BMI) and pancreas volume in Japanese.Methods The pancreas volume was examined in a total of 103 (60 men and 43 women) Japanese adults who had undergone abdominal computed tomography (CT) scan. The pancreas was outlined by hand in each CT image and the pancreas volume was computed by summing the product of pancreas area of each image and the CT section thickness.Results There was a significant positive correlation between BMI and pancreas volume (r = 0.41, P <0.001). This relationship was expressed by the following equation: y = 23.8 + 2.48x, where y is pancreas volume (cm³) and x is BMI.Conclusions There is a positive correlation between BMI and pancreas volume in Japanese and this relationship is similar to that in Caucasians. This information will be useful to estimate the impact of obesity on pancreas volume in Japanese and for comparison among different ethnicities.

1P2-U04 Development of Musculoskeletal Gait Simulator for Analyzing Human Foot Function(Mobiligence and embodiment systems science)

KUME Shinnosuke, ITO Kota, HOSODA Koh, OGIHARA Naomichi, SHIMIZU Masahiro, IKEMOTO Syuhei, JINZAKI Masahiro, NAGURA Takeo, NAKAMURA Toshiyasu, IMANISHI Nobuaki, AISO Sadakazu

The Proceedings of JSME annual Conference on Robotics and Mechatronics (Robomec) (The Japan Society of Mechanical Engineers) 2014 ( 0 ) _1P2-U04_1 - _1P2-U04_4 2014

A human foot has a complex structure which consists of a flexible flesh and many muscles, tendons, ligaments, and bones. The complex structure is supposed to contribute to efficient and stable bipedal locomotion. Detailed behavior of the foot complex during walking, however, is not well unerstood. We built a musculoskeletal gait simulator driven by pneumatic artificial muscles in order to solve a mechanism of a human gait. We measured ground reaction force of the musculoskeletal gait simulator during the stance phase by using a force plate. This gait simulator's vertical ground reaction force has two high peaks like a human's.

いま、注目の疾患2014 泌尿器・男性生殖器(症例1)　類上皮血管筋脂肪腫

塚田実郎, 陣崎雅弘, 栗林幸夫

画像診断 (学研メディカル秀潤社) 34 ( 1 ) 68 - 69 2013.12

ISSN 0285-0524

いま、注目の疾患2014 泌尿器・男性生殖器(症例2)　透析関連腎腫瘍　後天性嚢胞随伴腎細胞癌

秋田大宇, 陣崎雅弘

画像診断 (学研メディカル秀潤社) 34 ( 1 ) 70 - 71 2013.12

ISSN 0285-0524

Visceral fat is correlated with prolonged operative time in laparoendoscopic single-site adrenalectomy and laparoscopic adrenalectomy

Hasegawa Masanori, Miyajima Akira, Jinzaki Masahiro, Maeda Takahiro, Takeda Toshikazu, Kikuchi Eiji, Shibata Hirotaka, Oya Mototsugu

Urology (Urology) 82 ( 6 ) 1312 - 1318 2013.12

Research paper (scientific journal), Joint Work, ISSN 0090-4295

Objective To investigate the effect of visceral fat on operative time and discuss whether the measurement of adipose accumulation could be used as a sensitive predictor of technical difficulty in performing laparoendoscopic single-site adrenalectomy (LESS-A) and laparoscopic adrenalectomy (LA). Methods We reviewed the medical records of 106 patients undergoing LA or LESS-A at our institution. Total fat area (TFA) and visceral fat area (VFA) were measured at the level of the L4 vertebra by computed tomography. To categorize the type of obesity, the VFA/TFA ratio was calculated. Multiple logistic regression analyses were performed to identify independent predictors of prolonged operative time. Results The VFA/TFA ratio does not always coincide with body mass index (BMI, r = 0.415), and a higher correlation coefficient was observed between operative time and the VFA/TFA ratio (r = 0.359) than with that of BMI (r = 0.189). Multivariate analysis revealed that pheochromocytoma, tumor size ≥5 cm, and the VFA/TFA ratio ≥0.35, defined as the visceral type of adipose accumulation, were independent predictive factors for prolonged operative time in LA and LESS-A. We were able to stratify patients into short, intermediate, and long operative times using these preoperative variables. Conclusion This study revealed that the visceral type of adipose accumulation increases operative complexity in LA and LESS-A as measured by operative time. The VFA/TFA ratio might be a more sensitive indicator of technical difficulty than that of BMI. © 2013 Elsevier Inc. All Rights Reserved.

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Periprostatic fat area is an independent factor that prolonged operative time in laparoscopic radical prostatectomy

Kaneko Gou, Miyajima Akira, Yuge Kazuyuki, Hasegawa Masanori, Takeda Toshikazu, Jinzaki Masahiro, Kikuchi Eiji, Nakagawa Ken, Oya Mototsugu

Urology (Urology) 82 ( 6 ) 1304 - 1309 2013.12

Research paper (scientific journal), Joint Work, ISSN 0090-4295

Objective To evaluate the effect of visceral obesity on surgical outcomes in laparoscopic radical prostatectomy (LRP). Methods Visceral fat area (VFA) and periprostatic fat area (PPFA) were used as index of visceral obesity. In addition to VFA and PPFA, age, body mass index (BMI), prostate weight, cross-section area of Retzius space, history of previous abdominal surgery, repeated transrectal needle biopsy, and neoadjuvant hormone therapy were recorded. LRP was separated into 7 steps (1: port insertion and lymph node dissection, 2: endopelvic fascia incision, 3: dorsal vein complex ligation, 4: prostate dissection from bladder neck, 5: dissection of seminal vesicle and vas deferens, 6: prostate dissection from rectum, and 7: vesicourethral anastomosis). Potential factors that prolonged total operative time (OT), pneumoperitoneum time, and duration of each step were assessed by multivariate logistic regression analysis. The association between visceral obesity and other surgical outcomes was also evaluated. Results One hundred sixteen LRPs were performed by a single experienced surgeon. High PPFA and prostate weight were independent factors that prolonged total OT and pneumoperitoneum time. High BMI was not a factor. PPFA affected steps 1, 4, 5, and 6, and prostate weight affected prolonged steps 5 and 6. Estimated blood loss, duration of urethral catheterization, postoperative hospital stay, perioperative complications, and margin status were not affected by visceral obesity. Conclusion PPFA was more useful to accurately predict prolonged OT than VFA or BMI. Safety and margin status were not compromised even in high PPFA group when operations were performed by an experienced surgeon. © 2013 Elsevier Inc. All Rights Reserved.

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Epithelioid angiomyolipoma of the kidney

Tsukada Jitsuro, Jinzaki Masahiro, Yao Masahiro, Nagashima Yoji, Mikami Shuji, Yashiro Hideki, Nozaki Miwako, Mizuno Ryuichi, Oya Mototsugu, Kuribayashi Sachio

International Journal of Urology (International Journal of Urology) 20 ( 11 ) 1105 - 1111 2013.11

Research paper (scientific journal), Joint Work, ISSN 0919-8172

Objectives: To review the imaging findings of renal epithelioid angiomyolipomas. Methods: Eight patients treated at two institutions were pathologically diagnosed as having epithelioid angiomyolipoma. All of them underwent computed tomography, and four underwent magnetic resonance imaging. The tumor size, existence of fat, heterogeneity, computed tomography attenuation, degree of enhancement, enhancement pattern and magnetic resonance imaging signal intensity were evaluated. Results: Intratumoral fat was not detected in any of the cases. On unenhanced computed tomography, the intratumoral attenuation was hyperattenuating in six of the seven patients who were examined using this modality. On T2-weighted images, the signal intensity of the solid component, cyst wall or septum was low in three of the four cases. Four of the eight cases were heterogeneous solid-type accompanied by hemorrhage, necrosis or hyalinization. One homogeneous solid-type lesion was large in size and was pathologically accompanied by neither hemorrhage nor necrosis. All three multilocular cystic types were pathologically accompanied by massive hemorrhage in the cystic component. One was accompanied by spontaneous perirenal hematoma. Conclusions: The radiological appearance of most epithelioid angiomyolipomas has a tendency to be hyperattenuating on unenhanced computed tomography images, with low intensities on T2-weighted images. They can be heterogeneously solid, homogeneously solid or a multilocular cystic lesion with massive hemorrhage. © 2013 The Japanese Urological Association.

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Differential diagnosis of upper urinary tract disorders

Yazawa Satoshi, Kikuchi Eiji, Oya Mototsugu, Jinzaki Masahiro

Japanese Journal of Clinical Urology (Japanese Journal of Clinical Urology) 67 ( 11 ) 863 - 870 2013.10

Research paper (scientific journal), Joint Work, ISSN 0385-2393

癌の術後画像診断-合併症と局所再発のチェックポイント- (第9章)腎癌・腎盂尿管癌上部尿路癌　腎尿管全摘除術

秋田大宇, 陣崎雅弘, 大家基嗣

画像診断 (学研メディカル秀潤社) 33 ( 11 ) s163 - s166 2013.09

ISSN 0285-0524

癌の術後画像診断-合併症と局所再発のチェックポイント- (第9章)腎癌・腎盂尿管癌腎細胞癌　腎部分切除術

秋田大宇, 陣崎雅弘, 大家基嗣

画像診断 (学研メディカル秀潤社) 33 ( 11 ) s158 - s162 2013.09

ISSN 0285-0524

癌の術後画像診断-合併症と局所再発のチェックポイント- (第9章)腎癌・腎盂尿管癌腎細胞癌　根治的腎摘除術

秋田大宇, 陣崎雅弘, 大家基嗣

画像診断 (学研メディカル秀潤社) 33 ( 11 ) s152 - s157 2013.09

ISSN 0285-0524

Dose-Finding study of landiolol hydrochloride

Hirano Masaharu, Hara Kazuhiro, Ikari Yuji, Jinzaki Masahiro, Iino Misako, Hamada Chikuma, Kuribayashi Sachio

Advances in Therapy (Advances in Therapy) 30 ( 9 ) 803 - 818 2013.09

Research paper (scientific journal), Joint Work, ISSN 0741-238X

Introduction: Coronary computedtomography angiography (CCTA) has high diagnostic performance, but it sometimes does not allow evaluation because of artifacts. Currently, the use of a β -blocker is recommended to prevent motion artifacts, but the b-blocker (metoprolol, propranolol, etc.) commonly used has a slow onset and long duration of action. andiolol hydrochloride is an intravenous β ₁-blocker with a very short half-life. We investigated the efficacy and optimal dose of this drug for reduction of heart rate in patients undergoing CCTA. Methods: Eighty-seven subjects with ischemic heart disease were divided into three groups to receive landiolol hydrochloride at a dose of 0.125 (Group L), 0.25 (Group M), or 0.5 mg/kg (Group H). CCTA was performed at 3-7 min after administration, and heart rate, blood pressure, and image quality were assessed. Results: Heart rate decreased rapidly after completion of landiolol hydrochloride administration in all groups, with a heart rate reduction of 15.55 ± 6.56% in Group L, 16.48 ± 7.80% in Group M, and 21.49 ± 6.13%in Group H (Group L vs Group H, P = 0.0008; Group M vs Group H, P = 0.0109). Since there was no significant difference in heart rate during imaging among the three groups, although there was a significant difference between groups L and H and groups M and H in terms of percent change in heart rate, coronary stenosis was diagnosable in all groups with no significant difference. Conclusion: Landiolol hydrochloride showed a rapid onset and short b-blocking effect, and was most effective at a dose of 0.5 mg/kg. However, the diagnosable proportion had no significant differences among the three groups in CCTA. Therefore, the clinically recommended dose was 0.125 mg/kg or less, considering the heart rate of patients with suspected coronary stenosis during CCTA. © The Author(s) 2013.

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Tomosynthesis for the early detection of pulmonary emphysema

Yamada Yoshitake, Jinzaki Masahiro, Hashimoto Masahiro, Shiomi Eisuke, Abe Takayuki, Kuribayashi Sachio, Ogawa Kenji

European Radiology (European Radiology) 23 ( 8 ) 2118 - 2126 2013.08

Research paper (scientific journal), Joint Work, ISSN 0938-7994

Objectives: To compare the diagnostic performance of tomosynthesis with that of chest radiography for the detection of pulmonary emphysema, using multidetector computed tomography (MDCT) as reference. Methods: Forty-eight patients with and 63 without pulmonary emphysema underwent chest MDCT, tomosynthesis and radiography on the same day. Two blinded radiologists independently evaluated the tomosynthesis images and radiographs for the presence of pulmonary emphysema. Axial and coronal MDCT images served as the reference standard and the percentage lung volume with attenuation values of -950 HU or lower (LAA_-950) was evaluated to determine the extent of emphysema. Receiver-operating characteristic (ROC) analysis and generalised estimating equations model were used. Results: ROC analysis revealed significantly better performance (P < 0.0001) of tomosynthesis than radiography for the detection of pulmonary emphysema. The average sensitivity, specificity, positive predictive value and negative predictive value of tomosynthesis were 0.875, 0.968, 0.955 and 0.910, respectively, whereas the values for radiography were 0.479, 0.913, 0.815 and 0.697, respectively. For both tomosynthesis and radiography, the sensitivity increased with increasing LAA_-950. Conclusions: The diagnostic performance of tomosynthesis was significantly superior to that of radiography for the detection of pulmonary emphysema. In both tomosynthesis and radiography, the sensitivity was affected by the LAA_-950. Key Points: • Tomosynthesis showed significantly better diagnostic performance for pulmonary emphysema than radiography. • Interobserver agreement for tomosynthesis was significantly higher than that for radiography. • Sensitivity increased with increasing LAA _-950 in both tomosynthesis and radiography. • Tomosynthesis imparts a similar radiation dose to two projection chest radiography. • Radiation dose and cost of tomosynthesis are lower than those of MDCT. © 2013 European Society of Radiology.

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Clinical utility of preoperative evaluation of bronchial arteries by three-dimensional computed tomographic angiography for esophageal cancer surgery

Wada T., Takeuchi H., Kawakubo H., Nakamura R., Oyama T., Takahashi T., Wada N., Saikawa Y., Omori T., Jinzaki M., Kuribayashi S., Kitagawa Y.

Diseases of the Esophagus (Diseases of the Esophagus) 26 ( 6 ) 616 - 622 2013.08

Research paper (scientific journal), Joint Work, ISSN 1120-8694

An identification of bronchial arteries (BAs) is critical in esophageal cancer surgery to avoid tracheobronchial ischemia and unexpected massive bleeding during surgical procedure particularly in thoracoscopic video-assisted esophagectomy. We describe the efficacy of three-dimensional computed tomographic angiography (3D-CTA) of BAs for preoperative evaluation in esophageal cancer surgery. Sixty-four patients with esophageal cancer who preoperatively underwent multidetector computed tomography examination were included in this study. We evaluated the number, origin, and intraoperative preservation rate of BAs, and we compared the number of thoracic paratracheal lymph nodes harvested between two groups comprising patients who either underwent preoperative 3D-CTA of BAs (3D-CTA group) or did not (non-3D-CTA group). The right and left BAs were preoperatively identified in 62 patients (97%) and 55 patients (86%), respectively, using 3D-CTA. In 34 patients (53%), the right BA originated as a common trunk with the right intercostal artery. In 48 patients (75%), the left BA originated from the descending aorta as a single or double branch. Some anomalies such as the right BA originated from the left subclavian artery were observed. In all patients, either the right or the left BA was preserved. The number of harvested lymph nodes in left side of paratrachea was significantly increased in 3D-CTA group, than those in non-3D-CTA group. 3D-CTA clearly revealed BA anatomy, contributing to BA preservation and safe and precise lymphadenectomy in esophageal cancer surgery. 3D-CTA of BAs is useful for preoperative evaluation in esophageal cancer surgery. © 2012 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

Three-dimensional imaging and mapping of the right and left phrenic nerves

Fukumoto Kotaro, Takatsuki Seiji, Jinzaki Masahiro, Yamada Minoru, Tanimoto Kojiro, Nishiyama Nobuhiro, Aizawa Yoshiyasu, Hagiwara Yoko, Fukuda Yukiko, Kimura Takehiro, Miyoshi Shunichiro, Kuribayashi Sachio, Fukuda Keiichi

Europace (Europace) 15 ( 7 ) 937 - 943 2013.07

Research paper (scientific journal), Joint Work, ISSN 1099-5129

AimsPhrenic nerves (PNs) can be damaged during interventional cardiovascular therapy because of the nerves' proximity to the heart. This study aimed to analyse the anatomy of the PN by performing three-dimensional (3-D) imaging and pace mapping.Methods and resultsForty consecutive patients with atrial fibrillation referred for catheter ablation were enrolled in this study and underwent preoperative cardiovascular computed tomography (CT). In 10 patients with sinus rhythm during tomography, 3-D images of the right and left pericardiophrenic bundles (PBs), consisting of the ipsilateral PN and accompanying vessels, were reconstructed from the CT data. During the electrophysiological study, PN pace mapping was performed from both atria. The course of the PBs generated by CT imaging and the PN pace map generated by the 3-D mapping system were compared. By electrical pacing, the PNs were captured in 40 individuals (100%) from the superior vena cava and the right atrium, and in 17 patients (43%) from the left atrial appendage. Clear 3-D images of PBs were reconstructed in all cases in which CT-reconstruction was performed. The distance between the locations of the right PB generated by CT imaging and those of the right PN-capture sites in the right-sided heart on the mapping system was 8.7 ± 5.8 mm.ConclusionsThe 3-D routes of the bilateral PNs passing near the heart were verified by pace mapping. The preoperatively reconstructed 3-D course of the PB succeeded in locating the PN, which may facilitate the comprehension of PN anatomy to avoid its injury during interventional cardiovascular therapy. © 2013 The Author.

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