研究者詳細 - 陣崎　雅弘

論文 - 陣崎　雅弘

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特集腹部の最新画像情報2019 症例胸膜転移をきたした類上皮型腎血管筋脂肪腫の1例

永藤唯, 市川珠紀, 陣崎雅弘, 山室博, 中島信幸, 岡松千都子, 中村直哉, 今井裕

臨床放射線（金原出版） 64 （ 7 ） 951 - 955 2019年06月

ISSN 0009-9252

Preserved Kidney Volume, Body Mass Index, and Age Are Significant Preoperative Factors for Predicting Estimated Glomerular Filtration Rate in Living Kidney Donors at 1 Year After Donation

Shinoda K., Morita S., Akita H., Washizuka F., Tamaki S., Takahashi R., Oguchi H., Sakurabayashi K., Mizutani T., Takahashi Y., Hyodo Y., Itabashi Y., Muramatsu M., Kawamura T., Asanuma H., Kikuchi E., Jinzaki M., Shiraga N., Nakagawa K., Oya M., Shishido S., Sakai K.

Transplantation Proceedings （Transplantation Proceedings） 51 （ 5 ） 1306 - 1310 2019年06月

ISSN 00411345

© 2019 Elsevier Inc. Background: Securing postdonation renal function in the lifetime of donors is a consequential subject for physicians, and precise prediction of postdonation renal function would be considerably beneficial when judging the feasibility of kidney donation. The aim of this study was to investigate the optimum model for predicting eGFR at 1 year after kidney donation. Methods: We enrolled 101 living-related kidney donors for the development cohort and 44 for the external validation cohort. All patients in each cohort underwent thin-sliced (1 mm)enhanced computed tomography (CT)scans. We excluded individuals with diabetes, glucose intolerance, or albuminuria from this study. We evaluated preoperative factors including age, sex, hypertension, body mass index (BMI), serum uric acid, baseline eGFR, and body surface area (BSA)-adjusted preserved kidney volume (PKV)by using 3-dimensional reconstruction of thin-sliced enhanced CT images. To detect independent predictors, we performed multivariable regression analysis. Results: The multivariable regression analysis revealed that age, BMI, predonation eGFR, and BSA-adjusted PKV were independent predictors of eGFR at 1 year after kidney donation (correlation coefficient: −0.15, −0.476, 0.521, 0.127, respectively). A strong correlation between predicted eGFR and observed eGFR was obtained in the development cohort (r = 0.839, P <.0001). The significance of this predictive model was also confirmed with the external validation cohort (r = 0.797, P <.0001). Conclusions: Age, BMI, predonation eGFR, and BSA-adjusted PKV may be useful for precisely predicting eGFR at 1 year after living kidney donation and be helpful to determine the feasibility of kidney donation from marginal donors.

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【腹部の最新画像情報2019】胸膜転移をきたした類上皮型腎血管筋脂肪腫の1例

永藤唯, 市川珠紀, 陣崎雅弘, 山室博, 中島信幸, 岡松千都子, 中村直哉, 今井裕

臨床放射線（金原出版(株)） 64 （ 7 ） 951 - 955 2019年06月

ISSN 0009-9252

症例は30歳代女性で、胃圧迫感を主訴とした。近医CTにて左腎腫瘍が疑われ当院を受診された。淡明細胞型腎細胞癌としては、充実部にT2強調像で低信号域が目立ち、皮髄相での造影効果が弱かった。乳頭状腎細胞癌type 1やXp11.2転座型腎細胞癌としては、腎実質相で造影効果が低下する点が合致しない。嫌色素性腎細胞癌やオンコサイトーマとしては、充実部にT2強調像で低信号域が目立ち、中心性瘢痕様部位においても造影効果を認めないことから中心性瘢痕ではなく広汎な出血や壊死と考えられた。fat-poor AML(hyperattenuating type)としては、腫瘍径が大きく不均一であり、angular interfaceもみられず、偽被膜様構造が目立った。術前診断は腎悪性腫瘍とした。これに対し、開胸開腹根治的左腎摘除術を施行した。肉眼的に、腎上極に灰白色〜黄色調の境界明瞭な充実性腫瘤を認めた。病理組織学的に、腫瘤全体に大小の多稜形細胞(類上皮型平滑筋成分)がシート状に増生しており、淡明ないし顆粒の目立つ好酸性細胞質、明瞭な核小体を伴う類円形核を有していた。50%程度に細胞異型や核異型あり、部分的に紡錘形細胞(紡錘型平滑筋成分)を認めるが、脂肪成分は認めなかった。免疫組織学的に、HMB45陽性、一部にSMA陽性上皮マーカー陰性であり、類上皮型血管筋脂肪腫の診断となった。

Feasibility of T1rho and T2 map magnetic resonance imaging for evaluating graft maturation after anatomic double-bundle anterior cruciate ligament reconstruction

Niki Y., Yasuoka T., Kobayashi S., Harato K., Nagura T., Okuda S., Jinzaki M.

Journal of Orthopaedic Surgery and Research （Journal of Orthopaedic Surgery and Research） 14 （ 1 ） 2019年05月

© 2019 The Author(s). Background: Although T1rho and T2 map magnetic resonance imaging (MRI) have been perceived as useful diagnostic modalities for cartilage degeneration, no studies have assessed whether these two sequences are useful for monitoring ACL graft maturation after ACL reconstruction. The present study examined whether the two sequences reflect graft function and maturation after ACL reconstruction. Methods: Twenty consecutive patients who consented to undergo MRI at 3, 6, and 12 months after double-bundle ACL reconstruction were enrolled. MRI was performed using T1 rho and T2 map sequences in a single session. Temporal changes in T1rho and T2 values of a purely tendinous portion of graft were assessed at each time point. Correlations were analyzed between T1rho or T2 map values and clinical results, including anteroposterior laxity at 2 and 4 years postoperatively, pivot shift test results at 4 years, and graft tension on second-look arthroscopy. Separate analyses were performed for the anteromedial bundle (AMB) and posterolateral bundle (PLB). Results: T1rho sequence was able to visualize the tendinous portions of AMB and PLB more clearly than T2 map sequence even on gray-scale images. Mean T1rho and T2 map values gradually decreased during the first operative year, but the trend was more prominent and consistent for T1rho values than for T2 map values. Correlation analysis revealed that T1rho and T2 map values at 1 year correlated significantly with anteroposterior laxity at 2 and 4 years. This trend was found in both AMB and PLB. Both T1rho and T2 map values failed to exhibit a statistical correlation with arthroscopic findings of graft tension. Conclusions: The present study was the first trial to assess the feasibility of T1rho and T2 map sequences to objectively monitor the course of graft maturation after ACL reconstruction. Both sequences successfully detected purely tendinous portions of graft, and mean values gradually decreased during the first year postoperatively. Both values at 1 year correlated significantly with anteroposterior laxity of the knee joint at 4 years, indicating that the values reflected graft fate.

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特集治療関連肺障害の画像診断免疫チェックポイント阻害剤による肺障害の画像診断

杉浦弘明, 南康大, 山田祥岳, 陣崎雅弘

臨床放射線（金原出版） 64 （ 6 ） 777 - 786 2019年05月

ISSN 0009-9252

The relationship between the morphological axis and the kinematic axis of the proximal radius

Oki S., Inaba N., Matsumura N., Iwamoto T., Yamada Y., Jinzaki M., Nagura T.

Surgical and Radiologic Anatomy （Surgical and Radiologic Anatomy） 41 （ 4 ） 423 - 429 2019年04月

ISSN 09301038

© 2018, Springer-Verlag France SAS, part of Springer Nature. Purpose: Surgical procedures for impaired forearm rotation such as for chronic radial head dislocation remain controversial. We hypothesized that the morphological axis of the proximal radius is important for stable forearm rotation, and we aimed to clarify the relationship between the morphological axis and the kinematic axis of the proximal radius using four-dimensional computed tomography (4DCT). Methods: Ten healthy volunteers were enrolled. Four-dimensional CT of the dominant forearm during supination and pronation was obtained. The rotation axis of forearm rotation was calculated from all frames during supination and pronation. The principle axis of inertia, which represents the most stable rotation axis of a rigid body, was calculated for the proximal radius by extending its surface data incrementally by 1% from the proximal end. The angle between the kinematic rotation axis and the morphological rotation axis of each length was calculated. Results: The rotation axis of the forearm was positioned on the radial head 0.0 mm radial and 0.4 mm posterior to the center of the radial head proximally and 2.0 mm radial and 1.2 mm volar to the fovea of the ulnar head distally. The principle axis at 15.9% of the length of the proximal radius coincided with the forearm rotation axis (kinematic axis). Individual differences were very small (SD 1.4%). Conclusion: Forearm rotation was based on the axis at 16% of the length of the proximal radius. This portion should be aligned in cases of severe morphological deformity of the radial head that cause “rattling motion” of the radial head after reduction procedures.

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Small intestinal perforation due to a huge gastrointestinal stromal tumor in a kidney transplant recipient: A case report and literature review

Takahashi R., Shinoda K., Ishida T., Hamamoto Y., Morita S., Akita H., Kitaoka S., Tamaki S., Asanuma H., Yoshida T., Jinzaki M., Kameyama K., Oya M.

BMC Nephrology （BMC Nephrology） 20 （ 1 ） 2019年04月

© 2019 The Author(s). Background: Gastrointestinal stromal tumors (GISTs) in transplant recipients are very rare and only a handful of cases have been reported to date. Here we present the first known case of a huge GIST in a kidney transplant recipient with perforation of small intestine. Case presentation: A 64-year-old male presented at our hospital with right colic pain; he had received an ABO incompatible kidney transplant 6 years earlier and was treated with cyclosporine, mycophenolate mofetil, and methylprednisolone. Radiological evaluation revealed a huge (11 cm in diameter) solitary tumor at the small intestine without distant metastasis. The small intestinal wall at the tumor location was perforated one week after diagnosis and the patient underwent emergency surgery. The pathological findings were compatible with GIST and the tumor consisted of spindle cells with positive staining for KIT, CD34, and DOG1 and negative or weak staining for desmin and S-100 protein. A mutation in exon 11 of the c-kit gene was also detected. Cyclosporine was withdrawn and imatinib mesylate (400 mg daily) was introduced. However, thereafter, we needed to decrease the dose at 300 mg daily due to severe hyponatremia. Reduced imatinib treatment was well tolerated and recurrence was not observed for 18 months after surgery. Conclusions: The occurrence of GISTs in transplant patients is rare, and huge GISTs should be resected immediately after diagnosis because gastrointestinal tract at the tumor site could be perforated. Imatinib treatment is feasible in transplant recipients under immunosuppression, although immunosuppressive drugs metabolized by CYP3A4 should be used at a reduced dosage or withdrawn.

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<sup>18</sup> F-Fluoride Positron Emission Tomographic Imaging of Penile Arteries and Erectile Dysfunction

Nakahara T., Narula J., Tijssen J.G.P., Agarwal S., Chowdhury M.M., Coughlin P.A., Dweck M.R., Rudd J.H.F., Jinzaki M., Mulhall J., Strauss H.W.

Journal of the American College of Cardiology （Journal of the American College of Cardiology） 73 （ 12 ） 1386 - 1394 2019年04月

ISSN 07351097

© 2019 Background: Fluorine-18 sodium fluoride (NaF), a bone-seeking radiopharmaceutical used to detect osseous metastases, localizes in regions of microcalcification in atherosclerosis. Objectives: To determine if atherosclerosis of penile arteries plays a role in erectile dysfunction (ED), this study analyzed NaF images in prostate cancer patients. Methods: NaF positron emission tomography–computed tomography bone scans were evaluated in 437 prostate cancer patients (age 66.6 ± 8.7 years). Their urologic histories were reviewed for prevalent ED (diagnosed before the scan date) or incident ED (no ED at first scan, but developed during 1-year follow-up); patients with no ED (neither before the scan nor during follow-up) were included as a control group. A semicircular region of interest was set on the dorsal one-half of the penis (to avoid residual excreted activity in the urethra) on 5 contiguous slices at the base of the penis on positron emission tomography–computed tomography coronal reconstructions, and the average standardized uptake value (SUVmax) was described as NaF uptake. Results: Of 437 patients, 336 (76.9%) had prevalent ED, 60 incident ED (13.7%), and 41 had no ED (9.4%). SUVmax in patients with prevalent (median 1.88; interquartile range [IQR]: 1.67 to 2.16) or incident (median 1.86; IQR: 1.72 to 2.08) ED was significantly higher than no ED (median 1.42; IQR: 1.25 to 1.54) patients (p < 0.001). After adjustment for other risk factors, the odds ratio of prevalent or incident ED was 25.2 (95% confidence interval: 9.5 to 67.0) for every 0.5-U increment in SUVmax with receptor operating characteristic area of 0.91 (95% confidence interval: 0.88 to 0.94). Conclusions: NaF uptake in penile vessels suggests that atherosclerosis is associated with ED in prostate cancer patients. The importance of NaF uptake needs to be tested in noncancer subjects and cause-effect relationship needs to be established.

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Bridging vein and tentorial sinus in the subtemporal corridor during the anterior transpetrosal approach

Shibao S., Toda M., Fujiwara H., Jinzaki M., Yoshida K.

Acta Neurochirurgica （Acta Neurochirurgica） 161 （ 4 ） 821 - 829 2019年04月

ISSN 00016268

© 2019, Springer-Verlag GmbH Austria, part of Springer Nature. Background: The bridging vein (BV) and the tentorial sinus (TenS) are important venous structures in neurological surgery. These venous structures during the anterior transpetrosal approach (ATPA) have not been reported. The objective of this study is to examine the BV and the TenS in the subtemporal corridor during the ATPA and propose a technique to identify the BV preoperatively. Methods: This study included 126 patients treated via the ATPA. The BV and the TenS located in the operative fields were analyzed. Furthermore, in the preoperative evaluation, the cross-sectional shapes of the intradural vein and the interdural sinus were analyzed by curved planar reconstruction (CPR), and the flattening rate was calculated. Flattening rate = (a-b)/a = 1-b/a (a: long radius, b: short radius). Results: Seventeen BVs and 18 TenS were identified. The bridging site was divided into two groups: tentorial and middle fossa. The middle fossa group was divided into three subgroups: cavernous sinus, middle fossa dural sinus, and middle fossa dural adherence. Five isolated TenS were sacrificed and no venous complications were observed. The mean flattening rate was 0.13 in the intradural vein and 0.51 in the interdural sinus, respectively (P = 0.0003). Conclusions: We showed classification of the BV, and preservation of the BV and TenS during the ATPA. Furthermore, we found that the interdural sinus was significantly flatter than the intradural veins. Measuring the flattening rate by CPR may be useful to identify BVs preoperatively.

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Time-resolved quantitative evaluation of diaphragmatic motion during forced breathing in a health screening cohort in a standing position: Dynamic chest phrenicography

Hida T., Yamada Y., Ueyama M., Araki T., Nishino M., Kurosaki A., Jinzaki M., Honda H., Hatabu H., Kudoh S.

European Journal of Radiology （European Journal of Radiology） 113 59 - 65 2019年04月

ISSN 0720048X

© 2019 The Authors Objective: To assess diaphragmatic motion during forced breathing in a health screening center cohort by time-resolved quantitative analysis using dynamic chest radiography and demonstrate the characteristics and associations with demographics and pulmonary function of participants. Materials and methods: This prospective study includes 174 volunteers (99 males; median 57, range 36–93 years old) that underwent dynamic chest radiography with a flat panel detector system during forced breathing in a standing position. We automatically tracked and recorded the positions of the top of the diaphragms and the excursions on images of each participant and calculated peak motion speeds based on the data. We investigated the associations with demographics and pulmonary function statistically. Results: The average excursions of the diaphragms during forced breathing were 49.1 ± 17.0 mm (right; mean ± standard deviation) and 52.1 ± 15.9 mm (left). The peak motion speeds were 26.7 ± 10.0 mm/s (right) and 32.2 ± 12.4 mm/s (left) in the inspiratory phase and 22.1 ± 12.7 mm/s (right) and 24.3 ± 10.3 mm/s (left) in the expiratory phase. Excursions and peak motion speeds of the left diaphragm were significantly greater than the right. Higher body mass index (BMI) and vital capacity (VC) were associated with greater excursions and faster peak motion speeds of the diaphragms. Conclusions: Time-resolved quantitative analysis of the diaphragms with dynamic chest radiography demonstrated the characteristics of diaphragmatic motion during forced breathing in a health screening cohort. Higher BMI and VC were associated with excursions and peak motion speeds of the diaphragms.

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特集肺に淡い陰影が広がっていたらどう診断するか? アレルギー性肺疾患を疑うとき

松本晋作, 杉浦弘明, 南康大, 陣崎雅弘

画像診断（学研メディカル秀潤社） 39 （ 5 ） 419 - 429 2019年03月

ISSN 0285-0524

Focal 123I-MIBG Uptake in the Medial Segment of the Normal Liver

Matsusaka Y., Nakahara T., Iwabuchi Y., Minami Y., Jinzaki M.

Clinical Nuclear Medicine （Clinical Nuclear Medicine） 44 （ 3 ） e170 - e171 2019年03月

ISSN 03639762

© 2019 Wolters Kluwer Health, Inc. All rights reserved. An 84-year-old man with parkinsonism was referred for 123 I-MIBG scintigraphy. Abnormal uptake in the right upper abdomen was incidentally seen in planar image, and SPECT revealed focal uptake in the medial segment (S4) of the liver. Subsequent triple-phase contrast-enhanced CT showed no evidence of hepatic tumors, although in the arterial phase, there were an enhanced region corresponding to the uptake area and the enhanced vein of Sappey that flowed into S4. In this case, the focal 123 I-MIBG uptake would be attributable to hemodynamic change in the liver.

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Decreased and slower diaphragmatic motion during forced breathing in severe COPD patients: Time-resolved quantitative analysis using dynamic chest radiography with a flat panel detector system

Hida T., Yamada Y., Ueyama M., Araki T., Nishino M., Kurosaki A., Jinzaki M., Honda H., Hatabu H., Kudoh S.

European Journal of Radiology （European Journal of Radiology） 112 28 - 36 2019年03月

ISSN 0720048X

© 2019 Elsevier B.V. Objective: To assess the diaphragmatic motion in chronic obstructive pulmonary disease (COPD) patients during forced breathing by time-resolved quantitative analysis using dynamic chest radiography and to demonstrate the characteristics and the difference from that in normal subjects. Materials and methods: Thirty-one COPD patients and a matched control of 31 normal subjects on age, sex, height, and weight, who underwent chest radiographs during forced breathing using dynamic chest radiography, were included in this study. COPD patients were classified based on the criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (GOLD 1, n = 3; GOLD 2, n = 12; GOLD 3, n = 13; GOLD 4, n = 3). We measured excursions and peak motion speeds of the diaphragms for each participant. We compared the results among GOLD 1/2, GOLD 3/4 groups and normal subjects and investigated associations between the data, and participants’ demographics, or pulmonary function. Results: The excursions of bilateral diaphragms were significantly decreased in the GOLD 3/4 group relative to normal subjects (right, 39.8 ± 15.3 mm vs. 52.7 ± 15.1 mm, P = 0.030; left, 43.7 ± 14.0 mm vs. 56.9 ± 15.5 mm, P = 0.017; mean ± standard deviation) and the GOLD 1/2 group (right, 39.8 ± 15.3 mm vs. 54.4 ± 16.7 mm, P = 0.036; left, 43.7 ± 14.0 mm vs. 60.5 ± 13.9 mm, P = 0.008). The peak motion speeds of the left diaphragm in the inspiratory phase were slower in the GOLD 1/2 group than in normal subjects (24.5 ± 8.0 mm/s vs. 33.6 ± 14.0 mm/s, P = 0.038), and in the GOLD 3/4 group than in normal subjects (25.6 ± 6.8 mm/s vs. 33.6 ± 14.0 mm/s, P = 0.067). The excursions of the diaphragms showed correlation with VC, %VC, and FEV 1 , while the peak motion speeds showed no significant correlation with pulmonary function tests. Conclusions: Time-resolved quantitative analysis of diaphragms with dynamic chest radiography indicated differences in diaphragmatic motion between COPD groups and normal subjects during forced breathing. The excursions of the diaphragms during forced breathing were significantly lower in the GOLD 3/4 group than those in the GOLD 1/2 group and normal subjects.

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Current Topics 血管損傷に対するステントグラフト　ゴア　バイアバーン　ステントグラフト使用の初期経験

井上政則, 中塚誠之, 長谷学, 鳥飼秀幸, 田村全, 塚田実郎, 伊東伸剛, 陣崎雅弘, 御須学, 屋代英樹, 増田真木子

臨床画像（(株)メジカルビュー社） 35 （ 2 ） 229 - 233 2019年02月

ISSN 0911-1069

Pre-donation BMI and preserved kidney volume can predict the cohort with unfavorable renal functional compensation at 1-year after kidney donation

Shinoda K., Morita S., Akita H., Tamaki S., Takahashi R., Kono H., Asanuma H., Kikuchi E., Jinzaki M., Nakagawa K., Oya M.

BMC Nephrology （BMC Nephrology） 20 （ 1 ） 2019年02月

© 2019 The Author(s). Background: The magnitude of renal function recovery after kidney donation differs in donors with a heterogeneous background. Preoperative assessment of candidates with potentially unfavorable renal functional compensation is critical when baseline kidney function is marginal. We explored the significance of preserved kidney volume (PKV) and known preoperative risk factors for the prediction of unfavorable renal function compensation. Methods: We enrolled 101 living donors for whom a 1-mm sliced enhanced computed tomography scan was performed preoperatively and clinical data could be collected up to 1 year after donation. The donors whose estimated glomerular filtration rate (eGFR) at 1 year after donation was 70% or higher of baseline eGFR were assigned to the "favorable renal compensation" group and the others to the "unfavorable renal compensation" group. Results: Age, sex, and preoperative serum uric acid level were not significant predictors for "unfavorable renal compensation." Multivariable logistic regression analysis revealed that body mass index (BMI) and body surface area (BSA)-adjusted PKV were independent preoperative risk factors for "unfavorable renal compensation" (adjusted odds ratio, 1.342 and 0.929, respectively). Hypertension and preoperative eGFR were not independent predictors when adjusted with BMI and BSA-adjusted PKV. Receiver operative characteristic analysis revealed that the predictive equation with the two independent predictors yielded a good accuracy to detect donor candidates with unfavorable renal functional compensation (area under the curve = 0.803), and the optimal cut-off values were identified as 23.4 kg/m 2 for BMI and 107.3 cm 3 /m 2 for BSA-adjusted PKV. Conclusions: BMI and BSA-adjusted PKV may be useful to select candidates with potentially unfavorable renal function compensation before kidney donation.

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Early and late leaflet thrombosis after transcatheter aortic valve replacement: A multicenter initiative from the OCEAN-TAVI registry

Yanagisawa R., Tanaka M., Yashima F., Arai T., Jinzaki M., Shimizu H., Fukuda K., Watanabe Y., Naganuma T., Higashimori A., Mizutani K., Araki M., Tada N., Yamanaka F., Otsuka T., Yamamoto M., Hayashida K.

Circulation: Cardiovascular Interventions （Circulation: Cardiovascular Interventions） 12 （ 2 ） 2019年02月

ISSN 19417640

© 2019 American Heart Association, Inc. Background: The occurrence and clinical impact of untreated subclinical leaflet thrombosis beyond 1 year after transcatheter aortic valve replacement still remain unclear. Methods and Results: In a multicenter transcatheter aortic valve replacement registry, we analyzed data from 485 patients who underwent 4-dimensional multidetector computed tomography posttranscatheter aortic valve replacement performed to survey hypoattenuated leaflet thickening with reduced leaflet motion compatible with thrombus at a median of 3 days, 6 months, 1 year, 2 years, and 3 years. Incidence, predictors, and clinical outcomes of early (median 3 days) and late (>30 days) leaflet thrombosis were assessed. Additional anticoagulation was not administered because of subclinical findings at the time of computed tomography in all patients. Early leaflet thrombosis occurred in 45 (9.3%) of 485 patients. Mean pressure gradient at discharge was higher in patients with early leaflet thrombosis than in those without. Independent predictors of early leaflet thrombosis in balloon-expandable prostheses were low-flow, low-gradient aortic stenosis, severe prosthesis-patient mismatch, and 29-mm prostheses. No predictors could be identified for self-expanding prosthesis. Cumulative event rates of death, stroke, or rehospitalization for heart failure over 2 years were 10.7% and 16.9% in patients with and without early leaflet thrombosis, respectively (P=0.63). Late leaflet thrombosis occurred late up to 3 years, and male sex and paravalvular leak less than mild were independent predictors. Conclusions: Untreated early leaflet thrombosis did not affect the cumulative event rates of death, stroke, and rehospitalization for heart failure. Late leaflet thrombosis was newly detected during 3-year follow-up.

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Quantitative CT-based bone strength parameters for the prediction of novel spinal implant stability using resonance frequency analysis: a cadaveric study involving experimental micro-CT and clinical multislice CT

Nakashima D., Ishii K., Nishiwaki Y., Kawana H., Jinzaki M., Matsumoto M., Nakamura M., Nagura T.

European radiology experimental （European radiology experimental） 3 （ 1 ） 2019年01月

BACKGROUND: To predict conventional test forces (peak torque and pull-out force) and a new test force (implant stability quotient [ISQ] value of a spinal pedicle screw) from computed tomography (CT) parameters, including micro-architectural parameters, using high-resolution micro-CT and clinical multislice CT (MSCT) in human cadaveric vertebrae. METHODS: Micro-CT scans before/after screw insertion (n = 68) and MSCT scans before screw insertion (n = 58) of human cadaveric vertebrae were assessed for conventional test forces and ISQ value. Three-dimensional volume position adjustment between pre-insertion micro-CT and MSCT scans and post-insertion scans (micro-CT) was performed to extract the volume of the cancellous bone surrounding the pedicle screw. The following volume bone mineral density and micro-architectural parameters were calculated: bone volume fraction, bone surface density (bone surface/total volume (BS/TV)), trabecular thickness, trabecular separation, trabecular number, structure model index, and number of nodes (branch points) of the cancellous bone network/total volume (NNd/TV) using Spearman's rank correlation coefficient with Bonferroni correction. RESULTS: Conventional test forces showed the strongest correlation with BS/TV: peak torque, ρ = 0.811, p = 4.96 × 10-17(micro-CT) and ρ = 0.730, p = 7.87 × 10-11 (MSCT); pull-out force, ρ = 0.730, p = 1.64 × 10-12 (micro-CT) and ρ = 0.693, p = 1.64 × 10-9 (MSCT). ISQ value showed the strongest correlation with NNd/TV: ρ = 0.607, p = 4.01 × 10-8 (micro-CT) and ρ = 0.515, p = 3.52 × 10-5 (MSCT). CONCLUSIONS: Test forces, including the ISQ value, can be predicted using micro-CT and MSCT parameters. This is useful for establishing a preoperative fixation strength evaluation system.

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4DCTを用いた橈骨月状骨窩の応力解析

大木聡, 稲葉尚人, 岩本卓士, 松村昇, 陣崎雅弘, 佐藤和毅

日本手外科学会雑誌（(一社)日本手外科学会） 35 （ 4 ） 800 - 803 2019年01月

ISSN 2185-4092

我々は手関節自動運動中の橈骨月状骨面の月状骨接触領域を4DCTを用いて計測した.健常ボランティア8名(男性4名,女性4名)を対象とし,4DCT撮影を手関節掌背屈運動,前腕回内外運動について行った.最大掌屈位,中間位,最大背屈位と最大回内位,中間位,最大回外位のフレームでの月状骨と橈骨月状骨窩の表面間距離を計算し,表面間距離1.5mm以下の部分を推定接触領域と定義した.月状骨の重心位置の橈骨関節面の前後方向への変位も計算した.推定接触領域は中間位と比較し,背屈位と回内位で有意に増加していた.月状骨重心位置は中間位と比較して背屈位と回内位で掌側へ有意に移動していた.月状骨窩掌側への応力集中は背屈位に加え,回内位で大きくなることが推測される.これらの肢位における橈骨月状骨面への荷重変化を考慮して保存加療や手術後の後療法を施行することが重要であると考える.(著者抄録)

Hemodynamic stress distribution identified by SPECT reflects ischemic symptoms of Moyamoya disease patients

Arai N., Horiguchi T., Takahashi S., Nakahara T., Akiyama T., Jinzaki M., Yoshida K.

Neurosurgical Review （Neurosurgical Review） 43 （ 5 ） 1323 - 1329 2019年

ISSN 03445607

© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. This study aimed to validate the hypothesis that the ratio of cerebral blood flow (CBF) at rest in the lenticular nucleus (LN) territory to that in the middle cerebral artery (MCA) territory is higher in symptomatic Moyamoya disease (MMD) patients than in asymptomatic MMD patients. This was a retrospective observational study of adult patients with documented MMD who underwent single-photon emission computed tomography (SPECT) and had been examined at the Department of Neurosurgery of Keio University Hospital during a 10-year period (2006–2016). The diagnosis was made on the basis of typical imaging findings. We classified unoperated MMD patients into three groups: class I, no evidence of stenosis or occlusion hemispheres and without symptoms in unilateral MMD patients; class II, hemispheres with stenosis or occlusion but without ischemic symptoms; and class III, hemispheres with evidence of stenosis or occlusion associated with ischemic symptoms. Hemodynamic stress distribution (hdSD) was defined as the ratio of CBF in one LN to the CBF in the peripheral MCA; this was obtained by SPECT at rest. We compared the values of CBF and hdSD among the groups. A total of 173 adult patients were diagnosed with MMD from January 1, 2006, to January 1, 2016. Among them, 85 MMD patients underwent SPECT studies. After excluding inappropriate cases, 144 hemispheres were included in our analysis. hdSD was significantly higher (p < 0.001) in hemispheres with ischemic symptoms (class III, mean hdSD = 1.1; 36 sides) than in those without symptoms (class II, mean hdSD = 1.03; 82 sides). However, CBF at rest in the MCA or LN was not significantly associated with ischemic symptoms. The optimal threshold for hdSD to have ischemic symptoms was 1.040 (area under the curve; 74% sensitivity 91.7% and specificity 54.9%). We used SPECT to investigate cerebral blood from MMD patients and found that high hdSD values were predictive of ischemic symptom development in these patients.

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Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: Meta-analysis of individual patient data

Haase R., Schlattmann P., Gueret P., Andreini D., Pontone G., Alkadhi H., Hausleiter J., Garcia M.J., Leschka S., Meijboom W.B., Zimmermann E., Gerber B., Schoepf U.J., Shabestari A.A., Nørgaard B.L., Meijs M.F.L., Sato A., Ovrehus K.A., Diederichsen A.C.P., Jenkins S.M.M., Knuuti J., Hamdan A., Halvorsen B.A., Mendoza-Rodriguez V., Rochitte C.E., Rixe J., Wan Y.L., Langer C., Bettencourt N., Martuscelli E., Ghostine S., Buechel R.R., Nikolaou K., Mickley H., Yang L., Zhang Z., Chen M.Y., Halon D.A., Rief M., Sun K., Hirt-Moch B., Niinuma H., Marcus R.P., Muraglia S., Jakamy R., Chow B.J., Kaufmann P.A., Tardif J.C., Nomura C., Kofoed K.F., Laissy J.P., Arbab-Zadeh A., Kitagawa K., Laham R., Jinzaki M., Hoe J., Rybicki F.J., Scholte A., Paul N., Tan S.Y., Yoshioka K., Röhle R., Schuetz G.M., Schueler S., Coenen M.H., Wieske V., Achenbach S., Budoff M.J., Laule M., Newby D.E., Dewey M.

The BMJ （The BMJ） 365 2019年

ISSN 09598146

© 2019 Published by the BMJ Publishing Group Limited. Objective To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. Design Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. Data sources Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. Eligibility criteria for selecting studies Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. Results Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were obtained using CTA. At a pretest probability of 7%, the positive predictive value of CTA was 50.9% (95% confidence interval 43.3% to 57.7%) and the negative predictive value of CTA was 97.8% (96.4% to 98.7%); corresponding values at a pretest probability of 67% were 82.7% (78.3% to 86.2%) and 85.0% (80.2% to 88.9%), respectively. The overall sensitivity of CTA was 95.2% (92.6% to 96.9%) and the specificity was 79.2% (74.9% to 82.9%). CTA using more than 64 detector rows was associated with a higher empirical sensitivity than CTA using up to 64 rows (93.4% v 86.5%, P=0.002) and specificity (84.4% v 72.6%, P<0.001). The area under the receiver-operating-characteristic curve for CTA was 0.897 (0.889 to 0.906), and the diagnostic performance of CTA was slightly lower in women than in with men (area under the curve 0.874 (0.858 to 0.890) v 0.907 (0.897 to 0.916), P<0.001). The diagnostic performance of CTA was slightly lower in patients older than 75 (0.864 (0.834 to 0.894), P=0.018 v all other age groups) and was not significantly influenced by angina pectoris type (typical angina 0.895 (0.873 to 0.917), atypical angina 0.898 (0.884 to 0.913), non-anginal chest pain 0.884 (0.870 to 0.899), other chest discomfort 0.915 (0.897 to 0.934)). Conclusions In a no-treat/treat threshold model, the diagnosis of obstructive CAD using coronary CTA in patients with stable chest pain was most accurate when the clinical pretest probability was between 7% and 67%. Performance of CTA was not influenced by the angina pectoris type and was slightly higher in men and lower in older patients. Systematic review registration PROSPERO CRD42012002780.

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陣崎 雅弘

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陣崎　雅弘

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