研究者詳細 - 陣崎　雅弘

論文 - 陣崎　雅弘

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Arteriovenous malformation on the sole of the foot treated successfully by embolization

Yuzaki I., Aramaki-Hattori N., Tamura M., Torikai H., Okabe K., Sakai S., Nakatsuka S., Jinzaki M., Kishi K., Inoue M.

Radiology Case Reports （Radiology Case Reports） 15 （ 12 ） 2621 - 2626 2020年12月

Arteriovenous malformations of the sole of the foot are rare and can cause disturbances in normal living activities. We report a case of a plantar arteriovenous malformation in a 24-year-old male with pain and difficulty in walking. The arteriovenous malformation was complex, with a large and poorly marginated nidus, so we considered that with surgical resection, walking disabilities would be inevitable. When surgical removal of vascular mass is difficult, embolization alone can be effective. Therefore, he was treated with 4 therapeutic embolization procedures. Transvenous approaches to the venous sac and direct punctures of the nidus was performed. The nidus was successfully eradicated by embolization using alcohol, resulting in the disappearance of associated symptoms. Appropriate imaging is essential for diagnosis and evaluation of treatment. We were successful in achieving improved quality of life and satisfaction for a rare and difficult case by percutaneous embolization and sclerotherapy.

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Quantitative analysis of metacarpophalangeal joints during active flexion using four-dimensional computed tomography

Ishii K., Oki S., Iwamoto T., Jinzaki M., Nagura T., Matsumoto M., Nakamura M.

Clinical Biomechanics （Clinical Biomechanics） 80 2020年12月

ISSN 02680033

Background: The metacarpophalangeal joint has a unique morphology with a high degree of freedom. However, few studies have analyzed the kinematics of fingers owing to the rapid movement of the small bones involved. The in-vivo kinematics of metacarpophalangeal joints were analyzed by four-dimensional computed tomography (4DCT) and associated with its morphology. Methods: The flexion motion of the fingers of bilateral hands in 10 volunteers were examined using 4DCT. Iterative surfaces were registered to trace the surface of the proximal phalanges with respect to metacarpals. Rotation angles were calculated using Euler/Cardan angles. Findings: In the index finger, the proximal phalange supinated to a maximum flexion of 40° and then pronated, and its range of rotation was larger than the previous reports. In the other fingers, the proximal phalanges continued to supinate during flexion. The helical axis of the proximal phalange passed a point extremely close to the center point of bilateral condyles, and it moved toward the proximal and palmar directions until the middle stage of flexion and toward the proximal and dorsal directions during the late stage of flexion. The translation of the rotation axis was larger in the ring and little fingers. Interpretation: The rotation in the index finger was larger than previously reported. The helical axes moved in the dorsal direction and proximally during the latter phase of the flexion. These results can be employed to better understand the causes of implant failure of the metacarpophalangeal joints.

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Development of 68Ga-labeled tin colloids for evaluating phagocytic function of Kupffer cells using preclinical PET imaging

Matsusaka Y., Nakahara T., Takahashi K., Iwabuchi Y., Nakamura S., Jinzaki M.

Annals of Nuclear Medicine （Annals of Nuclear Medicine） 34 （ 11 ） 807 - 814 2020年11月

ISSN 09147187

Objective: This study aimed to investigate the optimal conditions for producing Ga-labeled tin colloid and the feasibility of Ga-tin colloid positron emission tomography (PET) for visualization and evaluation of the phagocytic function of Kupffer cells (KCs) in vivo. Methods: Ga-tin colloid was prepared by adding tin solution (1 mM, 0.2 mL) to Ga solution (1.0 mL), followed by pH adjustment with sodium acetate (1 M, 0.2 mL). Various labeling times were tested to find the optimal one. Colloid size was measured by filtering the solution through three-ply membrane filters (with pore sizes of 200, 3000, and 5000 nm), and radioactivity was measured in the whole filtrate and the filters using a gamma counter. The in vitro stability of the colloid was evaluated by the size measurement after incubation under ambient conditions for up to 60 min. PET scanning was performed for 30 min after intravenous administration of Ga-tin colloid solution (4 MBq) to healthy rats. Time-activity-curves for the liver, spleen, and blood pool were generated. Finally, liver uptake was compared before and after the establishment of KC-depletion and non-alcoholic steatohepatitis (NASH) rat models. Results: Colloid size increased with increasing labeling time. After pH adjustment, the colloid sizes remained nearly unchanged. The optimal labeling time was determined as 30 min. PET imaging of healthy rats revealed that liver uptake of the Ga-tin colloid increased with increasing colloid size. In KC-depleted rats, liver uptake significantly decreased (n = 4, p < 0.01). NASH model rats showed significantly decreased uptake of Ga-tin colloid in the livers (n = 5, p < 0.01). Conclusions: Ga-tin colloid, prepared by a simple radiolabeling method, enabled in vivo PET imaging to evaluate the phagocytic function of KCs. 68 68 68 68 68 68 68 68

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Neuroendocrine carcinoma of uterine cervix findings shown by MRI for staging and survival analysis - Japan multicenter study

Kitajima K., Kihara T., Kawanaka Y., Kido A., Yoshida K., Mizumoto Y., Tomiyama A., Okuda S., Jinzaki M., Kato F., Takahama J., Takahata A., Fukukura Y., Nakamoto A., Tsujikawa T., Munechika J., Ohgiya Y., Kawai N., Goshima S., Ohya A., Fujinaga Y., Fukunaga T., Fujii S., Tanabe M., Ito K., Tsuboyama T., Kanie Y., Umeoka S., Ichikawa S., Motosugi U., Daido S., Kido A., Tamada T., Matsuki M., Yamashiro T., Yamakado K.

Oncotarget （Oncotarget） 11 （ 40 ） 3675 - 3686 2020年10月

Objectives: To investigate neuroendocrine carcinoma (NEC) of the uterine cervix cases for MRI features and staging, as well as pathological correlations and survival. Results: FIGO was I in 42, II in 14, III in 1, and IV in 5 patients. T2-weighted MRI showed homogeneous slightly high signal intensity and obvious restricted diffusion (ADC map, low intensity; DWI, high intensity) throughout the tumor in most cases, and mild enhancement in two-thirds. In 50 patients who underwent a radical hysterectomy and lymphadenectomy without neoadjuvant chemotherapy (NAC), intrapelvic T staging by MRI overall accuracy was 88.0% with reference to pathology staging, while patient-based sensitivity, specificity, and accuracy for metastatic pelvic lymph node detection was 38.5%, 100%, and 83.3%, respectively. During a mean follow-up period of 45.6 months (range 4.3-151.0 months), 28 patients (45.2%) experienced recurrence and 24 (38.7%) died. Three-year progression-free and overall survival rates for FIGO I, II, III, and IV were 64.3% and 80.9%, 50% and 64.3%, 0% and 0%, and 0% and 0%, respectively. Materials and Methods: Sixty-two patients with histologically surgery-proven uterine cervical NEC were enrolled. Twelve received NAC. Clinical data, pathological findings, and pretreatment pelvic MRI findings were retrospectively reviewed. Thirtytwo tumors were pure NEC and 30 mixed with other histotypes. The NECs were small cell type (41), large cell type (18), or a mixture of both (3). Conclusions: Homogeneous lesion texture with obvious restricted diffusion throughout the tumor are features suggestive of cervical NEC. Our findings show that MRI is reliable for T staging of cervical NEC. Copyright:

Development of in vitro endothelialized drug-eluting stent using human peripheral blood-derived endothelial progenitor cells

Tsukada J., Wolf F., Vogt F., Schaaps N., Thoröe-Boveleth S., Keijdener H., Jankowski J., Tsukada H., Jockenhövel S., Jinzaki M., Schmitz-Rode T., Mela P.

Journal of Tissue Engineering and Regenerative Medicine （Journal of Tissue Engineering and Regenerative Medicine） 14 （ 10 ） 1415 - 1427 2020年10月

ISSN 19326254

We propose in vitro endothelialization of drug-eluting stents (DES) to overcome late stent thrombosis by directly introducing late-outgrowth human endothelial progenitor cells (EPCs) at the target site utilizing abluminal DES. Isolated EPCs were confirmed as late-outgrowth EPCs by flow cytometric analysis. Abluminally paclitaxel-loaded stents were seeded with different cell concentrations and durations to determine optimal seeding conditions, in both uncrimped and crimped configurations. The seeding yield was determined by evaluating the percent coverage of the stent struts' area. The EPC-seeded DES were exposed to arterial shear stress to evaluate the effect of high shear stress on EPCs. To investigate how much paclitaxel elutes during the seeding procedure, a pharmacokinetic analysis was performed. Finally, to validate the proof of concept, EPC-seeded DES were placed on a fibrin matrix with and without smooth muscle cells (SMCs) and cultured for 3 days under perfusion. The seeding procedure resulted in 47% and 26% coverage of the stent surface in uncrimped and crimped conditions, respectively. After the optimal seeding, almost 99% of drug was still available. When EPC-seeded DES were placed on a fibrin matrix and cultured for 3 days, the EPCs confluently covered the stent surface and spread to the surrounding fibrin gel. When EPC-seeded DES were placed on SMC-containing fibrin layers, cells in contact with the struts died. EPCs can be successfully seeded onto DES without losing drug-eluting capability, and EPCs exhibit sufficient proliferative ability. EPC-seeded DES may combine early re-endothelialization ability with the antirestenotic effectiveness of DES.

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Evaluation of three-dimensional acromiohumeral distance in the standing position and comparison with its conventional measuring methods

Yoshida Y., Matsumura N., Yamada Y., Yamada M., Yokoyama Y., Matsumoto M., Nakamura M., Nagura T., Jinzaki M.

Journal of Orthopaedic Surgery and Research （Journal of Orthopaedic Surgery and Research） 15 （ 1 ） 2020年09月

Background: Narrowing of the acromiohumeral distance (AHD) implies a rotator cuff tear. However, conventional AHD measurements using two-dimensional (2D) imaging or with the patient in the supine position might differ from that while standing during daily activity. This study aimed to evaluate the three-dimensional (3D) actual distance between the acromion and humeral head in the standing position and compare the AHD values with those obtained using conventional measuring methods. Methods: Computed tomography (CT) images of 166 shoulders from 83 healthy volunteers (31 male and 52 female; mean age 40.1 ± 5.8 years; age range, 30-49 years) were prospectively acquired in the supine and standing positions using conventional and upright CT scanners, respectively. The minimum distance between the acromion and humeral head on the 3D surface models was considered as the 3D AHD. We measured the 2D AHD on anteroposterior digitally reconstructed radiographs. The AHD values were compared between the supine and standing positions and between the 2D and 3D measurements. Results: The mean values of 2D AHD were 8.8 ± 1.3 mm (range, 5.9-15.4 mm) in the standing position and 8.1 ± 1.2 mm (range, 5.3-14.3 mm) in the supine position. The mean values of 3D AHD were 7.3 ± 1.4 mm (range, 4.7-14.0 mm) in the standing position and 6.6 ± 1.2 mm (range, 4.4-13.7 mm) in the supine position. The values of 3D AHD were significantly lower than those of 2D AHDs in both the standing and supine positions (P < 0.001). The values of 2D and 3D AHDs were significantly lower in the supine position than in the standing position (P < 0.001). Conclusions: This study evaluated the 3D AHD of normal shoulders in the standing position using an upright CT scanner. The present results indicated that assessments in the supine position can underestimate the value of the AHD compared with those made in the standing position and that assessments using 2D analysis can overestimate the value.

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Three-dimensional alignment changes of the shoulder girdle between the supine and standing positions

Matsumura N., Yamada Y., Oki S., Yoshida Y., Yokoyama Y., Yamada M., Nagura T., Jinzaki M.

Journal of Orthopaedic Surgery and Research （Journal of Orthopaedic Surgery and Research） 15 （ 1 ） 2020年09月

Background: Although humans spend most of their day in a standing or sitting position, it is difficult to accurately evaluate the alignment of the shoulder girdle during daily activity, and its alignment changes between positions. The purpose of this study was to evaluate the 3-dimensional alignment of the shoulder girdle in the supine and standing positions by computed tomography (CT) and to assess the alignment changes of the shoulder girdle between these two positions. Methods: CT scans of both shoulders of 100 healthy volunteers were prospectively taken in both supine and standing positions on the same day. The local 3-dimensional coordinate systems of the thorax, clavicle, and scapula were defined from the specific bony landmarks, and 3-dimensional angular rotations and positions of the clavicle and scapula were calculated. Differences in rotations and positions of the clavicle and scapula were evaluated between the supine and standing positions. Results: Compared with the supine position, the clavicle showed significantly less elevation and greater retraction, and the scapula showed significantly less upward rotation, anterior tilting, and internal rotation in the standing position. Compared with the supine position, the clavicle center was located more inferiorly, posteriorly, and laterally, and the scapula center was located more inferiorly, posteriorly, and medially in the standing position. Conclusions: The present study showed that angular rotations and positions of the clavicle and scapula change significantly with position due to the effect of gravity.

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循環系(動脈・静脈・リンパ)の非侵襲的な統合的画像評価を目指して

陣崎雅弘

心臓（公益財団法人日本心臓財団） 52 （ 9 ） 933 - 933 2020年09月

ISSN 0586-4488

今月の特集1 AI医療の現状と課題 AI医療の現状と課題

陣崎雅弘, 橋本正弘, 上蓑義典, 洪繁, 北川雄光

臨床検査（株式会社医学書院） 64 （ 8 ） 838 - 843 2020年08月

ISSN 0485-1420

特集 Q & Aでまとめる! 予後予測・治療効果予測の画像検査 4　胸部(呼吸器・循環器・乳腺) 慢性血栓塞栓性肺高血圧症の画像的予後因子は何か?

奥田茂男, 田村全, 山田祥岳, 岩渕雄, 松本俊亮, 川上崇史, 陣崎雅弘

臨床放射線（金原出版） 65 （ 8 ） 847 - 857 2020年08月

ISSN 0009-9252

Traction Bronchiectasis/Bronchiolectasis is Associated with Interstitial Lung Abnormality Mortality

Hida T., Nishino M., Hino T., Lu J., Putman R.K., Gudmundsson E.F., Araki T., Valtchinov V.I., Honda O., Yanagawa M., Yamada Y., Hata A., Jinzaki M., Tomiyama N., Honda H., Estepar R.S.J., Washko G.R., Johkoh T., Christiani D.C., Lynch D.A., Gudnason V., Gudmundsson G., Hunninghake G.M., Hatabu H.

European Journal of Radiology （European Journal of Radiology） 129 2020年08月

ISSN 0720048X

© 2020 Elsevier B.V. Purpose: To investigate if the presence and severity of traction bronchiectasis/bronchiolectasis are associated with poorer survival in subjects with ILA. Method: The study included 3,594 subjects (378 subjects with ILA and 3,216 subjects without ILA) in AGES-Reykjavik Study. Chest CT scans of 378 subjects with ILA were evaluated for traction bronchiectasis/bronchiolectasis, defined as dilatation of bronchi/bronchioles within areas demonstrating ILA. Traction bronchiectasis/bronchiolectasis Index (TBI) was assigned as: TBI = 0, ILA without traction bronchiectasis/bronchiolectasis: TBI = 1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion: TBI = 2, ILA with mild to moderate traction bronchiectasis: TBI = 3, ILA and severe traction bronchiectasis and/or honeycombing. Overall survival (OS) was compared among the subjects in different TBI groups and those without ILA. Results: The median OS was 12.93 years (95%CI; 12.67 – 13.43) in the subjects without ILA; 11.95 years (10.03 – not reached) in TBI-0 group; 8.52 years (7.57 – 9.30) in TBI-1 group; 7.63 years (6.09 – 9.10) in TBI-2 group; 5.40 years (1.85 – 5.98) in TBI-3 group. The multivariable Cox models demonstrated significantly shorter OS of TBI-1, TBI-2, and TBI-3 groups compared to subjects without ILA (P < 0.0001), whereas TBI-0 group had no significant OS difference compared to subjects without ILA, after adjusting for age, sex, and smoking status. Conclusions: The presence and severity of traction bronchiectasis/bronchiolectasis are associated with shorter survival. The traction bronchiectasis/bronchiolectasis is an important contributor to increased mortality among subjects with ILA.

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A case of pancreatic hamartoma with characteristic radiological findings: radiological-pathological correlation

Toyama K., Matsusaka Y., Okuda S., Miura E., Kubota N., Masugi Y., Kitago M., Hori S., Yokose T., Shinoda M., Sakamoto M., Jinzaki M.

Abdominal Radiology （Abdominal Radiology） 45 （ 7 ） 2244 - 2248 2020年07月

ISSN 2366004X

© 2020, Springer Science+Business Media, LLC, part of Springer Nature. Pancreatic hamartoma is a rare benign tumor. Its preoperative diagnosis is challenging. We present a case of pancreatic hamartoma whose radiological-pathological correlation was evaluated in detail. A 53-year-old man was referred to our institution for diagnosis and treatment. Contrast-enhanced computed tomography (CT) and magnetic resonance image revealed a 3.5 cm long tumor arising from the head of the pancreas with cystic and solid components, the latter of which was gradually and inhomogeneously enhanced in the delayed phase. Fluorodeoxyglucose (FDG) positron emission tomography/CT revealed slight FDG uptake in the solid component. Histologically, a number of pancreatic lobule-like structures, which were mainly composed of aggregates of small ducts embedded in concentric fibrous stroma with no apparent islets or peripheral nerves, were observed in the solid component, whereas multiple dilated ducts were seen in the cystic region. The solid component also contained a narrow area of edematous fibrous stroma with low vessel density, which corresponded with the unenhanced part in the inhomogeneously enhanced solid component. There was no remarkable cytological atypia throughout the mass. A pathological diagnosis of pancreatic hamartoma was made. The radiological findings agree well with the pathological findings. When a pancreatic tumor is of the solid type, preoperatively diagnosing it as pancreatic hamartoma is not possible. However, when a pancreatic tumor with cystic and solid components is inhomogeneously enhanced in contrast-enhanced studies, a diagnosis of pancreatic hamartoma can be considered.

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Egested Feces Revealed Massive Protein Loss in 99mTc-HSA-D Scintigraphy

Matsusaka Y., Nakahara T., Iwabuchi Y., Owaki Y., Narimatsu H., Jinzaki M.

Clinical Nuclear Medicine （Clinical Nuclear Medicine） 45 （ 7 ） e329 - e330 2020年07月

ISSN 03639762

© 2020 Wolters Kluwer Health, Inc. All rights reserved. A 66-year-old man with severe diarrhea and severe hypoproteinemia was referred for 99mTc-DTPA-human serum albumin (HSA-D) scintigraphy. The scintigraphy at 24 hours postinjection showed strong accumulation of 99mTc-HSA-D in not only the colon but also all his diapers containing his egested feces. The ratio of the diapers counts to the total counts was 17.0%, and a considerable amount of protein loss was confirmed. 99mTc-HSA-D scintigraphy has an important role in diagnosing protein-losing enteropathy, but the abdomen is the only routinely scanned area. Additional scanning of egested radiotracer and the whole body can be useful for evaluating the disease severity.

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Picked-up Knowledge from Foreign Journals 虚血性心筋症

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） 40 （ 8 ） 880 - 883 2020年06月

ISSN 0285-0524

Usefulness of 18F-fluorodeoxyglucose positron emission tomography/computed tomography for predicting the prognosis and treatment response of neoadjuvant therapy for pancreatic ductal adenocarcinoma

Yokose T., Kitago M., Matsusaka Y., Masugi Y., Shinoda M., Yagi H., Abe Y., Oshima G., Hori S., Endo Y., Toyama K., Iwabuchi Y., Takemura R., Ishii R., Nakahara T., Okuda S., Jinzaki M., Kitagawa Y.

Cancer Medicine （Cancer Medicine） 9 （ 12 ） 4059 - 4068 2020年06月

© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. Background: The Response Evaluation Criteria in Solid Tumors (RECIST) for computed tomography (CT) is preoperatively used to evaluate therapeutic effects. However, it does not reflect the pathological treatment response (PTR) of pancreatic ductal adenocarcinoma (PDAC). The Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) for positron emission tomography (PET)/CT is effective in other cancers. This study aimed to confirm the usefulness of PERCIST and the prognostic utility of PET/CT for PDAC. Methods: Forty-two consecutive patients with PDAC who underwent neoadjuvant therapy (NAT) and pancreatectomy at our institution between 2014 and 2018 were retrospectively analyzed. We evaluated the treatment response and prognostic significance of PET/CT parameters and other clinicopathological factors. Results: Twenty-two patients who underwent PET/CT both before and after NAT with the same protocol were included. RECIST revealed stable disease and partial response in 20 and 2 cases, respectively. PERCIST revealed stable metabolic disease, partial metabolic response, and complete metabolic response in 8, 9, and 5 cases, respectively. The PTR was G3, G2, and G1 in 8, 12, and 2 cases, respectively. For comparing the concordance rates between PTR and each parameter, PERCIST (72.7% [16/22]) was significantly superior to RECIST (36.4% [8/22]) (P =.017). The area under the curve survival values of PET/CT parameters were 0.777 for metabolic tumor volume (MTV), 0.500 for maximum standardized uptake value, 0.554 for peak standardized uptake value corrected for lean body mass, and 0.634 for total lesion glycolysis. A 50% cut-off value for the MTV reduction rate yielded the largest difference in survival between responders and nonresponders. On multivariate analysis, MTV reduction rates < 50% were independent predictors for relapse-free survival (hazard ratio [HR], 3.92; P =.044) and overall survival (HR, 14.08; P =.023). Conclusions: PERCIST was more accurate in determining NAT’s therapeutic effects for PDAC than RECIST. MTV reduction rates were independent prognostic factors for PDAC.

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特集ホスピタリストのための画像診断-①胸部・縦隔編【各論(胸部疾患)】 7.急性過敏性肺炎-キーとなる画像所見と類似する疾患

池田織人, 陣崎雅弘, 栗原泰之

Hospitalist （株式会社医学書院） 8 （ 2 ） 253 - 260 2020年06月

ISSN 2188-0409

Spatial resolution compensation by adjusting the reconstruction kernels for iterative reconstruction images of computed tomography

Sugisawa K., Ichikawa K., Urikura A., Minamishima K., Masuda S., Hoshino T., Nakahara A., Yamada Y., Jinzaki M.

Physica Medica （Physica Medica） 74 47 - 55 2020年06月

ISSN 11201797

© 2020 Associazione Italiana di Fisica Medica Purpose: Hybrid iterative reconstruction (IR) is useful to reduce noise in computed tomography (CT) images. However, it often decreases the spatial resolution. The ability of high spatial resolution kernels (harder kernels) to compensate for the decrease in the spatial resolution of hybrid IRs was investigated. Methods: An elliptic cylindrical phantom simulating an adult abdomen was used. Two types of rod-shaped objects with ~330 and ~130 HU were inserted to simulate contrasts of arteries in CT angiography. Two multi-slice CT systems were used to scan the phantoms with 120 kVp and scan doses of 20 and 10 mGy. The task transfer functions (TTFs) were measured from the circular edges of the rod images. The noise power spectrum (NPS) was measured from the images of the water-only section. The CT images were reconstructed using a filtered back projection (FBP) with baseline kernels and two levels of hybrid IRs with harder kernels. The profiles of the clinical images across the aortic dissection flaps were measured to evaluate actual spatial resolutions. Results: The TTF degradation of each hybrid IR was recovered by the harder kernels, whereas the noise reduction effect was retained, for both the 20 and 10 mGy. The profiles of the dissection flaps for the FBP were maintained by using the harder kernels. Even with the best combination of hybrid IR and harder kernel, the noise level at 10 mGy was not reduced to the level of FBP at 20 mGy, suggesting no capability of a 50% dose reduction while maintaining noise.

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The efficacy of the TachoSil binding suturing technique in laparoscopic partial nephrectomy to prevent the development of pseudoaneurysm

Shigeta K., Matsumoto K., Abe T., Komatsuda A., Takeda T., Mizuno R., Kikuchi E., Asanuma H., Arita Y., Akita H., Jinzaki M., Miyajima A., Oya M.

Asian Journal of Surgery （Asian Journal of Surgery） 43 （ 6 ） 668 - 675 2020年06月

ISSN 10159584

© 2019 Objective: Our specific aim was to introduce the TachoSil binding suturing technique for renal cell carcinoma (RCC) patients when closing the parenchymal defect after tumor excision during laparoscopic partial nephrectomy (LPN), which is a novel technique for reducing the risk of developing subsequent pseudoaneurysm (PA). Methods: We identified 113 pT1aN0M0 RCC patients who underwent LPN at our institution. Eighty-one (72%) patients underwent the suturing procedure without binding TachoSil, whereas 32 (28%) patients underwent renorraphy with the renal defect closed together with TachoSil. The vascular complications were evaluated by computed tomography or magnetic resonance imaging with enhanced contrast material at the first visit after LPN. We conducted Fischer's exact test to determine risk factors for transcatheter arterial embolization (TAE). Results: The median age was 55 (36–86) years old and the median follow-up time was 65 (12–147) months. In the overall population, there were 11 (11%) patients who underwent TAE because they developed PA. All 11 patients exhibited the imaging findings of PA, and were all from the conventional suturing group. In contrast, no patients for whom the TachoSil binding method was used had any significant findings on imaging (14% vs. 0%). Based on the analysis to determine risk factors for TAE due to PA development, the TachoSil binding suturing technique was one of the significant indicators for reducing the risk of developing PA. Conclusions: Our study demonstrated that the TachoSil binding suturing technique might reduce the development of PA after LPN. Prospective randomized study and comparison to the standard 2 or 3–layer renorrhaphy is needed to prove its actual value.

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Quantification of intratumoral collagen and elastin fibers within hepatocellular carcinoma tissues finds correlations with clinico-patho-radiological features

Maehara J., Masugi Y., Abe T., Tsujikawa H., Kurebayashi Y., Ueno A., Ojima H., Okuda S., Jinzaki M., Shinoda M., Kitagawa Y., Oda Y., Honda H., Sakamoto M.

Hepatology Research （Hepatology Research） 50 （ 5 ） 607 - 619 2020年05月

ISSN 13866346

© 2019 The Japan Society of Hepatology Aim: Emerging evidence suggests a promising role for tumor stromal factors in characterizing patients with various types of malignancies, including hepatocellular carcinoma (HCC). We quantified the amount of collagen and elastin fibers in HCC samples with the aim of clarifying the clinico-patho-radiological significance of fiber deposition in HCC. Methods: We computed the amount of collagen and elastin fibers using digital image analysis of whole-slide images of Elastica van Gieson-stained tissues from 156 surgically resected HCCs. Furthermore, we assessed the correlations between the fiber content of HCC samples and clinical, pathological, and radiological features, including immunohistochemistry-based molecular subtypes and immunosubtypes. Results: The intratumoral area ratio of collagen in HCC tissues (median 3.4%, range 0.1–22.2%) was more than threefold that of elastin (median 0.9%, range 0.1–9.0%); there was a strong positive correlation between the amounts of collagen and elastin. Higher levels of combined collagen and elastin were significantly associated with the confluent multinodular macroscopic tumor type, the absence of a fibrous capsule, intratumoral steatosis, scirrhous tumor stroma, dense inflammatory-cell infiltrates, and the biliary/stem cell markers-positive HCC subtype. The associations of higher collagen levels with radiological findings, including heterogeneous enhancement and persistent enhancement on dynamic computed tomography, were significant. In contrast, the associations of radiological findings with elastin fibers were not significant. Intratumoral fibrous stroma in HCC comprised septum-like and perisinusoidal fibrosis; these two forms represented distinct distribution patterns of fibers and fibroblasts. Conclusion: Quantitative analysis suggested that stromal fiber-rich HCCs likely represent a distinct clinico-patho-radiological entity.

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Subcutaneous lymphatic vessels in the lower extremities: Comparison between photoacoustic lymphangiography and near-infrared fluorescence lymphangiography

Suzuki Y., Kajita H., Konishi N., Oh A., Urano M., Watanabe S., Asao Y., Imanishi N., Tsuji T., Jinzaki M., Aiso S., Kishi K.

Radiology （Radiology） 295 （ 2 ） 469 - 474 2020年05月

ISSN 00338419

© RSNA, 2020. Background: Detailed visualization of the lymphatic vessels would greatly assist in the diagnosis and monitoring of lymphatic diseases and aid in preoperative planning of lymphedema surgery and postoperative evaluation. Purpose: To evaluate the usefulness of photoacoustic imaging (PAI) for obtaining three-dimensional images of both lymphatic vessels and surrounding venules. Materials and Methods: In this prospective study, the authors recruited healthy participants from March 2018 to January 2019 and imaged lymphatic vessels in the lower limbs. Indocyanine green (5.0 mg/mL) was injected into the subcutaneous tissue of the first and fourth web spaces of the toes and below the lateral malleolus. After confirmation of the lymphatic flow with near-infrared fluorescence (NIRF) imaging as the reference standard, PAI was performed over a field of view of 270 3 180 mm. Subsequently, the number of enhancing lymphatic vessels was counted in both proximal and distal areas of the calf and compared between PAI and NIRF. Results: Images of the lower limbs were obtained with PAI and NIRF in 15 participants (three men, 12 women; average age, 42 years 6 12 [standard deviation]). All participants exhibited a linear pattern on NIRF images, which is generally considered a reflection of good lymphatic function. A greater number of lymphatic vessels were observed with PAI than with NIRF in both the distal (mean: 3.6 vessels 6 1.2 vs 2.0 vessels 6 1.1, respectively; P , .05) and proximal (mean: 6.5 vessels 6 2.6 vs 2.6 vessels 6 1.6; P , .05) regions of the calf. Conclusion: Compared with near-infrared fluorescence imaging, photoacoustic imaging provided a detailed, three-dimensional representation of the lymphatic vessels and facilitated an increased understanding of their relationship with the surrounding venules.

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