研究者詳細 - 陣崎　雅弘

論文 - 陣崎　雅弘

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【胸部の最新画像情報2021】関節リウマチを背景にした多発nodular lymphoid hyperplasiaの1例

池田織人, 松迫正樹, 栗原泰之, 小島史嗣, 板東徹, 鈴木高祐, 陣崎雅弘

臨床放射線（金原出版(株)） 66 （ 1 ） 105 - 111 2021年01月

ISSN 0009-9252

症例は40歳代女性で、関節リウマチで通院中、CTで右肺下葉S9/10に結節を指摘された。PET-CTで結節の充実部に有意な集積亢進を認め、経気管支生検で悪性所見は認めなかったが洗浄細胞診で軽度異型細胞が検出された。原発性肺癌cT1aN0M0 Stage IAと診断し、右肺下葉部分切除術を施行した。組織学的に胚中心をもった濾胞構造の増加を認め、濾胞間組織には形質細胞の浸潤や膠原線維の増生を認めた。免疫染色ではCD20+B-cellやCD3+T-cellがともに増生していたが、IgG4/IgG比は10.2%と有意な上昇を認めず、標記の診断とした。その後4年の経過で両肺に、周囲にすりガラス影を伴う充実性結節→充実成分の増大とともに周囲のすりガラス影内に嚢胞構造が出現→周囲嚢胞構造が増大し中心部の充実成分を圧排することで充実成分が縮小傾向を示す、一連の特徴的な形態的変化を認めた。保存的加療にて経過観察中である。

A diagnostic strategy for Parkinsonian syndromes using quantitative indices of DAT SPECT and MIBG scintigraphy: an investigation using the classification and regression tree analysis

Iwabuchi Y., Kameyama M., Matsusaka Y., Narimatsu H., Hashimoto M., Seki M., Ito D., Tabuchi H., Yamada Y., Jinzaki M.

European Journal of Nuclear Medicine and Molecular Imaging （European Journal of Nuclear Medicine and Molecular Imaging） 48 （ 6 ） 1833 - 1841 2021年

ISSN 16197070

Purpose: We aimed to evaluate the diagnostic performances of quantitative indices obtained from dopamine transporter (DAT) single-photon emission computed tomography (SPECT) and I-metaiodobenzylguanidine (MIBG) scintigraphy for Parkinsonian syndromes (PS) using the classification and regression tree (CART) analysis. Methods: We retrospectively enrolled 216 patients with or without PS, including 80 without PS (NPS) and 136 with PS [90 Parkinson’s disease (PD), 21 dementia with Lewy bodies (DLB), 16 progressive supranuclear palsy (PSP), and 9 multiple system atrophy (MSA). The striatal binding ratio (SBR), putamen-to-caudate ratio (PCR), and asymmetry index (AI) were calculated using DAT SPECT. The heart-to-mediastinum uptake ratio (H/M) based on the early (H/M [Early]) and delayed (H/M [Delay]) images and cardiac washout rate (WR) were calculated from MIBG scintigraphy. The CART analysis was used to establish a diagnostic decision tree model for differentiating PS based on these quantitative indices. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 87.5, 96.3, 93.3, 92.9, and 93.1 for NPS; 91.1, 78.6, 75.2, 92.5, and 83.8 for PD; 57.1, 95.9, 60.0, 95.4, and 92.1 for DLB; and 50.0, 98.0, 66.7, 96.1, and 94.4 for PSP, respectively. The PCR, WR, H/M (Delay), and SBR indices played important roles in the optimal decision tree model, and their feature importance was 0.61, 0.22, 0.11, and 0.05, respectively. Conclusion: The quantitative indices showed high diagnostic performances in differentiating NPS, PD, DLB, and PSP, but not MSA. Our findings provide useful guidance on how to apply these quantitative indices in clinical practice. 123

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Treatment effect prediction using CT after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Tsukada J., Yamada Y., Kawakami T., Matsumoto S., Inoue M., Nakatsuka S., Okada M., Fukuda K., Jinzaki M.

European Radiology （European Radiology） 31 （ 8 ） 5524 - 5532 2021年

ISSN 09387994

Objective: To evaluate whether the change in computed tomography pulmonary angiography (CTPA) metrics after balloon pulmonary angioplasty (BPA) can predict treatment effect in chronic thromboembolic pulmonary hypertension (CTEPH) patients. Methods: This study included 82 CTEPH patients who underwent both CTPA and right heart catheterization (RHC) before and at the scheduled time of 6 months after BPA. The diameters of the main pulmonary artery (dPA), ascending aorta (dAA), right atrium (dRA), right ventricular free wall thickness (dRVW), and right and left ventricles (dRV, dLV) were measured on CTPA. The correlation of the New York Heart Association functional class (NYHA FC), 6-minute walking distance (6MWD), brain natriuretic peptide (BNP) level, and calculated CT metrics with a decrease in mean pulmonary artery pressure (ΔmPAP) using RHC (used as the reference for BPA effect) was investigated. Using multiple regression analysis, independent variables were also identified. Results: In univariate analysis, clinical indicators (NYHA FC, 6MWD, and BNP level) improved significantly after BPA and were significantly correlated with ΔmPAP (p < 0.01). In the univariate analysis of CTPA parameters, dPA, dRA, dPA/dAA ratio, dRVW, and dRV/dLV ratio decreased significantly and were significantly correlated with ΔmPAP (p < 0.01). Multivariate analysis demonstrated that decreased dPA (p = 0.001) and decreased dRA (p = 0.039) on CTPA were independent predictive factors of ΔmPAP. Conclusions: Decreased dPA and dRA on CTPA could predict a decrease in mPAP after BPA, thus potentially eliminating unnecessary invasive catheterization. Key Points: • The reduction in mean pulmonary artery pressure after balloon pulmonary angioplasty in CTEPH patients was significantly correlated with the clinical indices improvement and CTPA parameter decrease. • The decreased diameter of the main pulmonary artery and the decreased diameter of the right atrium on CTPA were independent predictors of mean pulmonary artery pressure reduction.

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Performance of a deep learning-based identification system for esophageal cancer from CT images

Takeuchi M., Seto T., Hashimoto M., Ichihara N., Morimoto Y., Kawakubo H., Suzuki T., Jinzaki M., Kitagawa Y., Miyata H., Sakakibara Y.

Esophagus （Esophagus） 18 （ 3 ） 612 - 620 2021年

ISSN 16129059

Background: Because cancers of hollow organs such as the esophagus are hard to detect even by the expert physician, it is important to establish diagnostic systems to support physicians and increase the accuracy of diagnosis. In recent years, deep learning-based artificial intelligence (AI) technology has been employed for medical image recognition. However, no optimal CT diagnostic system employing deep learning technology has been attempted and established for esophageal cancer so far. Purpose: To establish an AI-based diagnostic system for esophageal cancer from CT images. Materials and methods: In this single-center, retrospective cohort study, 457 patients with primary esophageal cancer referred to our division between 2005 and 2018 were enrolled. We fine-tuned VGG16, an image recognition model of deep learning convolutional neural network (CNN), for the detection of esophageal cancer. We evaluated the diagnostic accuracy of the CNN using a test data set including 46 cancerous CT images and 100 non-cancerous images and compared it to that of two radiologists. Results: Pre-treatment esophageal cancer stages of the patients included in the test data set were clinical T1 (12 patients), clinical T2 (9 patients), clinical T3 (20 patients), and clinical T4 (5 patients). The CNN-based system showed a diagnostic accuracy of 84.2%, F value of 0.742, sensitivity of 71.7%, and specificity of 90.0%. Conclusions: Our AI-based diagnostic system succeeded in detecting esophageal cancer with high accuracy. More training with vast datasets collected from multiples centers would lead to even higher diagnostic accuracy and aid better decision making.

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Outcomes of the Nuss procedure for pectus excavatum in adults

Sakamoto Y., Yokoyama Y., Nagasao T., Yamada Y., Yamada M., Jinzaki M., Kishi K.

Journal of Plastic, Reconstructive and Aesthetic Surgery （Journal of Plastic, Reconstructive and Aesthetic Surgery） 74 （ 9 ） 2279 - 2282 2021年

ISSN 17486815

Limited data exist with regard to the outcome of the Nuss procedure for pectus excavatum repair in adults. Here, we analysed changes in lung capacity and thoracic morphology based on computed tomography (CT) imaging in adults with pectus excavatum before surgery, during bar insertion and after bar removal. Patients who underwent the Nuss procedure for pectus excavatum after the age of 20 were included in this study. Chest CT scans of the included participants were taken before the Nuss procedure, immediately before removal of the pectus bar and 6 months after removal of the pectus bar. Lung capacity and thoracic morphology measurements were made from the CT scans. Six patients aged 24–43 years were included in this study. After the Nuss procedure, lung capacity was decreased in all patients. Although the pectus bar was removed, lung capacity had not significantly increased and was almost the same volume as before the Nuss procedure. After the Nuss procedure, the funnel chest shape had improved in all cases, patients’ thoracic spine had also moved forward as the thorax moved forward and patients’ stoop had improved. Despite a lack of change in lung capacity, surgical modification should be considered to reduce stress on the thoracic spine and in turn, reduce pain in patients with pectus excavatum. However, further long-term observation seems necessary.

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Extremely imbalanced subarachnoid hemorrhage detection based on DenseNet-LSTM network with class-balanced loss and transfer learning

Lu Z., Oda M., Hayashi Y., Hu T., Itoh H., Watadani T., Abe O., Hashimoto M., Jinzaki M., Mori K.

Progress in Biomedical Optics and Imaging - Proceedings of SPIE （Progress in Biomedical Optics and Imaging - Proceedings of SPIE） 11597 2021年

ISSN 9781510640238

Subarachnoid Hemorrhage (SAH) detection is a critical, severe problem that confused clinical residents for a long time. With the rise of deep learning technologies, SAH detection made a significant breakthrough in recent ten years. Whereas, the performances are significantly degraded on imbalanced data, makes deep learning models have always suffered criticism. In this study, we present a DenseNet-LSTM network with Class-Balanced Loss and the transfer learning strategy to solve the SAH detection problem on an extremely imbalanced dataset. Compared to the previous works, the proposed framework not merely effectively integrate greyscale features the and spatial information from the consecutive CT scans, but also employ Class-Balanced loss and transfer learning to alleviate the adverse effects and broaden feature diversity respectively on an extreme SAH cases scarcity dataset, mimicking the actual situation of emergency departments. Comprehensive experiments are conducted on a dataset, consisted of 2,519 cases without hemorrhage cases and only 33 cases with SAH. Experimental results demonstrate the F-measure score of SAH detection achieved a remarkable improvement, the backbone DenseNet121 gained around 33% promotion after transfer learning, and on this basis, importing the Class-Balanced Loss and the LSTM structure, the F-measure score further increased 6.1% and 2.7% sequentially.

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Accuracy of ultra-high–resolution computed tomography with a 0.3-mm detector for quantitative assessment of coronary artery stenosis grading in comparison with conventional computed tomography: A phantom study

Yamada M., Yamada Y., Nakahara T., Okuda S., Abe T., Kuribayashi S., Jinzaki M.

Journal of Cardiovascular Computed Tomography （Journal of Cardiovascular Computed Tomography） 2021年

ISSN 19345925

Background: The development of ultra-high–resolution CT (U-HRCT) is expected to improve the accuracy of coronary stenosis evaluation. This study aimed to evaluate the accuracy of the stenosis severities of coronary artery phantoms estimated using U-HRCT by comparing them to those estimated with conventional CT. Methods: Coronary artery phantoms with non-calcified and calcified lesions were scanned with conventional CT (64-row × 0.625 mm) and U-HRCT (32-row × 0.3125 mm). The coronary artery phantoms had lumen diameters of 2.0, 3.0, and 4.0 mm with non-calcified lesions representing 0%, 25%, 50%, and 75% stenosis and 3.0 and 4.0 mm with calcified lesions representing 0%, 25%, 50%, and 75% stenosis. The lumen diameters at the stenotic and non-stenotic regions were measured, and the stenosis severities were compared with the true values. Results: For non-calcified lesions, conventional CT significantly underestimated the stenosis severity in the phantom showing 75% stenosis with lumen diameters of 2.0 and 3.0 mm (p < 0.05), while the estimated stenosis severities were not significantly different from the true values at all settings with U-HRCT. For the calcified lesions, conventional CT overestimated the stenosis severities at all settings (p < 0.05), while U-HRCT yielded estimations closer to the true values, although still with some overestimation (p < 0.05). Conclusion: By using U-HRCT, the estimated stenosis severities of the coronary artery with non-calcified lesion become almost equal to the true value, while those with calcified lesion are still overestimated although they become closer to the true value.

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A national survey on safety management at mr imaging facilities in Japan

Azuma M., Kumamaru K.K., Hirai T., Khant Z.A., Koba R., Ijichi S., Jinzaki M., Murayama S., Aoki S.

Magnetic Resonance in Medical Sciences （Magnetic Resonance in Medical Sciences） 20 （ 4 ） 347 - 358 2021年

ISSN 13473182

Purpose: To investigate safety management at Japanese facilities performing human MRI studies. Methods: All Japanese facilities performing human MRI studies were invited to participate in a comprehensive survey that evaluated their MRI safety management. The survey used a questionnaire prepared with the cooperation of the Safety Committee of the Japanese Society for Magnetic Resonance in Medicine. The survey addressed items pertaining to the overall MRI safety management, questions on the occurrence of incidents, and questions specific to facility and MRI scanner or examination. The survey covered the period from October 2017 to September 2018. Automated machine learning was used to identify factors associated with major incidents. Results: Of 5914 facilities, 2015 (34%) responded to the questionnaire. There was a wide variation in the rate of compliance with MRI safety management items among the participating facilities. Among the facilities responding to this questionnaire, 5% reported major incidents and 27% reported minor incidents related to MRI studies. Most major incidents involved the administration of contrast agents. The most influential factor in major incidents was the total number of MRI studies performed at the facility; this number was significantly correlated with the risk of major incidents (P < 0.0001). Conclusion: There were large variations in the safety standards applied at Japanese facilities performing clinical MRI studies. The total number of MRI studies performed at a facility affected the number of major incidents.

A Case of Severe Biliary Anastomotic Stricture after Living Donor Liver Transplantation Successfully Treated Using the Modified Gunsight Technique with Two Balloon Catheters

Iwasawa Sayuri, Tamura Masashi, Okamura Teppei, Torikai Hideyuki, Ito Nobutake, Inoue Masanori, Yamada Yohei, Jinzaki Masahiro, Kuroda Tatsuo, Nakatsuka Seishi

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） 6 （ 2 ） 65 - 68 2021年

Biliary stricture is a serious postoperative complication of liver transplantation. We report the case of a 2-year-old boy with severe biliary anastomotic stricture after left lobe living donor liver transplantation. As cannulation from the occluded B3 into the jejunum was impossible using the conventional technique, a gunsight approach was utilized. By puncturing balloons dilated at the occluded site of B3 and the proximal end of the non-occlusive B2, a tract between B3 and B2 was created, and the catheter was finally successfully inserted from B3 into the jejunum through the dilated tract and B2. The gunsight approach is an option for severe biliary strictures when the conventional approach proves impossible.

Clinical Utility of the Electrocardiographic P-Wave Axis in Patients with Chronic Obstructive Pulmonary Disease

Otake S., Chubachi S., Nakayama S., Sakurai K., Irie H., Hashiguchi M., Itabashi Y., Yamada Y., Jinzaki M., Murata M., Nakamura H., Asano K., Fukunaga K.

Respiration （Respiration） 2021年

ISSN 00257931

Background: The vertical P-wave axis on electrocardiography (ECG) is a useful criterion for screening patients with chronic obstructive pulmonary disease (COPD). This study aimed to investigate the clinical characteristics of patients with COPD with a vertical P-wave axis as they have not yet been elucidated. Methods: Keio University and its affiliated hospitals conducted an observational COPD cohort study over 3 years. We analyzed 201 patients using ECG and chest computed tomography. Results: The severity of airflow limitation was higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. Patients with a P-wave axis >75° exhibited significantly higher total COPD assessment test scores and increased St. George's Respiratory Questionnaire total, activity, and impact scores than those with a P-wave axis ≤75°. The incidence of exacerbations over 1 and 3 years was significantly higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. The optimal cutoff for the P-wave axis for a percentage of the predicted forced expiratory volume in 1 s <50% and future exacerbations over 3 years was 70° (the areas under the curve [AUC]: 0.788; sensitivity: 65.3%; specificity: 78.3%) and 79° (AUC: 0.642; sensitivity: 36.7%; specificity: 92.6%). The ratio of the low attenuation area was also significantly higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. However, the ratio of the airway wall area did not differ between the 2 groups. Conclusions: Patients with COPD with a vertical P-wave axis exhibited severe airflow limitation and emphysema, a worse health status, and more frequent exacerbation than patients without a vertical P-wave. Detection of the vertical P-wave axis by ECG is beneficial for the management of patients with COPD.

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リンパ管造影とリンパ系IVR

井上政則, 中塚誠之, 曽我茂義, 吉川裕紀, 長谷学, 鳥飼秀幸, 田村全, 塚田実郎, 屋代英樹, 小柳喬幸, 山岸敬幸, 陣崎雅弘

日本小児放射線学会雑誌（日本小児放射線学会） 37 （ 2 ） 134 - 146 2021年

ISSN 0918-8487

リンパ系システムは水分バランスの調整に於いて重要な役割を担っている．従来リンパ系システムの重要性は認識されてきたが，臨床的にリンパ系システムの画像化が困難であり，インターベンションによる治療介入も他の脈管系と比較して遅れをとってきた．しかし近年発達してきた鼠径部リンパ節からのリンパ管造影やMR lymphangiographyは新たな画像診断とインターベンションへのへの門戸を開いた．リンパ系システムの異常はリンパ浮腫とリンパ漏に大別される．この中で，リンパ漏れまれであるが重篤になり得る状態である．術後リンパ漏はリンパ漏の原因では頻度が高く，乳び胸水や腹部リンパ漏に代表される．適切な画像診断を行い，漏れを描出することでインターベンションにて治療可能となる．本稿では，総括的に臨床に重要なリンパ管解剖，リンパ管造影，適切なリンパ管造影の選択や様々なリンパ漏に対するインターベンションによる治療戦略を概説する．

Visualization of Lymphatic Vessels Using Photoacoustic Imaging

Kajita H., Suzuki Y., Sakuma H., Imanishi N., Tsuji T., Jinzaki M., Aiso S., Kishi K.

Keio Journal of Medicine （Keio Journal of Medicine） 70 （ 4 ） 82 - 92 2021年

ISSN 00229717

Lymphedema occurs when interstitial fluid and fibroadipose tissues accumulate abnormally because of decreased drainage of lymphatic fluid as a result of injury, infection, or congenital abnormalities of the lymphatic system drainage pathway. An accurate anatomical map of the lymphatic vasculature is needed not only for understanding the pathophysiology of lymphedema but also for surgical planning. However, because of their limited spatial resolution, no imaging modalities are currently able to non-invasively provide a clear visualization of the lymphatic vessels. Photoacoustic imaging is an emerging medical imaging technique that provides unique scalability of optical resolution and acoustic depth of penetration. Moreover, light-absorbing biomolecules, including oxy-and deoxyhemoglobin, lipids, water, and melanin, can be imaged. Using exogenous contrast agents that are taken up by lymphatic vessels, e.g., indocyanine green, photoacoustic lymphangiography, which has a higher spatial resolution than previous imaging modalities, is possible. Using a new prototype of a photoacoustic imaging system with a wide field of view developed by a Japanese research group, high-resolution three-dimensional structural information of the vasculatures was successfully obtained over a large area in both healthy and lymphedematous extremities. Anatomical information on the lymphatic vessels and adjacent veins provided by photoacoustic lymphangiography is helpful for the management of lymphedema. In par-ticular, such knowledge will facilitate the planning of microsurgical lymphaticovenular anastomoses to bypass the excess fluid component by joining with the circulatory system peripherally. Although challenges remain to establish its implementation in clinical practice, photoacoustic lymphangiography may contribute to improved treatments for lymphedema patients in the near future.

Quantification of adipose tissue around the aortic aneurysm -at the dawn of a new era

Okuda S., Yamada Y., Nakahara T., Jinzaki M.

Circulation Journal （Circulation Journal） 85 （ 12 ） 2181 - 2183 2021年

ISSN 13469843

Diagnostic Performance of Computed Tomography Imaging for COVID-19 in a Region with Low Disease Prevalence

Lee Ho, Suzuki Tatsuya, Okada Yohei, Tanaka Hiromu, Okamori Satoshi, Kamata Hirofumi, Ishii Makoto, Jinzaki Masahiro, Fukunaga Koichi

Ｔｈｅ　Ｋｅｉｏ　Ｊｏｕｒｎａｌ　ｏｆ　Ｍｅｄｉｃｉｎｅ（The Keio Journal of Medicine） advpub （ 0 ） 2021年

ISSN 0022-9717

Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, in December 2019 as an outbreak of pneumonia of unknown origin. Previous studies have suggested the utility of chest computed tomography (CT) in the diagnosis of COVID-19 because of its high sensitivity (93%–97%), relatively simple procedure, and rapid test results. This study, performed in Japan early in the epidemic when COVID-19 prevalence was low, evaluated the diagnostic accuracy of chest CT in a population presenting with lung diseases having CT findings similar to those of COVID-19. We retrospectively included all consecutive patients (≥18 years old) presenting to the outpatient department of Keio University Hospital between March 1 and May 31, 2020, with fever and respiratory symptoms. We evaluated the performance of diagnostic CT for COVID-19 by using polymerase chain reaction (PCR) results as the reference standard. We determined the numbers of false-positive (FP) results and assessed the clinical utility using decision curve analysis. Of the 175 patients, 22 were PCR-positive. CT had a sensitivity of 68% and a specificity of 57%. Patients with FP results on CT diagnosis were mainly diagnosed with diseases mimicking COVID-19, e.g., interstitial lung disease. Decision curve analysis indicated that the clinical utility of CT imaging was limited. The diagnostic performance of CT for COVID-19 was inadequate in an area with low COVID-19 prevalence and a high prevalence of other lung diseases with chest CT findings similar to those of COVID-19. Considering this insufficient diagnostic performance, CT findings should be evaluated in the context of additional medical information to diagnose COVID-19.

Comparative radiographic analysis of three-dimensional innate mobility of the foot bones under axial loading of humans and African great apes

Negishi T., Ito K., Hosoda K., Nagura T., Ota T., Imanishi N., Jinzaki M., Oishi M., Ogihara N.

Royal Society Open Science （Royal Society Open Science） 8 （ 11 ） 2021年

The human foot is considered to be morphologically adapted for habitual bipedal locomotion. However, how the mobility and mechanical interaction of the human foot with the ground under a weight-bearing condition differ from those of African great apes is not well understood. We compared three-dimensional (3D) bone kinematics of cadaver feet under axial loading of humans and African great apes using a biplanar X-ray fluoroscopy system. The calcaneus was everted and the talus and tibia were internally rotated in the human foot, but such coupling motion was much smaller in the feet of African great apes, possibly due to the difference in morphology of the foot bones and articular surfaces. This study also found that the changes in the length of the longitudinal arch were larger in the human foot than in the feet of chimpanzees and gorillas, indicating that the human foot is more deformable, possibly to allow storage and release of the elastic energy during locomotion. The coupling motion of the calcaneus and the tibia, and the larger capacity to be flattened due to axial loading observed in the human foot are possibly morphological adaptations for habitual bipedal locomotion that has evolved in the human lineage.

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Picked-up Knowledge from Foreign Journals 新型コロナウイルス感染症(COVID-19)における心筋イメージング

中原健裕, 奥田茂男, 陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 1 ） 116 - 118 2020年12月

ISSN 0285-0524

特集関節の解剖を再考する─正常 & 疾患Case Review─ 肩関節MRI

荒井学, 野崎太希, 陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 1 ） 61 - 71 2020年12月

ISSN 0285-0524

Comparison of inspiratory and expiratory lung and lobe volumes among supine, standing, and sitting positions using conventional and upright CT

Yamada Y., Yamada M., Chubachi S., Yokoyama Y., Matsuoka S., Tanabe A., Niijima Y., Murata M., Fukunaga K., Jinzaki M.

Scientific Reports （Scientific Reports） 10 （ 1 ） 2020年12月

Currently, no clinical studies have compared the inspiratory and expiratory volumes of unilateral lung or of each lobe among supine, standing, and sitting positions. In this prospective study, 100 asymptomatic volunteers underwent both low-radiation-dose conventional (supine position, with arms raised) and upright computed tomography (CT) (standing and sitting positions, with arms down) during inspiration and expiration breath-holds and pulmonary function test (PFT) on the same day. We compared the inspiratory/expiratory lung/lobe volumes on CT in the three positions. The inspiratory and expiratory bilateral upper and lower lobe and lung volumes were significantly higher in the standing/sitting positions than in the supine position (5.3–14.7% increases, all P < 0.001). However, the inspiratory right middle lobe volume remained similar in the three positions (all P > 0.15); the expiratory right middle lobe volume was significantly lower in the standing/sitting positions (16.3/14.1% decrease) than in the supine position (both P < 0.0001). The Pearson’s correlation coefficients (r) used to compare the total lung volumes on inspiratory CT in the supine/standing/sitting positions and the total lung capacity on PFT were 0.83/0.93/0.95, respectively. The r values comparing the total lung volumes on expiratory CT in the supine/standing/sitting positions and the functional residual capacity on PFT were 0.83/0.85/0.82, respectively. The r values comparing the total lung volume changes from expiration to inspiration on CT in the supine/standing/sitting positions and the inspiratory capacity on PFT were 0.53/0.62/0.65, respectively. The study results could impact preoperative CT volumetry of the lung in lung cancer patients (before lobectomy) for the prediction of postoperative residual pulmonary function, and could be used as the basis for elucidating undetermined pathological mechanisms. Furthermore, in addition to morphological evaluation of the chest, inspiratory and expiratory upright CT may be used as an alternative tool to predict lung volumes such as total lung capacity, functional residual capacity, and inspiratory capacity in situation in which PFT cannot be performed such as during an infectious disease pandemic, with relatively more accurate predictability compared with conventional supine CT.

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Posture-induced changes in the vessels of the head and neck: evaluation using conventional supine CT and upright CT

Kosugi K., Yamada Y., Yamada M., Yokoyama Y., Fujiwara H., Yoshida K., Yoshida K., Toda M., Jinzaki M.

Scientific Reports （Scientific Reports） 10 （ 1 ） 2020年12月

Since the venous system is affected by gravity, upright computed tomography (CT) in addition to conventional supine CT has great potential for evaluating postural changes in the venous system. We evaluated the morphological differences in the head and neck vessels by performing a contrast CT study in both the supine and the sitting positions. In this study, the 20 included participants (10 men and 10 women) were healthy adults aged 30 to 55 years. The cross-sectional area of the cervical vessels, craniocervical junction veins, and intracranial vessels were obtained quantitatively. Venous sinuses and venous plexuses that were difficult to measure were evaluated qualitatively. The average change in areas from a supine to an upright posture was − 77.87 ± 15.99% (P < 0.0001) in the right internal jugular vein (IJV), − 69.42 ± 23.15% (P < 0.0001) in the left IJV, − 61.52 ± 12.81% (P < 0.0001) in the right external jugular vein (EJV), and − 58.91 ± 17.37% (P < 0.0001) in the left EJV. In contrast, the change in the anterior condylar vein (ACV) from a supine to an upright posture was approximately + 144% (P < 0.005) on the right side and + 110% (P < 0.05) on the left side. In addition, according to the qualitative analysis, the posterior venous structures including the anterior condylar confluence (ACC) of the craniocervical junction became more prominent in an upright posture. Despite these changes, the intracranial vessels showed almost no change between postures. From a supine to an upright position, the IJVs and EJVs above the heart collapsed, and venous channels including the ACCs and ACVs opened, switching the main cerebral venous drainage from the IJVs to the vertebral venous system. Upright head CT angiography can be useful for investigating physiological and pathophysiological hemodynamics of the venous system accompanying postural changes.

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[123I]-IMP single-photon emission computed tomography imaging in visual snow syndrome: A case series

Shibata M., Tsutsumi K., Iwabuchi Y., Kameyama M., Takizawa T., Nakahara T., Fujiwara H., Jinzaki M., Nakahara J., Dodick D.W.

Cephalalgia （Cephalalgia） 40 （ 14 ） 1671 - 1675 2020年12月

ISSN 03331024

Background: Visual snow syndrome (VSS) is a neurological condition characterized by persistent flickering dots in the visual fields, palinopsia, enhanced entoptic phenomenon, photophobia, and nyctalopia. Neuroimaging evidence supports the role of the visual association cortex in visual snow syndrome. Case series: We provided clinical care to three patients with visual snow syndrome, in whom [ I]-IMP single-photon emission computed tomography (SPECT) imaging was performed. Case 1 was a 21-year-old male with a past history of migraine with aura who exhibited visual snow and entoptic phenomenon. In this patient, [ I]-IMP SPECT imaging revealed right occipital and temporal hypoperfusion with a distribution matching the ventral visual stream. [ I]-IMP SPECT imaging detected only mild bilateral frontal hypoperfusion in Case 2 and no overt abnormalities in Case 3. Conclusion: Although visual snow syndrome seems to be a heterogenous condition, our observations indicate that abnormal visual processing within the ventral visual stream may play a role in the pathogenesis of this condition. 123 123 123

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陣崎 雅弘

論文 - 陣崎 雅弘

陣崎　雅弘

論文 - 陣崎　雅弘