研究者詳細 - 陣崎　雅弘

論文 - 陣崎　雅弘

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Impact of noise reduction on radiation dose reduction potential of virtual monochromatic spectral images: Comparison of phantom images with conventional 120 kVp images using deep learning image reconstruction and hybrid iterative reconstruction

Masuda S., Yamada Y., Minamishima K., Owaki Y., Yamazaki A., Jinzaki M.

European Journal of Radiology （European Journal of Radiology） 149 2022年04月

ISSN 0720048X

Purpose: To assess the effects of deep learning image reconstruction (DLIR) and hybrid iterative reconstruction (HIR) on the image quality of virtual monochromatic spectral (VMS) images and to investigate the dose reduction potential of the VMS and conventional 120 kVp images. Methods: A cylindrical phantom simulating an adult abdomen was used. The contrast was set to 60 (medium) and 300 (high) Hounsfield units. CT acquisitions were performed at three dose levels: 12, 9, and 6 mGy. Images were reconstructed via filtered back projection (FBP), DLIR, and HIR. The noise power spectrum (NPS) and task transfer function (TTF) were measured, and the system performance (SP) function was calculated (TTF2/NPS). Results: The noise magnitudes at low spatial frequencies with DLIR and HIR were lower than that with FBP by 45.6% and 24.4%, respectively. Compared to the FBP results, the TTF values at 50% with DLIR at medium and high contrast changed by –13.2% and +25.3% with the VMS images and –2.0% and +9.3% with the 120 kVp images, respectively. In the VMS and 120 kVp images, compared to the SP values of 12 mGy FBP images, SP values of 6 mGy DLIR images decreased at medium contrast and increased at high contrast. Conclusions: DLIR achieved better noise reduction than HIR. The spatial resolution of VMS-DLIR varied significantly depending on the contrast. The image quality of VMS-DLIR and 120 kVp-DLIR potentially decrease in medium contrast tasks and increase in high contrast tasks with 50% dose reduction.

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Does neoadjuvant chemotherapy have therapeutic benefit for node-positive upper tract urothelial carcinoma? Results of a multi-center cohort study

Shigeta K., Matsumoto K., Ogihara K., Murakami T., Anno T., Umeda K., Izawa M., Baba Y., Sanjo T., Shojo K., Tanaka N., Takeda T., Morita S., Kosaka T., Mizuno R., Arita Y., Akita H., Jinzaki M., Kikuchi E., Oya M.

Urologic Oncology: Seminars and Original Investigations （Urologic Oncology: Seminars and Original Investigations） 40 （ 3 ） 105.e19 - 105.e26 2022年03月

ISSN 10781439

Objective: The indications of neoadjuvant chemotherapy (NAC) for lymph node-positive upper tract urothelial carcinoma (UTUC) have not been investigated regarding improved survival outcomes. Our specific aim was to compare the clinical outcomes of clinically node-positive UTUC patients who were treated by NAC followed by radical nephroureterectomy (RNU) or upfront RNU followed by adjuvant chemotherapy (AC). Materials and methods: Among 966 UTUC patients, we identified 89 with clinical nodal involvement who received either NAC before RNU nor AC after upfront RNU. Cox proportional hazard models were employed to evaluate the impact of chemotherapy modality on the oncological outcomes. Results: Of the patient cohort, 36 (40.4%) received NAC followed by RNU, whereas 53 (59.6%) underwent RNU followed by AC. Multivariate analysis revealed that tumor size ≥3 cm, clinical T4, and gemcitabine and cisplatin regimen were independent risk factors for disease recurrence, whereas NAC followed by RNU was an independent factor for favorable RFS. Furthermore, regarding cancer-specific survival (CSS), NAC followed by RNU remained an independent factor for favorable CSS. According to Kaplan-Meier analysis, the 1-year and 2-year RFS were 67.9% and 47.0%, respectively, in the NAC+RNU group, which were significantly higher than those in the RNU+AC group (43.9% and 24.6%, respectively, P = 0.006). Moreover, the 1-year and 2-year CSS were 80.5% and 64.2%, respectively, in the NAC+RNU group, which were higher than those in the RNU+AC group (68.6% and 48.2%, respectively, P = 0.016). Conclusion: For node-positive UTUC patients, NAC followed by RNU was more clinically beneficial than RNU followed by AC.

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Photoacoustic lymphangiography exhibits advantages over near-infrared fluorescence lymphangiography as a diagnostic tool in patients with lymphedema

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

Journal of Vascular Surgery: Venous and Lymphatic Disorders （Journal of Vascular Surgery: Venous and Lymphatic Disorders） 10 （ 2 ） 454 - 462.e1 2022年03月

ISSN 2213333X

Objective: Photoacoustic imaging is a new technique that can evaluate the vascular system using photoacoustic effects. The present study compared the ability of the new photoacoustic lymphangiography (PAL) method and more standard near-infrared fluorescence (NIRF) to image the lymphatic system in patients with secondary lymphedema after gynecological cancer surgery. Methods: Patients with secondary lymphedema in the lower extremities after gynecologic cancer surgery, who were assessed using PAL between May 2018 and January 2019, were recruited. NIRF was performed first using 5.0 mg/mL of indocyanine green injected using a 0.2-cc 30-gauge needle. Correlations between NIRF and PAL findings on patient images were subsequently examined. Results: Seventeen patients with secondary lymphedema were enrolled. The mean age of the patients was 61 ± 11 years. The imaging sites were the medial lower leg in 15 patients, the posterior lower leg in 9 patients, the lateral lower leg in 7 patients, the medial knee in 4 patients, and other areas in 3 patients. A total of 38 pictures were obtained. Five distinct lymphatic patterns were observed over the entire sample using PAL: straight, winding, spiderweb, nebulous, and black-out pattern. Eighteen of the 24 limbs (75%) that exhibited a linear pattern in NIRF exhibited a straight pattern in PAL, and 19 of the 20 limbs (95%) that exhibited a splash pattern in NIRF exhibited a winding or spiderweb pattern in PAL. Eight limbs exhibiting diffuse patterns without linear or splash patterns with NIRF were all nebulous or black-out patterns in PAL. This suggests that more severe lymphatic degeneration was associated with poorer visualization in PAL. Conclusions: NIRF plays an important role in lymphedema treatment. In the present study, various PAL patterns were compared with those observed using NIRF. PAL provided clearer images including transectional views, which were not available using NIRF, and may promote further understanding of the changes in the lymphatic structure and function in patients with secondary lymphedema.

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Lower limb lymphedema staging based on magnetic resonance lymphangiography

Soga S., Onishi F., Mikoshi A., Okuda S., Jinzaki M., Shinmoto H.

Journal of Vascular Surgery: Venous and Lymphatic Disorders （Journal of Vascular Surgery: Venous and Lymphatic Disorders） 10 （ 2 ） 445 - 453.e3 2022年03月

ISSN 2213333X

Objective: Dermal backflow (DBF) and reduced lymphatic visualization are common findings of lymphedema on various imaging modalities. However, there is a lack of knowledge about how these findings vary with the anatomic location and severity of lymphedema, and previous reports using indocyanine green lymphography or lymphoscintigraphy show variable results. Magnetic resonance lymphangiography (MRL) is expected to clarify this clinical question due to its superior ability for lymphatic visualization. This retrospective study aimed to investigate the following: (1) Are there any characteristic patterns for DBF and lymphatics' visualization, depending on the anatomic location within lower limbs and severity of lymphedema? (2) Is it possible to classify the severity of lymphedema based on MRL findings? Methods: Two radiologists performed consensus readings of MRL of 56 patients (112 limbs) with lower-limb lymphedema. The frequency of visualized DBF and lymphatics was analyzed in six regions in each lower limb. The results were compared with the International Society of Lymphology clinical stages and etiology of lymphedema. Characteristic findings were categorized and compared with the clinical stage and duration of lymphedema. Results: DBF and lymphatics were observed more frequently in the distal regions than the proximal regions of lower limbs. DBF appeared more frequently as the clinical stage increased, reaching statistical significance (P < 10−3) between stages 0 or I and II. DBF above the knee joint was rarely observed (0.48%) in early stages (0 and I) but appeared more frequently (13.5%, P < 10−5) in stage II. Lymphatics appeared less frequently as the stage progressed, with significant differences (P <.05) between stages I and II and between II and III. The frequency of lymphatics above the knee joint decreased significantly (P <.05) between stages I and II and between II and III as the stage progressed, reaching 0% in stage III. An MRL staging was proposed and showed significant positive correlations with the clinical stage (r = 0.79, P <.01) and the duration of lymphedema (r = 0.57, P <.01). Conclusions: MRL-specific patterns of DBF and lymphatics that depended on the site within the lower limb and clinical stage were shown. The DBF pattern differed from those observed in previous studies with other imaging techniques. The proposed MRL staging based on these characteristic findings allows new stratification of patients with lymphedema. Combined with its excellent ability to visualize lymphatic anatomy, MRL could enable a more detailed understanding of individual patient's pathology, useful for determining the most appropriate treatment.

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Three-Dimensional Innate Mobility of the Human Foot on Coronally-Wedged Surfaces Using a Biplane X-Ray Fluoroscopy

Negishi T., Nozaki S., Ito K., Seki H., Hosoda K., Nagura T., Imanishi N., Jinzaki M., Ogihara N.

Frontiers in Bioengineering and Biotechnology （Frontiers in Bioengineering and Biotechnology） 10 2022年02月

Improving our understanding on how the foot and ankle joints kinematically adapt to coronally wedged surfaces is important for clarifying the pathogenetic mechanism and possible interventions for the treatment and prevention of foot and lower leg injuries. It is also crucial to interpret the basic biomechanics and functions of the human foot that evolved as an adaptation to obligatory bipedal locomotion. Therefore, we investigated the three-dimensional (3D) bone kinematics of human cadaver feet on level (0°, LS), medially wedged (−10°, MWS), and laterally wedged (+10°, LWS) surfaces under axial loading using a biplanar X-ray fluoroscopy system. Five healthy cadaver feet were axially loaded up to 60 kg (588N) and biplanar fluoroscopic images of the foot and ankle were acquired during axial loading. For the 3D visualization and quantification of detailed foot bony movements, a model-based registration method was employed. The results indicated that the human foot was more largely deformed from the natural posture when the foot was placed on the MWS than on the LWS. During the process of human evolution, the human foot may have retained the ability to more flexibly invert as in African apes to better conform to MWS, possibly because this ability was more adaptive even for terrestrial locomotion on uneven terrains. Moreover, the talus and tibia were externally rotated when the foot was placed on the MWS due to the inversion of the calcaneus, and they were internally rotated when the foot was placed on the LWS due to the eversion of the calcaneus, owing to the structurally embedded mobility of the human talocalcaneal joint. Deformation of the foot during axial loading was relatively smaller on the MWS due to restricted eversion of the calcaneus. The present study provided new insights about kinematic adaptation of the human foot to coronally wedged surfaces that is inherently embedded and prescribed in its anatomical structure. Such detailed descriptions may increase our understanding of the pathogenetic mechanism and possible interventions for the treatment and prevention of foot and lower leg injuries, as well as the evolution of the human foot.

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Diagnostic performance of the vesical imaging-reporting and data system for detecting muscle-invasive bladder cancer in real clinical settings: Comparison with diagnostic cystoscopy

Kufukihara R., Kikuchi E., Shigeta K., Ogihara K., Arita Y., Akita H., Suzuki T., Abe T., Mizuno R., Jinzaki M., Oya M.

Urologic Oncology: Seminars and Original Investigations （Urologic Oncology: Seminars and Original Investigations） 40 （ 2 ） 61.e1 - 61.e8 2022年02月

ISSN 10781439

Purpose: We herein compared the diagnostic performance of Vesical Imaging-Reporting and Data System (VI-RADS) scoring with diagnostic cystoscopy and evaluated diagnostic accuracies based on tumor locations. Materials and Methods: Among 112 bladder cancer patients who underwent multiparametric magnetic resonance imaging and diagnostic cystoscopy preoperatively to detect bladder cancer, 61 were analyzed. VI-RADS was categorized into 5 stages by 2 radiologists (R1 and R2). Cut-off values ≥3 indicated muscle-invasive bladder cancer (MIBC). Muscle invasion (MI) was visually evaluated using diagnostic cystoscopy by 2 urologists (U1 and U2). The sensitivity and specificity of VI-RADS scores and diagnostic cystoscopy for diagnosing MI were compared. Results: 16 patients (26.2%) were pathologically diagnosed with MIBC. Regarding MI diagnostic accuracy, the sensitivity/specificity of VI-RADS scores were 93.8/88.9% by R1 and 87.5/86.7% by R2, while those of diagnostic cystoscopy were 56.3/68.9% by U1 and 68.8/84.4% by U2. Therefore, the diagnostic accuracy of VI-RADS was significantly higher than that of cystoscopy, particularly for tumors located on the bladder neck, trigone, dome, and posterior and anterior walls. Over- and under-diagnosis rates were higher with VI-RADS than with diagnostic cystoscopy (25.9% vs. 14.8%) for tumors located on the lateral wall or ureteral orifice. Conclusion: VI-RADS had superior diagnostic performance for detecting MI, especially in tumors located at the bladder neck/trigone/dome/posterior and anterior wall. However, VI-RADS was inferior to cystoscopy in terms of MI detection for tumors located on the lateral wall or ureteral orifice. Therefore, a combination of diagnostic tools is recommended for the accurate staging of these tumors.

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Comparative Functional Morphology of Human and Chimpanzee Feet Based on Three-Dimensional Finite Element Analysis

Ito K., Nakamura T., Suzuki R., Negishi T., Oishi M., Nagura T., Jinzaki M., Ogihara N.

Frontiers in Bioengineering and Biotechnology （Frontiers in Bioengineering and Biotechnology） 9 2022年01月

To comparatively investigate the morphological adaptation of the human foot for achieving robust and efficient bipedal locomotion, we develop three-dimensional finite element models of the human and chimpanzee feet. Foot bones and the outer surface of the foot are extracted from computer tomography images and meshed with tetrahedral elements. The ligaments and plantar fascia are represented by tension-only spring elements. The contacts between the bones and between the foot and ground are solved using frictionless and Coulomb friction contact algorithms, respectively. Physiologically realistic loading conditions of the feet during quiet bipedal standing are simulated. Our results indicate that the center of pressure (COP) is located more anteriorly in the human foot than in the chimpanzee foot, indicating a larger stability margin in bipedal posture in humans. Furthermore, the vertical free moment generated by the coupling motion of the calcaneus and tibia during axial loading is larger in the human foot, which can facilitate the compensation of the net yaw moment of the body around the COP during bipedal locomotion. Furthermore, the human foot can store elastic energy more effectively during axial loading for the effective generation of propulsive force in the late stance phase. This computational framework for a comparative investigation of the causal relationship among the morphology, kinematics, and kinetics of the foot may provide a better understanding regarding the functional significance of the morphological features of the human foot.

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A novel technique for automating stiffness measurement and emphasizing the main wave: Coherent-wave auto-selection (CHASE)

Ito D., Numano T., Habe T., Mizuhara K., Arita Y., Soga S., Okuda S., Jinzaki M.

Magnetic Resonance Imaging （Magnetic Resonance Imaging） 85 133 - 140 2022年01月

ISSN 0730725X

This study aims to develop and assess a new automated processing technique in MR elastography (MRE), namely coherent-wave auto-selection (CHASE). CHASE enables automatic selection of the region of interest (ROI) for stiffness measurement by extraction of the coherent wave region (CHASE ROI), and it improves the reconstruction of stiffness by a directional filter oriented along the main wave in each pixel (CHASE filtering). In this study, MRE of a phantom and of the liver of four healthy volunteers was performed. To investigate the potential of CHASE, this study assessed the CHASE according to three indices through the phantom study: 1) agreement on the ROI settings between CHASE and expert observers, 2) noise dependency, and 3) effect of the CHASE on stiffness variability within the CHASE ROI. The agreements on the ROI settings were analyzed by Cohen's kappa coefficient (κ). The noise dependency was analyzed by the mean absolute percentage errors (MAPEs) within the ROI between low (20%–80% amplitudes) and high vibration amplitudes (100% amplitude). The stiffness variability was assessed by standard deviation (SD) within the ROI. In the volunteer study, agreements on the ROI settings (or stiffness value) and stiffness variability within the CHASE ROI were assessed using κ-value (or intraclass correlation coefficient: ICC) and coefficient of variation, respectively. The results showed close agreement on the ROI settings and stiffness (κ-value: greater than 0.61 in both the phantom and volunteer studies, ICC: 0.97 in the volunteer study). The MAPEs within the CHASE ROI were much smaller than those in the whole region of the phantom (CHASE ROI vs. the whole region at 20% amplitude: 10.3% vs. 50.8%). Moreover, in both the phantom and volunteer studies, the stiffness variation within the CHASE ROI was smaller in the elastogram processed with CHASE filtering than in the unprocessed one. Our results demonstrated that the CHASE has high robustness against noise and the potential to provide ROI settings for stiffness measurement comparable to expert observers, as well as improve the reconstruction of stiffness.

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Development of In Vitro Endothelialised Stents - Review -

Tsukada J., Mela P., Jinzaki M., Tsukada H., Schmitz-Rode T., Vogt F.

Stem Cell Reviews and Reports （Stem Cell Reviews and Reports） 18 （ 1 ） 179 - 197 2022年01月

ISSN 26293269

Endovascular treatment is prevalent as a primary treatment for coronary and peripheral arterial diseases. Although the introduction of drug-eluting stents (DES) dramatically reduced the risk of in-stent restenosis, stent thrombosis persists as an issue. Notwithstanding improvements in newer generation DES, they are yet to address the urgent clinical need to abolish the late stent complications that result from in-stent restenosis and are associated with late thrombus formation. These often lead to acute coronary syndromes with high mortality in coronary artery disease and acute limb ischemia with a high risk of limb amputation in peripheral arterial disease. Recently, a significant amount of research has focused on alternative solutions to improve stent biocompatibility by using tissue engineering. There are two types of tissue engineering endothelialisation methods: in vitro and in vivo. To date, commercially available in vivo endothelialised stents have failed to demonstrate antithrombotic or anti-stenosis efficacy in clinical trials. In contrast, the in vitro endothelialisation methods exhibit the advantage of monitoring cell type and growth prior to implantation, enabling better quality control. The present review discusses tissue-engineered candidate stents constructed by distinct in vitro endothelialisation approaches, with a particular focus on fabrication processes, including cell source selection, stent material composition, stent surface modifications, efficacy and safety evidence from in vitro and in vivo studies, and future directions. Graphical abstract: [Figure not available: see fulltext.]

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Synthetic magnetic resonance imaging for primary prostate cancer evaluation: Diagnostic potential of a non-contrast-enhanced bi-parametric approach enhanced with relaxometry measurements

Arita Y., Akita H., Fujiwara H., Hashimoto M., Shigeta K., Kwee T.C., Yoshida S., Kosaka T., Okuda S., Oya M., Jinzaki M.

European Journal of Radiology Open （European Journal of Radiology Open） 9 2022年01月

Purpose: Bi-parametric magnetic resonance imaging (bpMRI) with diffusion-weighted images has wide utility in diagnosing clinically significant prostate cancer (csPCa). However, bpMRI yields more false-negatives for PI-RADS category 3 lesions than multiparametric (mp)MRI with dynamic-contrast-enhanced (DCE)-MRI. We investigated the utility of synthetic MRI with relaxometry maps for bpMRI-based diagnosis of csPCa. Methods: One hundred and five treatment-naïve patients who underwent mpMRI and synthetic MRI before prostate biopsy for suspected PCa between August 2019 and December 2020 were prospectively included. Three experts and three basic prostate radiologists evaluated the diagnostic performance of conventional bpMRI and synthetic bpMRI for csPCa. PI-RADS version 2.1 category 3 lesions were identified by consensus, and relaxometry measurements (T1-value, T2-value, and proton density [PD]) were performed. The diagnostic performance of relaxometry measurements for PI-RADS category 3 lesions in peripheral zone was compared with that of DCE-MRI. Histopathological evaluation results were used as the reference standard. Statistical analysis was performed using the areas under the receiver operating characteristic curve (AUC) and McNemar test. Results: In 102 patients without significant MRI artefacts, the diagnostic performance of conventional bpMRI was not significantly different from that of synthetic bpMRI for all readers (p = 0.11–0.79). The AUCs of the combination of T1-value, T2-value, and PD (T1 + T2 + PD) for csPCa in peripheral zone for PI-RADS category 3 lesions were 0.85 for expert and 0.86 for basic radiologists, with no significant difference between T1 + T2 + PD and DCE-MRI for both expert and basic radiologists (p = 0.29–0.45). Conclusion: Synthetic MRI with relaxometry maps shows promise for contrast media-free evaluation of csPCa.

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Multisystem Imaging Manifestations of Kawasaki Disease

Tsujioka Y., Handa A., Nishimura G., Miura M., Yokoyama K., Sato K., Handa H., Jinzaki M., Nosaka S., Kono T.

Radiographics （Radiographics） 42 （ 1 ） 268 - 288 2022年01月

ISSN 02715333

Kawasaki disease (KD) is a common pediatric vasculitis syndrome involving medium-and small-sized arteries that is especially preva-lent in early childhood (ie, age 6 months to 5 years). The diagnosis of KD is made on the basis of clinical features, such as fever, char-acteristic mucocutaneous changes, and nonsuppurative cervical lymphadenopathy. However, early diagnosis is often challenging because many children with KD present with atypical symptoms. The most serious complication of KD is coronary artery aneurysm caused by coronary arteritis. Prompt intravenous immunoglobu-lin therapy reduces the risk of cardiac morbidity. In addition, the systemic extension of KD-related vasculitis during the acute phase causes a variety of multisystem manifestations, including encepha-lopathy, stroke, retropharyngeal edema, pericarditis, myocarditis, KD shock syndrome, pulmonary lesions, intestinal pseudo-obstruc-tion, gallbladder hydrops, arthritis, and myositis. These complications tend to be more common in affected children with atypical presentation. Radiologists can play an important role in the timely identification of diverse KD-associated morbidities and thus may contribute to the early diagnosis of atypical KD.

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BCG osteomyelitis: tips for diagnosis

Tsujioka Y., Nozaki T., Nishimura G., Miyazaki O., Jinzaki M., Kono T.

Skeletal Radiology （Skeletal Radiology） 2022年

ISSN 03642348

Objective: To report the clinical and imaging characteristics of BCG-osteomyelitis, and compare them with those of pyogenic osteomyelitis. Materials and methods: Clinical and imaging findings were retrospectively evaluated in 14 children with BCG osteomyelitis, including 3 with Mendelian susceptibility to mycobacterial diseases (MSMD), and in 40 children with pyogenic osteomyelitis, using Fisher exact and Mann-Whitney U tests. Results: BCG-osteomyelitis was an indolent inflammatory disease of young children (mean age 15.5 months). Immunocompetent patients came to medical attention over months after vaccination, while patients with MSMD much earlier (the average time lapse: 13.7 vs. 5.0 months). The former manifested with a slowly progressive, painless mass with only mildly increased acute-phase reactants, while the latter started with lymphadenitis with significant inflammatory reactions and later developed osteomyelitis. These clinical scenarios contrasted with acute febrile illness in pyogenic osteomyelitis. The imaging findings were identical in both immunocompetent and MSMD groups; however, the former showed monoostotic involvement, while the latter polyostotic affliction. The typical imaging finding of BCG-osteomyelitis comprises a large intraosseous abscess with modest reactive edema commonly associated with transphyseal extension from the metaphysis to the epiphysis, contrasting with the manifestation of pyogenic osteomyelitis; size of abscess (p=0.028), pattern of abscess extension (p<0.001), and extent of surrounding edema (p<0.001). Conclusions: BCG-osteomyelitis should be suspected in children under 2 years of age with insidious osteomyelitis, accompanied with characteristic imaging findings. Polyostotic BCG osteomyelitis is highly suggestive of MSMD. Awareness of the distinctive features of BCG-osteomyelitis enables the early diagnosis and timely therapeutic intervention.

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Differences in airway lumen area between supine and upright computed tomography in patients with chronic obstructive pulmonary disease

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

Respiratory Research （Respiratory Research） 22 （ 1 ） 2021年12月

ISSN 14659921

Background: No clinical studies to date have compared the inspiratory and expiratory airway lumen area between supine and standing positions. Thus, the aims of this study were twofold: (1) to compare inspiratory and expiratory airway lumen area (IAA and EAA, respectively) on computed tomography (CT) among supine and standing positions; and (2) to investigate if IAA and EAA are associated with lung function abnormality in patients with chronic obstructive pulmonary disease (COPD). Methods: Forty-eight patients with COPD underwent both low-dose conventional (supine position) and upright CT (standing position) during inspiration and expiration breath-holds and a pulmonary function test (PFT) on the same day. We measured the IAA and EAA in each position. Results: For the trachea to the third-generation bronchi, the IAA was significantly larger in the standing position than in the supine position (4.1–4.9% increase, all p < 0.05). The EAA of all bronchi was significantly larger in the standing position than in the supine position (9.7–62.5% increases, all p < 0.001). The correlation coefficients of IAA in the standing position and forced expiratory volume in 1 s were slightly higher than those in the supine position. The correlation coefficients of EAA or EAA/IAA in the standing position and residual volume, and the inspiratory capacity/total lung capacity ratio were higher than those in the supine position. Conclusions: Airway lumen areas were larger in the standing position than in the supine position. IAAs reflect airway obstruction, and EAAs reflect lung hyperinflation. Upright CT might reveal these abnormalities more precisely. Trial registration University Hospital Medical Information Network (UMIN 000026587), Registered 17 March 2017. URL: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000030456.

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Three-dimensional evaluation of the coccyx movement between supine and standing positions using conventional and upright computed tomography imaging

Yagi F., Yamada Y., Yamada M., Yokoyama Y., Mukai K., Nakahara T., Narita K., Jinzaki M.

Scientific Reports （Scientific Reports） 11 （ 1 ） 2021年12月

Currently, no three-dimensional reference data exist for the normal coccyx in the standing position on computed tomography (CT); however, this information could have utility for evaluating patients with coccydynia and pelvic floor dysfunction. Thus, we aimed to compare coccygeal parameters in the standing versus supine positions using upright and supine CT and evaluate the effects of sex, age, and body mass index (BMI) on coccygeal movement. Thirty-two healthy volunteers underwent both upright (standing position) and conventional (supine position) CT examinations. In the standing position, the coccyx became significantly longer and straighter, with the tip of the coccyx moving backward and downward (all p < 0.001). Additionally, the coccygeal straight length (standing/supine, 37.8 ± 7.1/35.7 ± 7.0 mm) and sacrococcygeal straight length (standing/supine, 131.7 ± 11.2/125.0 ± 10.7 mm) were significantly longer in the standing position. The sacrococcygeal angle (standing/supine, 115.0 ± 10.6/105.0 ± 12.5°) was significantly larger, while the lumbosacral angle (standing/supine, 21.1 ± 5.9/25.0 ± 4.9°) was significantly smaller. The migration length of the tip of the coccyx (mean, 7.9 mm) exhibited a moderate correlation with BMI (r = 0.42, p = 0.0163). Our results may provide important clues regarding the pathogenesis of coccydynia and pelvic floor dysfunction.

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Effect of gravity on brain structure as indicated on upright computed tomography

Yokoyama Y., Yamada Y., Kosugi K., Yamada M., Narita K., Nakahara T., Fujiwara H., Toda M., Jinzaki M.

Scientific Reports （Scientific Reports） 11 （ 1 ） 2021年12月

We aimed to use upright computed tomography (CT) to depict posture-related changes in the brain tissue under normal gravity. Thirty-two asymptomatic volunteers underwent upright CT in the sitting position and conventional CT in the supine position on the same day. We compared the shift of the pineal body, cerebellar tonsil, the length of pituitary stalk, optic nerve sheath area and perimeter (ONSA and ONSP, respectively), and lateral ventricular volume between the supine and sitting positions. We also compared shape changes of the cerebrospinal fluid (CSF) spaces at different sites between both positions. In the sitting position, the pineal body shifted 0.68 ± 0.27 mm in the ventral direction and 0.76 ± 0.24 mm in the caudal direction, the length of pituitary stalk decreased by 1.23 ± 0.71 mm, the cerebellar tonsil descended by 2.10 ± 0.86 mm, the right ONSA decreased by 15.21 ± 6.54%, the left ONSA decreased by 15.30 ± 7.37%, the right ONSP decreased by 8.52 ± 3.91%, the left ONSP decreased by 8.20 ± 4.38%, and the lateral ventricular volume decreased by 5.07 ± 3.24% (all P < 0.001). We also observed changes in the shape of CSF spaces with changes in posture. We concluded that the intracranial structure of healthy subjects and volume of ventricles changed according to posture on Earth.

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Characteristics of chronic obstructive pulmonary disease patients with robust progression of emphysematous change

Tsutsumi A., Chubachi S., Irie H., Sasaki M., Yamada Y., Sugiura H., Jinzaki M., Nakamura H., Asano K., Betsuyaku T., Fukunaga K.

Scientific Reports （Scientific Reports） 11 （ 1 ） 2021年12月

Emphysema is a major pathological change in chronic obstructive pulmonary disease (COPD). However, the annual changes in the progression of emphysematous have not been investigated. We aimed to determine possible baseline predicting factors of the change in emphysematous progression in a subgroup of COPD patients who demonstrated rapid progression. In this observational study, we analyzed patients with COPD who were followed up by computed tomography (CT) at least two times over a 3-year period (n = 217). We divided the annual change in the low attenuation area percentage (LAA%) into quartiles and defined a rapid progression group (n = 54) and a non-progression group (n = 163). Predictors of future changes in emphysematous progression differed from predictors of high LAA% at baseline. On multivariate logistic regression analysis, low blood eosinophilic count (odds ratio [OR], 3.22; P = 0.04) and having osteoporosis (OR, 2.13; P = 0.03) were related to rapid changes in emphysematous progression. There was no difference in baseline nutritional parameters, but nutritional parameters deteriorated in parallel with changes in emphysematous progression. Herein, we clarified the predictors of changes in emphysematous progression and concomitant deterioration of nutritional status in COPD patients.

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Unbiased, comprehensive analysis of Japanese health checkup data reveals a protective effect of light to moderate alcohol consumption on lung function

Makino K., Shimizu-Hirota R., Goda N., Hashimoto M., Kawada I., Kashiwagi K., Hirota Y., Itoh H., Jinzaki M., Iwao Y., Ko M., Ko S., Takaishi H.

Scientific Reports （Scientific Reports） 11 （ 1 ） 2021年12月

The overall effect of lifestyle habits, such as alcohol consumption, on general health remains controversial and it is important to clarify how such habits affect aging-related health impairments. To discover novel impacts of lifestyle on general health, we employed a mathematical approach to perform a comprehensive, unbiased, cross-sectional analysis of data from 6036 subjects who participated in a Japanese health checkup. Notably, we found that moderate alcohol consumption was positively correlated with lung function, muscle mass, and strength. Health checkup data were collected periodically from the same subjects. These people were light to moderate drinkers who had high health awareness and were basically free of major underlying diseases. We next analyzed 5 years of data from 1765 of these subjects. We found that higher baseline alcohol consumption, as well as increased alcohol intake over 5 years attenuated time-related deterioration of forced vital capacity without affecting total lung volume. This effect was independent of smoking. Our study suggests a possible protective effect of moderate amounts of alcohol on lung function, due to increased muscle mass/strength and forced vital capacity.

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Saphenous vein valve assessment utilizing upright CT to potentially improve graft assessment for bypass surgery

Nakahara T., Yamada M., Yokoyama Y., Yamada Y., Narita K., Imanishi N., Yamazaki M., Shimizu H., Narula J., Jinzaki M.

Scientific Reports （Scientific Reports） 11 （ 1 ） 2021年12月

Saphenous veins (SVs) are frequently employed as bypass grafts. The SV graft failure is predominantly seen at the valve site. Avoiding valves during vein harvest would help reduce graft failure. We endeavored to detect SV valves, tributaries, and vessel size employing upright computed tomography (CT) for the raw cadaver venous samples and in healthy volunteers. Five cadaver legs were scanned. Anatomical analysis showed 3.0 (IQR: 2.0–3.0) valves and 13.50 (IQR: 10.00–16.25) tributaries. The upright CT completely detected, compared to 2.0 (IQR: 1.5–2.5, p = 0.06) valves and 9.5 (IQR: 7.5–13.0, p = 0.13) tributaries by supine CT. From a total of 190 volunteers, 138 (men:75, women:63) were included. The number of valves from the SF junction to 35 cm were significantly higher in upright CT than in supine CT bilaterally [upright vs. supine, Right: 4 (IQR: 3–5) vs. 2 (IQR:1–2), p < 0.0001, Left: 4 (IQR: 3–5) vs. 2 (IQR: 1–2), p < 0.0001]. The number of tributaries and vessel areas per leg were also higher for upright compared with supine CT. Upright CT enables non-invasive detection of SV valves, tributaries, and vessel size. Although not tested here, it is expected that upright CT may potentially improve graft assessment for bypass surgery.

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Determining the validity and reliability of spinopelvic parameters through comparing standing whole spinal radiographs and upright computed tomography images

Fujita N., Yagi M., Watanabe K., Nakamura M., Matsumoto M., Yokoyama Y., Yamada M., Yamada Y., Nagura T., Jinzaki M.

BMC Musculoskeletal Disorders （BMC Musculoskeletal Disorders） 22 （ 1 ） 2021年12月

Background: Standing whole spinal radiographs are used to evaluate spinal alignment in adult spinal deformity (ASD), yet some studies have reported that pelvic incidence, pelvic tilt, and thoracic kyphosis (TK) intra- and inter-observer reliability is low. This study aimed to evaluate the accuracy of spinopelvic parameters through comparing standing whole spinal radiographs and upright CT images. Methods: We enrolled 26 patients with ASD. All standing whole spinal posterior/anterior and lateral radiographs and upright whole spinal CT had been obtained in a natural standing position. Two examiners independently measured 13 radiographic parameters. Interclass correlation coefficients (ICCs) were used to analyze measurement intra- and inter-observer reliability. Paired t- and Pearson’s correlation tests were used to analyze validity of the standing whole spinal radiographs. Results: ICCs of upright CT were excellent in both intra- and inter-observer reliability. However, intra-observer ICCs for TK2–12, TK1–5, TK2–5, and TK5–12 on standing lateral radiographs were relatively low, as were inter-observer ICCs for TK2–12, TK1–5, TK2–5, and TK5–12. Concerning TK values, the difference between the radiographs and CT in TK1–12 and TK2–12 were 4.4 ± 3.1 and 6.6 ± 4.6, respectively, and TK values from T2 showed greater measurement error (p < 0.05). Conclusions: Upright CT showed excellent intra- and inter-observer reliability in the measurement of spinopelvic parameters. Measurement of TK with T2 on standing whole spinal radiographs resulted in a greater measurement error of up to 6.6°. Surgeons need to consider this when planning surgery and measuring postoperative TK changes in patients with ASD.

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特集 AI と心臓病診療日常診療への可能性を探る企画にあたって

陣崎雅弘

Heart View （メジカルビュー社） 25 （ 11 ） 1015 - 1015 2021年11月

ISSN 1342-6591

特集 AI と心臓病診療日常診療への可能性を探る診る1 AI 総論

橋本正弘, 陣崎雅弘

Heart View （メジカルビュー社） 25 （ 11 ） 1016 - 1019 2021年11月

ISSN 1342-6591

Portal Vein Damage after DEB-TACE and Lipiodol-TACE: Based on Evaluation by Computed Tomography during Arterial Portography

Tamura Masashi, Nakatsuka Seishi, Torikai Hideyuki, Misu Manabu, Tsukada Jitsuro, Tamura Kentaro, Ito Nobutake, Inoue Masanori, Yashiro Hideki, Jinzaki Masahiro

Interventional Radiology （一般社団法人日本インターベンショナルラジオロジー学会） 6 （ 3 ） 93 - 101 2021年11月

Purpose: To reveal the effect of drug-eluting beads transarterial chemoembolization and Lipiodol transarterial chemoembolization on portal perfusion, and to identify factors predisposing portal vein damage after transarterial chemoembolization, based on evaluation by computed tomography during arterial portography.Material and Methods: This retrospective cohort analysis included 49 patients with hepatocellular carcinoma who underwent transarterial chemoembolization and preprocedural/follow-up computed tomography during arterial portography between October 2013 and April 2015. The preprocedural and follow-up computed tomography during arterial portography were compared to identify the following new changes suggestive of portal vein damage in the follow-up computed tomography during arterial portography: small perfusion defects, large perfusion defects, and narrowing/disappearance or portal vein obstruction. The frequency of portal vein damage after drug-eluting beads transarterial chemoembolization and Lipiodol transarterial chemoembolization was calculated, and relationships between portal vein damage and clinical variables were analyzed. Finally, a multivariate logistic regression analysis with adjustments for potentially confounding factors was performed to identify factors predisposing portal vein damage.Results: The analysis included 24 patients who underwent drug-eluting beads transarterial chemoembolization and 25 who underwent Lipiodol transarterial chemoembolization. Emergence of small perfusion defects and narrowing/disappearance or obstruction of portal vein were observed at a significantly higher frequency following drug-eluting beads transarterial chemoembolization than following Lipiodol transarterial chemoembolization (70.8% [17/24] vs. 20% [5/25]; p < 0.001; 41.7% [10/24] vs. 12% [3/25]; p = 0.019). Drug-eluting beads transarterial chemoembolization and selectivity of transarterial chemoembolization (selective [<subsegmental], segmental or lobar) were significantly associated with portal vein damage (p < 0.001 and p = 0.016, respectively). However, multivariate logistic regression analysis identified drug-eluting beads transarterial chemoembolization as a significant independent predictor of portal vein damage (odds ratio: 34.95; 95% confidence interval: 1.137-1073.99; p = 0.042).Conclusions: Portal vein damage occurred at a significantly higher frequency following drug-eluting beads transarterial chemoembolization than following Lipiodol transarterial chemoembolization, and drug-eluting beads transarterial chemoembolization was an independent predictor of portal vein damage after transarterial chemoembolization.

Prognostic value of noninvasive combined anatomic/functional assessment by cardiac CT in patients with suspected coronary artery disease — Comparison with invasive coronary angiography and nuclear myocardial perfusion imaging for the five-year-follow up of the CORE320 multicenter study: Combined CTA/CTP for Long-Term Patient Outcome

Dewey M., Rochitte C.E., Ostovaneh M.R., Chen M.Y., George R.T., Niinuma H., Kitagawa K., Laham R., Kofoed K., Nomura C., Sakuma H., Yoshioka K., Mehra V.C., Jinzaki M., Kuribayashi S., Laule M., Paul N., Scholte A.J., Cerci R., Hoe J., Tan S.Y., Rybicki F.J., Matheson M.B., Vavere A.L., Arai A.E., Miller J.M., Cox C., Brinker J., Clouse M.E., Di Carli M., Lima J.A.C., Arbab-Zadeh A.

Journal of Cardiovascular Computed Tomography （Journal of Cardiovascular Computed Tomography） 15 （ 6 ） 485 - 491 2021年11月

ISSN 19345925

Background: Few data exist on long-term outcome in patients undergoing combined coronary CT angiography (CTA) and myocardial CT perfusion imaging (CTP) as well as invasive coronary angiography (ICA) and single photon emission tomography (SPECT). Methods: At 16 centers, 381 patients were followed for major adverse cardiac events (MACE) for the CORE320 study. All patients underwent coronary CTA, CTP, and SPECT before ICA within 60 days. Prognostic performance according binary results (normal/abnormal) was assessed by 5-year major cardiovascular events (MACE) free survival and area under the receiver-operating-characteristic curve (AUC). Results: Follow up beyond 2-years was available in 323 patients. MACE-free survival rate was greater among patients with normal combined CTA-CTP findings compared to ICA-SPECT: 85 vs. 80% (95% confidence interval [CI] for difference 0.1, 11.3) though event-free survival time was similar (4.54 vs. 4.37 years, 95% CI for difference: -0.03, 0.36). Abnormal results by combined CTA-CTP was associated with 3.83 years event-free survival vs. 3.66 years after abnormal combined ICA-SPECT (95% CI for difference: -0.05, 0.39). Predicting MACE by AUC also was similar: 65 vs. 65 (difference 0.1; 95% CI -4.6, 4.9). When MACE was restricted to cardiovascular death, myocardial infarction, or stroke, AUC for CTA-CTP was 71 vs. 60 by ICA-SPECT (difference 11.2; 95% CI -1.0, 19.7). Conclusions: Combined CTA-CTP evaluation yields at least equal 5-year prognostic information as combined ICA-SPECT assessment in patients presenting with suspected coronary artery disease. Noninvasive cardiac CT assessment may eliminate the need for diagnostic cardiac catheterization in many patients. Clinical trial registration: NCT00934037.

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Anatomic and diagnostic considerations of facial mobility for understanding the effectiveness of facial massage: A pilot study

Okuda I., Yamada M., Yamada Y., Yokoyama Y., Kampan N., Akita K., Jinzaki M.

Skin Research and Technology （Skin Research and Technology） 27 （ 6 ） 1057 - 1063 2021年11月

ISSN 0909752X

Background: The effectiveness of facial massage is often explained by the resulting increases in the blood and lymphatic flow. However, it is difficult to explain the lifting effect on the cheeks. The aim of this study was to analyze facial mobility to further current understanding of the effectiveness of facial massage. Materials and Methods: Two kinds of analytical methods were designed using a cadaveric head as well as advanced computed tomography (CT). The cadaveric face was divided into three sections, and three different colors of ink were injected into each section. It was kept in a supine position for 24 hours, and the ink distribution was observed. Upright and supine CT examinations were performed on six healthy adult volunteers. The images of both were superimposed by a three-dimensional image analysis system, and changes in facial contours were analyzed. Results: The three colors of ink spread craniocaudally and were distributed differently from the gravitational vector. When both CT images were superimposed, two distinct lines were formed, which represented overlapping of the facial contours due to the two different CT images. These lines were found to correspond to the border of each color of the ink. Conclusion: Focusing on the mobility of the face, the soft tissue of the face had vertical mobility, and it was speculated that this mobility is involved in the effectiveness of facial massage. Our results could provide useful information for cosmetic treatment and contribute to the collection of scientific knowledge for anti-aging medicine.

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Difference in the airway luminal area between the standing and supine positions using upright and conventional computed tomography

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

Clinical Anatomy （Clinical Anatomy） 34 （ 8 ） 1150 - 1156 2021年11月

ISSN 08973806

No clinical studies to date have compared the airway luminal area between supine and standing positions. Our aim was therefore to compare the airway luminal area between these two positions on computed tomography (CT) and to determine its correlation with forced expiratory volume in 1 s (FEV1). Thirty-two asymptomatic volunteers underwent both conventional (supine position) and upright (standing position) CT during deep inspiration breath-holding. Pulmonary function tests were conducted on the same day. We measured the airway luminal area on CT in each position. Paired t-tests and Pearson's correlation coefficients were used for statistical analysis. The average luminal areas of the trachea, right and left main bronchi, and average third-generation airway were greater in the standing than the supine position by 3.4%, 6.1%, 5.5%, and 5.2%, respectively. The correlation coefficients between airway luminal areas and FEV1 tended to be higher in the standing than the supine position; this correlation was highest for the average third-generation airway (r = 0.70, P < 0.0001). The airway luminal areas of the trachea, bilateral main bronchi, and average third-generation airway were greater in the standing than the supine position. The average third-generation airway area in the standing position had the highest correlation with FEV1.

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特別寄稿日本初の放射線科医藤浪剛一と草創期の放射線医学

陣崎雅弘, 茂松直之

画像診断（学研メディカル秀潤社） 41 （ 13 ） 1429 - 1433 2021年10月

ISSN 0285-0524

Diagnostic value of texture analysis of apparent diffusion coefficient maps for differentiating fat-poor angiomyolipoma from non-clear-cell renal cell carcinoma

Arita Y., Yoshida S., Kwee T.C., Akita H., Okuda S., Iwaita Y., Mukai K., Matsumoto S., Ueda R., Ishii R., Mizuno R., Fujii Y., Oya M., Jinzaki M.

European Journal of Radiology （European Journal of Radiology） 143 2021年10月

ISSN 0720048X

Purpose: To investigate the feasibility of texture analysis of apparent diffusion coefficient (ADC) maps for differentiating fat-poor angiomyolipomas (fpAMLs) from non-clear-cell renal cell carcinomas (non-ccRCCs). Methods: In this bi-institutional study, we included two consecutive cohorts from different institutions with pathologically confirmed solid renal masses: 67 patients (fpAML = 46; non-ccRCC = 21) for model development and 39 (fpAML = 24; non-ccRCC = 15) for validation. Patients underwent preoperative magnetic resonance imaging (MRI), including diffusion-weighted imaging. We extracted 45 texture features using a software with volumes of interest on ADC maps. Receiver operating characteristic curve analysis was performed to compare the diagnostic performance between the random forest (RF) model (derived from extracted texture features) and conventional subjective evaluation using computed tomography and MRI by radiologists. Results: RF analysis revealed that grey-level zone length matrix long-zone high grey-level emphasis was the dominant texture feature for diagnosing fpAML. The area under the curve (AUC) of the RF model to distinguish fpAMLs from non-ccRCCs was not significantly different between the validation and development cohorts (p = .19). In the validation cohort, the AUC of the RF model was similar to that of board-certified radiologists (p = .46) and significantly higher than that of radiology residents (p = .03). Conclusions: Texture analysis of ADC maps demonstrated similar diagnostic performance to that of board-certified radiologists for discriminating between fpAMLs and non-ccRCCs. Diagnostic performances in the development and validation cohorts were comparable despite using data from different imaging device manufacturers and institutions.

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深層学習を用いた超音波画像における腎嚢胞の計測補助機能の開発

金内友里恵, 橋本正弘, 東田直樹, Haque Hasnine, 陣崎雅弘, 榊原康文

日本医用画像工学会大会予稿集（(一社)日本医用画像工学会） 40回 304 - 308 2021年10月

超音波検査において,臓器や腫瘍の計測のために2点1組の計測マーカーが付与される.計測マーカーに基づいて対象所見の位置やサイズが計測される.本研究は腹部超音波検査における計測マーカーの付与をサポートすることを目的として,深層学習を用いた超音波画像における計測補助機能の開発を行なった.対象は,超音波検査の中でも計測頻度の高い腎嚢胞とした.慶應義塾大学病院で2019年1月から2020年5月に撮影された腹部超音波画像170,538枚のうち,腎嚢胞が計測されている2,664枚を使用して,画像を入力すると計測マーカーの位置を表すdistance mapを予測するようにモデルを訓練した.モデルはUNet++を用いた.出力されたdistance mapから決定した計測マーカーの位置について,座標誤差を用いて予測精度を評価したところ,平均8.13mm,中央値4.63mmという結果になった.(著者抄録)

Transformerベースのモデルを用いた肺領域における所見文からの疾患名抽出

岡崎真治, 林雄一郎, 小田昌宏, 橋本正弘, 陣崎雅弘, 明石敏昭, 青木茂樹, 森健策

日本医用画像工学会大会予稿集（(一社)日本医用画像工学会） 40回 199 - 202 2021年10月

本稿では,TransformerベースのBERTモデルを用いた肺領域における所見文の疾患分類を行う方法を提案する.これは疾患名が付与された画像データセット構築の初期検討である.画像処理において,一般的には機械学習モデルの性能向上のため多くの学習データが必要である.しかし,医用画像のアノテーションには膨大な手間がかかる問題がある.そこで,放射線科医がCT画像の診断結果から作成し,患者の状態を詳細に記載している所見文を利用する.本研究では疾患名が付与された画像データセット構築の初期検討として,TransformerベースのモデルでFine-tuningを行い,肺領域において4クラス分類を行った.肺領域における400例の疾患分類実験によりMacro-F1で79.4%となった.(著者抄録)

The efficacy of transarterial embolization for postpartum hemorrhage complicated with disseminated intravascular coagulation: A single‐center experience

Ochiai D., Nakatsuka S., Abe Y., Ikenoue S., Kasuga Y., Inoue M., Jinzaki M., Tanaka M.

Journal of Clinical Medicine （Journal of Clinical Medicine） 10 （ 18 ） 2021年09月

Indications for the use of transarterial embolization (TAE) for postpartum hemorrhage (PPH) have been established. However, the efficacy of TAE for PPH complicated by disseminated intravascular coagulation (DIC) remains controversial. In this study, we investigated the efficacy of TAE for PPH complicated by DIC. A database review was conducted to identify patients who were treated with TAE for PPH at our hospital. TAE was performed in 41 patients during the study period. Effective hemostasis was achieved in all cases, but additional procedures, such as reembolization or hysterectomy, were required in five patients (12.2%). The typical causes of PPH included uterine atony (18 cases), placenta previa (15 cases), amniotic fluid embolism (DIC‐type) (11 cases), and placenta accreta spectrum (10 cases). The mean blood loss was 3836 mL. The mean obstetrical DIC and the International Society on Thrombosis and Hemostasis DIC scores were 7.9 and 2.6, respectively. The efficacy of hemostasis was comparable between patients with and without DIC. However, the complete success rate of TAE was lower in patients with DIC as the condition worsened than that in non‐DIC patients. Overall, TAE is effective as a minimally invasive treatment for PPH complicated by DIC.

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特集 CT 再入門- 新技術で何がわかる?- 3. 面検出器CTの活用　2 頭部全体の血流評価

長谷学, 堤啓, 藤原広和, 陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 9 ） 938 - 939 2021年07月

ISSN 0285-0524

特集 CT 再入門- 新技術で何がわかる?- 序説

陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 9 ） 919 - 919 2021年07月

ISSN 0285-0524

特集 CT 再入門- 新技術で何がわかる?- 6. 立位CTの活用　3 骨盤臓器脱

横山陽一, 山田祥岳, 山田稔, 陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 9 ） 1010 - 1011 2021年07月

ISSN 0285-0524

特集 CT 再入門- 新技術で何がわかる?- 6. 立位CTの活用　2 鼠径ヘルニア

山田祥岳, 山田稔, 横山陽一, 陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 9 ） 1008 - 1009 2021年07月

ISSN 0285-0524

特集 CT 再入門- 新技術で何がわかる?- 6. 立位CTの活用　1 脊椎すべり症

山田祥岳, 山田稔, 横山陽一, 名倉武雄, 陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 9 ） 1006 - 1007 2021年07月

ISSN 0285-0524

特集 CT 再入門- 新技術で何がわかる?- 5. Dual energy CTの活用　5 肺塞栓症

田村全, 山田祥岳, 陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 9 ） 984 - 985 2021年07月

ISSN 0285-0524

特集 CT 再入門- 新技術で何がわかる?- 3. 面検出器CTの活用　9 関節動態

山田稔, 山田祥岳, 横山陽一, 石井和典, 名倉武雄, 陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 9 ） 952 - 953 2021年07月

ISSN 0285-0524

Evaluation of Dynamic Carpal Arch Stability following Carpal Tunnel Release Using Four-Dimensional Computed Tomography

Kimura H., Sato K., Matsumura N., Suzuki T., Iwamoto T., Ohori K., Yamada Y., Matsumoto M., Nakamura M., Jinzaki M., Nagura T.

Journal of Hand and Microsurgery （Journal of Hand and Microsurgery） 13 （ 3 ） 138 - 142 2021年07月

ISSN 09743227

Introduction This study aimed to assess the carpal arch dynamics during active finger and wrist motion following carpal tunnel release using four-dimensional computed tomography (4D-CT). Materials and Methods Four patients who diagnosed with bilateral carpal tunnel syndrome and underwent unilateral carpal tunnel release were prospectively included. 4D-CT of the bilateral wrists during active finger and wrist motion was performed for 10 seconds at five frames per second. The distances between the tip of tuberosity of the scaphoid and the volar ridge of the pisiform (S-P distance) and volar ridge of trapezium and the tip of hook of hamate (T-H distance) were measured at each position and the values of S-P and T-H distances were compared between the postoperative and contralateral wrists. Results During finger motion, the S-P and T-H distances were not different at any position between the postoperative side and contralateral side. Conversely, S-P and T-H distances gradually increased in the postoperative wrists. The differences between the sides of S-P distance were significant, with >0 degrees of wrist extension, and differences of T-H distance were significant with >15 degrees of wrist extension. Conclusion This study demonstrated the carpal arch dynamics using 4D-CT and revealed that the carpal arch was widened with the wrist in extension after carpal tunnel release. This study suggests that the transverse carpal ligament plays an important role in maintaining carpal arch stability.

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Picked-up Knowledge from Foreign Journals 画像をリファレンスとした,循環器臨床診断における機械学習

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 （ 8 ） 880 - 882 2021年06月

ISSN 0285-0524

Statin therapy for patients with aortic stenosis who underwent transcatheter aortic valve implantation: A report from a Japanese multicentre registry

Yashima F., Hara M., Inohara T., Jinzaki M., Shimizu H., Fukuda K., Tanaka M., Yamamoto M., Watanabe Y., Naganuma T., Shirai S., Yamawaki M., Tada N., Yamanaka F., Mizutani K., Ueno H., Tabata M., Takagi K., Hayashida K.

BMJ Open （BMJ Open） 11 （ 6 ） 2021年06月

Objective Data on statin for patients with aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI) are limited. The present study aimed to evaluate the impact of statin on midterm mortality of TAVI patients. Design Observational study. Setting This study included patients with AS from a Japanese multicentre registry who underwent TAVI. Participants The overall cohort included 2588 patients (84.4±5.2 years); majority were women (69.3%). The Society of Thoracic Surgeons risk score was 6.55% (IQR 4.55%-9.50%), the Euro II score was 3.74% (IQR 2.34%-6.02%) and the Clinical Frailty Scale score was 3.9±1.2. Interventions We classified patients based on statin at admission and identified 936 matched pairs after propensity score matching. Primary and secondary outcome measures The outcomes were all-cause and cardiovascular mortality. Results The median follow-up was 660 days. Statin at admission was associated with a significant reduction in all-cause mortality (adjusted HR (aHR) 0.76, 95% CI 0.58 to 0.99, p=0.04) and cardiovascular mortality (aHR 0.64, 95% CI 0.42 to 0.97, p=0.04). In the octogenarians, statin was associated with significantly lower all-cause mortality (aHR 0.87, 95% CI 0.75 to 0.99, p=0.04); however, the impact in the nonagenarians appeared to be lower (aHR 0.84, 95% CI 0.62 to 1.13, p=0.25). Comparing four groups according to previous coronary artery disease (CAD) and statin, there was a significant difference in all-cause mortality, and patients who did not receive statin despite previous CAD showed the worst prognosis (aHR 1.33, 95% CI 1.12 to 1.57 (patients who received statin without previous CAD as a reference), p<0.01). Conclusions Statin for TAVI patients will be beneficial even in octogenarians, but the benefits may disappear in nonagenarians. In addition, statin will be essential for TAVI patients with CAD. Further research is warranted to confirm and generalise our findings since this study has the inherent limitations of an observational study and included only Japanese patients.

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特集これだけおさえる胸腹部解剖-血管と管腔のvariation & anomalyを中心に- 1. 胸部　胸郭出口症候群

荒井学, 陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 6 ） 555 - 558 2021年04月

ISSN 0285-0524

特集これだけおさえる胸腹部解剖-血管と管腔のvariation & anomalyを中心に- 2. 腹部(2)膵臓・脾臓　膵・十二指腸の破格と血管解剖

田村謙太郎, 井上政則, 岸本理和, 尾松徳彦, 山﨑香奈, 西井龍一, 陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 6 ） 588 - 595 2021年04月

ISSN 0285-0524

Diagnostic value of computed high b-value whole-body diffusion-weighted imaging for primary prostate cancer

Arita Y., Yoshida S., Waseda Y., Takahara T., Ishii C., Ueda R., Kwee T.C., Miyahira K., Ishii R., Okuda S., Jinzaki M., Fujii Y.

European Journal of Radiology （European Journal of Radiology） 137 2021年04月

ISSN 0720048X

Purpose: To investigate the utility of post-acquisition computed diffusion-weighted imaging (cDWI) for primary prostate cancer (PCa) evaluation in biparametric whole-body MRI (bpWB-MRI). Methods: Patients who underwent pelvic MRI for PCa screening and subsequent bpWB-MRI for staging were included. Two radiologists assessed the diagnostic performance of the following datasets for clinically significant PCa diagnosis (grade group ≥2 according to the Prostate Imaging-Reporting and Data System, version 2.1): bpMRI (axial DWI scans with a b-value of 2,000 s/mm + axial T2WI scans from pre-biopsy pelvic MRI), computed bpWB-MRI (computed WB-DWI scans with a b-value of 2,000 s/mm + axial WB-T2WI scans), and native bpWB-MRI (native axial WB-DWI scans with a b-value of 1,000 s/mm + axial WB-T2WI scans). Systemic biopsy was used as reference standard. Results: Fifty-one patients with PCa were included. The areas under the curve (AUCs) of bpMRI (0.89 for reader 1 and 0.86 for reader 2) and computed bpWB-MRI (0.86 for reader 1 and 0.83 for reader 2) were significantly higher (p < 0.001) than those of native bpWB-MRI (0.67 for both readers). No significant difference was observed between the AUCs of bpMRI and computed bpWB-MRI (p = 0.10 for reader 1 and p = 0.25 for reader 2). Conclusions: The diagnostic performance of computed bpWB-MRI was similar to that of dedicated pelvic bpMRI for primary PCa evaluation. cDWI can be recommended for implementation in standard WB-MRI protocols to facilitate a one-step evaluation for concurrent detection of primary and metastatic PCa. 2000 2000 1000 2000 2000 1000 2000 2000 2000 2000 2 2 2

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Radiologic features of mixed epithelial and stromal tumors of the kidney: Hyperattenuating on unenhanced computed tomography and T2-hypointensity on magnetic resonance imaging

Tatsuya S., Hirotaka A., Yuki A., Akiko T., Masahiro H., Shigeo O., Shuji M., Ryuichi M., Mototsugu O., Masahiro J.

Radiology Case Reports （Radiology Case Reports） 16 （ 4 ） 858 - 862 2021年04月

In the 2016 World Health Organization renal tumor classification, the mixed epithelial and stromal tumor family was introduced as a new entity. This family encompasses a spectrum of tumors, ranging from predominantly cystic tumors (adult cystic nephromas) to tumors that are variably solid (mixed epithelial and stromal tumors). The majority of previous studies incorporating “mixed epithelial and stromal tumor” in the titles were actually reports of imaging findings of adult cystic nephroma. Thus, the solid component of mixed epithelial and stromal tumors has not been well evaluated. In this study, we present 2 cases of mixed epithelial and stromal tumors, as defined by the 2016 World Health Organization classification, showing a predominantly solid component. The characteristic findings of the solid component of these tumors were T2-hypointensity on magnetic resonance imaging and hyperattenuation on unenhanced computed tomography. Angiomyolipoma with epithelial cysts and epithelioid angiomyolipoma should be considered in the differential diagnosis of mixed epithelial and stromal tumors.

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Dynamic chest X-ray using a flat-panel detector system: Technique and applications

Hata A., Yamada Y., Tanaka R., Nishino M., Hida T., Hino T., Ueyama M., Yanagawa M., Kamitani T., Kurosaki A., Sanada S., Jinzaki M., Ishigami K., Tomiyama N., Honda H., Kudoh S., Hatabu H.

Korean Journal of Radiology （Korean Journal of Radiology） 22 （ 4 ） 634 - 651 2021年04月

ISSN 12296929

Dynamic X-ray (DXR) is a functional imaging technique that uses sequential images obtained by a flat-panel detector (FPD). This article aims to describe the mechanism of DXR and the analysis methods used as well as review the clinical evidence for its use. DXR analyzes dynamic changes on the basis of X-ray translucency and can be used for analysis of diaphragmatic kinetics, ventilation, and lung perfusion. It offers many advantages such as a high temporal resolution and flexibility in body positioning. Many clinical studies have reported the feasibility of DXR and its characteristic findings in pulmonary diseases. DXR may serve as an alternative to pulmonary function tests in patients requiring contact inhibition, including patients with suspected or confirmed coronavirus disease 2019 or other infectious diseases. Thus, DXR has a great potential to play an important role in the clinical setting. Further investigations are needed to utilize DXR more effectively and to establish it as a valuable diagnostic tool.

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JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases

Yamagishi M., Tamaki N., Akasaka T., Ikeda T., Ueshima K., Uemura S., Otsuji Y., Kihara Y., Kimura K., Kimura T., Kusama Y., Kumita S., Sakuma H., Jinzaki M., Daida H., Takeishi Y., Tada H., Chikamori T., Tsujita K., Teraoka K., Nakajima K., Nakata T., Nakatani S., Nogami A., Node K., Nohara A., Hirayama A., Funabashi N., Miura M., Mochizuki T., Yokoi H., Yoshioka K., Watanabe M., Asanuma T., Ishikawa Y., Ohara T., Kaikita K., Kasai T., Kato E., Kamiyama H., Kawashiri M., Kiso K., Kitagawa K., Kido T., Kinoshita T., Kiriyama T., Kume T., Kurata A., Kurisu S., Kosuge M., Kodani E., Sato A., Shiono Y., Shiomi H., Taki J., Takeuchi M., Tanaka A., Tanaka N., Tanaka R., Nakahashi T., Nakahara T., Nomura A., Hashimoto A., Hayashi K., Higashi M., Hiro T., Fukamachi D., Matsuo H., Matsumoto N., Miyauchi K., Miyagawa M., Yamada Y., Yoshinaga K., Wada H., Watanabe T., Ozaki Y., Kohsaka S., Shimizu W., Yasuda S., Yoshino H.

Circulation journal : official journal of the Japanese Circulation Society （Circulation journal : official journal of the Japanese Circulation Society） 85 （ 4 ） 402 - 572 2021年03月

ISSN 13469843

特集押さえておくべき注目の疾患2021 7章泌尿生殖器　1 腎のmixed epithelial and stromal tumor(MEST)

鈴木達也, 有田祐起, 秋田大宇, 陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 5 ） 464 - 465 2021年03月

ISSN 0285-0524

特集押さえておくべき注目の疾患2021 7章泌尿生殖器　4 前立腺神経内分泌腫瘍

有田祐起, 陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 5 ） 470 - 471 2021年03月

ISSN 0285-0524

特集押さえておくべき注目の疾患2021 7章泌尿生殖器　3 内反性尿路上皮乳頭腫

秋田大宇, 陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 5 ） 468 - 469 2021年03月

ISSN 0285-0524

特集押さえておくべき注目の疾患2021 7章泌尿生殖器　2 腎のBCG肉芽腫

成田啓一, 秋田大宇, 陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 5 ） 466 - 467 2021年03月

ISSN 0285-0524

Assessment of the image quality of virtual monochromatic spectral computed tomography images: a phantom study considering object contrast, radiation dose, and frequency characteristics

Masuda S., Sugisawa K., Minamishima K., Yamazaki A., Jinzaki M.

Radiological Physics and Technology （Radiological Physics and Technology） 14 （ 1 ） 41 - 49 2021年03月

ISSN 18650333

Fast kilovoltage (kVp)-switching technology cannot obtain conventional 120 kVp images; thus, 70 keV virtual monochromatic spectral computed tomography (CT) images (VMSI) are generally used. The contrast-to-noise ratio (CNR) is used to evaluate the image quality of VMSI; however, CNR does not include frequency characteristics. The present study aimed to investigate the evaluation methods of VMSI considering frequency characteristics by comparing the image quality of 70 keV VMSI with that of conventional 120 kVp images. The evaluated object contrasts were 70 and 300 Hounsfield units (HU). Scans used two radiation dose levels: low (LD) and standard (SD). The volume CT dose index of LD and SD was 4.8- and 12 mGy, respectively. Images were reconstructed by filtered back projection, evaluating CNR, noise power spectrum (NPS), task transfer function (TTF), and system performance (SP) function calculated as TTF / NPS. The total NPS values (spatial frequency range: 0.2 ~ 0.4 mm ) of 70 keV VMSI were higher than those of 120 kVp images. The spatial frequency TTF values that reached 10% (f ) of the 70 keV VMSI changed based on object contrast. For the low-contrast condition, a lower f was observed with 70 keV VMSI. The CNR of 70 keV VMSI was comparable to that of 120 kVp images in low- and high-contrast conditions. However, for 70 keV VMSI, SP of low-contrast was low, and SP of high-contrast was high, compared with those of 120 kVp images. This study suggested that only CNR was not sufficient to evaluate the image quality of VMSI; thus, evaluation methods considering frequency characteristics should be used. 2 −1 10% 10%

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特集 CTとMRIのサインから読み解く病態・病理Ⅱ 胸部(肺)領域-心血管は除く

八木文子, 栗原泰之, 山田祥岳, 杉浦弘明, 陣崎雅弘

臨床放射線（金原出版） 66 （ 2 ） 137 - 146 2021年02月

ISSN 0009-9252

Clinical utility of the Vesical Imaging-Reporting and Data System for muscle-invasive bladder cancer between radiologists and urologists based on multiparametric MRI including 3D FSE T2-weighted acquisitions

Arita Y., Shigeta K., Akita H., Suzuki T., Kufukihara R., Kwee T.C., Ishii R., Mikami S., Okuda S., Kikuchi E., Oya M., Jinzaki M.

European Radiology （European Radiology） 31 （ 2 ） 875 - 883 2021年02月

ISSN 09387994

Objectives: To investigate the clinical utility of the Vesical Imaging-Reporting and Data System (VI-RADS) by comparing its diagnostic performance for muscle-invasive bladder cancer (MIBC) between radiologists and urologists based on multiparametric MRI, including three-dimensional (3D) fast spin-echo (FSE) T2-weighted acquisitions. Methods: This study included 66 treatment-naïve patients (60 men, 6 women; mean age 74.0 years) with pathologically proven bladder cancer who underwent multiparametric MRI, including 3D FSE T2-weighted imaging, before transurethral bladder tumour resection between January 2010 and November 2018. The MRI scans were categorised according to the five-point VI-RADS score by four independent readers (two board-certified radiologists and board-certified urologists each), blinded to the histopathological findings. The VI-RADS scores were compared with the postoperative histopathological diagnosis. Interobserver agreement was assessed using weighted kappa coefficients. ROC analysis and generalised estimating equations were used to evaluate the diagnostic performance. Results: Forty-nine (74.2%) and 17 (25.8%) tumours were confirmed to be non-MIBC and MIBC, respectively, based on pathological examination. The interobserver agreement was good-to-excellent between all pairs of readers (range, 0.73–0.91). The urologists’ sensitivity/specificity values for DCE-MRI VI-RADS scores were significantly lower than those of radiologists. No significant differences were observed for the overall VI-RADS score. The AUC for the overall VI-RADS score was 0.94, 0.92, 0.89, and 0.87 for radiologists 1 and 2 and urologists 1 and 2, respectively. Conclusions: The VI-RADS score, based on multiparametric MRI including 3D FSE T2-weighted acquisitions, can be useful for radiologists and urologists to determine the bladder cancer muscle invasion status preoperatively. Key Points: • VI-RADS (using multiparametric MRI including 3D FSE T2-weighted acquisitions) achieves good to excellent interobserver agreement and has similar diagnostic performance for detecting muscle invasion by both radiologists and urologists. • The diagnostic performance of the overall VI-RADS score is high for both radiologists and urologists, particularly due to the dominant effect of diffusion-weighted imaging on the overall VI-RADS score. • The sensitivity and specificity values of the T2WI VI-RADS scores for four readers in our study (using 3D FSE T2-weighted acquisitions) were similar (with slightly higher specificity values) to previously published results (using 2D FSE T2-weighted acquisitions).

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Embolization of congenital hemangioma with severe hemorrhage

Kamata M., Aramaki-Hattori N., Okabe K., Sakai S., Nakatsuka S., Jinzaki M., Kishi K., Inoue M.

Journal of Pediatric Surgery Case Reports （Journal of Pediatric Surgery Case Reports） 65 2021年02月

Congenital hemangioma is a rare vascular lesion in children. Although most cases are asymptomatic, severe complications can arise, including severe bleeding. We describe the case of a female infant who was born with a congenital hemangioma on her right thigh. Ulceration appeared at the center of the tumor and gradually progressed over the following weeks. One month after birth, the lesion started hemorrhaging severely. Transfusions were required. The bleeding recurred repeatedly despite compression therapy. Embolization was performed urgently and succeeded in arresting the hemorrhage. Bleeding did not recur and the lesion involuted completely over the next few months. A literature review revealed that this is the eighth case where embolization was used to arrest severe hemorrhage of a congenital hemangioma. In the previous cases, embolization permanently (five cases) or temporarily (two cases) arrested the bleeding. In one of the latter cases, selective hemostatic surgery successfully arrested bleeding recurrence after embolization. In the other, the patient had Von Willebrand's Disease; while embolization arrested the hemorrhaging for several years, it restarted at the age of 18 years and the lesion had to be resected to manage the bleeding. Thus, embolization can be a first choice to arrest massive bleeding of congenital hemangioma.

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CT screening for COVID-19 in asymptomatic patients before hospital admission

Uchida S., Uno S., Uwamino Y., Hashimoto M., Matsumoto S., Obara H., Jinzaki M., Kitagawa Y., Hasegawa N.

Journal of Infection and Chemotherapy （Journal of Infection and Chemotherapy） 27 （ 2 ） 232 - 236 2021年02月

ISSN 1341321X

Introduction: In the novel coronavirus disease (COVID-19) pandemic era, it is essential to rule out COVID-19 effectively to prevent transmission in both communities and medical facilities. According to previous reports in high prevalence areas, CT screening may be useful in the diagnosis of COVID-19. However, the value of CT screening in low prevalence areas has scarcely been reported. Methods: This report examines the diagnostic efficacy of CT screening before admission to a hospital in Tokyo. We conducted a retrospective analysis at Keio University Hospital from April 6, 2020, through May 29, 2020. We set up an outpatient screening clinic on April 6 for COVID-19, administering both PCR with nasopharyngeal swabs and chest CT for all patients scheduled for surgery under general anesthesia. Results: A total of 292 asymptomatic patients were included in this study. There were three PCR-positive patients, and they all had negative CT findings, which revealed that both the sensitivity and positive predictive value of CT (PPV) were 0%. There were nine CT-positive patients; the specificity and the negative predictive value (NPV) were 96.9% and 98.9%, respectively. Conclusion: CT screening was not useful in low prevalence areas at this time in Tokyo, even with the inclusion of the most prevalent phase. Given that the utility of CT screening depends on disease prevalence, the criteria for performing CT screening based on the prevalence of COVID-19 should be established.

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多発性肝嚢胞に起因した門脈圧亢進症・肝性脳症の制御に経皮的嚢胞ドレナージ・硬化療法が有用であった1例

小川遼, 中塚誠之, 鳥飼秀幸, 田村全, 伊東伸剛, 井上政則, 陣崎雅弘

日本インターベンショナルラジオロジー学会雑誌（(一社)日本インターベンショナルラジオロジー学会） 35 （ 3 ） 241 - 244 2021年02月

ISSN 1340-4520

症例は50歳代女性。意識障害を主訴に、肝性脳症の診断で入院となった。造影CTにて残肝に存在する多発嚢胞により、門脈右枝は高度な狭小化を認め、門脈本幹に血栓を疑う造影欠損を認めた。胃静脈瘤は認めなかった。嚢胞による門脈右枝圧排が主因と考え、経皮的ドレナージを行った。CTガイド下に18G Chiba針にて門脈右枝腹側・背側の嚢胞を穿刺し、次に0.335"J型ワイヤ誘導下に、7Fr.J型ドレナージカテーテルを2本留置し、腹側病変と背側病変から嚢胞を吸引した。術後、門脈血栓症に対し、抗凝固療法を継続し、15日目には食道静脈瘤に対して内視鏡的静脈瘤結紮術が施行された。翌日、背側病変は70%の縮小が得られたが、腹側病変は48%に留まったため、硬化療法が行われた。その後は経過良好で、34日目に退院となった。1年9ヵ月後の現在も外来観察にて肝性脳症の再燃や肝機能の増悪は認められていない。

新連載　AI画像診断は,いま第1回連載序説−AI時代を迎えて−

陣崎雅弘

画像診断（学研メディカル秀潤社） 41 （ 2 ） 238 - 239 2021年01月

ISSN 0285-0524

特集胸部の最新画像情報2021 症例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, 鈴木髙祐, 陣崎雅弘

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

ISSN 0009-9252

Orthostatic Enlargement of a Supracerebellar Arachnoid Cyst With Cerebellar Descent Visualized by Upright Computed Tomography

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

World Neurosurgery （World Neurosurgery） 145 256 - 259 2021年01月

ISSN 18788750

Background: Posterior fossa arachnoid cysts are often asymptomatic, but can rarely cause postural headache, the mechanism of which remains unknown. Case Description: We present a 40-year-old woman with an asymptomatic supracerebellar arachnoid cyst. Upright computed tomography (CT) showed enlargement of the arachnoid cyst and caudal descent of the cerebellum compared with supine CT with narrowing of the craniocervical junction cerebrospinal fluid space. Conclusions: This finding aids in understanding the association of posterior fossa arachnoid cysts with orthostatic headache. Clinicians should be aware of possible posture-related changes in intracranial structures.

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Progression of traction bronchiectasis/bronchiolectasis in interstitial lung abnormalities is associated with increased all-cause mortality: Age Gene/Environment Susceptibility-Reykjavik Study

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

European Journal of Radiology Open （European Journal of Radiology Open） 8 2021年01月

Purpose: The aim of this study is to assess the role of traction bronchiectasis/bronchiolectasis and its progression as a predictor for early fibrosis in interstitial lung abnormalities (ILA). Methods: Three hundred twenty-seven ILA participants out of 5764 in the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study who had undergone chest CT twice with an interval of approximately five-years were enrolled in this study. Traction bronchiectasis/bronchiolectasis index (TBI) was classified on a four-point scale: 0, ILA without traction bronchiectasis/bronchiolectasis; 1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion; 2, ILA with mild to moderate traction bronchiectasis; 3, ILA and severe traction bronchiectasis and/or honeycombing. Traction bronchiectasis (TB) progression was classified on a five-point scale: 1, Improved; 2, Probably improved; 3, No change; 4, Probably progressed; 5, Progressed. Overall survival (OS) among participants with different TB Progression Score and between the TB progression group and No TB progression group was also investigated. Hazard radio (HR) was estimated with Cox proportional hazards model. Results: The higher the TBI at baseline, the higher TB Progression Score (P < 0.001). All five participants with TBI = 3 at baseline progressed; 46 (90 %) of 51 participants with TBI = 2 progressed. TB progression was also associated with shorter OS with statistically significant difference (adjusted HR = 1.68, P < 0.001). Conclusion: TB progression was visualized on chest CT frequently and clearly. It has the potential to be the predictor for poorer prognosis of ILA.

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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

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.

特集腎・泌尿器の画像診断update 前立腺癌のMRI 診断

有田祐起, 玉田勉, 池田織人, 陣崎雅弘

画像診断（学研メディカル秀潤社） 40 （ 6 ） 521 - 532 2020年04月

ISSN 0285-0524

特集腎・泌尿器の画像診断update 腎腫瘍の画像診断

秋田大宇, 池田織人, 若井理可子, 陣崎雅弘

画像診断（学研メディカル秀潤社） 40 （ 6 ） 565 - 576 2020年04月

ISSN 0285-0524

In vivo monitoring of remnant undifferentiated neural cells following human induced pluripotent stem cell-derived neural stem/progenitor cells transplantation

Tanimoto Y., Yamasaki T., Nagoshi N., Nishiyama Y., Nori S., Nishimura S., Iida T., Ozaki M., Tsuji O., Ji B., Aoki I., Jinzaki M., Matsumoto M., Fujibayashi Y., Zhang M.R., Nakamura M., Okano H.

Stem Cells Translational Medicine （Stem Cells Translational Medicine） 9 （ 4 ） 465 - 477 2020年04月

ISSN 21576564

© 2020 The Authors. Stem Cells Translational Medicine published by Wiley Periodicals, Inc. on behalf of AlphaMed Press Transplantation of human-induced pluripotent stem cell-derived neural stem/progenitor cells (hiPSC-NS/PCs) is a promising treatment for a variety of neuropathological conditions. Although previous reports have indicated the effectiveness of hiPSC-NS/PCs transplantation into the injured spinal cord of rodents and nonhuman primates, long-term observation of hiPSC-NS/PCs post-transplantation suggested some “unsafe” differentiation-resistant properties, resulting in disordered overgrowth. These findings suggest that, even if “safe” NS/PCs are transplanted into the human central nervous system (CNS), the dynamics of cellular differentiation of stem cells should be noninvasively tracked to ensure safety. Positron emission tomography (PET) provides molecular-functional information and helps to detect specific disease conditions. The current study was conducted to visualize Nestin (an NS/PC marker)-positive undifferentiated neural cells in the CNS of immune-deficient (nonobese diabetic-severe combined immune-deficient) mice after hiPSC-NS/PCs transplantation with PET, using 18 kDa translocator protein (TSPO) ligands as labels. TSPO was recently found to be expressed in rodent NS/PCs, and its expression decreased with the progression of neuronal differentiation. We hypothesized that TSPO would also be present in hiPSC-NS/PCs and expressed strongly in residual immature neural cells after transplantation. The results showed high levels of TSPO expression in immature hiPSC-NS/PCs-derived cells, and decreased TSPO expression as neural differentiation progressed in vitro. Furthermore, PET with [18F] FEDAC (a TSPO radioligand) was able to visualize the remnant undifferentiated hiPSC-NS/PCs-derived cells consisting of TSPO and Nestin+ cells in vivo. These findings suggest that PET with [18F] FEDAC could play a key role in the safe clinical application of CNS repair in regenerative medicine.

Silent MRA: arterial spin labeling magnetic resonant angiography with ultra-short time echo assessing cerebral arteriovenous malformation

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

Neuroradiology （Neuroradiology） 62 （ 4 ） 455 - 461 2020年04月

ISSN 00283940

© 2020, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: MR angiography using the silent MR angiography algorithm (silent MRA), which combines arterial spin labeling and an ultrashort time echo, has not been used for the evaluation of cerebral arteriovenous malformations (CAVMs). We aimed to determine the usefulness of silent MRA for the evaluation of CAVMs. Methods: Twenty-nine CAVMs of 28 consecutive patients diagnosed by 4D CT angiography or digital subtraction angiography, who underwent both time-of-flight (TOF) MRA and silent MRA, were enrolled. Two observers independently assessed the TOF-MRA and silent MRA images of CAVMs. Micro AVM was defined as AVM with a nidus diameter less than 10 mm. The detection rate, visualization of the components, and accuracy of Spetzler–Martin grade were evaluated with statistical software R. Results: For all 29 CAVMs, 23 (79%) lesions were detected for TOF-MRA and all for silent MRA. Of 10 micro AVMs, only 4 (40%) lesions were detectable on TOF-MRA and all (100%) on silent MRA. The visibility of the nidus and drainer was significantly better for silent MRA than TOF-MRA (p < 0.001), while there was no significant difference in the feeder between the two sequences. The accuracy rates of the Spetzler–Martin grade for the TOF and silent MRA were 38% (11/29) and 79.3% (23/29), respectively (p < 0.001). Conclusions: Silent MRA is useful for evaluating CAVM components and detecting micro AVM.

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Analysis of the superficial middle cerebral vein in sphenoid ridge meningioma using contrast-enhanced dynamic computed tomography angiography

Murase M., Mizutani K., Kawata K., Fujiwara H., Jinzaki M., Toda M., Yoshida K.

Clinical Neurology and Neurosurgery （Clinical Neurology and Neurosurgery） 191 2020年04月

ISSN 03038467

© 2020 Objective: The superficial middle cerebral vein (SMCV) is of clinical importance because of its contribution to the venous drainage of the superficial part of the cerebrum. Sphenoid ridge meningioma (SRM) grows adjacent to the SMCV and its drainage routes, and is thought to occasionally influence the hemodynamics of the SMCV, although this has seldom been suggested in the literature. We investigated the effect of SRM on the SMCV via blood flow analysis using multi-detector computed tomography. Patients and Methods: Overall, 22 patients with SRM who preoperatively underwent contrast-enhanced dynamic computed tomography at our institution were included in this study. We serially measured the Hounsfield units at each point of the SMCV and its adjacent veins on the side on which the tumor was located. We then obtained a time-density curve for each point via gamma distribution fitting. We determined the time-to-peak at each point by calculating the derivative of the time-density curve function and deduced the direction of blood passing through each vein by comparing the time-to-peak values between several points. Results: In total, 26 SMCVs were measured in 19 out of 22 cases. Of the 26 SMCVs, 16 were patent in the medial portion and contributed to normal venous drainage: 4 of them emptied into the cavernous sinus (CS), and 12 of them into the para-cavernous sinus (ParaCS). Out of the 10 that had their medial portions occluded because of the effects of the tumor, 6 SMCVs mainly drained into the vein of Labbé and/or the vein of Trolard retrogradely. However, in 2 of these, the small medial portions of the SMCVs near the occluded portion were maintained anterogradely by the collateral venous structures. In 4 SMCVs, the blood flow through the collateral veins remained anterograde; this was considered to contribute to normal venous drainage. Conclusion: The SRM is likely to cause occlusion or stenosis in the SMCV and influence its hemodynamics. In cases in which the connection between the SMCV and the CS or the ParaCS has been lost, the SMCV may still be involved in normal venous drainage via the collateral veins in some of those cases. Thus, the contribution of these veins to normal venous drainage in the brain should be analyzed preoperatively in careful detail.

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特集画像診断における脂肪の意味:存在からその意義まで泌尿器疾患

秋田大宇, 若井理可子, 陣崎雅弘

臨床画像（メジカルビュー社） 36 （ 3 ） 266 - 279 2020年03月

ISSN 0911-1069

Efficacy of a topical gelatin-thrombin hemostatic matrix, FLOSEAL®, in intracranial tumor resection

Kamamoto D., Kanazawa T., Ishihara E., Yanagisawa K., Tomita H., Ueda R., Jinzaki M., Yoshida K., Toda M.

Surgical Neurology International （Surgical Neurology International） 11 （ 16 ） 2020年02月

© 2020 Scientific Scholar. All rights reserved. Background: Hemostasis plays an important role in safe brain tumor resection and also reduces the risk for surgical complications. This study aimed to evaluate the efficacy of FLOSEAL®, a topical hemostatic agent that contains thrombin and gelatin granules, in brain tumor resections. Methods: We evaluated the hemostatic effect of FLOSEAL by scoring the intensity of bleeding from 1 (mild) to 4 (life threatening). We assessed the rate of success of hemostasis with 100 patients who underwent intracranial tumor resection. We also investigated the duration of the operation, the amount of intra- and postoperative bleeding, the number of hospital stays, and adverse events in patients who used FLOSEAL compared with those who did not use FLOSEAL. Results: FLOSEAL was applied to a total of 109 bleeding areas in 100 patients. A total of 95 bleeding areas had a score of 1 and 91 (96%) showed successful hemostasis. Thirteen bleeding areas scored 2 and 8 (62%) showed hemostasis with the first application of FLOSEAL. The second application was attempted with five bleeding areas and four showed hemostasis. About 94% (103/109 areas) of bleeding points successfully achieved hemostasis by FLOSEAL. Moreover, FLOSEAL significantly decreased the amount of intraoperative bleeding and postoperative bleeding as assessed with computed tomography on 1 day postoperatively compared with no use of FLOSEAL. There were no adverse events related to FLOSEAL use. Conclusion: Our results indicate that FLOSEAL is a reliable, convenient, and safe topical hemostatic agent for intracranial tumor resection.

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Development of Upright Computed Tomography with Area Detector for Whole-Body Scans: Phantom Study, Efficacy on Workflow, Effect of Gravity on Human Body, and Potential Clinical Impact

Jinzaki M., Yamada Y., Nagura T., Nakahara T., Yokoyama Y., Narita K., Ogihara N., Yamada M.

Investigative Radiology （Investigative Radiology） 55 （ 2 ） 73 - 83 2020年02月

ISSN 00209996

© Wolters Kluwer Health, Inc. All rights reserved. Objectives Multiple human systems are greatly affected by gravity, and many disease symptoms are altered by posture. However, the overall anatomical structure and pathophysiology of the human body while standing has not been thoroughly analyzed due to the limitations of various upright imaging modalities, such as low spatial resolution, low contrast resolution, limited scan range, or long examination time. Recently, we developed an upright computed tomography (CT), which enables whole-torso cross-sectional scanning with 3-dimensional acquisition within 15 seconds. The purpose of this study was to evaluate the performance, workflow efficacy, effects of gravity on a large circulation system and the pelvic floor, and potential clinical impact of upright CT. Materials and Methods We compared noise characteristics, spatial resolution, and CT numbers in a phantom between supine and upright CT. Thirty-two asymptomatic volunteers (48.4 ± 11.5 years) prospectively underwent both CT examinations with the same scanning protocols on the same day. We conducted a questionnaire survey among these volunteers who underwent the upright CT examination to determine their opinions regarding the stability of using the pole throughout the acquisition (closed question), as well as safety and comfortability throughout each examination (both used 5-point scales). The total access time (sum of entry time and exit time) and gravity effects on a large circulation system and the pelvic floor were evaluated using the Wilcoxon signed-rank test and the Mann-Whitney U test. For a large circulation system, the areas of the vena cava and aorta were evaluated at 3 points (superior vena cava or ascending aorta, at the level of the diaphragm, and inferior vena cava or abdominal aorta). For the pelvic floor, distances were evaluated from the bladder neck to the pubococcygeal line and the anorectal junction to the pubococcygeal line. We also examined the usefulness of the upright CT in patients with functional diseases of spondylolisthesis, pelvic floor prolapse, and inguinal hernia. Results Noise characteristics, spatial resolution, and CT numbers on upright CT were comparable to those of supine CT. In the volunteer study, all volunteers answered yes regarding the stability of using the pole, and most reported feeling safe (average rating of 4.2) and comfortable (average rating of 3.8) throughout the upright CT examination. The total access time for the upright CT was significantly reduced by 56% in comparison with that of supine CT (upright: 41 ± 9 seconds vs supine: 91 ± 15 seconds, P < 0.001). In the upright position, the area of superior vena cava was 80% smaller than that of the supine position (upright: 39.9 ± 17.4 mm2 vs supine: 195.4 ± 52.2 mm2, P < 0.001), the area at the level of the diaphragm was similar (upright: 428.3 ± 87.9 mm2 vs supine: 426.1 ± 82.0 mm2, P = 0.866), and the area of inferior vena cava was 37% larger (upright: 346.6 ± 96.9 mm2 vs supine: 252.5 ± 93.1 mm2, P < 0.001), whereas the areas of aortas did not significantly differ among the 3 levels. The bladder neck and anorectal junction significantly descended (9.4 ± 6.0 mm and 8.0 ± 5.6 mm, respectively, both P < 0.001) in the standing position, relative to their levels in the supine position. This tendency of the bladder neck to descend was more prominent in women than in men (12.2 ± 5.2 mm in women vs 6.7 ± 5.6 mm in men, P = 0.006). In 3 patients, upright CT revealed lumbar foraminal stenosis, bladder prolapse, and inguinal hernia; moreover, it clarified the grade or clinical significance of the disease in a manner that was not apparent on conventional CT. Conclusions Upright CT was comparable to supine CT in physical characteristics, and it significantly reduced the access time for examination. Upright CT was useful in clarifying the effect of gravity on the human body: Gravity differentially affected the volume and shape of the vena cava, depending on body position. The pelvic floor descended significantly in the standing position, compared with its location in the supine position, and the descent of the bladder neck was more prominent in women than in men. Upright CT could potentially aid in objective diagnosis and determination of the grade or clinical significance of common functional diseases.

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Prediction of postoperative recurrence of chronic subdural hematoma using quantitative volumetric analysis in conjunction with computed tomography texture analysis

Kanazawa T., Takahashi S., Minami Y., Jinzaki M., Toda M., Yoshida K.

Journal of Clinical Neuroscience （Journal of Clinical Neuroscience） 72 270 - 276 2020年02月

ISSN 09675868

© 2019 Elsevier Ltd Chronic subdural hematoma (CSDH) is a common disease in older individuals with a substantial rate of recurrence. The mechanism of CSDH recurrence remains unclear. This study aimed to detect imaging parameters that could indicate the risk for CSDH recurrence by using quantitative volumetric analysis and computed tomography (CT) texture analysis (CTTA). Clinical and imaging parameters were retrospectively investigated in 147 newly diagnosed CSDH lesions in 114 patients surgically treated at the Keio University Hospital during a 6-year period. For CT images, quantitative volumetric and texture analyses were performed. Hematoma volume, postoperative air volume, hematoma density, and texture parameters including kurtosis, skewness, and entropy were evaluated and compared with CSDH recurrence rate. Data were statistically evaluated, and a difference of p < 0.05 was considered significant. Reoperation for CSDH recurrence was required in 27 sides (18.4%) of 26 patients. Multivariate analysis showed that postoperative hematoma volume and postoperative hematoma density were independent risk factors for symptomatic CSDH recurrence that required reoperation. Postoperative hematoma volume, postoperative significant residual air, and postoperative hematoma density were also identified as independent risk factors for potential CSDH recurrence. Preoperative hematoma entropy was prone to be associated with both symptomatic and potential CSDH recurrence in univariate analysis, but not in multivariate analysis because of confounding factors. Quantitative volumetric analysis and CTTA could aid in distinguishing individuals at risk for CSDH recurrence.

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特集胸部の最新画像情報2020 症例肺トキソカラ症の1例

児玉さゆり, 杉浦弘明, 成松英俊, 渡邉浩美, 大熊潔, 川田真幹, 陣崎雅弘

臨床放射線（金原出版） 65 （ 1 ） 25 - 28 2020年01月

ISSN 0009-9252

特集胸部の最新画像情報2020 症例肺野の画像所見が診断の契機となったEhlers-Danlos症候群の1例

松本晋作, 杉浦弘明, 南康大, 山田祥岳, 渡辺理沙, 福永興壱, 陣崎雅弘

臨床放射線（金原出版） 65 （ 1 ） 67 - 70 2020年01月

ISSN 0009-9252

Disclosure of Amyloid Status for Risk of Alzheimer Disease to Cognitively Normal Research Participants With Subjective Cognitive Decline: A Longitudinal Study

Wake T., Tabuchi H., Funaki K., Ito D., Yamagata B., Yoshizaki T., Nakahara T., Jinzaki M., Yoshimasu H., Tanahashi I., Shimazaki H., Mimura M.

American journal of Alzheimer's disease and other dementias （American journal of Alzheimer's disease and other dementias） 35 153331752090455 2020年01月

ISSN 15333175

This study aimed to investigate the long-term impacts of disclosing amyloid status for a risk of Alzheimer disease (AD) to cognitively normal research participants with subjective cognitive decline (SCD), which represents an initial manifestation of AD. Forty-two participants were classified as the amyloid-positive (n = 10) or amyloid-negative (n = 32) groups. We assessed symptoms of anxiety, depression, and test-related distress at 6, 24, and 52 weeks after results disclosure. No difference was found over time in anxiety, depression, and test-related distress in either group. Although no significant differences were observed between groups in anxiety or depression, the amyloid-negative group had a significantly higher level of test-related distress than the amyloid-positive group at 52 weeks. Disclosing amyloid status to cognitively healthy research participants with SCD did not cause significant long-term psychological risks. However, a theoretical spectrum of subjective concern may exist about cognitive decline in amyloid-negative individuals.

Early prediction of clinical outcomes in patients with aneurysmal subarachnoid hemorrhage using computed tomography texture analysis

Kanazawa T., Takahashi S., Minami Y., Jinzaki M., Toda M., Yoshida K.

Journal of Clinical Neuroscience （Journal of Clinical Neuroscience） 71 144 - 149 2020年01月

ISSN 09675868

© 2019 Elsevier Ltd Radiological evaluation of subarachnoid hemorrhage (SAH) is often subject to interobserver variability. The aim of this study was to retrospectively detect computed tomography (CT) texture parameters in the early postictal state to predict cerebral vasospasm, delayed cerebral ischemia (DCI), and functional outcome in aneurysmal SAH using quantitative CT texture analysis (CTTA) via a commercially available software program and routine CT images. 40 patients with aneurysmal SAH surgically treated at the Keio University Hospital during a four-year period were analyzed. CT texture analyses were performed using a commercially available software program (Synapse Vincent). The following texture parameters of blood clots in the subarachnoid space and cerebral edema were assessed: mean CT value, entropy, skewness, and kurtosis. The mean CT value of blood clots in the subarachnoid space was significantly associated with cerebral vasospasm, DCI, and functional outcome. The mean CT value ≥ 49.64 Hounsfield units (HU) predicted cerebral vasospasm with a sensitivity and specificity of 85.7% and 61.5%, respectively (area under the curve [AUC] = 0.758). The mean CT value ≥ 49.95 HU predicted DCI with a sensitivity and specificity of 100% and 60.6%, respectively (AUC = 0.810). The mean CT value ≥ 53.00 HU predicted poor functional outcome with a sensitivity and specificity of 56.3% and 91.7%, respectively (AUC = 0.747). CTTA using a commercially available software program demonstrated that the mean CT value of clots in the subarachnoid space in the early postictal state could predict vasospasm, DCI, and clinical outcome with a high sensitivity and specificity.

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【胸部の最新画像情報2020】肺トキソカラ症の1例

児玉さゆり, 杉浦弘明, 成松英俊, 渡邉浩美, 大熊潔, 川田真幹, 陣崎雅弘

臨床放射線（金原出版(株)） 65 （ 1 ） 25 - 28 2020年01月

ISSN 0009-9252

症例は20歳代女性で、後頸部から後頭部痛を主訴に近医を受診し、化膿性脊椎炎の疑いで当院整形外科を紹介受診した。頸部MRIでは頸椎に有意な所見を認めなかった。血液検査では好酸球増多を認め、内科で精査の方針となり入院した。入院10日目に再度CT検査を施行したところ、初回CT検査と比較してすりガラス影、小結節状陰影は消退しており、一部に新規出現を認めた。抗寄生虫抗体スクリーニング検査では、ブタ回虫がクラス2と弱陽性、糞線虫がクラス1と偽陽性であった。そこで抗体定量検査を追加したところ、ブタ回虫や糞線虫に対する抗体価の上昇はなく、トキソカラに対する抗体価が有意に上昇しており、トキソカラ症と診断した。CT画像もトキソカラ症と合致する所見であった。albendazoleの内服は行わずに経過観察の方針となった。その後、再受診することなく経過している。

【胸部の最新画像情報2020】肺野の画像所見が診断の契機となったEhlers-Danlos症候群の1例

松本晋作, 杉浦弘明, 南康大, 山田祥岳, 渡辺理沙, 福永興壱, 陣崎雅弘

臨床放射線（金原出版(株)） 65 （ 1 ） 67 - 70 2020年01月

ISSN 0009-9252

症例は40歳代女性で、胸痛を主訴に近医を受診し、胸部単純X線で左気胸を指摘され当院へ紹介入院となった。胸部単純CTにて左気胸を認めた。両肺底部に複数の不整な嚢胞、両下葉に浸潤影、小葉中心性陰影および気管支拡張を認めた。なお、約1年前の肺炎時のCTでは嚢胞は認められなかった。胸腔ドレーンを留置するも気胸およびリークの改善を認めなかったため、胸腔鏡下左肺下葉嚢胞切除術を施行した。術後経過は良好で、術後約1週間で退院した。比較的若年者に繰り返す肺炎後に不整な嚢胞が散見され、難治性の気胸を発症したことから肺組織の脆弱性が示唆され、基礎疾患としてEhlers-Danlos症候群の可能性が疑われた。遺伝子検査ではCOL5A2遺伝子変異が陽性(ミスセンス変異)であり、古典型Ehlers-Danlos症候群と診断された。また、COL3A1遺伝子変異は陰性であったことから、血管型Ehlers-Danlos症候群は否定された。

Comparison of silent navigator waveform generation methods

Iwadate Y., Nozaki A., Nunokawa Y., Okuda S., Kabasawa H., Jinzaki M.

Magnetic Resonance in Medical Sciences （Magnetic Resonance in Medical Sciences） 19 （ 2 ） 154 - 158 2020年

ISSN 13473182

© 2019 Japanese Society for Magnetic Resonance in Medicine. The silent navigator technique utilizes a non-selective excitation and an appropriate respiratory waveform generation method is necessary for an accurate motion detection. We compared three methods for silent navigator waveform generation. The profile generation method with coil selection (prof-selection) resulted in a high cross correlation with bellows signals and a large respiration amplitude. The prof-selection method should be used for silent navigator waveform generation.

Pelvic floor morphology in the standing position using upright computed tomography: age and sex differences

Narita K., Yamada Y., Yamada M., Yokoyama Y., Nakahara T., Jinzaki M.

International Urogynecology Journal （International Urogynecology Journal） 31 （ 11 ） 2387 - 2393 2020年

ISSN 09373462

© 2020, The International Urogynecological Association. Introduction and hypothesis: This study was aimed at comparing pelvic floor parameters between the standing and supine positions using upright computed tomography (CT) and evaluating the effects of sex and age in normal healthy volunteers. Methods: In total, 139 volunteers (70 men, mean 46.7 years; 69 women, mean 47.3 years) underwent both upright CT in the standing position and conventional CT in the supine position. The distances from the bladder neck to the pubococcygeal line (PCL) and anorectal junction (ARJ), defined as the posterior aspect of the puborectalis muscle, to PCL were measured. The length, width, and area of the levator hiatus (LH) were measured on oblique axial images. Results: The bladder neck (men, 22.2 ± 4.9 mm vs 28.3 ± 5.3 mm; women, 9.0 ± 5.1 mm vs 19.0 ± 4.0 mm) and ARJ (men, −18.8 ± 5.5 mm vs −12.1 ± 5.1 mm; women, −20.0 ± 4.7 mm vs −11.2 ± 4.3 mm) were significantly lower in the standing position than in the supine position (all p < 0.0001). The LH area (men, 1,990 ± 380 mm2 vs 1,697 ± 329 mm2; women, 2,284 ± 344 mm2 vs 1,811 ± 261 mm2) was significantly larger in the standing position (both p < 0.0001). Differences in all parameters between the standing and supine positions were larger in women than in men. ARJ in women showed a significant tendency to descend with age only in the standing position (r = −0.29, p = 0.017). Conclusions: The bladder neck and ARJ descend and the LH area enlarges in the standing position. Pelvic floor mobility is greater in women than in men. Descent of the ARJ in the standing position is associated with aging in women.

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Quantitative analysis of the anatomical changes in the scalp and hair follicles in androgenetic alopecia using magnetic resonance imaging

Soga S., Koyama T., Mikoshi A., Jinzaki M., Arafune T., Kawashima M., Kobayashi K., Shinmoto H.

Skin Research and Technology （Skin Research and Technology） 27 （ 1 ） 56 - 61 2020年

ISSN 0909752X

© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Background: Although the structural changes of the scalp in androgenetic alopecia (AGA) have been reported, these changes have been poorly understood. It is expected that modern MRI would visualize the scalp anatomy in vivo. This study aimed to explore whether AGA causes (a) changes in the thickness of the scalp, (b) anatomical changes in the hair follicles, and (c) changes in the signal intensity of MRI. Materials and Methods: Twenty-seven volunteers underwent MRI for hair and scalp (MRH) and were categorized into two according to the Hamilton-Norwood Scale: the “AGA group” and the “normal group.” Two radiologists analyzed the thickness and signal intensity of the scalp, and the depth of hair follicles. These measurements were compared between the two groups. Results: The thickness of the hypodermis and the entire scalp was significantly thinner in the AGA group than in the control group. The AGA group had significantly shallower depth of hair follicles and relative depth of the hair follicles to that of the entire scalp than the normal group. The hypodermis showed higher signal intensity in the AGA group than the normal group. Conclusion: MRH allowed noninvasive visualization of the scalp anatomy and demonstrated the thinner nature of the entire scalp and hypodermis, along with the shallower depth of the hair follicles in the AGA group in comparison to the normal group. Additionally, MRH demonstrated the increased MR signal intensity in the scalp associated with AGA. MRH may be a promising new method for quantitative and objective analyses of AGA.

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Differences in Lung and Lobe Volumes between Supine and Standing Positions Scanned with Conventional and Newly Developed 320-Detector-Row Upright CT: Intra-Individual Comparison

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

Respiration （Respiration） 99 （ 7 ） 598 - 605 2020年

ISSN 00257931

© 2020 Background: No clinical studies to date have compared unilateral lung or lobe volumes between the supine and standing positions. Objectives: To compare lung/lobe volumes on computed tomography (CT) between these two positions and evaluate the correlation between the total lung volume and total lung capacity (TLC) on pulmonary function tests (PFTs). Methods: Thirty-two asymptomatic volunteers underwent both conventional CT (supine position) and upright CT (standing position), during deep inspiration breath-hold, and PFTs on the same day. We measured lung/lobe volumes on CT in each position. Paired t tests were used for statistical analysis. Results: The volumes of the total lung (10.9% increase), right lung (10.3% increase), right upper lobe (8.6% increase), right lower lobe (14.6% increase), left lung (11.6% increase), left upper lobe (7.1% increase), and left lower lobe (16.0% increase) were significantly greater in the standing position than in the supine position (all p < 0.0001). The right middle lobe volume was similar between the two positions (p = 0.16). Intraclass correlation coefficients for agreement between total lung volumes on CT in the supine/standing positions and the TLC on PFT were 0.891/0.938, respectively. Conclusions: While the volumes of the bilateral upper and lower lobes and bilateral lungs were significantly greater in the standing than in the supine position, with lower lobes showing larger changes, the right middle lobe volume did not change significantly between positions. The total lung volume on upright CT in the standing position was more similar to TLC on PFT than that in the supine position.

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Analysis of collateral lymphatic circulation in patients with lower limb lymphedema using magnetic resonance lymphangiography

Soga S., Onishi F., Jinzaki M., Mikoshi A., Minabe T., Shinmoto H.

Journal of Vascular Surgery: Venous and Lymphatic Disorders （Journal of Vascular Surgery: Venous and Lymphatic Disorders） 9 （ 2 ） 471 - 481.e1 2020年

ISSN 2213333X

© 2020 Society for Vascular Surgery Objective: Although the development of lymphatic collaterals is expected following lymphedema, little is known about the anatomic details of such compensatory pathways or their association with symptoms. Magnetic resonance lymphangiography (MRL) has been shown to be superior to lymphoscintigraphy and indocyanine green lymphography in visualizing lymphatics. This study aimed to analyze MRL images of lower limbs to elucidate the patterns of lymphatic collateral formation and their association with the clinical stages of lymphedema. Methods: We enrolled 56 consecutive patients (112 lower limbs) with lymphedema who underwent MRL. Two radiologists performed a consensus reading of MRL images for the presence or absence of collateral lymphatic pathways, and the results were compared with the clinical stages. Furthermore, the frequency of abnormal MRL findings in 43 asymptomatic lower limbs of patients with unilateral lymphedema was analyzed and compared with that in the 69 symptomatic lower limbs of the patients. The imaging findings were also compared with the cause of lymphedema. Results: All three collateral pathways (anterolateral, deep, and posteromedial lymphatics) were visualized at a higher (P <.05) frequency in stage II than in stage 0 lower limbs. The frequency of visualization of the three collaterals was significantly higher in symptomatic (stages I-III) lower limbs than in asymptomatic (stage 0) lower limbs. Most (76.8%) of the symptomatic limbs exhibited at least one of these collaterals, and the frequency was significantly higher than in the asymptomatic limbs (P <.001). Most (81.4%) of the asymptomatic (stage 0) lower limbs had at least one abnormal finding in terms of lymphatic circulation, although this proportion was significantly lower compared with the symptomatic limbs (98.6%). The collaterals tended to appear less frequently in primary lymphedema than in secondary lymphedema, reaching statistical significance in the posteromedial lymphatics. Conclusions: These results suggested that the two superficial lymphatic groups and the deep lymphatic system act as major collaterals of the lower limbs in patients with lymphedema. Furthermore, MRL of most patients with unilateral lymphedema demonstrated abnormal findings, including collateral formation, not only in the affected lower limb but also in the asymptomatic lower limb. In primary lymphedema, the collaterals may appear less frequently than in secondary lymphedema. Collaterals should be taken into consideration in planning the site of lymphaticovenous anastomosis and assessing disease progression. MRL can visualize preclinical alterations in lymphatic flow and compensatory pathways; therefore, we expect that it will be useful for the early diagnosis of lymphedema.

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Usefulness of fine-tuning for deep learning based multi-organ regions segmentation method from non-contrast CT volumes using small training dataset

Hayashi Y., Shen C., Roth H.R., Oda M., Misawa K., Jinzaki M., Hashimoto M., Kumamaru K.K., Aoki S., Mori K.

Progress in Biomedical Optics and Imaging - Proceedings of SPIE （Progress in Biomedical Optics and Imaging - Proceedings of SPIE） 11314 2020年

ISSN 9781510633957

© 2020 SPIE. This paper presents segmentation of multiple organ regions from non-contrast CT volume based on deep learning. Also, we report usefulness of fine-tuning using a small number of training data for multi-organ regions segmentation. In medical image analysis system, it is vital to recognize patient specific anatomical structures in medical images such as CT volumes. We have studied on a multi-organ regions segmentation method from contrast-enhanced abdominal CT volume using 3D U-Net. Since non-contrast CT volumes are also usually used in the medical field, segmentation of multi-organ regions from non-contrast CT volume is also important for the medical image analysis system. In this study, we extract multi-organ regions from non-contrast CT volume using 3D U-Net and a small number of training data. We perform fine-tuning from a pre-trained model obtained from the previous studies. The pre-trained 3D U-Net model is trained by a large number of contrast enhanced CT volumes. Then, fine-tuning is performed using a small number of non-contrast CT volumes. The experimental results showed that the fine-tuned 3D U-Net model could extract multi-organ regions from non-contrast CT volume. The proposed training scheme using fine-tuning is useful for segmenting multi-organ regions using a small number of training data.

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Successful depiction of systemic collateral supply to pulmonary artery in CTEPH using time-resolved 4D CT angiography: a case report

Tamura M., Kawakami T., Yamada Y., Kataoka M., Nakatsuka S., Fukuda K., Jinzaki M.

Pulmonary Circulation （Pulmonary Circulation） 10 （ 2 ） 2020年

ISSN 20458932

© The Author(s) 2020. A 49-year-old man with CTEPH (pre-procedural mean pulmonary artery pressure: 36 mmHg) underwent balloon pulmonary angioplasty. Chronic total occlusion of the left inferior pulmonary artery trunk was observed. To evaluate the collateral vessels of the chronic total occlusion, 4D-CTA was performed. The examination was performed using a 256-row detector CT system using the test bolus tracking method. 4D-CTA showed the bronchial artery-to-left inferior pulmonary artery collateral supply, which was confirmed by a selective bronchial artery angiography. The patient’s symptoms improved with balloon pulmonary angioplasty of the other stenotic lesions. 4D-CTA can noninvasively evaluate the anatomy and hemodynamics of multiple systemic collaterals simultaneously. This technique can support interventions in systemic artery-to-pulmonary artery collaterals, such as embolization, and could be helpful in challenging balloon pulmonary angioplasty interventions for chronic total occlusion to identify vessel structures distal to the chronic total occlusion and collateral channels for a retrograde approach.

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Sinking skin flap syndrome visualized by upright computed tomography

Yoshida K., Toda M., Yamada Y., Yamada M., Yokoyama Y., Fujiwara H., Kosugi K., Fukumura M., Koike K., Takahashi S., Yoshida K., Jinzaki M.

Acta Neurochirurgica （Acta Neurochirurgica） 162 （ 8 ） 1825 - 1828 2020年

ISSN 00016268

© 2020, Springer-Verlag GmbH Austria, part of Springer Nature. Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. We present a 33-year-old man who experienced hemiparesis in the upright position after craniectomy. Upright computed tomography (CT) before cranioplasty showed a remarkable shift of the brain compared to supine CT. After cranioplasty, both symptoms and brain shift on CT resolved. Upright CT enables detection and objective evaluation of paradoxical herniation and midline shift that is not obvious on supine imaging modalities. Clinicians need to be aware of positional brain shift in postcraniectomy patients.

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Quantitative analysis of intervertebral disc degeneration using Q-space imaging in a rat model

Nakashima D., Fujita N., Hata J., Komaki Y., Suzuki S., Nagura T., Fujiyoshi K., Watanabe K., Tsuji T., Okano H., Jinzaki M., Matsumoto M., Nakamura M.

Journal of Orthopaedic Research （Journal of Orthopaedic Research） 38 （ 10 ） 2220 - 2229 2020年

ISSN 07360266

© 2020 Orthopaedic Research Society. Published by Wiley Periodicals LLC The degree of intervertebral disc (IVD) degeneration is qualitatively evaluated on T2-weighted imaging (T2WI). However, it is difficult to assess subtle changes in IVD degeneration using T2WI. Q-space imaging (QSI) is a quantitative diffusion-weighted imaging modality used to detect subtle changes in microenvironments. This study aimed to evaluate whether QSI can detect the inhibitory effects of the antioxidant N-acetylcysteine (NAC) in IVD degeneration. We classified female Wistar rats into control, puncture, and NAC groups (n = 5 per group). In the puncture and NAC groups, IVDs were punctured using a needle. The antioxidant NAC, which suppresses the progression of IVD degeneration, was orally administered in the NAC group 1 week prior to puncture. The progression and inhibitory effect of NAC in IVD degeneration were assessed using magnetic resonance imaging (MRI): IVD height, T2 mapping, apparent diffusion coefficient (ADC), and QSI. MRI was performed using a 7-Tesla system with a conventional probe (20 IVDs in each group). QSI parameters that were assessed included Kurtosis, the probability at zero displacement (ZDP), and full width at half maximum (FWHM). IVD degeneration by puncture was confirmed by histology, IVD height, T2 mapping, ADC, and all QSI parameters (P <.001); however, the inhibitory effect of NAC was confirmed only by QSI parameters (Kurtosis and ZDP: both P <.001; FWHM: P <.01). Kurtosis had the largest effect size (Kurtosis: 1.13, ZDP: 1.06, and FWHM: 1.02) when puncture and NAC groups were compared. QSI has a higher sensitivity than conventional quantitative methods for detecting the progressive change and inhibitory effect of NAC in IVD degeneration.

Diagnosis, prevention, and treatment of cardiovascular diseases in people with type 2 diabetes and prediabetes: a consensus statement jointly from the Japanese Circulation Society and the Japan Diabetes Society

Araki E., Tanaka A., Inagaki N., Ito H., Ueki K., Murohara T., Imai K., Sata M., Sugiyama T., Ishii H., Yamane S., Kadowaki T., Komuro I., Node K., Amano T., Anzai T., Babazono T., Emoto M., Fukuda K., Hagiwara N., Hirata K.i., Ikari Y., Ikeda T., Izumi C., Jinzaki M., Kaneto H., Katagiri H., Kimura T., Kobayashi Y., Maemura K., Matoba S., Minamino T., Mitani Y., Miura S.i., Morino Y., Nakamura J., Nishio Y., Ogawa W., Ohishi M., Okura H., Ono M., Sakata Y., Sato A., Shimada A., Shimizu W., Shimomura I., Shiojima I., Takamura M., Takeishi Y., Tanemoto K., Tanizawa Y., Terauchi Y., Tobe K., Tetsuou Y., Watada H., Yamauchi T., Yano M., Yoshioka N.

Diabetology International （Diabetology International） 2020年

ISSN 21901678

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Relationship between hip joint proximity area and sagittal balance parameters: an upright computed tomography study

Kikuchi S., Nakashima D., Yamada Y., Yamada M., Yokoyama Y., Kanaji A., Nakamura M., Nagura T., Jinzaki M.

European Spine Journal （European Spine Journal） 2020年

ISSN 09406719

Purpose: A close relationship between sagittal spinal alignment and hip osteoarthritis (OA) has been documented. This study aimed to examine the relationship between hip joint proximity area and sagittal balance parameters in healthy subjects. Methods: This prospective study enrolled 47 healthy volunteers who underwent 320-detector row upright computed tomography. Acquired data were reconstructed in a virtual three-dimensional space. The proximity area was determined by < 1 mm of the Hausdorff distance between the acetabulum and the femoral head. Volunteers were divided into the anterior and posterior proximity groups depending on the position of the closest area. Sagittal balance parameters [sagittal vertical axis (SVA), T1 spinopelvic inclination (T1-SPi), T1-pelvic angle, pelvic tilt, sacral slope, pelvic incidence, lumbar lordosis, thoracic kyphosis), offset distance between the centre of the acoustic meati (CAM) and C7 plumb line (CAM-C7-offset), and offset distance between the CAM and hip axis (HA) (CAM-HA-offset)] were compared between the two groups using independent sample t test. Results: The anterior proximity group (n = 24) had higher SVA (p = 0.016) and T1-Spi (p = 0.015) than the posterior proximity group (n = 23). CAM-HA-offset was higher in the posterior than in the anterior proximity group (p < 0.000). There was no difference in other parameters (p > 0.05). Conclusion: The anterior proximity group had a positive anterior spinal balance; the posterior proximity group may have a more posterior gravity line than the hip joint centre. The anterior spinal balance may contribute to the anterior loading of the hip joint, with known relation with the initiation and onset of hip OA.

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Projected lung areas using dynamic X-ray (DXR)

Hino T., Hata A., Hida T., Yamada Y., Ueyama M., Araki T., Kamitani T., Nishino M., Kurosaki A., Jinzaki M., Ishigami K., Honda H., Hatabu H., Kudoh S.

European Journal of Radiology Open （European Journal of Radiology Open） 7 2020年

Background: Dynamic X-ray (DXR) provides images of multiple phases of breath with less radiation exposure than CT. The exact images at end-inspiratory or end-expiratory phases can be chosen accurately. Purpose: To investigate the correlation of the projected lung area (PLA) by dynamic chest X-ray with pulmonary functions. Material and Methods: One hundred sixty-two healthy volunteers who received medical check-ups for health screening were included in this study. All subjects underwent DXR in both posteroanterior (PA) and lateral views and pulmonary function tests on the same day. All the volunteers took several tidal breaths before one forced breath as instructed. The outlines of lungs were contoured manually on the workstation with reference to the motion of diaphragm and the graph of pixel values. The PLAs were calculated automatically, and correlations with pulmonary functions and demographic data were analyzed statistically. Results: The PLAs have correlation with physical characteristics, including height, weight and BMI, and pulmonary functions such as vital capacity (VC) and forced expiratory volume in one second (FEV ). VC and FEV revealed moderate correlation with the PLAs of PA view in forced inspiratory phase (VC: right, r = 0.65; left, r = 0.69. FEV1: right, r = 0.54; left, r = 0.59). Multivariate analysis showed that body mass index (BMI), sex and VC were considered independent correlation factors, respectively. Conclusion: PLA showed statistically significant correlation with pulmonary functions. Our results indicate DXR has a possibility to serve as an alternate method for pulmonary function tests in subjects requiring contact inhibition including patients with suspected or confirmed covid-19. 1 1

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MR imaging of mushroom-like skin adnexal tumors in the scalp: A report of two cases

Arai M., Nozaki T., Matsusako M., Zenke Y., Arai S., Matsui M., Suzuki K., Jinzaki M., Kurihara Y.

Magnetic Resonance in Medical Sciences （Magnetic Resonance in Medical Sciences） 19 （ 3 ） 282 - 285 2020年

ISSN 13473182

Few studies had been published regarding imaging findings of skin adnexal tumors. We experienced two giant cases of them with a characteristic mushroom-like growth pattern. MRI showed a circumscribed mushroom-like shaped mass extruding from the subcutaneous tissue with microcystic lesions. Although differentiation between benignancy and malignancy may be difficult by radiological examinations, MRI may be helpful to identify its origin and differentiate soft tissue tumors with skin adnexal tumors in having these imaging findings.

A Case of Head and Neck Lymphatic Malformation in which Sclerotherapy with Polidocanol was Useful for Hemostasis

Kikuchi Akira, Aramaki-Hattori Noriko, Inoue Masanori, Ozawa Hiroyuki, Nakamura Shintaro, Sakai Shigeki, Okabe Keisuke, Nakatsuka Seishi, Jinzaki Masahiro, Kishi Kazuo

International Journal of Surgical Wound Care （一般社団法人日本創傷外科学会） 1 （ 1 ） 38 - 41 2020年

Lymphatic malformations that occur in the head and neck are often difficult to treat. Sclerotherapy using polidocanol, which has little tissue damage, can be treated with minimal dysfunction and complications. In particular, it is considered an effective treatment for superficial lesions that bleed from the mucosal surface. In this study, we performed sclerotherapy using polidocanol for a 17-year-old woman with lymphatic malformations with blood containing lymphorrhea in the pharynx and larynx. A total of 3 sclerotherapy treatments were performed, and lesion reduction and bloody lymphorrhea control were observed. At 1 year after treatment, the course of treatment was good with no re-enlargement of the lesions.

腹部リンパ漏病変に対するIVR

井上政則, 鳥飼秀幸, 伊東伸剛, 田村全, 小川遼, 中塚誠之, 陣崎雅弘

日本インターベンショナルラジオロジー学会雑誌（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） 34 （ 3 ） 187 - 192 2020年

ISSN 1340-4520

One of the important functions of the lymphatic system is maintenance of fluid balance, and lymphatic leakage after surgery potentially becomes a critical condition. Interventional techniques could not treat lymphatic leakage effectively mostly due to the lack of clinical imaging. However, the recently developed intranodal lymphangiography provides new insight into lymphatic intervention. At first, thoracic duct embolization has become the method of choice for the treatment of patients with chylothorax. Abdominal lymphatic leakage as a complication of abdominal and pelvic surgery is an uncommon but difficult-to-treat condition when conservative measures have failed. Embolization and sclerotherapy are also very useful for refractory lymphatic leakage. These current advances will open up new treatments and diag-nostic opportunities for abdominal lymphatic leakage.

Prediction of extraprostatic extension by MRI tumor contact length: difference between anterior and posterior prostate cancer

Matsumoto K., Akita H., Narita K., Hashiguchi A., Takamatsu K., Takeda T., Kosaka T., Mizuno R., Kikuchi E., Oya M., Jinzaki M.

Prostate Cancer and Prostatic Diseases （Prostate Cancer and Prostatic Diseases） 22 （ 4 ） 539 - 545 2019年12月

ISSN 13657852

© 2019, Springer Nature America, Inc. Background: Tumor contact length (TCL) is defined as the extent of contact between prostate cancer and the prostatic capsule, and its predictive value for microscopic extraprostatic extension (EPE) has been reported. However, the impact of the zonal origin (anterior or posterior tumor) of the tumor on the diagnosis of EPE is controversial. Methods: We retrospectively analyzed the records of 233 consecutive patients who underwent preoperative MRI and radical prostatectomy. We designated their tumors as anterior or posterior, and evaluated the correlation between the TCL measured by MRI and microscopic EPE in the radical prostatectomy specimen. Then, we created the predicted probability curves for EPE versus TCL for anterior and posterior prostate cancer. Results: There were 109 patients (47%) with an anterior tumor and 124 patients (53%) with a posterior tumor. Postoperative pathological analysis confirmed pT3 in 18 patients (17%) with an anterior tumor and in 53 patients (43%) with a posterior tumor. Multivariate analysis demonstrated that the zonal origin of the tumor was an independent predictive factor for EPE. We developed separate probability curves of EPE versus TCL for anterior and posterior prostate cancer, which revealed that anterior tumors were less likely to invade the extraprostatic tissues. Among patients whose TCL was 10–20 mm, 9/32 patients (28%) with an anterior tumor had EPE compared with 24/45 patients (53%) with a posterior tumor (p = 0.036). The decision curve of this EPE predictive model had high clinical efficacy. Conclusions: Our results indicate that anterior tumors have more favorable pathological characteristics than posterior tumors with the same TCL measured by MRI. We constructed two separate predicted probability curves for EPE after discriminating anterior and posterior tumors, which will be useful for decision making in clinical practice.

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Use of CT in a standing position for preoperative evaluation in abdominal incisional hernia: A pilot study

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

Journal of plastic, reconstructive & aesthetic surgery : JPRAS （Journal of plastic, reconstructive & aesthetic surgery : JPRAS） 72 （ 12 ） 2019年12月

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Predictive markers for MGMT promoter methylation in glioblastomas

Kanazawa T., Minami Y., Jinzaki M., Toda M., Yoshida K., Sasaki H.

Neurosurgical Review （Neurosurgical Review） 42 （ 4 ） 867 - 876 2019年12月

ISSN 03445607

© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. The promoter methylation status of the O6-methylguanine-DNA methyltransferase (MGMT) gene has been described as the most important predictor of chemotherapeutic response and patients’ survival in glioblastomas (GBs). Therefore, prediction of the MGMT promoter methylation status by imaging would help to preoperatively decide the overall treatment strategy as well as surgical strategy. This study aimed to detect imaging parameters to predict MGMT promoter methylation in GBs by using a commercially available software. We investigated three imaging features (ring enhancement, tumor location, and laterality) and apparent diffusion coefficient (ADC) parameters in 48 newly diagnosed GBs treated at Keio University Hospital in 2006 or later. For ADC, texture analyses were performed. Regions of interest (ROIs) were drawn manually with reference to contrast-enhanced areas, excluding necrotic and cystic regions. Mean ADC value and ADC histogram parameters, including kurtosis, skewness, and entropy, were compared with MGMT promoter methylation. Each parameter was evaluated to determine correlation with MGMT promoter methylation, and the parameters with significant associations with the methylation status were correlated with the MGMT-positive cell ratio determined by immunohistochemistry (IHC) analysis. The mean ADC value and ADC entropy were significantly associated with MGMT promoter methylation. The combination of mean ADC value and ADC entropy predicted MGMT promoter methylation, with a PPV of 81.2% and specificity of 88.9%. The mean ADC value and ADC entropy were negatively correlated with the MGMT-positive cell ratio in the IHC analysis. This study demonstrated that texture analyses of ADC histograms in GBs were predictive of MGMT promoter methylation.

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Picked-up Knowledge from Foreign Journals 血管周囲の脂肪

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 （ 1 ） 112 - 114 2019年11月

ISSN 0285-0524

Three-dimensional kinematic change of hindfoot during full weightbearing in standing: An analysis using upright computed tomography and 3D-3D surface registration

Kaneda K., Harato K., Oki S., Ota T., Yamada Y., Yamada M., Matsumoto M., Nakamura M., Nagura T., Jinzaki M.

Journal of Orthopaedic Surgery and Research （Journal of Orthopaedic Surgery and Research） 14 （ 1 ） 2019年11月

© 2019 The Author(s). Background: Weightbearing of the hindfoot affects positional changes of the ankle joint and subtalar joint (ankle-joint complex [AJC]). However, it is difficult to assess the kinematic changes in the hindfoot in a natural full weightbearing condition using conventional CT or cone beam computed tomography (CT) due to limitations of acquiring foot images under a physiological weightbearing condition using those imaging modalities. Analysis of AJC kinematics using fluoroscopy and 2D-3D registration technique requires data on the number of steps and amount of time to build and match the bones. This study aimed to analyze the effect of full weightbearing on hindfoot motion when standing using upright CT and 3D-3D surface registration. Methods: Forty-eight AJCs of 24 asymptomatic volunteers (13 women, 11 men) were examined under no weightbearing, 50% weightbearing, and single leg full weightbearing conditions while standing. The CT images were acquired from the distal femur to the whole foot using a 320-row upright CT scanner. The condition of each weightbearing stance was measured using a pressure mat. Bone-to-bone rotations of the talus relative to the tibia and calcaneus relative to the talus were evaluated using the surface registration technique. Image quality of the CT and intra- and interobserver reliabilities of the rotation angle were also evaluated. Results: All CT images were excellent or good quality and the intra- and interobserver correlation coefficients for the angle were 0.996 and 0.995, respectively. The motion of the ankle joint and subtalar joint under 50% and 100% weightbearing were as follows (in degrees); the talus plantarflexed (5.1 ± 4.5 and 6.8 ± 4.8), inverted (1.3 ± 1.4 and 2.0 ± 1.6), and internally rotated (2.4 ± 4.2 and 4.3 ± 4.6) relative to the tibia, and the calcaneus dorsiflexed (2.8 ± 1.4 and 3.8 ± 1.7), everted (5.3 ± 2.6 and 8.0 ± 3.6), and externally rotated (3.0 ± 2.0 and 4.1 ± 2.4) relative to the talus, respectively. Conclusions: The effect of weightbearing was clearly identified using an upright CT and the 3D-3D registration technique. Three-dimensional kinematics under static full weightbearing were opposite between the ankle and subtalar joints on their respective axes.

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Myocardial T1 values in healthy volunteers measured with saturation method using adaptive recovery times for T1 mapping (SMART1Map) at 1.5 T and 3 T

Matsumoto S., Okuda S., Yamada Y., Suzuki T., Tanimoto A., Nozaki A., Jinzaki M.

Heart and Vessels （Heart and Vessels） 34 （ 11 ） 1889 - 1894 2019年11月

ISSN 09108327

© 2019, Springer Japan KK, part of Springer Nature. Myocardial T1 mapping is clinically valuable for assessing the myocardium, and modified look-locker inversion-recovery (MOLLI) approaches have been commonly used for measuring myocardial T1 values. To date, several other sequences have been developed for measuring myocardial T1 values, and saturation-recovery-based sequences have been shown to be less dependent on various factors, such as T2 times and magnetization transfer, than inversion-recovery techniques. Systematic differences in T1 values between different sequences have been reported; therefore, definition of the normal range of native T1 values is required before clinical usage can begin. The purpose of this study was to evaluate the reference range and sex dependency of native T1 values in the myocardium measured using one such saturation-recovery sequence, i.e., saturation method using adaptive recovery times for cardiac T1 mapping (SMART1Map). Myocardial T1 values were compared between SMART1Map and MOLLI in 24 young healthy volunteers at 1.5 T and 3 T, and differences in the T1 values between the sexes were assessed. The mean native T1 values in the myocardium were significantly longer with SMART1Map than MOLLI [1530.4 ± 49.2 vs 1222.1 ± 48.9 ms at 3 T (p < 0.001) and 1227.3 ± 41.9 ms vs 1014.8 ± 49.4 ms at 1.5 T (p < 0.001)]. A significant difference between the sexes was observed in the T1 values obtained using each sequence, excluding SMART1Map at 3 T. The SMART1Map has a potential advantage to overcome the shortcoming of MOLLI, which underestimates T1 values; however, the sex-dependent difference remains obscure using SMART1Map.

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Usefulness of contrast-enhanced ultrasonography for diagnosis of renal cell carcinoma in dialysis patients: Comparison with computed tomography

Hashimoto M., Ohkuma K., Akita H., Yamada Y., Nakatsuka S., Mizuno R., Oya M., Jinzaki M.

Medicine (United States) （Medicine (United States)） 98 （ 47 ） 2019年11月

ISSN 00257974

© 2019 the Author(s). Published by Wolters Kluwer Health, Inc. Aims:To investigate the usefulness of contrast-enhanced ultrasonography for diagnosing renal cell carcinoma (RCC) in dialysis patients.Material and methods:Of 1301 dialysis patients who underwent abdominal computed tomography (CT) between January 2012 and March 2017, 19 were suspected to have solid renal lesions; of these patients, 18 gave consent for and underwent contrast-enhanced ultrasonography with perflubutane in addition to CT; 13 underwent dynamic contrast-enhanced CT, and 5, who could not be administered iodinated contrast media, underwent unenhanced CT. The final diagnoses were based on histopathological findings or the presence/absence of enlargement of the lesion during follow-up.Results:Of the 19 lesions in 18 patients, 14 were diagnosed as RCC and 5 as benign cysts. CT facilitated accurate diagnosis in 10/19 lesions (52.6%) with obvious enhancement (≥20 Hounsfield units [HU]), while definitive diagnosis by CT was difficult in 9 lesions: 2 lesions showed ambiguous enhancement (10-20 HU), 1 lesion was an inflammatory cyst with obvious enhancement, and 6 lesions were assessed by unenhanced CT. Compared with CT, contrast-enhanced ultrasonography allowed more accurate diagnosis (McNemar test, P = .02) in 17/19 lesions (89.5%, 14 RCC and 3 cysts; including all lesions assessed by unenhanced CT and 2 with ambiguous enhancement on CT), with 1 false-positive (inflammatory cyst with hyper-enhancement) and 1 false-negative result due to deep location of the lesion.Conclusions:Contrast-enhanced ultrasonography was useful for the diagnosis of RCC in dialysis patients with suspected solid renal lesions especially when contrast enhancement was not obvious on CT or contrast-enhanced CT could not be performed.

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Four-dimensional ct analysis using sequential 3d-3d registration

Oki S., Kaneda K., Yamada Y., Yamada M., Morishige Y., Harato K., Matsumura N., Nagura T., Jinzaki M.

Journal of Visualized Experiments （Journal of Visualized Experiments） 2019 （ 153 ） 2019年11月

ISSN 1940087X

© 2019 Journal of Visualized Experiments. Four-dimensional computed tomography (4DCT) provides a series of volume data and visualizes joint motions. However, numerical analysis of 4DCT data remains difficult because segmentation in all volumetric frames is time-consuming. We aimed to analyze joint kinematics using a sequential 3D-3D registration technique to provide the kinematics of the moving bone with respect to the fixed bone semiautomatically using 4DCT DICOM data and existing software. Surface data of the source bones are reconstructed from 3DCT. The trimmed surface data are respectively matched with surface data from the first frame in 4DCT. These trimmed surfaces are sequentially matched until the last frame. These processes provide positional information for target bones in all frames of the 4DCT. Once the coordinate systems of the target bones are decided, translation and rotation angles between any two bones can be calculated. This 4DCT analysis offers advantages in kinematic analyses of complex structures such as carpal or tarsal bones. However, fast or large-scale motions cannot be traced because of motion artifacts.

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A Novel Flow Dynamics Study of the Intracranial Veins Using Whole Brain Four-Dimensional Computed Tomography Angiography

Mizutani K., Arai N., Toda M., Akiyama T., Fujiwara H., Jinzaki M., Yoshida K.

World Neurosurgery （World Neurosurgery） 131 e176 - e185 2019年11月

ISSN 18788750

© 2019 Elsevier Inc. Background: The flow dynamics of the intracranial venous channels are fundamentally important for understanding intracranial physiology and pathophysiology. However, the method clinically applicable to the evaluation of the flow dynamics of the intracranial venous system has not been well described in the reported data. We have developed a new method to evaluate intracranial venous flow direction and velocity using 4-dimensional (4D) computed tomography angiography (CTA). The aim of the present study was to verify the accuracy and validity of 4D-CTA in a clinical setting. Methods: We retrospectively analyzed 97 veins from 26 patients (16 cases of arteriovenous shunt disease, 9 intracranial tumor cases, and 1 cerebral aneurysm case) who had undergone both 4D-CTA and conventional digital subtraction angiography (DSA). Using 4D-CTA, we analyzed the time-density curve with gamma distribution extrapolation and obtained the direction of the flow and flow velocity of each vein. The direction of the flow in 4D-CTA was also collated with that obtained using conventional DSA to verify the experimental method. Results: The direction of the flow determined by 4D-CTA was consistent with that of conventional DSA in 94.8% of cases. The average venous flow velocity was 64.3 mm/second and 81.8 mm/second, respectively, in the antegrade and retrograde channels affected by arteriovenous shunts. Conclusions: The present flow analysis using 4D-CTA enabled us to evaluate the direction and velocity of intracranial venous flow. Other than some limitations, the presented method is reliable and its potential for application in clinical settings is promising.

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特集希少癌に備える-いざという時のための基礎知識後腹膜腫瘍:画像診断

秋田大宇, 池田織人, 陣崎雅弘

臨床泌尿器科（株式会社医学書院） 73 （ 11 ） 806 - 814 2019年10月

ISSN 0385-2393

Quantitative Assessment of Bone Metastasis in Prostate Cancer Using Synthetic Magnetic Resonance Imaging

Arita Y., Takahara T., Yoshida S., Kwee T.C., Yajima S., Ishii C., Ishii R., Okuda S., Jinzaki M., Fujii Y.

Investigative Radiology （Investigative Radiology） 54 （ 10 ） 638 - 644 2019年10月

ISSN 00209996

© Wolters Kluwer Health, Inc. All rights reserved. Objectives The aims of this study were to evaluate the feasibility of quantitative synthetic magnetic resonance imaging (SyMRI) for characterizing bone lesions in prostate cancer and to discriminate viable progressive osteoblastic bone metastasis from nonviable bone metastases with treatment-induced sclerosis during the treatment course. Materials and Methods This institutional review board-approved prospective study included 96 consecutive prostate cancer patients who underwent whole-body MRI including diffusion-weighted imaging at the time of staging at diagnosis or starting a new line of anticancer treatment. Additional synthetic MRI of the lumbosacral spine, pelvis, and proximal femurs was performed. A region of interest of 1.0 cm in diameter was set in each bone lesion by 2 independent readers who were blinded to bone lesions' diagnosis. Differences in SyMRI variables between the different bone lesions were compared with the Wilcoxon rank sum test, and associations of SyMRI variables with active disease were analyzed with logistic regression analysis. Performance of T1, T2, and proton density (PD) for diagnosing active disease was assessed using the area under the receiver operating characteristic curve. Results Ninety-three bone lesions were eligible for analysis. The PD values of active (viable) bone metastatic lesions were significantly higher than those of inactive (nonviable) bone metastatic lesions without sclerosis and those of red bone marrow (P < 0.001 for both readers). The PD values of inactive bone metastatic lesions with sclerosis were significantly lower than those of inactive bone metastatic lesions without sclerosis and red bone marrow (P < 0.001 for both readers). The PD value proved to be an independent significant indicator (P < 0.001) for differentiating bone lesions. The areas under the curve of T1/T2/PD for identifying active disease were 0.81/0.69/0.93 for reader 1 and 0.78/0.70/0.92 for reader 2, respectively. Conclusions Signal quantification on SyMRI provides objective assessment of bone lesions in the lower trunk. The PD value can be useful to determine the viability of bone metastases in prostate cancer.

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Diagnostic imaging of retroperitoneal tumor

Akita H., Jinzaki M., Ikeda O.

Japanese Journal of Clinical Urology （Japanese Journal of Clinical Urology） 73 （ 11 ） 806 - 814 2019年10月

ISSN 03852393

Glenohumeral translation during active external rotation with the shoulder abducted in cases with glenohumeral instability: a 4-dimensional computed tomography analysis

Matsumura N., Oki S., Fukasawa N., Matsumoto M., Nakamura M., Nagura T., Yamada Y., Jinzaki M.

Journal of Shoulder and Elbow Surgery （Journal of Shoulder and Elbow Surgery） 28 （ 10 ） 1903 - 1910 2019年10月

ISSN 10582746

© 2019 Journal of Shoulder and Elbow Surgery Board of Trustees Background: Although glenohumeral instability is common, the mechanism of instability remains unclear. The purpose of this study was to quantitatively evaluate humeral head translation during active external rotation with abduction in patients with glenohumeral instability by use of 4-dimensional computed tomography scans. Methods: Ten patients with unilateral glenohumeral instability with a positive fulcrum test were prospectively included in this study. Sequential computed tomography of bilateral shoulders during active external rotation at 90° of shoulder abduction was performed for 6 seconds at 5 frames per second. The 3-dimensional positions of the humeral head center in the anteroposterior, superoinferior, and mediolateral directions were calculated at 0°, 20°, 40°, 60°, and maximum shoulder abduction–external rotation from the starting position. Translation of the humeral head center from the starting position was evaluated using Dunnett multiple-comparison tests, and the differences between the affected and intact shoulders were assessed using Wilcoxon signed rank tests. Results: The humeral head center translated posteriorly, inferiorly, and medially during glenohumeral external rotation with the shoulder in the abducted position on the intact side. However, the affected humeral head showed significantly less posterior translation (P = .028), greater inferior translation (P = .047), and less medial translation (P = .037) than the contralateral side. Conclusions: This study indicated that dysfunction of the anterior band of the inferior glenohumeral ligament causes decreased posterior, increased inferior, and decreased medial translation of the humeral head during active shoulder abduction–external rotation.

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連載特集アドバンストコース『臨床画像』Vol.35,5月号特集　前立腺癌の画像診断 update

有田祐起, 秋田大宇, 陣崎雅弘

臨床画像（メジカルビュー社） 35 （ 9 ） 1099 - 1103 2019年09月

ISSN 0911-1069

誌上シンポジウム肩腱板断裂画像診断の進歩 MRIによる腱板の筋萎縮・脂肪変性評価 MRIによる筋萎縮および筋内脂肪浸潤の定量的評価

松村昇, 小黒草太, 奥田茂男, 陣崎雅弘, 中村雅也, 松本守雄

臨床整形外科（株式会社医学書院） 54 （ 9 ） 897 - 903 2019年09月

ISSN 0557-0433

救急疾患の鑑別診断のポイント第10章その他,石灰化など　2 動静脈の石灰化の鑑別

秋田大宇, 中尾千恵, 陣崎雅弘

画像診断（学研メディカル秀潤社） 39 （ 11 ） A190 - A193 2019年09月

ISSN 0285-0524

救急疾患の鑑別診断のポイント第2章臓器造影効果欠如・脈管内造影欠損　4 脾・腎など実質臓器造影欠損の鑑別

古後斗冴, 南康大, 杉浦弘明, 陣崎雅弘

画像診断（学研メディカル秀潤社） 39 （ 11 ） A30 - A35 2019年09月

ISSN 0285-0524

救急疾患の鑑別診断のポイント第11章肺野異常陰影　3 肺間質影の鑑別

杉浦弘明, 南康大, 山田祥岳, 陣崎雅弘

画像診断（学研メディカル秀潤社） 39 （ 11 ） A210 - A215 2019年09月

ISSN 0285-0524

救急疾患の鑑別診断のポイント第11章肺野異常陰影　2 肺野空洞性病変の鑑別

南康大, 山田祥岳, 杉浦弘明, 陣崎雅弘

画像診断（学研メディカル秀潤社） 39 （ 11 ） A204 - A209 2019年09月

ISSN 0285-0524

経鼻内視鏡手術における蝶形骨洞の発達度と下垂体腺腫海綿静脈洞浸潤部の摘出率について

小杉健三, 戸田正博, 田村亮太, 間瀬太郎, 田村遙, 陣崎雅弘, 吉田一成

日本内分泌学会雑誌（(一社)日本内分泌学会） 95 （ Suppl.HPT ） 54 - 55 2019年09月

ISSN 0029-0661

頭蓋底腫瘍のなかで、正中から外側方向に位置する海綿静脈洞部へ進展するような腫瘍では、その摘出手術において、蝶形骨洞の外側方向への発達(蝶形洞洞側窩の発達)が摘出率に影響を及ぼす可能性がある。そこで今回、海綿静脈洞内へ浸潤した下垂体腺腫の摘出率と蝶形骨洞側窩の発達度との関連ついて検討した。対象は当院で2012〜2018年に初発の下垂体腺腫に対して経鼻内視鏡手術を行った症例のうち、Knosp grade 3以上の海綿静脈洞浸潤があった23例とし、術前の頭部CT画像から蝶形骨洞側窩の体積を測定した。蝶形骨洞の冠状断像でvidian canalとforamen rotundumを結び、その線より外側を蝶形骨洞側窩と定義した。検討の結果、蝶形骨洞側窩体積と腫瘍全体摘出率との間に有意な相関関係は認めなかったが、海綿静脈洞内腫瘍摘出率との間には有意な正の相関が認められた。

特集循環器疾患の画像診断-現状と進歩序文

陣崎雅弘

循環器ジャーナル（株式会社　医学書院） 67 （ 3 ） 320 - 321 2019年07月

ISSN 2432-3284

特集循環器疾患の画像診断-現状と進歩 Ⅴ.肺循環疾患 MRIを用いた右室機能評価を知る

奥田茂男, 山田祥岳, 陣崎雅弘

循環器ジャーナル（株式会社　医学書院） 67 （ 3 ） 420 - 426 2019年07月

ISSN 2432-3284

特集循環器疾患の画像診断-現状と進歩 Ⅴ.肺循環疾患 CT angiographyおよびCT perfusionを活用する

田村全, 杉浦弘明, 山田祥岳, 川上崇史, 陣崎雅弘

循環器ジャーナル（株式会社　医学書院） 67 （ 3 ） 410 - 419 2019年07月

ISSN 2432-3284

特集循環器疾患の画像診断-現状と進歩 Ⅳ.弁膜疾患 CTでTAVIの術前評価を行う

山田祥岳, 松本俊亮, 山田稔, 中原健裕, 陣崎雅弘

循環器ジャーナル（株式会社　医学書院） 67 （ 3 ） 388 - 401 2019年07月

ISSN 2432-3284

特集循環器疾患の画像診断-現状と進歩 Ⅰ.総論非侵襲的画像診断の近年の進歩と位置づけ

中原健裕, 奥田茂男, 陣崎雅弘

循環器ジャーナル（株式会社　医学書院） 67 （ 3 ） 322 - 330 2019年07月

ISSN 2432-3284

Effect of natural full weight-bearing during standing on the rotation of the first metatarsal bone

Ota T., Nagura T., Yamada Y., Yamada M., Yokoyama Y., Ogihara N., Matsumoto M., Nakamura M., Jinzaki M.

Clinical Anatomy （Clinical Anatomy） 32 （ 5 ） 715 - 721 2019年07月

ISSN 08973806

© 2019 Wiley Periodicals, Inc. To evaluate the rotational change in the first metatarsal bone (1MT) of the foot during natural standing using an upright computed tomography (CT) scanner with 320-detector rows. A total of 52 feet of 28 asymptomatic subjects (aged 23–39 years) were evaluated in the natural standing position with or without weight-bearing. A foot pressure plate was used to determine the non-weight-bearing (NWB) or single leg full-weight-bearing (s-FWB) conditions. CT examinations were performed using a noise index of 15 for a slice thickness of 5 mm, rotation speed of 0.5 sec, and slice thickness of 0.5 mm. The rotation of the 1MT was measured on the coronal CT image, which cut the sesamoids' bellies in the frontal slide of the first metatarsal and sesamoids perpendicular to the longitudinal bisection of the third metatarsal, and compared between the weight-bearing conditions. Intra- and inter-observer reliabilities of the rotation angle were also evaluated. The intra- and inter-observer correlation coefficients were 0.961 and 0.934, respectively. The 1MT pronation angle was significantly greater in the s-FWB condition than in the NWB condition (15.2° ± 5.4° vs. 12.5° ± 5.3°, P < 0.01). No sex difference was found in the magnitude of the 1MT pronation angle as a result of weight-bearing. This study first demonstrated that pronation of 1MT occurs due to natural full-weight-bearing in asymptomatic feet. The 1MT's rotational movement under weight-bearing conditions may relate to the onset and pathogenesis of the hallux valgus. Clin. Anat. 32:715–721, 2019. © 2019 Wiley Periodicals, Inc.

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Clinical value of 3D SPECT/CT imaging for assessing jaw bone invasion in oral cancer patients

Miyashita H., Nakahara T., Asoda S., Kameyama K., Kawaida M., Enomoto R., Shiba H., Jinzaki M., Kawana H., Nakagawa T.

Journal of Cranio-Maxillofacial Surgery （Journal of Cranio-Maxillofacial Surgery） 47 （ 7 ） 1139 - 1146 2019年07月

ISSN 10105182

© 2019 European Association for Cranio-Maxillo-Facial Surgery Purpose: This study compared the diagnostic accuracy of jaw bone invasion (JBI) of oral cancer observed with three-dimensional (3D) SPECT/CT, CT, and MRI, and evaluated the clinical advantages of 3D SPECT/CT compared to conventional two-dimensional (2D) SPECT/CT. Materials and methods: From April 2014 to January 2018, consecutive 16 oral cancer patients with suspected JBI, who had preoperatively undergone the imaging tests, were retrospectively enrolled. The likelihood of JBI was independently scored by a radiologist and oral surgeon. Using 2D or 3D SPECT/CT images, 20 oral surgeons delineated virtual surgical areas on 3D-printed jaws for 3 cases in which the extent of JBI was fully pathologically confirmed. The surgeons completed questionnaires regarding surgical planning and explanations for patients using Likert scales. Results: JBI was found in 9 patients including 5 (56%) with initial bone invasion. 3D SPECT/CT showed very high negative predictive value (100%) and inter-observer agreement (kappa = 0.917). 3D SPECT/CT was more sensitive than CT and MRI when inconclusive findings for JBI were considered negative. Compared to 2D SPECT/CT, 3D SPECT/CT had greater clinical advantages such as surgical planning and explanation to patients (p < 0.005). Conclusion: 3D SPECT/CT is useful not only for detecting JBI but also for surgical planning.

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Can we predict amyloid deposition by objective cognition and regional cerebral blood flow in patients with subjective cognitive decline?

Funaki K., Nakajima S., Noda Y., Wake T., Ito D., Yamagata B., Yoshizaki T., Kameyama M., Nakahara T., Murakami K., Jinzaki M., Mimura M., Tabuchi H.

Psychogeriatrics （Psychogeriatrics） 19 （ 4 ） 325 - 332 2019年07月

ISSN 13463500

© 2019 Japanese Psychogeriatric Society Background: Subjective cognitive decline (SCD) may herald the first symptoms of Alzheimer's disease (AD) whereas individuals with beta-amyloid (Aβ) deposition are regarded as a high-risk group for AD. Recently, amyloid positron emission tomography (PET) studies have demonstrated clinical and cognitive feature differences between Aβ-positive and negative SCD, but details of their differences remain unclear. We aimed to investigate the relationships among Aβ deposition, clinical, and cognitive features in patients with SCD. Methods: Forty-two patients with SCD (22 women, 74.5 ± 4.7 years) were examined using fluorine-18 florbetaben PET and were divided into Aβ-positive (n = 10) and negative (n = 32) groups. We compared cognitive and psychological outcomes, and single photon emission computed tomography (SPECT) imaging data between the two groups. In addition, a linear regression analysis was performed to assess relationships between the severity of SCD and neuropsychological tests, affective scores, and demographic factors. Results: The rate of score changes from the immediate recall to delayed recall in the logical memory subtest of the Wechsler's Memory Scale Revised were different between the groups (P = 0.04). However, the binary logistic regression analysis showed no significant differences between the two. In addition, the severity of SCD was significantly strong in women (P = 0.002). Furthermore, within the Aβ-negative group, subjective memory loss correlated with word fluency category score (P = 0.023) and apathy scale (P = 0.037). Conclusions: No significant differences were observed between Aβ-positive and -negative SCD on any of the neuropsychological measures, clinical measures, or SPECT imaging. Further, the severity of SCD was not predicted by the symptoms of anxiety, depression, or neuropsychological examination.

全身撮影可能な立位CTの開発　ファントムスタディ、人体に対する重力の影響

横山陽一, 山田祥岳, 名倉武雄, 中原健裕, 成田啓一, 山田稔, 南島一也, 荻原直道, 陣崎雅弘

日本医用画像工学会大会予稿集（(一社)日本医用画像工学会） 38回 471 - 475 2019年07月

【目的】(1)立位CTの物理特性の評価,(2)大血管と骨盤底への重力の影響を評価すること.【方法】ファントムを用いて立位CTと臥位CT,それぞれの物理特性の評価を行った.健常人ボランティアを対象に立位CTと臥位CTを同日に施行,大静脈と大動脈の面積と骨盤底の変化を評価した.【結果】立位CTと臥位CT両者の物理特性に有意差は見られなかった.仰臥位と比較して直立位では,上大静脈の面積は有意に小さく,横隔膜の高さでの下大静脈の面積に有意差は見られず,下大静脈下端部での面積は有意に大きくなった.一方,大動脈の面積に関しては姿勢による有意差は見られなかった.骨盤底は直立位で下降した.【結論】立位CTと臥位CTの性能はほぼ同等であり,立位CTは,人体に対する重力の影響を評価するのに有用であった.(著者抄録)

Picked-up Knowledge from Foreign Journals 心筋の線維化

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） 39 （ 8 ） 924 - 926 2019年06月

ISSN 0285-0524

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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18 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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Bone SPECT-based segmented attenuation correction for quantitative analysis of bone metastasis (B-SAC): comparison with CT-based attenuation correction

Nakahara T., Owaki Y., Shindou T., Nakajima K., Jinzaki M.

EJNMMI Research （EJNMMI Research） 9 2019年

© 2019, The Author(s). Background: Evidence has shown the clinical usefulness of measuring the metastatic tumor burden of bone for prognostic assessment especially in prostate cancer; quantitative evaluation by dedicated SPECT is difficult due to the lack of attenuation correction (AC) method. We developed a novel method for attenuation correction using bone SPECT emission data (bone SPECT-based segmented attenuation correction; B-SAC) where emission data were virtually segmented into three tissues (i.e., bone, soft tissue, and air). Then, the pixel values in SPECT were replaced by 50 for the virtual soft tissue, and − 1000 for the virtual air. The replaced pixel values for the virtual bone were based on the averaged CT values of the normal vertebrae (B-SACN) or the metastatic bones (B-SACM). Subsequently, the processed SPECT data (i.e., SPECT value) were supposed to realize CT data (i.e., CT value) that were used for B-SAC. The standardized uptake values (SUVs) of 112 metastatic bone tumors in 15 patients with prostate cancer were compared between CTAC with scatter correction (SC) and resolution recovery (RR) and the following reconstruction conditions: B-SACN (+)SC(+)RR(+), B-SACM (+)SC(+)RR(+), uniform AC(UAC)(+)SC(+)RR(+), AC(−)SC(+)RR(+), and no correction (NC). Results: The SUVs in the five reconstruction conditions were all correlated with those in CTAC(+)SC(+)RR(+) (p < 0.01), and the correlations between B-SACN or B-SACM and CTAC images were excellent (r > 0.94). Bland-Altman analysis showed that the mean SUV differences between CTAC (+)SC(+)RR(+) and the other five reconstructions were 0.85 ± 2.25 for B-SACN (+)SC(+)RR(+), 1.61 ± 2.36 for B-SACM (+)SC(+)RR(+), 1.54 ± 3.84 for UAC(+)SC(+)RR(+), − 3.12 ± 4.97 for AC(−)SC(+)RR(+), and − 5.96 ± 4.59 for NC. Compared to CTAC(+)SC(+)RR(+), B-SACN (+)SC(+)RR(+) showed a slight but constant overestimation (approximately 17%) of the metastatic tumor burden of bone when the same threshold of metabolic tumor volume was used. Conclusions: The results of this preliminary study suggest the potential for B-SAC to improve the quantitation of bone metastases in bone SPECT when X-ray CT or transmission CT data are not available. Considering the small but unignorable differences of lesional SUVs between CTAC and B-SAC, SUVs obtained with the current version of B-SAC seem difficult to be directly compared with those obtained with CTAC.

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A rare case of unroofed coronary sinus with a secundum atrial septal defect incidentally detected by computed tomography

Shoji S., Kanazawa H., Yamada Y., Jinzaki M., Fukuda K.

Journal of Cardiovascular Computed Tomography （Journal of Cardiovascular Computed Tomography） 14 （ 6 ） e105 - e106 2019年

ISSN 19345925

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Impact of a combination of quantitative indices representing uptake intensity, shape, and asymmetry in DAT SPECT using machine learning: comparison of different volume of interest settings

Iwabuchi Y., Nakahara T., Kameyama M., Yamada Y., Hashimoto M., Matsusaka Y., Osada T., Ito D., Tabuchi H., Jinzaki M.

EJNMMI Research （EJNMMI Research） 9 2019年

© 2019, The Author(s). Background: We sought to assess the machine learning-based combined diagnostic accuracy of three types of quantitative indices obtained using dopamine transporter single-photon emission computed tomography (DAT SPECT)—specific binding ratio (SBR), putamen-to-caudate ratio (PCR)/fractal dimension (FD), and asymmetry index (AI)—for parkinsonian syndrome (PS). We also aimed to compare the effect of two different types of volume of interest (VOI) settings from commercially available software packages DaTQUANT (Q) and DaTView (V) on diagnostic accuracy. Methods: Seventy-one patients with PS and 40 without PS (NPS) were enrolled. Using SPECT images obtained from these patients, three quantitative indices were calculated at two different VOI settings each. SBR-Q, PCR-Q, and AI-Q were derived using the VOI settings from DaTQUANT, whereas SBR-V, FD-V, and AI-V were derived using those from DaTView. We compared the diagnostic value of these six indices for PS. We incorporated a support vector machine (SVM) classifier for assessing the combined accuracy of the three indices (SVM-Q: combination of SBR-Q, PCR-Q, and AI-Q; SVM-V: combination of SBR-V, FD-V, and AI-V). A Mann-Whitney U test and receiver-operating characteristics (ROC) analysis were used for statistical analyses. Results: ROC analyses demonstrated that the areas under the curve (AUC) for SBR-Q, PCR-Q, AI-Q, SBR-V, FD-V, and AI-V were 0.978, 0.837, 0.802, 0.906, 0.972, and 0.829, respectively. On comparing the corresponding quantitative indices between the two types of VOI settings, SBR-Q performed better than SBR-V (p = 0.006), whereas FD-V performed better than PCR-Q (p = 0.0003). No significant difference was observed between AI-Q and AI-V (p = 0.56). The AUCs for SVM-Q and SVM-V were 0.988 and 0.994, respectively; the two different VOI settings displayed no significant differences in terms of diagnostic accuracy (p = 0.48). Conclusion: The combination of the three indices obtained using the SVM classifier improved the diagnostic performance for PS; this performance did not differ based on the VOI settings and software used.

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Temporal relationship between 18F-sodium fluoride uptake in the abdominal aorta and evolution of CT-verified vascular calcification

Nakahara T., Narula J., Fox J.J., Jinzaki M., Strauss H.W.

Journal of Nuclear Cardiology （Journal of Nuclear Cardiology） 28 （ 5 ） 1936 - 1945 2019年

ISSN 10713581

© 2019, American Society of Nuclear Cardiology. Background: Fluoride-18 sodium fluoride (18F-NaF) localizes in microcalcifications in atheroma. The microcalcifications may aggregate, passing the resolution threshold to visualize on computed tomography (CT). We evaluated serial NaF positron emission tomography (PET)-CT scans to determine the temporal relationship between vascular NaF uptake and CT evident calcification in the abdominal aorta. Methods: Prostate cancer patients who had at least 3 NaF PET-CT scans over at least 1.5 years were retrospectively enrolled. Regions of interest were traced in the abdominal aorta on both PET and CT images, excluding skeletal NaF activity. The maximum standardized uptake value (SUVmax) of NaF and the density and volume of calcium (exceeding 130 HU) were summed and divided by the number of slices to produce the SUVmax/slice and the mm3·slice−1 of calcium. Results: Of 437 patients, 45 patients met criteria. NaF uptake waxed and waned between scans, while the calcium volume plateaued or increased over time. NaF uptake correlated with calcium volume on the baseline scan (P =.60, <.0001†) and calcium volume increment, especially from 1.0 to 1.5 years (r =.79, P <.0001†). Patients with persistently high NaF uptake showed a higher calcium volume increment (0-1.5 years) than patients with low or transiently high NaF uptake. Conclusions: Abdominal aortic NaF uptake varied over time. NaF uptake on the baseline scans and high NaF uptake on the serial scans preceded an increase in calcium volume, especially by 1.0-1.5 years. Persistently high NaF uptake was associated with a greater increment in calcium volume than patients with transiently elevated or persistently low fluoride uptake.

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Previously implanted mitral surgical prosthesis in patients undergoing transcatheter aortic valve implantation: Procedural outcome and morphologic assessment using multidetector computed tomography

Tanaka M., Yanagisawa R., Yashima F., Arai T., Jinzaki M., Shimizu H., Fukuda K., Watanabe Y., Naganuma T., Shirai S., Araki M., Tada N., Yamanaka F., Higashimori A., Takagi K., Ueno H., Tabata M., Mizutani K., Yamamoto M., Hayashida K., Hayashida K., Yamamoto M., Shimura T., Adachi Y., Yamaguchi R., Sago M., Tsunaki T., Hosoba S., Koyama Y., Kagase A., Tokuda T., Kobayashi T., Shibata K., Watanabe Y., Hioki H., Kataoka A., Yamamoto H., Kawashima H., Nakashima M., Nara Y., Nagura F., Ito M., Sasaki K., Ishibashi R., Yukimitsu N., Takamura S., Nomura T., Naganuma T., Mitomo S., Onishi H., Kawamoto H., Amano T., Arai Y., Isotani A., Hayashi M., Kawaguchi T., Ito S., Takiguchi H., Yano M., Taniguchi T., Ishizu K., Mori S., Fujioka S., Araki M., Yamawaki M., Honda Y., Makino K., Akatsu Y., Hata M., Miyasaka M., Ishii K., Inoue A., Nakashima M., Saigan M., Ootomo T., Munehisa Y., Sakurai M., Toki Y., Sakamoto Y., Shishido K., Ochiai T., Mizuno S., Moriyama N., Takagi K., Yoshioka N., Ueno H., Sobajima M., Onoda H., Kuwahara H., Ueno Y., Tabata M., Ito J., Morimura H., Hibino M., Watanabe S., Obunai K.

PLoS ONE （PLoS ONE） 14 （ 12 ） 2019年

© 2019 Tanaka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Transcatheter aortic valve implantation (TAVI) in the presence of a preexisting mitral prosthesis is challenging and its influence on the morphology of mitral prosthesis and the positioning of transcatheter heart valve (THV) is unknown. We assessed the feasibility of TAVI for patients with preexisting mitral prostheses, its influence on mitral prosthesis morphology, and the positional interaction between a newly implanted THV and mitral prosthesis using serial multidetector computed tomography (MDCT). Thirty-one patients with preexisting mitral prosthesis undergoing TAVI were included. MDCT was performed before and after TAVI. Thirty patients successfully underwent TAVI without interference from preexisting mitral prosthesis. Although opening disturbance of the mechanical mitral prosthesis by the THV edge was observed in 1 patient, the patient was managed conservatively. No THV embolization occurred. THV shift during deployment occurred in 9 patients and was predicted by a larger aortic annulus area (odds ratio: 1.24 per 10 mm2, 1.03-1.49, p = 0.02), possibly because of large THVs. The mitral mean pressure gradient was slightly higher after TAVI (3.7 vs. 4.3 mmHg, p = 0.002), whereas the mitral regurgitation grade was similar. MDCT showed that the size of the mitral prosthesis housing was unchanged after TAVI. The median distance between the mitral prosthesis and THV was 2.6 mm. The postprocedural angle between the mitral prosthesis and THV was larger than the preprocedural angle between the mitral prosthesis and the left ventricular outflow tract (64° vs. 61°, p = 0.03). Thus, TAVI is feasible in the case of preexisting mitral prosthesis. Serial MDCT demonstrated favorable THV positioning and unchanged mitral prosthesis morphology after TAVI.

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Magnetic resonance imaging texture analyses in lower-grade gliomas with a commercially available software: correlation of apparent diffusion coefficient and T2 skewness with 1p/19q codeletion

Kanazawa T., Minami Y., Takahashi H., Fujiwara H., Toda M., Jinzaki M., Yoshida K., Sasaki H.

Neurosurgical Review （Neurosurgical Review） 43 （ 4 ） 1211 - 1219 2019年

ISSN 03445607

© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Preoperative prediction of molecular information of lower-grade gliomas (LrGGs) helps to determine the overall treatment strategy as well as the initial surgical strategy. This study aimed to detect magnetic resonance imaging (MRI) texture parameters to predict the molecular signature of LrGGs using a commercially available software and routine MR images. Forty-three patients treated at Keio University Hospital who had World Health Organization grade II or III gliomas were included. All patients having preoperative T1- and T2-weighted, fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted (DW) images were also included. Texture analyses of T2, FLAIR, and apparent diffusion coefficient (ADC) histograms were performed using a commercially available software. Texture parameters including kurtosis, skewness, and entropy were investigated to determine any correlation with the presence or absence of isocitrate dehydrogenase (IDH) mutations, 1p/19q codeletion, and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation. ADC skewness and T2 skewness were significantly associated with 1p/19q codeletion status. ADC skewness of ≥ 0.25 predicted 1p/19q codeletion with a sensitivity and specificity of 80% and 65.2%, respectively (AUC = 0.728). T2 skewness of ≥ − 0.11 predicted 1p/19q codeletion with a sensitivity and specificity of 80% and 91.3%, respectively, (AUC = 0.866). None of the texture parameters were associated with IDH mutation and MGMT promoter methylation. MRI texture analysis using a commercially available software demonstrated that T2 skewness could predict 1p/19q codeletion with high sensitivity and specificity, suggesting a clinical utility.

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Impact of the cerebrospinal fluid-mask algorithm on the diagnostic performance of 123I-Ioflupane SPECT: an investigation of parkinsonian syndromes

Iwabuchi Y., Nakahara T., Kameyama M., Matsusaka Y., Minami Y., Ito D., Tabuchi H., Yamada Y., Jinzaki M.

EJNMMI Research （EJNMMI Research） 9 （ 1 ） 2019年

© 2019, The Author(s). Background: A cerebrospinal fluid (CSF)-mask algorithm has been developed to reduce the adverse influence of CSF-low-counts on the diagnostic utility of the specific binding ratio (SBR) index calculated with Southampton method. We assessed the effect of the CSF-mask algorithm on the diagnostic performance of the SBR index for parkinsonian syndromes (PS), including Parkinson’s disease, and the influence of cerebral ventricle dilatation on the CSF-mask algorithm. Methods: We enrolled 163 and 158 patients with and without PS, respectively. Both the conventional SBR (non-CSF-mask) and SBR corrected with the CSF-mask algorithm (CSF-mask) were calculated from 123I-Ioflupane single-photon emission computed tomography (SPECT) images of these patients. We compared the diagnostic performance of the corresponding indices and evaluated whether the effect of the CSF-mask algorithm varied according to the extent of ventricle dilatation, as assessed with the Evans index (EI). A receiver-operating characteristics (ROC) analysis was used for statistical analyses. Results: ROC analyses demonstrated that the CSF-mask algorithm performed better than the non-CSF-mask (no correction, area under the curve [AUC] = 0.917 [95% confidence interval (CI) 0.887–0.947] vs. 0.895 [95% CI 0.861–0.929], p < 0.001; attenuation correction, AUC = 0.930 [95% CI 0.902–0.957] vs. 0.903 [95% CI 0.870–0.936], p < 0.001). When not corrected for attenuation, no significant difference in the AUC was observed in the low EI group between the non-CSF-mask and CSF-mask algorithms (0.927 [95% CI 0.877–0.978] vs. 0.942 [95% CI 0.898–0.986], p = 0.11); in the middle and high EI groups, the CSF-mask algorithm performed better than the non-CSF-mask algorithm (middle EI group, AUC = 0.894 [95% CI 0.825–0.963] vs. 0.872 [95% CI 0.798–0.947], p < 0.05; high EI group, AUC = 0.931 [95% CI 0.883–0.978] vs. 0.900 [95% CI 0.840–0.961], p < 0.01). When corrected for attenuation, significant differences in the AUC were observed in all three EI groups (low EI group, AUC = 0.961 [95% CI 0.924–0.998] vs. 0.942 [95% CI 0.895–0.988], p < 0.05; middle EI group, AUC = 0.905 [95% CI 0.843–0.968] vs. 0.872 [95% CI 0.800–0.944], p < 0.005; high EI group, AUC = 0.954 [95% CI 0.917–0.991] vs. 0.917 [95% CI 0.862–0.973], p < 0.005). Conclusion: The CSF-mask algorithm improved the performance of the SBR index in informing the diagnosis of PS, especially in cases with ventricle dilatation.

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Relationship between pneumatization of lateral recess in the sphenoid sinus and removal of cavernous sinus invasion in pituitary adenomas by endoscopic endonasal surgery

Kosugi K., Tamura R., Mase T., Tamura H., Jinzaki M., Yoshida K., Toda M.

Surgical Neurology International （Surgical Neurology International） 10 2019年

Background: Endoscopic endonasal transsphenoidal surgery (EES) is the gold standard for pituitary adenoma (PA) resection. The sphenoid sinus (SS), a highly variable anatomic structure, is located in the center of the cranial base. It has previously been reported that poor pneumatization of the lateral recess of the SS (LRSS) increases the difficulty level of the surgery and the risk of neural and vascular injury. However, to date no studies have evaluated the association between LRSS volume and PAs removal rate by EES. Methods: The present study analyzed 23 consecutive patients with new-onset PAs categorized as Knosp Grades 3 and 4 who underwent EES. A retrospective radiographic analysis was conducted on patients undergoing magnetic resonance imaging and high-resolution computed tomography scans. Results: Among PA cases categorized as Knosp 3 and 4, no significant association was found between the whole tumor's resection rate and LRSS volume (R = 0.08, P = 0.70). However, a significant association was found between cavernous sinus (CS) tumors' removal rate and LRSS volume (R = 0.52, P = 0.011). The same results were achieved in PAs with a Knosp Grade 4, with a stronger correlation (R = 0.60, P = 0.014). Conclusion: The development of LRSS pneumatization affects the removal rate of CS tumors in PAs. Preoperative analysis of LRSS development should be considered when planning EES against PA with CS invasion.

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新生児CT検査における逐次近似応用再構成法のdisplay field of view依存性

南島一也, 杉澤浩一, 木津啓介, 益田翔太, 大脇由樹, 陣崎雅弘

日本CT技術学会雑誌（(NPO)日本CT技術学会） 7 （ 2 ） 1 - 5 2019年

ISSN 2434-2769

逐次近似応用再構成法(HIR)では、display field of view(DFOV)や画像ノイズなどによって非線形な挙動を示すことが報告されており、特に小児は体格に合わせて再構成することからDFOVの影響を受けると考えられる。しかし、小児患者の線量低減割合や参考プロトコルを公表しているImage Gentlyや日本のCT撮影ガイドラン(GALACTIC)には詳細なデータによる報告や具体的な撮影条件の検討に関する報告はなされていない。そこで、HIRのDFOV依存に着目し、GALACTICの撮影条件に準拠した成人と新生児のCT検査を対象として、HIRによる線量低減率が成人と新生児でどのように異なるか検討した。方法は、成人および新生児ファントムを撮影し、それぞれstandard deviationが10となる画像を基準画像とした。また、基準画像に対して撮影線量を低減しHIRで再構成した画像を低線量画像とした。そして各画像にて、noise power spectrum(NPS)、task transfer function(TTF)、システム性能関数(SP)を測定し、HIRにより低減可能な線量を算出した。NPS解析の結果、同一線量低減率下の比較において新生児は成人よりもノイズ量が2.0倍程度多かった。TTF解析の結果、低線量画像の10%TTFは基準画像に比べて低下し、低下の程度は新生児が成人よりも小さかった。SP解析の結果、成人では50%、新生児では37.5%の線量低減が可能であった。これらの結果から、新生児CTにおけるHIRの使用には、DFOV依存を考慮した撮影プロトコルの設定が必要と考えられた。

腎・上部尿路の画像診断－適切なマネージメントにつなげるためのminimum essence－

秋田大宇, 陣崎雅弘

画像診断 39 61 - 75 2019年

CiNii Research

特集画像診断においてピットフォールに陥らないために腎・上部尿路−適切なマネージメントにつなげるためのminimum essence−

秋田大宇, 陣崎雅弘

画像診断（学研メディカル秀潤社） 39 （ 1 ） 61 - 75 2018年12月

ISSN 0285-0524

Preoperative Prediction of Solitary Fibrous Tumor/Hemangiopericytoma and Angiomatous Meningioma Using Magnetic Resonance Imaging Texture Analysis

Kanazawa T., Minami Y., Jinzaki M., Toda M., Yoshida K., Sasaki H.

World Neurosurgery （World Neurosurgery） 120 e1208 - e1216 2018年12月

ISSN 18788750

© 2018 Elsevier Inc. Background: Solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is radiologically difficult to distinguish from meningioma, especially angiomatous meningioma. This study aimed to detect texture parameters to distinguish SFT/HPC from angiomatous meningioma using magnetic resonance imaging texture analysis with commercially available software. Methods: We retrospectively investigated textural parameters in 43 newly diagnosed SFTs/HPCs, angiomatous meningiomas, and other World Health Organization (WHO) grade I meningiomas treated at Keio University Hospital. For T1 contrast-enhanced, T2, and apparent diffusion coefficient (ADC) images, texture analyses were performed. Regions of interest were drawn manually with reference to the greater signal on contrast-enhanced T1-weighted images. ADC values and texture parameters, including kurtosis, skewness, and entropy, were evaluated and compared between these 3 groups. Results: The mean ADC value was significantly high in angiomatous meningioma, compared with SFT/HPC and other WHO grade I meningioma. ADC entropy was highest in SFT/HPC, followed by angiomatous and other WHO grade I meningioma. T2 skewness was significantly high in SFT/HPC, compared with angiomatous and other WHO grade I meningioma. T1 contrast-enhanced skewness was significantly low in angiomatous meningioma, compared with other WHO grade I meningioma. Mean ADC value distinguished SFT/HPC from angiomatous meningioma with a positive predictive value (PPV) of 62.5% and specificity of 62.5%. ADC entropy distinguished SFT/HPC from angiomatous meningioma with a PPV of 100% and specificity of 100%. ADC skewness distinguished SFT/HPC from angiomatous meningioma with a PPV of 66.7% and specificity of 71.4%. Conclusions: This study demonstrated that magnetic resonance imaging texture analysis was useful for distinguishing SFT/HPC from meningioma, especially angiomatous meningioma.

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Quantitative assessment of erector spinae muscles in patients with Mycobacterium avium complex lung disease

Asakura T., Yamada Y., Suzuki S., Namkoong H., Okamori S., Kusumoto T., Niijima Y., Ozaki A., Hashimoto M., Yagi K., Kamata H., Funatsu Y., Ishii M., Jinzaki M., Betsuyaku T., Hasegawa N.

Respiratory Medicine （Respiratory Medicine） 145 66 - 72 2018年12月

ISSN 09546111

© 2018 Elsevier Ltd Background and objective: No reports exist regarding skeletal muscle involvement in patients with Mycobacterium avium complex lung disease (MAC-LD). The cross-sectional area of the erector spinae muscles (ESMCSA) reflects physical activity and can be assessed by computed tomography (CT). We investigated the relationship between ESMCSA and physiological parameters and prognosis in MAC-LD patients. Material and methods: In this prospective observational study, the ESMCSA was measured on single-slice axial CT images. MAC-LD patients and sex- and age-matched controls (non-MAC-LD participants) were evaluated. We evaluated the relationship between the ESMCSA and physiological parameters and prognosis. Results: A total of 260 patients (209 female; median age, 69 years; 190 with nodular/bronchiectatic disease; 74 with cavitary lesions) were enrolled. The ESMCSA was not different between MAC-LD patients and controls. In MAC-LD patients, the ESMCSA was significantly associated with age, body mass index (BMI), pulmonary function, CT severity, and health-related quality of life (HRQL). Multivariate Cox proportional hazards analyses revealed that an ESMCSA < −1 standard derivation (hazards ratio [HR], 2.76; P = 0.047) was significantly associated with all-cause mortality, along with BMI < 18.5 kg/m2 (HR, 3.67; P = 0.02) and presence of cavitary lesions (HR, 5.84; P = 0.001). However, the ESMCSA was not significantly associated with all-cause mortality when current treatment status, % predicted functional vital capacity, and forced expiratory volume in 1 s were added to the analyses. Conclusions: Although the prognostic impact was limited, ESMCSA was significantly associated with HRQL and prognostic physiological parameters, such as BMI and pulmonary function.

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Evaluation of pancreatic fibrosis with acoustic radiation force impulse imaging and automated quantification of pancreatic tissue components

Fujita Y., Kitago M., Abe T., Itano O., Shinoda M., Abe Y., Yagi H., Hibi T., Ishii M., Nakano Y., Okuma K., Hashimoto M., Takeuchi A., Masugi Y., Jinzaki M., Sakamoto M., Kitagawa Y.

Pancreas （Pancreas） 47 （ 10 ） 1277 - 1282 2018年11月

ISSN 08853177

© 2018 Wolters Kluwer Health, Inc. All rights reserved. Objectives The aim of this study was to determine whether computer-assisted digital analysis and acoustic radiation force impulse (ARFI) imaging were useful for assessing pancreatic fibrosis, and if ARFI imaging predicted postoperative pancreatic fistula (POPF). Methods Seventy-eight patients scheduled to undergo pancreatic resection were enrolled. Shear wave velocity (SWV) at the pancreatic neck was measured preoperatively using ARFI imaging. Pancreatic tissue components on a whole slide image were quantified using an automatic image processing software. The relationship between SWV, fibrotic tissue content, and POPF incidence and clinical severity was analyzed. Results The median collagen fiber, fatty tissue, and acinar cell contents were 11.6%, 8.5%, and 61.3%, respectively. Unlike fatty tissue, collagen fiber content and acinar cells were correlated with SWV (ρ = 0.440, P < 0.001 and ρ =-0.428, P < 0.001, respectively). Although collagen fiber content and SWV were associated with the overall incidence of POPF (P = 0.004 and 0.001, respectively), collagen fiber content and SWV had no statistical correlation with clinically relevant POPF (P = 0.268 and 0.052, respectively). Conclusions We objectively quantified the pancreatic tissue components using an automatic image processing software. Shear wave velocity was significantly related to collagen fiber content and suggests that ARFI imaging can be useful for evaluating pancreatic fibrosis.

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Performance of diffusion-weighted MRI post-CT urography for the diagnosis of upper tract urothelial carcinoma: Comparison with selective urine cytology sampling

Akita H., Kikuchi E., Hayakawa N., Mikami S., Sugiura H., Oya M., Jinzaki M.

Clinical Imaging （Clinical Imaging） 52 208 - 215 2018年11月

ISSN 08997071

© 2018 Objectives: To evaluate the usefulness of adding diffusion-weighted MRI (DW-MRI) to CT urography (CTU) for diagnosing upper tract urothelial carcinoma (UTUC). Materials and methods: We retrospectively evaluated 102 high-risk patients with UTUC who underwent both CTU and DW-MRI. The diagnostic performance of CTU and DW-MRI was evaluated in all the patients. Then, the diagnostic performance of DW-MRI in the patients with positive CTU findings was assessed based on the types of CTU findings (mass formation, wall thickening, and small filling defects). The diagnostic performance of DW-MRI and selective urine cytology sampling in these patients was also compared. Results: The sensitivity of DW-MRI (92%) was less than that of CTU (98%) (P = 0.25), since DW-MRI could not detect any small papillary tumors. The specificity of DW-MRI (91%) was greater than that of CTU (78%) (P = 0.065), since DW-MRI could discriminate some benign conditions from UTUC. Among the 59 positive CTU lesions, DW-MRI correctly diagnosed all 41 mass-forming lesions and improved the accuracy from 36% using CTU alone to 79% for 14 wall-thickening lesions but could not add any additional information for 4 small filling-defect lesions. Among the 44 patients with positive CTU findings who underwent selective urine cytology sampling, the sensitivity of DW-MRI (95%) was significantly greater than that of selective urine cytology sampling (56%) (P < 0.001). Conclusions: The addition of DW-MRI would be useful for both mass-forming and wall-thickening lesions. DW-MRI has the potential to reduce the frequency of selective urine cytology sampling for such lesions.

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特集知っておきたいリンパ系の画像診断リンパ漏病変に対するIVR

井上政則, 中塚誠之, 御須学, 長谷学, 鳥飼秀幸, 田村全, 塚田実郎, 伊東伸剛, 陣崎雅弘

画像診断（学研メディカル秀潤社） 38 （ 12 ） 1173 - 1180 2018年09月

ISSN 0285-0524

特集知っておきたいリンパ系の画像診断序説

陣崎雅弘

画像診断（学研メディカル秀潤社） 38 （ 12 ） 1109 - 1109 2018年09月

ISSN 0285-0524

Evaluation of prostate‑specific antigen density in the diagnosis of prostate cancer combined with magnetic resonance imaging before biopsy in men aged 70�years and older with elevated PSA

Yoshinori Yanai, Takeo Kosaka, Hiroshi Hongo, Kazuhiro Matsumoto, Toshiaki Shinojima, Eiji Kikuchi, Akira Miyajima, Ryuichi Mizuno, Shuji Mikami, Masahiro Jinzaki, Mototsugu Oya

Molecular and Clinical Oncology （Spandidos Publications） 2018年09月

ISSN 2049-9450

押さえておきたい臨床・画像分類序文

青木茂樹, 陣崎雅弘

画像診断（学研メディカル秀潤社） 38 （ 11 ） A3 - A3 2018年09月

ISSN 0285-0524

押さえておきたい臨床・画像分類第5章腹部・骨盤　5. Budd-Chiari症候群

田村全, 中塚誠之, 陣崎雅弘

画像診断（学研メディカル秀潤社） 38 （ 11 ） A186 - A189 2018年09月

ISSN 0285-0524

押さえておきたい臨床・画像分類第5章腹部・骨盤　16. 気腫性腎盂腎炎

成田啓一, 秋田大宇, 陣崎雅弘

画像診断（学研メディカル秀潤社） 38 （ 11 ） A232 - A234 2018年09月

ISSN 0285-0524

押さえておきたい臨床・画像分類第5章腹部・骨盤　15. 血管筋脂肪腫

成田啓一, 秋田大宇, 陣崎雅弘

画像診断（学研メディカル秀潤社） 38 （ 11 ） A228 - A231 2018年09月

ISSN 0285-0524

押さえておきたい臨床・画像分類第5章腹部・骨盤　14. 嚢胞性腎病変

成田啓一, 秋田大宇, 陣崎雅弘

画像診断（学研メディカル秀潤社） 38 （ 11 ） A224 - A227 2018年09月

ISSN 0285-0524

押さえておきたい臨床・画像分類第5章腹部・骨盤　1. 肝動脈,胆道の解剖学的変異

田村全, 中塚誠之, 陣崎雅弘

画像診断（学研メディカル秀潤社） 38 （ 11 ） A166 - A169 2018年09月

ISSN 0285-0524

押さえておきたい臨床・画像分類第4章心臓・血管　7. 下大静脈の破格

横山陽一, 山田祥岳, 陣崎雅弘

画像診断（学研メディカル秀潤社） 38 （ 11 ） A152 - A156 2018年09月

ISSN 0285-0524

押さえておきたい臨床・画像分類第4章心臓・血管　6. 閉塞性動脈硬化症

田村全, 井上政則, 中塚誠之, 陣崎雅弘

画像診断（学研メディカル秀潤社） 38 （ 11 ） A148 - A151 2018年09月

ISSN 0285-0524

押さえておきたい臨床・画像分類第4章心臓・血管　2. 冠動脈と心筋のセグメント

中原健裕, 山田稔, 中原理紀, 山田祥岳, 陣崎雅弘

画像診断（学研メディカル秀潤社） 38 （ 11 ） A130 - A135 2018年09月

ISSN 0285-0524

下部消化管出血の治療戦略―放射線科の立場から―

御須学, 井上政則, 伊東伸剛, 塚田実郎, 中塚誠之, 陣崎雅弘

日本腹部救急医学会雑誌（日本腹部救急医学会） 38 （ 5 ） 831 - 834 2018年07月

ISSN 1340-2242

下部消化管出血は年齢とともに増加し，背景疾患として大腸憩室，angiodysplasia，大腸炎や大腸癌があげられる。中でも大腸憩室出血は頻度がもっとも高く，本邦で増加している。NSAIDsやステロイド，抗血小板薬の使用が憩室出血の増加に拍車をかけている。出血の程度は軽微なものから生命を脅かすほど重篤なものまであるが，多くは保存的治療によって自然に止血し，特別な処置を要さない。重篤な出血に対しては内視鏡的止血術，IVRによる止血術いずれの有用性も報告されているが，どちらの治療法にも長所，短所がある。本稿では当院での大腸からの出血に対するIVRの治療成績を検討し，若干の文献的考察を加えて報告する。

Fatal Intracranial Hemorrhage Due to Thrombocytopenia in a Patient with Castration-Resistant Prostate Cancer Showing Extensive Bone Uptake of Injected 223Ra Dichloride

Nakahara T., Owaki Y., Kosaka T., Fukada J., Ichimura A., Jinzaki M.

Clinical Nuclear Medicine （Clinical Nuclear Medicine） 43 （ 7 ） 546 - 547 2018年07月

ISSN 03639762

© 2018 Wolters Kluwer Health, Inc. All rights reserved. A 64-year-old man with castration-resistant prostate cancer received 223Ra injection to treat bone metastases. The patient underwent a 223Ra SPECT scan after the first 223Ra injection in which there was increased uptake all over the spine. Spine-to-background activity ratio in the patient was approximately three times greater than normal spine-to-background activity ratios in 223Ra SPECT obtained from the other patients. Eight days after the fifth injection, the patient exhibited a very poor neurologic examination and died of intracranial hemorrhage due to severe thrombocytopenia (platelet counts, 23,000/mm3). The extensive radiation to the spine may have enhanced myelophthisic process in this case.

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【大腸憩室出血に対する診断と治療-各科からの提言-】下部消化管出血の治療戦略　放射線科の立場から

御須学, 井上政則, 伊東伸剛, 塚田実郎, 中塚誠之, 陣崎雅弘

日本腹部救急医学会雑誌（(一社)日本腹部救急医学会） 38 （ 5 ） 831 - 834 2018年07月

ISSN 1340-2242

下部消化管出血は年齢とともに増加し、背景疾患として大腸憩室、angiodysplasia、大腸炎や大腸癌があげられる。中でも大腸憩室出血は頻度がもっとも高く、本邦で増加している。NSAIDsやステロイド、抗血小板薬の使用が憩室出血の増加に拍車をかけている。出血の程度は軽微なものから生命を脅かすほど重篤なものまであるが、多くは保存的治療によって自然に止血し、特別な処置を要さない。重篤な出血に対しては内視鏡的止血術、IVRによる止血術いずれの有用性も報告されているが、どちらの治療法にも長所、短所がある。本稿では当院での大腸からの出血に対するIVRの治療成績を検討し、若干の文献的考察を加えて報告する。(著者抄録)

特集エキスパートが本音で語る! 膀胱癌診療の最前線〈膀胱癌診断の最前線〉膀胱癌の画像診断

秋田大宇, 岩渕雄, 陣崎雅弘

臨床泌尿器科（株式会社医学書院） 72 （ 7 ） 514 - 525 2018年06月

ISSN 0385-2393

Bilateral Adrenal Hyperplasia Due to Adrenocorticotropic Hormone-Secreting Esthesioneuroblastoma on FDG PET and 111In-Pentetreotide Scintigraphy

Matsusaka Y., Nakahara T., Kurihara I., Iwabuchi Y., Jinzaki M.

Clinical Nuclear Medicine （Clinical Nuclear Medicine） 43 （ 6 ） 452 - 453 2018年06月

ISSN 03639762

© 2018 Wolters Kluwer Health, Inc. All rights reserved. A 53-year-old woman with metastatic esthesioneuroblastoma was referred for FDG PET/CT imaging. FDG PET/CT showed symmetrical uptake in bilaterally enlarged adrenal glands, in addition to abnormal uptake in bone and lymph node metastases. 111In-pentetreotide scintigraphy was further performed and revealed the lack of adrenal uptake. The patient's serum adrenocorticotropic hormone (ACTH) level was extremely high, suggesting that hyperplastic condition in the adrenal glands due to ACTH stimulation from the metastatic esthesioneuroblastoma was responsible for increased FDG uptake. The combination of FDG PET and 111In-pentetreotide scintigraphy was useful for the pathophysiological evaluation of ACTH-secreting esthesioneuroblastoma.

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Quantitative evaluation of the tracer distribution in dopamine transporter SPECT for objective interpretation

Iwabuchi Y., Nakahara T., Kameyama M., Yamada Y., Hashimoto M., Ogata Y., Matsusaka Y., Katagiri M., Itoh K., Osada T., Ito D., Tabuchi H., Jinzaki M.

Annals of Nuclear Medicine （Annals of Nuclear Medicine） 32 （ 5 ） 363 - 371 2018年06月

ISSN 09147187

© 2018, The Japanese Society of Nuclear Medicine. Purpose: Quantification of the tracer distribution would add objectivity to the visual assessments of dopamine transporter (DAT) single photon emission computed tomography (SPECT) data. Our study aimed to evaluate the diagnostic utility of fractal dimension (FD) as a quantitative indicator of tracer distribution and compared with the conventional quantitative value: specific binding ratio (SBR). We also evaluated the utility of the combined index SBR/FD (SBR divided by FD). Materials and methods: We conducted both clinical and phantom studies. In the clinical study, 150 patients including 110 patients with Parkinsonian syndrome (PS) and 40 without PS were enrolled. In the phantom study, we used a striatal phantom with the striatum chamber divided into two spaces, representing the caudate nucleus and putamen. The SBR, FD, and SBR/FD were calculated and compared between datasets for evaluating the diagnostic utility. Mann–Whitney test and receiver-operating characteristics (ROC) analysis were used for analysis. Results: ROC analysis revealed that the FD value had high diagnostic performance [the areas under the curve (AUC) = 0.943] and the combined use of SBR and FD (SBR/FD) delivered better results than the SBR alone (AUC, 0.964 vs 0.899; p < 0.001). The sensitivity, specificity, and accuracy, respectively, were 79.1, 85.0, and 80.7% with SBR, 84.5, 97.5, and 88.0% with FD, and 92.7, 87.5, and 91.3% with SBR/FD. Conclusion: Our results confirmed that the FD value is a useful diagnostic index, which reflects the tracer distribution in DAT SPECT images. The combined use of SBR and FD was more useful than either used alone.

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特集症例から迫る!関節疾患のMRI診断新入門膝関節

許斐佑介, 大堀訓明, 陣崎雅弘, 新津守

臨床画像（(株)メジカルビュー社） 34 （ 5 ） 558 - 568 2018年05月

ISSN 0911-1069

FDG PET/CT Findings in a Localized Reactive Lymphoid Hyperplasia of the Spleen

Ito Y., Nakahara T., Nishihara Y., Shiraishi J., Jinzaki M.

Clinical Nuclear Medicine （Clinical Nuclear Medicine） 43 （ 5 ） 354 - 355 2018年05月

ISSN 03639762

© 2018 Wolters Kluwer Health, Inc. All rights reserved. A 38-year-old man with sigmoid colon cancer underwent a preoperative contrast-enhanced CT which incidentally revealed a modestly enhancing splenic mass. FDG PET/CT showed mildly increased uptake in the splenic lesion in contrast to prominently increased uptake in the colonic tumor. In addition, the splenic mass demonstrated only slightly increased signal intensity in diffusion-weighted MRI, suggesting low probability of metastasis. Splenectomy nonetheless was performed at surgery of the colon cancer. The histopathologic examination showed aggregated lymphoid follicles with germinal centers in the splenic lesion and made the diagnosis of localized reactive lymphoid hyperplasia a rare benign lymphoid tumor.

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Intraosseous venous structures adjacent to the jugular tubercle associated with an anterior condylar dural arteriovenous fistula

Mizutani K., Akiyama T., Minami Y., Toda M., Fujiwara H., Jinzaki M., Yoshida K.

Neuroradiology （Neuroradiology） 60 （ 5 ） 487 - 496 2018年05月

ISSN 00283940

© 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: Although involvement of the osseous component with an anterior condylar dural arteriovenous fistula (AC-DAVF) has been frequently described, osseous venous structures in which AC-DAVFs develop have not been fully elucidated. We investigated osseous venous structures adjacent to the hypoglossal canal in normal controls and patients with AC-DAVFs. Methods: The study included 50 individuals with unruptured aneurysms as normal controls and seven patients with AC-DAVFs. Osseous venous structures adjacent to the hypoglossal canal in normal controls were analyzed using computed tomography (CT) digital subtraction venography. In patients with AC-DAVFs, the fistulous pouches, draining veins, and surrounding venous structures were examined using cone beam CT. Results: In 46.0% of laterals in normal controls, osseous venous structures were visualized within the jugular tubercle superomedially to the hypoglossal canal. We named these structures the jugular tubercle venous complex (JTVC). The JTVC was always continuous with the anterior condylar vein and was sometimes connected to surrounding venous channels. We detected nine fistulous pouches in the seven patients with AC-DAVFs. The fistulous pouches were in the JTVC (33.3%), anterior condylar vein (33.3%), and other venous channels within the exoccipital region (33.3%). Conclusion: Although the JTVC is a venous structure frequently found in normal people, it had not been investigated until now. The venous channel between the anterior condylar vein and JTVC is a common origin site for AC-DAVFs, and it was associated with 66.6% of the AC-DAVF cases in the current study.

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The psychological impact of disclosing amyloid status to Japanese elderly: A preliminary study on asymptomatic patients with subjective cognitive decline

Wake T., Tabuchi H., Funaki K., Ito D., Yamagata B., Yoshizaki T., Kameyama M., Nakahara T., Murakami K., Jinzaki M., Mimura M.

International Psychogeriatrics （International Psychogeriatrics） 30 （ 5 ） 635 - 639 2018年05月

ISSN 10416102

© 2018 International Psychogeriatric Association. In Japan, 4.6 million people are living with dementia and the number is expected to rise to 7 million by 2025. Amyloid-β (Aβ) positron emission tomography (PET) is used for cognitively normal Japanese people with or without subjective cognitive decline (SCD) for the purpose of clinical trials or diagnosis. Nevertheless, no empirical studies have been conducted on the safety of disclosing amyloid status to such populations. We conducted amyloid PET imaging on 42 participants (Aβ positive (n = 10) and negative (n = 32)). State anxiety and depression were measured at pre- and post-disclosure, and test-related distress at post-disclosure. Mean state anxiety and depression scores were below the cut-off through pre- and post-disclosure in the Aβ positive and negative groups. State anxiety and depression did not change over time and were not different between groups. Mean test-related distress scores were within normal limits at post-disclosure in both groups. No significant difference was found between groups. Disclosing Aβ positive results did not cause greater mood disturbance than negative results in a short period of time. The short-term psychological safety of disclosing Aβ PET results to asymptomatic Japanese adults with SCD was indicated.

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Quantitative and qualitative evaluation of hybrid iterative reconstruction, with and without noise power spectrum models: A phantom study

Minamishima K., Sugisawa K., Yamada Y., Jinzaki M.

Journal of Applied Clinical Medical Physics （Journal of Applied Clinical Medical Physics） 19 （ 3 ） 318 - 325 2018年05月

© 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine. The purpose of this phantom study was to investigate the feasibility of dose reduction with hybrid iterative reconstruction, with and without a noise power spectrum (NPS) model, using both quantitative and qualitative evaluations. Standard dose (SD), three-quarter dose (TQD), and half-dose (HD) of radiation were used. Images were reconstructed with filtered back projection (FBP), adaptive iterative dose reduction 3D (AIDR 3D) (MILD, STR), and AIDR 3D enhanced (eAIDR 3D) (eMILD, eSTR). An NPS analysis, task-based modulation transfer function (MTFtask) analysis, and comparisons of low-contrast detectability and image texture were performed. Although the eAIDR 3D had a higher NPS value in the high-frequency range and improved image texture and resolution as compared with AIDR 3D at the same radiation dose and iteration levels, it yielded higher noise than AIDR 3D. Additionally, although there was no statistically significant difference between SD-FBP and the TQD series in the comparison of the mean area under the curve (AUC), the mean AUC was statistically significantly different between SD-FBP and the HD series. NPS values in the high-frequency range, 10% MTFtask values, low-contrast detectability, and image textures of TQD-eMILD were comparable to those of SD-FBP. Our findings suggested that using eMILD can reduce the radiation dose by 25%, while potentially maintaining diagnostic performance, spatial resolution, and image texture; this could support selecting the appropriate protocol in a clinical setting.

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ここが知りたい! 画像診断2017年12月号特集「知っておきたい泌尿器画像診断─新たな動向も含めて─」

片平和博, 陣崎雅弘

画像診断（学研メディカル秀潤社） 38 （ 6 ） 590 - 591 2018年04月

ISSN 0285-0524

Silent navigator–triggered silent MRI of the abdomen

Iwadate Y., Nozaki A., Nunokawa Y., Okuda S., Jinzaki M., Kabasawa H.

Magnetic Resonance in Medicine （Magnetic Resonance in Medicine） 79 （ 4 ） 2170 - 2175 2018年04月

ISSN 07403194

© 2017 International Society for Magnetic Resonance in Medicine Purpose: To develop and demonstrate the feasibility of a silent respiratory navigator technique for prospective triggering, which was incorporated into a three-dimensional radial zero-echo-time sequence for respiratory navigated silent abdominal imaging. Methods: A nonselective hard excitation radiofrequency pulse was used for the navigator sequence with a derated readout gradient, to avoid generation of high levels of acoustic noise. The acquired navigator signals were processed in real time and used for prospective triggering of the zero-echo-time sequence. Ten healthy volunteers were scanned using the proposed and conventional techniques at 1.5 T. An acoustic noise measurement with A-weighted continuous equivalent sound pressure level was also performed. Results: The sound pressure–level values of the background noise, zero-echo-time imaging, conventional, and silent navigators were 68.3, 68.4, 102.5, and 69.4 dBA, respectively. Excellent correlation with correlation coefficients greater than 0.9 was observed between the bellows signals and displacement values calculated from the navigators. Sharpness of the portal vein of both conventional and silent navigator–triggered images was significantly higher than those of nontriggered images. Conclusions: The silent navigator–triggered zero-echo-time technique is feasible and might improve image quality and workflow of abdominal MRI of patients who are prone to acoustic noise. Magn Reson Med 79:2170–2175, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

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The analysis of the cerebral venous blood volume in cavernous sinus using 320 row multi-detector CT

Mizutani K., Toda M., Yajima Y., Akiyama T., Fujiwara H., Yoshida K., Jinzaki M.

Clinical Neurology and Neurosurgery （Clinical Neurology and Neurosurgery） 167 11 - 16 2018年04月

ISSN 03038467

© 2018 Elsevier B.V. Objectives: : Functional venous anatomy in the brain has been mostly understood from the morphological and embryological points of view and no published study has directly evaluated the blood flow volume of cerebral small veins. We developed a method to directly evaluate the relative blood volume in small venous channels using multi-detector computed tomography (CT) and applied it to evaluate the blood volume in each tributary of the cavernous sinus, which plays an important role in cerebral venous drainage. Patients and Methods: : Ten patients with small brain tumors who had normal venous anatomy were included in the present study. All of them underwent preoperative 320-row multi-detector CT. After injecting the contrast bolus, we measured the Hounsfield units (HUs) at 10 time point over 60 s in each tributary of the cavernous sinus. The gamma distribution fitting to each HU enabled us to obtain a time-density curve and determine the relative venous volume in each venous channel. Results: : In terms of blood volume, the superficial middle cerebral vein and inferior petrosal sinus were the largest inflow and outflow channels of the cavernous sinus and accounted for 36.1% and 24.7% of its inflow and outflow on average, respectively. The superior orbital vein did not contribute to the blood volume passing through the cavernous sinus in the current study. Conclusions: : The present study allowed us to determine the relative blood volume in each tributary of the cavernous sinus, which was very useful to understand the physiological actual venous drainage pattern concerning the cavernous sinus in normal anatomy.

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Comparison of fluorine-18 fluorodeoxyglucose positron emission tomography with gallium-67 scintigraphy in the initial clinical staging of diffuse large B-cell lymphoma

Sakurai M., Toyama T., Kikuchi T., Kato J., Shimizu T., Koda Y., Karigane D., Yamane Y., Abe R., Yamazaki R., Nakazato T., Nakahara T., Jinzaki M., Okamoto S., Mori T.

International Journal of Hematology （International Journal of Hematology） 107 （ 2 ） 194 - 200 2018年02月

ISSN 09255710

© 2017, The Japanese Society of Hematology. Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has been recommended as a complementary tool for the staging of various malignancies, including malignant lymphoma. PET findings often shift patients to higher stages and may affect treatment outcomes. In this study, we retrospectively compared staging and treatment outcomes of newly diagnosed diffuse large B-cell lymphoma (DLBCL) assessed by PET (n = 153) or gallium-67 scintigraphy (Ga) (n = 95). In total, Ga upstaged two (2.1%) of 95 patients, whereas PET upstaged 13 (8.5%) of 153 patients. Bone/bone marrow (15 vs. 4%, P = 0.01) and muscle lesion (5 vs. 0%, P = 0.03) were identified more frequently in the PET group than in the Ga group. The estimated 3-year overall and progression-free survival rates did not differ significantly in the two groups at any stage. However, patients with stage III disease tended to have better progression-free survival in the PET group than in the Ga group [92.3 (95% CI 56.6–98.9%) vs. 58.3% (95% CI 27.0–80.1%), P = 0.086]. These results suggest that PET has a greater potential in detecting musculoskeletal lesions of DLBCL as extranodal lesions than Ga, and may contribute to the optimal staging.

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特集大動脈疾患の画像診断:画像所見・画像からみた自然史・治療効果判定慢性期・高齢者の大動脈病変

伊東伸剛, 陣崎雅弘

臨床画像（(株)メジカルビュー社） 34 （ 1 ） 30 - 38 2018年01月

ISSN 0911-1069

特集大血管CTの必須知識─治療に直結する最新の情報も含めて─ TAVI術前評価

山田祥岳, 山田稔, 松本俊亮, 中原健裕, 鈴木達也, 橋本正弘, 林田健太郎, 陣崎雅弘

画像診断（学研メディカル秀潤社） 38 （ 2 ） 164 - 179 2018年01月

ISSN 0285-0524

High-Energy Collimator Is Preferable to Medium-Energy Collimator for Evaluating 223Ra Uptake in Bone Metastasis at 2 Weeks Postinjection

Ichimura A., Nakahara T., Owaki Y., Nakajima K., Jinzaki M.

Clinical nuclear medicine （Clinical nuclear medicine） 43 （ 1 ） 71 - 72 2018年01月

An 80-year-old man with castration-resistant prostate cancer received Ra injection to treat bone metastases. Two weeks after the injection, the patient underwent static Ra scan of the chest with medium-energy and high-energy collimators for 30 minutes each. Images obtained with the 2 collimators showed that uptake in metastatic lesions was visually clearer and semiquantitatively higher with the high-energy collimator. The use of HE collimator for Ra imaging in the early phase has been reported, and the present case suggests that in the late phase HE collimator would also be preferable to medium-energy collimator in terms of lesion-based evaluation.

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Preclinical evaluation of heat-denatured [18F]FDG-labeled red blood cells for detecting splenic tissues with PET in rats

Matsusaka Y., Nakahara T., Takahashi K., Iwabuchi Y., Ogata Y., Nishime C., Kajimura M., Jinzaki M.

Nuclear Medicine and Biology （Nuclear Medicine and Biology） 56 26 - 30 2018年01月

ISSN 09698051

© 2017 Elsevier Inc. Introduction Heat-denatured 99mTc-labeled red blood cells (RBCs) are used for detecting splenic tissues with scintigraphy. The present study aimed to evaluate the feasibility of using heat-denatured [18F]fluorodeoxyglucose ([18F]FDG)-labeled RBCs in detecting splenic tissues using positron emission tomography (PET) in rats. Methods RBCs were washed with phosphate buffered saline, labeled with [18F]FDG at 38°C, and heat-denatured at 50°C for 15 min. In vitro stability was assessed by measuring extracellular radioactivity during the 0–180 min incubation at 37°C. Thin layer chromatography (TLC) of the extracellular fluid was performed. The autologous RBCs were intravenously injected in four rats and PET scanning was simultaneously performed for 30 min. Time-activity curves of several organs, including the spleen, were analyzed on the PET images. Results Labeling efficiency was 92%. Low levels of radioactivity were released from the labeled RBCs for 180 min. TLC revealed that 80% of the released radioactivity was due to [18F]FDG-6-phosphate. Whole body images showed strong uptake of heat-denatured [18F]FDG-labeled RBCs in the spleen soon after injection in all four rats. Time-activity curves revealed that the splenic uptake continued to increase for 30 min and the amount of radioactivity in the other organs, except the urinary bladder, decreased after the initial surge. Conclusions Heat-denatured [18F]FDG-labeled RBCs are suitable spleen-specific agents for PET. This method is clinically relevant as an alternative for heat-denatured 99mTc-labeled RBC scintigraphy.

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Giant cell tumors of the bone: Changes in image features after denosumab administration

Oguro S., Okuda S., Sugiura H., Matsumoto S., Sasaki A., Susa M., Morioka H., Jinzaki M.

Magnetic Resonance in Medical Sciences （Magnetic Resonance in Medical Sciences） 17 （ 4 ） 325 - 330 2018年

ISSN 13473182

© 2018 Japanese Society for Magnetic Resonance in Medicine. Purpose: To assess the clinical importance in the feature change in giant cell tumors of the bone (GCTB) after denosumab treatment, detected by MRI. Methods: In 12 patients, MRI and CT of GCTB obtained before and after the treatment retrospectively compared. The tumor size, the signal intensity (SI) ratio between the solid part of the GCTB and muscle, cystic part size, gadolinium enhancement and apparent diffusion coefficient (ADC) value were measured on MRI. The bone formation in the tumor was observed on CT and X-ray. Results: The mean number of denosumab injections was 19 ± 10. The follow-up period was up to 2 years. One case showed partial remission, while the other 11 cases were stable. A mean SI ratio on T2-weighted image statistically significantly decreased from 3.9 to 1.9 after the treatment. A cystic component in the tumor was observed in five cases before the treatment, and the diameter of the cystic part decreased after the treatment in 80% of cases (4/5). All the tumors showed contrast enhancement on T1-weighted image pre-and post-treatment (11/11). The averaged ADC values were 1.52 × 10−3 mm2/s before and 1.44 × 10−3 mm2/s after the treatment (P = 0.63). Bone formation in the tumor was observed in 58% of cases (7/12). Conclusion: The decrease of SI ratio on T2-weighted image, shrinkage of cystic part and bone formation should be regarded as the effectiveness of denosumab treatment despite of no substantial change in the tumor size.

Diagnostic imaging of bladder cancer

Akita H., Iwabuchi Y., Jinzaki M.

Japanese Journal of Clinical Urology （Japanese Journal of Clinical Urology） 72 （ 7 ） 514 - 525 2018年

ISSN 03852393

The added value of tomosynthesis in endoscopic retrograde cholangiography with radiography for the detection of choledocholithiasis

Suyama Y., Yamada Y., Yamaguchi H., Someya G., Otsuka S., Murayama Y., Shinmoto H., Jinzaki M., Ogawa K.

British Journal of Radiology （British Journal of Radiology） 91 （ 1087 ） 2018年

ISSN 00071285

© 2018 The Authors. Objective: The diagnostic performance of endoscopic retrograde cholangiography (ERC) with radiography is imperfect. We assessed the value of adding tomosynthesis to ERC with radiography for the detection of choledocholithiasis. Methods: This study included 102 consecutive patients (choledocholithiasis/non-choledocholithiasis, n = 57/45), who underwent both radiography and tomosynthesis for ERC in the same examination and were not diagnosed with malignancy. The reference standard for the existence of choledocholithiasis was confirmed by endoscopic stone extraction during ERC, intraoperative cholangiography, or follow up with magnetic resonance cholangiopancreatography (n = 78, 11, and 13, respectively). A gastroenterologist and a radiologist independently evaluated the radiographs and the combination of tomosynthesis and radiographic images in a blinded and randomised manner. Receiver operating characteristic analysis was used for statistical analysis. Results: The areas under the receiver operating characteristic curve for combined tomosynthesis and radiography were significantly higher than those for radiography alone for both readers: Reader 1/ Reader 2, 0.929/0.956 [95% confidence interval (CI), 0.861-0.965/0.890-0.983) vs 0.803/0.769 (95% confidence interval, 0.707-0.873/0.668-0.846), respectively (p = 0.0047/> 0.0001). Conclusion: Adding tomosynthesis to radiography improved the diagnostic performance of ERC for detection of choledocholithiasis. Advances in knowledge: Adding tomosynthesis to radiography improves detection of choledocholithiasis and tomosynthesis images can be obtained easily after radiographs and repeated immediately.

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Use of a digital phantom developed by QIBA for harmonizing SUVs obtained from the state-of-the-art SPECT/CT systems: a multicenter study

陣崎雅弘

EJNMMI Research （EJNMMI Research） 7 （ 1 ） 53 2017年12月

研究論文（学術雑誌）, 共著

Background: Although quantitative analysis using standardized uptake value (SUV) becomes realistic in clinical single-photon emission computed tomography/computed tomography (SPECT/CT) imaging, reconstruction parameter settings can deliver different quantitative results among different SPECT/CT systems. This study aims to propose a use of the digital reference object (DRO), which is a National Electrical Manufacturers Association (NEMA) phantom-like object developed by the Quantitative Imaging Biomarker Alliance (QIBA) fluorodeoxyglucose-positron emission tomography technical committee, for the purpose of harmonizing SUVs in Tc-99m SPECT/CT imaging. Methods: The NEMA body phantom with determined Tc-99m concentration was scanned with the four state-of-the-art SPECT/CT systems. SPECT data were reconstructed using different numbers of the product of subset and iteration numbers (SI) and the width of 3D Gaussian filter (3DGF). The mean (SUVmean), maximal (SUVmax), and peak (SUVpeak) SUVs for six hot spheres (10, 13, 17, 22, 28, and 37 mm) were measured after converting SPECT count into SUV using Becquerel calibration factor. DRO smoothed by 3DGF with a FWHM of 17 mm (DRO17 mm) was generated, and the corresponding SUVs were measured. The reconstruction condition to yield the lowest root mean square error (RMSE) of SUVmeans for all the spheres between DRO17 mm and actual phantom images was determined as the harmonized condition for each SPECT/CT scanner. Then, inter-scanner variability in all quantitative metrics was measured before (i.e., according to the manufacturers’ recommendation or the policies of their own departments) and after harmonization. Results: RMSE was lowest in the following reconstruction conditions: SI of 100 and 3DGF of 13 mm for Brightview XCT, SI of 160 and 3DGF of 3 pixels for Discovery NM/CT, SI of 60 and 3DGF of 2 pixels for Infinia, and SI of 140 and 3DGF of 15 mm for Symbia. In pre-harmonized conditions, coefficient of variations (COVs) among the SPECT/CT systems were greater than 10% for all quantitative metrics in three of the spheres, SUVmax and SUVmean, in one of the spheres. In contrast, all metrics except SUVmax in the 17-mm sphere yielded less than 10% of COVs after harmonization. Conclusions: Our proposed method clearly reduced inter-scanner variability in SUVs. A digital phantom developed by QIBA would be useful for harmonizing SUVs in multicenter trials using SPECT/CT.

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18F-FDG-labeled red blood cell PET for blood-pool imaging: preclinical evaluation in rats

陣崎雅弘

EJNMMI Research （EJNMMI Research） 7 （ 1 ） 19 2017年12月

研究論文（学術雑誌）, 共著

Background: Red blood cells (RBCs) labeled with single-photon emitters have been clinically used for blood-pool imaging. Although some PET tracers have been introduced for blood-pool imaging, they have not yet been widely used. The present study investigated the feasibility of labeling RBCs with 18F-2-deoxy-2-fluoro-D-glucose (18F-FDG) for blood-pool imaging with PET. RBCs isolated from venous blood of rats were washed with glucose-free phosphate-buffered saline and labeled with 18F-FDG. To optimize labeling efficiency, the effects of glucose deprivation time and incubation (labeling) time with 18F-FDG were investigated. Post-labeling stability was assessed by calculating the release fraction of radioactivity and identifying the chemical forms of 18F in the released and intracellular components of 18F-FDG-labeled RBCs incubated in plasma. Just after intravenous injection of the optimized autologous 18F-FDG-labeled RBCs, dynamic PET scans were performed to evaluate in vivo imaging in normal rats and intraabdominal bleeding models (temporary and persistent bleeding). Results: The optimal durations of glucose deprivation and incubation (labeling) with 18F-FDG were 60 and 30 min, respectively. As low as 10% of 18F was released as the form of 18F-FDG from 18F-FDG-labeled RBCs after a 60-min incubation. Dynamic PET images of normal rats showed strong persistence in the cardiovascular system for at least 120 min. In the intraabdominal bleeding models, 18F-FDG-labeled RBC PET visualized the extravascular blood clearly and revealed the dynamic changes of the extravascular radioactivity in the temporary and persistent bleeding. Conclusions: RBCs can be effectively labeled with 18F-FDG and used for blood-pool imaging with PET in rats.

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特集知っておきたい泌尿器画像診断─新たな動向も含めて─ 副腎腫瘍の診断とIVR治療の動向

小黒草太, 有田祐起, 塚田実郎, 伊東伸剛, 井上政則, 中塚誠之, 陣崎雅弘

画像診断（学研メディカル秀潤社） 37 （ 14 ） 1461 - 1470 2017年11月

ISSN 0285-0524

特集知っておきたい泌尿器画像診断─新たな動向も含めて─ 序説

陣崎雅弘

画像診断（学研メディカル秀潤社） 37 （ 14 ） 1425 - 1425 2017年11月

ISSN 0285-0524

Incidental spade-shaped FDG uptake in the left ventricular apex suggests apical hypertrophic cardiomyopathy

Katagiri M., Nakahara T., Murata M., Ogata Y., Matsusaka Y., Iwabuchi Y., Yamada Y., Fukuda K., Jinzaki M.

Annals of Nuclear Medicine （Annals of Nuclear Medicine） 31 （ 5 ） 399 - 406 2017年11月

研究論文（学術雑誌）, 共著, ISSN 09147187

Purpose: Apical wall thickening with an “ace-of-spades” configuration is a unique sign of apical hypertrophic cardiomyopathy (AHCM). We investigated spade-shaped FDG uptake around the left ventricular apex (SSUA) incidentally found in routine oncological FDG PET. Methods: Cases showing SSUA were selected based on retrospective review. The pattern or intensity of SSUA was compared with the results of electrocardiogram (ECG), echocardiography, and stress myocardial perfusion SPECT. The diagnosis of ACHM was based on the presence of giant negative T wave in ECG, thickness of spade-shaped hypertrophy in the apex in echocardiography, and increased tracer uptake in the apex in rest SPECT. Results: Among the 34 patients in 36 PET scans showing SSUA, SSUA was weak in 17 and intense in 17. There were isolated SSUA (n = 29) and SSUA with diffuse or other focal left ventricular uptake (n = 5). Three patients with the latter uptake pattern turned out to have coexistence of AHCM and asymmetric septal hypertrophy. Of the 16 SSUA-positive patients who underwent echocardiography, 13 (81%) were diagnosed as AHCM and the remaining 3 were regarded as borderline AHCM (apical wall thickness, 14–15 mm). There were 16 patients with SSUA who also underwent PET scans after the study period among which 11 (69%) had persistent SSUA in the follow-up PET. In the remaining 5, follow-up PET scans showed diffuse left ventricular uptake and SSUA was barely visible. The intensity of SSUA was significantly or marginally associated with giant negative T wave (p < 0.01), apical asynergy (p = 0.08), and impaired coronary flow reserve (p < 0.05). There were no other factors correlated with the pattern or intensity of SSUA. Conclusion: SSUA incidentally found in oncological FDG PET appeared to be associated with AHCM, especially in ischemic conditions. The moderate repeatability of SSUA was probably due to obscurity by physiological uptake.

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静荷重条件下におけるヒト足部と類人猿足部の3次元骨格運動の比較解析

伊藤幸太, 細田耕, 名倉武雄, 今西宣晶, 相磯貞和, 陣崎雅弘, 大石元治, 荻原直道

バイオメカニズム学術講演会予稿集（バイオメカニズム学会） 38回 217 - 218 2017年11月

特集薬物治療に起因する諸病態の画像所見胸部　薬物治療に関連する肺疾患

南康大, 杉浦弘明, 陣崎雅弘

臨床画像（(株)メジカルビュー社） 33 （ 10 ） 1130 - 1143 2017年10月

ISSN 0911-1069

特集泌尿器の画像診断と放射線治療画像診断　腎臓嚢胞性腎腫瘤

秋田大宇, 成田啓一, 陣崎雅弘

臨床放射線（金原出版） 62 （ 11 ） 1331 - 1340 2017年10月

ISSN 0009-9252

Three-dimensional innate mobility of the human foot bones under axial loading using biplane X-ray fluoroscopy

Ito K., Hosoda K., Shimizu M., Ikemoto S., Nagura T., Seki H., Kitashiro M., Imanishi N., Aiso S., Jinzaki M., Ogihara N.

Royal Society Open Science （Royal Society Open Science） 4 （ 10 ） 171086 2017年10月

The anatomical design of the human foot is considered to facilitate generation of bipedal walking. However, how the morphology and structure of the human foot actually contribute to generation of bipedal walking remains unclear. In the present study, we investigated the three-dimensional kinematics of the foot bones under a weight-bearing condition using cadaver specimens, to characterize the innate mobility of the human foot inherently prescribed in its morphology and structure. Five cadaver feet were axially loaded up to 588N (60 kgf), and radiographic images were captured using a biplane X-ray fluoroscopy system. The present study demonstrated that the talus is medioinferiorly translated and internally rotated as the calcaneus is everted owing to axial loading, causing internal rotation of the tibia and flattening of the medial longitudinal arch in the foot. Furthermore, as the talus is internally rotated, the talar head moves medially with respect to the navicular, inducing external rotation of the navicular and metatarsals. Under axial loading, the cuboid is everted simultaneously with the calcaneus owing to the osseous locking mechanism in the calcaneocuboid joint. Such detailed descriptions about the innate mobility of the human foot will contribute to clarifying functional adaptation and pathogenic mechanisms of the human foot.

Ra-223 SPECT for semi-quantitative analysis in comparison with Tc-99m HMDP SPECT: phantom study and initial clinical experience

Owaki Y., Nakahara T., Kosaka T., Fukada J., Kumabe A., Ichimura A., Murakami M., Nakajima K., Fukushi M., Inoue K., Oya M., Jinzaki M.

EJNMMI Research （EJNMMI Research） 7 （ 1 ） 81 2017年10月

研究論文（学術雑誌）, 共著

Background: Image-based measurement of absorbed dose of Ra-223 dichloride may be useful in predicting therapeutic outcome in patients with castration-resistant prostate cancer (CRPC). In general, SPECT has been found to be more accurate than planar imaging in terms of lesion-based analysis. The aims of this study were to assess the feasibility and clinical usefulness of Ra-223 SPECT. The energy spectrum of Ra-223 and SPECT images of a cylindrical phantom with a hot rod were obtained to determine the collimator candidates and energy window settings suitable for clinical Ra-223 SPECT (basic study A). Another phantom with a tube-shaped chamber and two spheres simulating bowel activity and metastatic lesions in the lumbar spine was scanned with medium-energy general-purpose (MEGP) and high-energy general-purpose (HEGP) collimators (basic study B). Ten patients with CRPC underwent SPECT imaging 2 h after Ra-223 injection successively with MEGP and HEGP collimators in random order for 30 min each. Lesion detectability and semi-quantitative analyses of bone metastasis (i.e. lesion-to-background ratio (LBR)) were performed compared to Tc-99m HMDP SPECT. Results: Basic study A revealed that an 84-keV photopeak ± 20% using the HEGP collimator offers better SPECT image quality than the other imaging conditions. Basic study B showed that uptake in one of the spheres was overestimated by overlapped activity of the tube-shaped chamber in planar imaging whereas the spheres had similar counts and significantly higher sphere-to-background ratio in SPECT. On both planar and SPECT images, HEGP gave higher image contrast than MEGP (p < 0.01). In the clinical study, Ra-223 SPECT at 84 keV ± 20% depicted more lesions with the HEGP than with the MEGP collimator (51 vs 36, p = 0.013). There was a positive correlation between LBR in Tc-99m SPECT and in Ra-223 SPECT (r = 0.67 with the MEGP and 0.69 with the HEGP collimator, p < 0.01). LBRs were significantly higher with the HEGP than with the MEGP collimator (p < 0.01). Conclusions: We recommended the use of the HEGP collimator at 84 keV ± 20% for Ra-223 SPECT imaging. Lesion-based semi-quantitative analysis in the human study revealed a good correlation between Ra-223 and Tc-99m HMDP SPECT in the early phase (2–3 h post injection).

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特集放射線科研修医の胸腹部画像診断must know 腹部・骨盤部　腎臓　腎腫瘍に特徴的な所見

荒井学, 成田啓一, 秋田大宇, 陣崎雅弘

臨床画像（(株)メジカルビュー社） 33 （ 14 ） 138 - 150 2017年10月

ISSN 0911-1069

Quantitative assessment of fatty infiltration and muscle volume of the rotator cuff muscles using 3-dimensional 2-point Dixon magnetic resonance imaging

陣崎雅弘

Journal of Shoulder and Elbow Surgery （Journal of Shoulder and Elbow Surgery） 26 （ 10 ） e309 - e318 2017年10月

研究論文（学術雑誌）, 共著, ISSN 10582746

Background In patients with rotator cuff tears, muscle degeneration is known to be a predictor of irreparable tears and poor outcomes after surgical repair. Fatty infiltration and volume of the whole muscles constituting the rotator cuff were quantitatively assessed using 3-dimensional 2-point Dixon magnetic resonance imaging. Methods Ten shoulders with a partial-thickness tear, 10 shoulders with an isolated supraspinatus tear, and 10 shoulders with a massive tear involving supraspinatus and infraspinatus were compared with 10 control shoulders after matching age and sex. With segmentation of muscle boundaries, the fat fraction value and the volume of the whole rotator cuff muscles were computed. After reliabilities were determined, differences in fat fraction, muscle volume, and fat-free muscle volume were evaluated. Results Intra-rater and inter-rater reliabilities were regarded as excellent for fat fraction and muscle volume. Tendon rupture adversely increased the fat fraction value of the respective rotator cuff muscle (P <.002). In the massive tear group, muscle volume was significantly decreased in the infraspinatus (P =.035) and increased in the teres minor (P =.039). With subtraction of fat volume, a significant decrease of fat-free volume of the supraspinatus muscle became apparent with a massive tear (P =.003). Conclusion Three-dimensional measurement could evaluate fatty infiltration and muscular volume with excellent reliabilities. The present study showed that chronic rupture of the tendon adversely increases the fat fraction of the respective muscle and indicates that the residual capacity of the rotator cuff muscles might be overestimated in patients with severe fatty infiltration.

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Preliminary Experience of Endovascular Embolization Using N-Butyl Cyanoacrylate for Hemoptysis due to Infectious Pulmonary Artery Pseudoaneurysms via Systemic Arterial Approach

Torikai H., Hasegawa I., Jinzaki M., Narimatsu Y.

Journal of Vascular and Interventional Radiology （Journal of Vascular and Interventional Radiology） 28 （ 10 ） 1438 - 1442.e1 2017年10月

研究論文（学術雑誌）, 共著, ISSN 10510443

We report 5 patients with hemoptysis due to infectious pulmonary artery pseudoaneurysm (PAP) treated with endovascular embolization using N-butyl cyanoacrylate (NBCA) injected via bronchial and nonbronchial systemic arterial approaches. Infectious diseases included inactive tuberculosis (n = 3), nontuberculous mycobacteriosis (n = 1), and chronic infection of unknown origin (n = 1). Seven PAPs were detected on selective systemic angiography, and injection of NBCA was performed. Disappearance of all PAPs was confirmed on systemic arteriography after the intervention. In all patients, hemoptysis was stopped without major complications, and it did not recur during the follow-up period (mean, 351 d; range, 285–427 d).

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Bone SPECT/CT localizes increased bone metabolism and subsequent bone resorption in reflex sympathetic dystrophy

Narimatsu H., Nakahara T., Kodama S., Hisazumi H., Tominaga S., Ohkuma K., Jinzaki M.

Clinical Nuclear Medicine （Clinical Nuclear Medicine） 42 （ 10 ） 784 - 786 2017年10月

研究論文（学術雑誌）, 共著, ISSN 03639762

A 64-year-old man with lung cancer with a history of revascularization of the occluded right femoral artery underwent bone scintigraphy, which showed intense uptake in the distal side of the right leg. The additional SPECT/CT clarified that the uptake was predominantly increased in the epiphyses of the right ankle and foot with possible osteopenia. One month later, follow-up SPECT/CT showed the manifestation of periosteal resorption in the hypermetabolic sites with slight decrease in bone metabolism. Radiological correlation between bone metabolism and subsequent bone resorption in addition to clinical symptoms in this patient suggested the diagnosis of reflex sympathetic dystrophy.

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Image quality of virtual monochromatic images obtained using 320-detector row CT: A phantom study evaluating the effects of iterative reconstruction and body size

Okamura T., Yamada Y., Yamada M., Yamazaki A., Shiraga N., Jinzaki M.

European Journal of Radiology （European Journal of Radiology） 95 212 - 221 2017年10月

ISSN 0720048X

Objectives To compare the image quality between virtual monochromatic spectral (VMS) images obtained using 320-row detector CT and polychromatic 120-kVp images reconstructed with or without iterative reconstruction using various phantom sizes. Materials and methods Torso phantoms simulating three patient sizes and containing four syringes filled with water or different contrast media (5, 10, 15 mgI/mL15 mgI/ml) were used. The phantoms were scanned using dual-energy (80/135-kVp) and single-energy (120-kVp) protocols at different settings (20 mGy, 12 mGy, and 6 mGy). VMS images were generated at 1-keV intervals (range, 35–135 keV). Both the VMS images and the single-energy 120-kVp images were reconstructed using filtered back projection (FBP) and adaptive iterative dose reduction 3D (AIDR-3D). The signal-to-noise ratio (SNR), and the contrast-to-noise ratio (CNR) were assessed. Results Using FBP reconstruction, the SNR and CNR of the VMS images were lower than or similar to those of the 120-kVp images for most dose settings. Using AIDR-3D reconstruction, however, the 70-keV VMS images had higher SNRs and CNRs than the 120-kVp images at most settings. Conclusions The image quality of VMS images with FBP reconstruction tended to be lower than that of the 120-kVp images. With the use of AIDR-3D, however, approximately 70-keV VMS images had a higher image quality than the 120-kVp images.

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【血管性病変の塞栓術　コンプレックスケースレビュー】コイル塞栓後に、瘤のネック近傍の再増大を認めた腎動脈瘤の1例

井上政則, 中塚誠之, 陣崎雅弘

IVR: Interventional Radiology （(一社)日本インターベンショナルラジオロジー学会） 32 （ 3 ） 192 - 196 2017年10月

ISSN 1340-4520

症例は70歳代男性で、内腸骨動脈瘤の精査中に左腎動脈瘤を指摘された。ダイナミックCTでは、動脈相にて左腎門部近傍の腹側枝の分枝に洋なし状の26×24×23mm大の嚢状動脈瘤を認めた。壁在血栓を伴い、瘤壁の石灰化を部分的に認めた。末梢分枝の支配領域は狭いことを考慮して、末梢分枝を塞栓した上で瘤内塞栓を行う方針となった。瘤の流入血管の塞栓は行わず、末梢分枝の近位の枝は1本開存している。30ヵ月後のダイナミックCTにて瘤のネック部の急速な増大とコイルの変位を認めたため、再塞栓を施行した。CTでネック部は急速に増大しているため、真性瘤ではあると思われたが、瘤壁が脆弱である可能性が高いと判断した。このため瘤壁に圧をかけないように慎重にpackingを行い、そのコイルを土台に流入血管を密に塞栓する方針とした。DSAで瘤は完全に塞栓され、流入血管内のコイルも腎動脈に突出することなく密に塞栓されたことを確認して手技を終了した。

Diagnostic accuracy of lung subtraction iodine mapping CT for the evaluation of pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension: Correlation with perfusion SPECT/CT

陣崎雅弘

International Journal of Cardiology （International Journal of Cardiology） 243 538 - 543 2017年09月

研究論文（学術雑誌）, 共著, ISSN 01675273

Background For treatment of chronic thromboembolic pulmonary hypertension (CTEPH), the evaluation of segmental pulmonary perfusion is important. There are no previous reports about lung subtraction iodine mapping (LSIM) computed tomography (CT) for evaluation of segmental pulmonary perfusion in patients with CTEPH, using lung perfusion SPECT/CT (LPS) as the reference. Methods 50 patients (age, 60.7 ± 16.7 years) with known or suspected CTEPH were enrolled in this study. Non-contrast chest CT and CT pulmonary angiography (CTPA) were performed on a 320-detector row CT system. Then, based on a non-rigid registration followed by subtraction of non-contrast images from contrast-enhanced images, color-coded LSIM images were generated. LPS was performed using a SPECT/CT system within a period of 2 months, and served as the reference standard. LSIM and CTPA images were evaluated in a blinded manner for the detection of pulmonary perfusion defects on a segment-by-segment basis. Results The sensitivity, specificity, accuracy, and positive and negative predictive values of LSIM for the detection of segmental perfusion defects were 95% (734/773), 84% (107/127), 93% (841/900), 97% (734/754) and 73% (107/146), respectively, while the corresponding values for CTPA were 65% (505/773), 61% (78/127), 65% (583/900), 91% (505/554) and 23% (78/346). Generalized estimating equations analyses revealed a significantly better performance of LSIM than that of CTPA regarding the sensitivity, accuracy, and positive and negative predictive values (all P < 0.0001). Conclusions LSIM is a feasible technique for segment-based evaluation of pulmonary perfusion in patients with CTEPH, and it provides a significantly higher diagnostic accuracy compared with CTPA.

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Preoperatively determining the margins of subcutaneous malignant soft tissue tumours using contrast-enhanced ultrasonography

Oguro S., Kikuta K., Sasaki A., Okuma K., Matsumoto S., Sugiura H., Morioka H., Nakamura M., Matsumoto M., Jinzaki M.

Journal of Medical Ultrasonics （Journal of Medical Ultrasonics） Epub ahead of print （ 2 ） 385 - 388 2017年09月

研究論文（学術雑誌）, 共著, ISSN 13464523

© 2017, The Japan Society of Ultrasonics in Medicine. The purpose of this technical report is to demonstrate the feasibility of contrast-enhanced ultrasonography for preoperative evaluation of the lateral extent of subcutaneous malignant soft tissue tumours. Patients with subcutaneous malignant soft tissue tumours who underwent surgery between March 2016 and May 2016 were selected for inclusion. Contrast-enhanced ultrasonography using Sonazoid® was performed 1 day before the operation. The tumour margin was determined based on contrast-enhanced ultrasonography and marked on the skin using a permanent marker. After surgery, the extent of the tumour area was determined based on microscopic findings. The distance between the edge of the tumour and the skin markings was histologically measured. The mean distance between the extent of infiltrative tumour growth based on the microscopic findings and the skin marking was 1.3 ± 1.6 mm. The greatest distance between microscopically determined tumour invasion and the skin marking was 4 mm. Contrast-enhanced ultrasonography of subcutaneous malignant soft tissue tumours was not only feasible, but also highly accurate in estimating tumour margins as well as infiltrative tumour growth compared with macroscopic and microscopic analysis, respectively.

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婦人科疾患の鑑別診断のポイント第2章子宮頸部　1. 子宮頸部の充実性腫瘤の鑑別

秋田あやの, 秋田大宇, 奥田茂男, 陣崎雅弘

画像診断（学研メディカル秀潤社） 37 （ 11 ） s50 - s55 2017年09月

ISSN 0285-0524

婦人科疾患の鑑別診断のポイント第2章子宮頸部　2. 子宮頸管内腫瘤の鑑別

秋田あやの, 秋田大宇, 奥田茂男, 陣崎雅弘

画像診断（学研メディカル秀潤社） 37 （ 11 ） s56 - s61 2017年09月

ISSN 0285-0524

Imaging Findings of Atypical Type II Endoleak Through Vasa Vasorum After Abdominal Endovascular Aneurysm Repair

Torikai H., Inoue M., Nakatsuka S., Tamura M., Yashiro H., Yoshitake A., Shimizu H., Jinzaki M.

CardioVascular and Interventional Radiology （CardioVascular and Interventional Radiology） Epub ahead of print （ 1 ） 186 - 190 2017年08月

研究論文（学術雑誌）, 共著, ISSN 01741551

© 2017, Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). A type II endoleak (T2EL) is the most common endoleak after endovascular aneurysm repair (EVAR), and a persistent T2EL has been occasionally associated with aneurysmal enlargement. Typical findings of a T2EL consist of an endoleak cavity with inflow and outflow arteries of aortic branch vessels. However, an atypical T2EL, in which hypertrophied vasa vasorum and enlargement of a thrombosed aneurysm are observed, has no endoleak cavity. We have seen three cases of continuous aortic aneurysmal growth after EVAR caused by atypical T2ELs without endoleak cavities through developed vasa vasorum. In this report, the imaging findings of selective angiography and dynamic computed tomography of these cases are reviewed.

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腎嚢胞のCT画像に生じるpseudoenhancement effectの抑制に関わる撮影条件の検討　連続X線と仮想単色X線、画像再構成法、およびビーム幅の違いにおけるファントム検証

杉澤浩一, 市川勝弘, 南島一也, 長谷川雅一, 山田祥岳, 陣崎雅弘

日本放射線技術学会雑誌（(公社)日本放射線技術学会） 73 （ 8 ） 636 - 645 2017年08月

ISSN 0369-4305

Relationship between diminution of small pulmonary vessels and emphysema in chronic obstructive pulmonary disease

陣崎雅弘

Clinical Imaging （Clinical Imaging） 46 85 - 90 2017年07月

研究論文（学術雑誌）, 共著, ISSN 08997071

Objectives To investigate the relationship between small pulmonary vessels and extent of emphysema on CT in individual lungs with chronic obstructive pulmonary disease (COPD). Methods Forty-nine patients were included. The percentage of cross-sectional area of vessels < 5 mm2 (%CSA < 5) and extent of emphysema were assessed. Results Less than half of the COPD patients demonstrated an inverse correlation between %CSA < 5 and percentage of low attenuation area (LAA%). In the remaining patients, %CSA < 5 was homogeneously distributed. Conclusion Not all patients with COPD demonstrated an inverse correlation of the distributions between %CSA < 5 and LAA% in individual lungs.

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Pre-treatment interleukin-6 levels strongly affect bone erosion progression and repair detected by magnetic resonance imaging in rheumatoid arthritis patients

Kondo Y., Kaneko Y., Sugiura H., Matsumoto S., Nishina N., Kuwana M., Jinzaki M., Takeuchi T.

Rheumatology (United Kingdom) （Rheumatology (United Kingdom)） 56 （ 7 ） 1089 - 1094 2017年07月

研究論文（学術雑誌）, 共著, ISSN 14620324

Objective. To examine the relationship between MRI structural damage and repair and plasma inflammatory cytokines in patients with RA. Methods. A total of 88 newly diagnosed, untreated RA patients were enrolled. Contrast MRI of the dominant hand and X-rays of the hands and feet were performed at baseline and 1 year later. MR images were evaluated using RA MRI scoring, and X-raywere assessed by the modified total Sharp score. Erosion progression was defined as changes in RA MRI scoring erosion or modified total Sharp score erosion of >0.5. Erosion repair was defined as erosion score changes of less than -0.5. Plasma levels of 10 cytokines were measured by electrochemiluminescence assay. Results. Progression of bone erosion and repair were observed more frequently in MRI than in X-rays (erosion, 52% vs 26%, P < 0.001; repair, 26% vs 15%, P = 0.003, respectively). Baseline IL-6 levels and seropositivity were independent relevant factors for MRI erosion progression, with IL-6 having stronger effect than seropositivity. A receiver operating characteristic curve identified the baseline IL-6 level of 7.6 pg/ml for predicting erosion progression during 1 year, with an area under the curve of 0.82; higher IL-6 levels resulted in more erosion progression. Baseline low IL-6 was also an independent predictor for MRI erosion repair. Conclusion. In newly diagnosed, untreated RA patients, baseline plasma IL-6 levels are responsible for 1-year MRI bone erosion progression and repair.

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Prognostic value of combined CT angiography and myocardial perfusion imaging versus invasive coronary angiography and nuclear stress perfusion imaging in the prediction of major adverse cardiovascular events: The CORE320 multicenter study

Chen M.Y., Rochitte C.E., Arbab-Zadeh A., Dewey M., George R.T., Miller J.M., Niinuma H., Yoshioka K., Kitagawa K., Sakuma H., Laham R., Vavere A.L., Cerci R.J., Mehra V.C., Nomura C., Kofoed K.F., Jinzaki M., Kuribayashi S., Scholte A.J., Laule M., Tan S.Y., Hoe J., Paul N., Rybicki F.J., Brinker J.A., Arai A.E., Matheson M.B., Cox C., Clouse M.E., Di Carli M.F., Lima J.A.C.

Radiology （Radiology） 284 （ 1 ） 55 - 65 2017年07月

研究論文（学術雑誌）, 共著, ISSN 00338419

Purpose: To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial perfusion imaging. Materials and Methods: This study was approved by all institutional review boards, and written informed consent was obtained. Between November 2009 and July 2011, 381 participants clinically referred for ICA and aged 45-85 years were enrolled in the Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) prospective multicenter diagnostic study. All images were analyzed in blinded independent core laboratories, and a panel of physicians adjudicated all adverse events. MACE was defined as revascularization (>30 days after index ICA), myocardial infarction, or cardiac death; hospitalization for chest pain or congestive heart failure; or arrhythmia. Late MACE was defined similarly, except for patients who underwent revascularization within the first 182 days after ICA, who were excluded. Comparisons of 2-year survival (time to MACE) used standard Kaplan-Meier curves and restricted mean survival times bootstrapped with 2000 replicates. Results: An MACE (49 revascularizations, five myocardial infarctions, one cardiac death, nine hospitalizations for chest pain or congestive heart failure, and one arrhythmia) occurred in 51 of 379 patients (13.5%). The 2-year MACE-free rates for combined CT angiography and CT perfusion findings were 94% negative for coronary artery disease (CAD) versus 82% positive for CAD and were similar to combined ICA and single photon emission CT findings (93% negative for CAD vs 77% positive for CAD, P < .001 for both). Event-free rates for CT angiography and CT perfusion versus ICA and single photon emission CT for either positive or negative results were not significantly different for MACE or late MACE (P > .05 for all). The area under the receiver operating characteristic curve (AUC) for combined CT angiography and CT perfusion (AUC = 68; 95% confidence interval [CI]: 62, 75) was similar (P = .36) to that for combined ICA and single photon emission CT (AUC = 71; 95% CI: 65, 79) in the identification of MACE at 2-year follow-up. Conclusion: Combined CT angiography and CT perfusion enables similar prediction of 2-year MACE, late MACE, and event-free survival similar to that enabled by ICA and single photon emission CT.

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Difference in the craniocaudal gradient of the maximum pixel value change rate between chronic obstructive pulmonary disease patients and normal subjects using sub-mGy dynamic chest radiography with a flat panel detector system

陣崎雅弘

European Journal of Radiology （European Journal of Radiology） 92 37 - 44 2017年07月

研究論文（学術雑誌）, 共著, ISSN 0720048X

Objectives To compare the craniocaudal gradients of the maximum pixel value change rate (MPCR) during tidal breathing between chronic obstructive pulmonary disease (COPD) patients and normal subjects using dynamic chest radiography. Materials and methods This prospective study was approved by the institutional review board and all participants provided written informed consent. Forty-three COPD patients (mean age, 71.6 ± 8.7 years) and 47 normal subjects (non-smoker healthy volunteers) (mean age, 54.8 ± 9.8 years) underwent sequential chest radiographs during tidal breathing in a standing position using dynamic chest radiography with a flat panel detector system. We evaluated the craniocaudal gradient of MPCR. The results were analyzed using an unpaired t-test and the Tukey–Kramer method. Results The craniocaudal gradients of MPCR in COPD patients were significantly lower than those in normal subjects (right inspiratory phase, 75.5 ± 48.1 vs. 108.9 ± 42.0 s−1 cm−1, P < 0.001; right expiratory phase, 66.4 ± 40.6 vs. 89.8 ± 31.6 s−1 cm−1, P = 0.003; left inspiratory phase, 75.5 ± 48.2 vs. 108.2 ± 47.2 s−1 cm−1, P = 0.002; left expiratory phase, 60.9 ± 38.2 vs. 84.3 ± 29.5 s−1 cm−1, P = 0.002). No significant differences in height, weight, or BMI were observed between COPD and normal groups. In the sub-analysis, the gradients in severe COPD patients (global initiative for chronic obstructive lung disease [GOLD] 3 or 4, n = 26) were significantly lower than those in mild COPD patients (GOLD 1 or 2, n = 17) for both right and left inspiratory/expiratory phases (all P ≤ 0.005). Conclusions A decrease of the craniocaudal gradient of MPCR was observed in COPD patients. The craniocaudal gradient was lower in severe COPD patients than in mild COPD patients.

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FDG-PET/CTにて原発巣の指摘が困難であった転移性卵巣癌の一例

岩渕雄, 中原理紀, 片桐真理, 伊藤一成, 松坂陽至, 緒方雄史, 陣崎雅弘

臨床核医学（放射線診療研究会） 50 （ 4 ） 50 - 52 2017年07月

ISSN 0912-5817

症例は40歳代女性で、10年前、左卵巣癌ステージIa(粘液性腺癌G1)に対し左付属器切除術が行われた。下腹部痛で受診し、卵巣腫大を指摘され、産婦人科へ紹介受診となった。経腟超音波で内部に嚢胞成分を伴う卵巣充実性腫瘍を認め、術前に精査のため造影FDG-PET/CTを施行した。右卵巣に16cm大の嚢胞成分を伴う腫瘤を認め、SUVmax:3.15とFDG軽度集積亢進を認めた。卵巣原発もしくは転移性卵巣癌のも考えられたが、PETのMIP像で積極的に原発巣を疑うような明瞭なFDG異常蓄積は指摘できなかった。しかし、造影CTでは胃のび漫性壁肥厚を認め、腹腔動脈近傍から左胃動脈周囲に不整な軟部影形成を認めた。転移性卵巣癌の可能性が考えられ、MRIを施行したところ、骨盤内に嚢胞成分を有し、T2強調像で全体に高信号を呈する腫瘍性病変を認めた。脂肪抑制造影T1強調像では腫瘍内部に緩徐な造影効果を認めた。症状、画像から卵巣茎捻転とそれに伴う卵巣広範性浮腫が疑われ、緊急で腹式単純子宮全摘+右付属器切除術を施行した。部分的な腺管形成傾向も認め、多臓器からの腺癌の転移と診断した。上部消化管内視鏡検査で胃に潰瘍性病変や粘膜上皮の肥厚が確認され、生検で粘液を含む印環細胞癌およびそれに伴う転移性卵巣癌(Krukenberg腫瘍)と診断し、化学療法のため消化器内科に転科となった。

Three-dimensional measurement of the human cadaver foot bone kinematics under axial loading condition using biplane X-ray fluoroscopy

Ito K., Hosoda K., Shimizu M., Ikemoto S., Nagura T., Seki H., Kitashiro M., Jinzaki M., Imanishi N., Aiso S., Ogihara N.

Footwear Science （Footwear Science） 9 S148 - S150 2017年06月

ISSN 19424280

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Low-signal Intensity Rims along the Cerebral Cortex and U-fibers on Susceptibility-weighted Imaging in Progressive Multifocal Leukoencephalopathy.

陣崎雅弘

Magnetic Resonance in Medicine （Wiley） Epub ahead of print 2017年06月

研究論文（学術雑誌）, 共著

産婦人科におけるリスクマネジメント妊娠中のX線照射

鈴木達也, 奥田茂男, 杉澤浩一, 陣崎雅弘

産婦人科の実際（金原出版） 66 （ 6 ） 753 - 757 2017年06月

ISSN 0558-4728

Quantitative Analysis of Iodine Image of Dual-energy Computed Tomography at Rest: Comparison With 99mTc-Tetrofosmin Stress-rest Single-photon Emission Computed Tomography Myocardial Perfusion Imaging as the Reference Standard

陣崎雅弘

Journal of Thoracic Imaging （Journal of Thoracic Imaging） Epub ahead of print （ 2 ） 97 - 104 2017年06月

研究論文（学術雑誌）, ISSN 08835993

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. Purpose: Dual-energy computed tomography (DECT) can be used for visual determination of iodine distribution in the myocardium (iodine image); however, the accuracy and reproducibility of the process remains debatable. Because of the low contrast-to-noise ratio of CT, we hypothesized that quantitative measurement may be more accurate for detecting myocardial ischemia. In this study, we evaluated our quantitative method by comparing it with visual analysis using 99mTc-tetrofosmin (TF) stress-rest single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) as the reference standard. Materials and Methods: Forty-three patients who had a significant stenosis on cardiac rest DECT and had received 99mTc-TF stress-rest SPECT MPI within 1 month were retrospectively analyzed. The regions of interest were set on iodine images in accordance with the American Heart Association (AHA) 17-segment model (a total of 731 segments). The regions of interest values were divided by the amount of iodine (mg) per unit weight (kg) and defined as perfusion value (perfusion value analysis). All segments were also visually analyzed and receiver operating characteristic curve analysis performed to identify the superior analysis. Results: The receiver operating characteristic curve analysis showed that perfusion value analysis is significantly superior to visual analysis [the area under the curve: 0.921 (95% confidence interval, 0.860-0.981) versus 0.685 (95% confidence interval, 0.580-0.791), respectively, P<0.05], with 93.8% sensitivity, 99.1% specificity, 98.9% accuracy, 83.3% positive predictive value, and 99.7% negative predictive value (P<0.01). Conclusions: Quantitative analysis of the iodine image of rest DECT, called perfusion value analysis, is more accurate than visual analysis when compared with 99mTc-TF SPECT MPI as the reference standard.

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Can Angiomyolipomas be classified fully into three types?

陣崎雅弘

European Journal of Radiology （Elsevier） Epub ahead of print 2017年05月

研究論文（学術雑誌）

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Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement

Tetsuro Shimura, Masanori Yamamoto, Seiji Kano, Ai Kagase, Atsuko Kodama, Yutaka Koyama, Etsuo Tsuchikane, Takahiko Suzuki, Toshiaki Otsuka, Shun Kohsaka, Norio Tada, Futoshi Yamanaka, Toru Naganuma, Motoharu Araki, Shinichi Shirai, Yusuke Watanabe, Kentaro Hayashida, Fumiaki Yashima, Taku Inohara, Yuki Kakefuda, Takahide Arai, Ryo Yanagisawa, Makoto Tanaka, Takashi Kawakami, Yuichiro Maekawa, Kohno Takashi, Akihiro Yoshitake, Yasunori Iida, Masataka Yamazaki, Hideyuki Shimizu, Yoshitake Yamada, Masahiro Jinzaki, Hikaru Tsuruta, Yuji Itabashi, Mitsushige Murata, Michiyuki Kawakami, Shogo Fukui, Motoaki Sano, Keiichi Fukuda, Soh Hosoba, Hirotomo Sato, Tomohiko Teramoto, Masashi Kimura, Mitsuru Sago, Tatsuya Tsunaki, Shoko Watarai, Masanao Tsuzuki, Keisuke Irokawa, Kazuki Shimizu, Toshihiro Kobayashi, Yasuhide Okawa, Masaki Miyasaka, Yusuke Enta, Koki Shishido, Tomoki Ochiai, Tsuyoshi Yamabe, Kenichiro Noguchi, Shigeru Saito, Hiroyoshi Kawamoto, Hirokazu Onishi, Hiroto Yabushita, Satoru Mitomo, Sunao Nakamura, Masahiro Yamawaki, Yui Akatsu, Yosuke Honda, Takuro Takama, Akihito Isotani, Masaomi Hayashi, Norihiko Kamioka, Mizuki Miura, Takashi Morinaga, Tomohiro Kawaguchi, Mariko Yano, Michiya Hanyu, Yoshio Arai, Hideki Tsubota, Masafumi Kudo, Yuki Kuroda, Akihisa Kataoka, Hitofumi Hioki, Yugo Nara, Hideyuki Kawashima, Fukuko Nagura, Makoto Nakashima, Kazuya Sasaki, Junichi Nishikawa, Tomoki Shimokawa, Tadanori Harada, Ken Kozuma

Circulation （Ovid Technologies (Wolters Kluwer Health)） 135 （ 21 ） 2013 - 2024 2017年05月

ISSN 0009-7322

<jats:sec>
<jats:title>Background:</jats:title>
<jats:p>The semiquantitative Clinical Frailty Scale (CFS) is a simple tool to assess patients’ frailty and has been shown to correlate with mortality in elderly patients even when evaluated by nongeriatricians. The aim of the current study was to determine the prognostic value of CFS in patients who underwent transcatheter aortic valve replacement.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods:</jats:title>
<jats:p>We utilized the OCEAN (Optimized Catheter Valvular Intervention) Japanese multicenter registry to review data of 1215 patients who underwent transcatheter aortic valve replacement. Patients were categorized into 5 groups based on the CFS stages: CFS 1-3, CFS 4, CFS 5, CFS 6, and CFS ≥7. We subsequently evaluated the relationship between CFS grading and other indicators of frailty, including body mass index, serum albumin, gait speed, and mean hand grip. We also assessed differences in baseline characteristics, procedural outcomes, and early and midterm mortality among the 5 groups.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results:</jats:title>
<jats:p>
Patient distribution into the 5 CFS groups was as follows: 38.0% (CFS 1-3), 32.9% (CFS4), 15.1% (CFS 5), 10.0% (CFS 6), and 4.0% (CFS ≥7). The CFS grade showed significant correlation with body mass index (Spearman’s ρ=−0.077,
<jats:italic>P</jats:italic>
=0.007), albumin (ρ=−0.22,
<jats:italic>P</jats:italic>
<0.001), gait speed (ρ=−0.28,
<jats:italic>P</jats:italic>
<0.001), and grip strength (ρ=−0.26,
<jats:italic>P</jats:italic>
<0.001). Cumulative 1-year mortality increased with increasing CFS stage (7.2%, 8.6%. 15.7%, 16.9%, 44.1%,
<jats:italic>P</jats:italic>
<0.001). In a Cox regression multivariate analysis, the CFS (per 1 category increase) was an independent predictive factor of increased late cumulative mortality risk (hazard ratio, 1.28; 95% confidence interval, 1.10–1.49;
<jats:italic>P</jats:italic>
<0.001).
</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions:</jats:title>
<jats:p>In addition to reflecting the degree of frailty, the CFS was a useful marker for predicting late mortality in an elderly transcatheter aortic valve replacement cohort.</jats:p>
</jats:sec>

3D SPECT/CT fusion using image data projection of bone SPECT onto 3D volume-rendered CT images: feasibility and clinical impact in the diagnosis of bone metastasis

陣崎雅弘

Annals of Nuclear Medicine （Annals of Nuclear Medicine） 31 （ 4 ） 304 - 314 2017年05月

研究論文（学術雑誌）, 共著, ISSN 09147187

Purpose: We developed a method of image data projection of bone SPECT into 3D volume-rendered CT images for 3D SPECT/CT fusion. The aims of our study were to evaluate its feasibility and clinical usefulness. Methods: Whole-body bone scintigraphy (WB) and SPECT/CT scans were performed in 318 cancer patients using a dedicated SPECT/CT systems. Volume data of bone SPECT and CT were fused to obtain 2D SPECT/CT images. To generate our 3D SPECT/CT images, colored voxel data of bone SPECT were projected onto the corresponding location of the volume-rendered CT data after a semi-automatic bone extraction. Then, the resultant 3D images were blended with conventional volume-rendered CT images, allowing to grasp the three-dimensional relationship between bone metabolism and anatomy. WB and SPECT (WB + SPECT), 2D SPECT/CT fusion, and 3D SPECT/CT fusion were evaluated by two independent reviewers in the diagnosis of bone metastasis. The inter-observer variability and diagnostic accuracy in these three image sets were investigated using a four-point diagnostic scale. Results: Increased bone metabolism was found in 744 metastatic sites and 1002 benign changes. On a per-lesion basis, inter-observer agreements in the diagnosis of bone metastasis were 0.72 for WB + SPECT, 0.90 for 2D SPECT/CT, and 0.89 for 3D SPECT/CT. Receiver operating characteristic analyses for the diagnostic accuracy of bone metastasis showed that WB + SPECT, 2D SPECT/CT, and 3D SPECT/CT had an area under the curve of 0.800, 0.983, and 0.983 for reader 1, 0.865, 0.992, and 0.993 for reader 2, respectively (WB + SPECT vs. 2D or 3D SPECT/CT, p < 0.001; 2D vs. 3D SPECT/CT, n.s.). The durations of interpretation of WB + SPECT, 2D SPECT/CT, and 3D SPECT/CT images were 241 ± 75, 225 ± 73, and 182 ± 71 s for reader 1 and 207 ± 72, 190 ± 73, and 179 ± 73 s for reader 2, respectively. As a result, it took shorter time to read 3D SPECT/CT images than 2D SPECT/CT (p < 0.0001) or WB + SPECT images (p < 0.0001). Conclusions: 3D SPECT/CT fusion offers comparable diagnostic accuracy to 2D SPECT/CT fusion. The visual effect of 3D SPECT/CT fusion facilitates reduction of reading time compared to 2D SPECT/CT fusion.

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Spontaneous Regression of Possible Transcatheter Aortic Valve Thrombosis Without Additional Anticoagulant: Two-Year Follow-Up

Yanagisawa R., Hayashida K., Jinzaki M., Fukuda K.

Journal of Invasive Cardiology （Journal of Invasive Cardiology） 29 （ 5 ） E64 2017年05月

研究論文（学術雑誌）, 共著, ISSN 10423931

An 84-year-old man with symptomatic severe aortic stenosis received transcatheter aortic valve implantation (TAVI). Dual-antiplatelet therapy was continued for 6 months post TAVI, and aspirin alone was used thereafter. Four-dimensional multidetector computed tomography revealed a new hypoattenuated leaflet thickening (HALT) with reduced leaflet motion at 1 year, considered to indicate leaflet thrombosis. At the 2-year follow-up, leaflet mobility had improved, with spontaneous regression of HALT. This is the first report of confirmed spontaneous regression of possible transcatheter heart valve thrombosis and recovery of leaflet mobility without the need for additional anticoagulant.

Impact of cavity and infiltration on pulmonary function and health-related quality of life in pulmonary Mycobacterium avium complex disease: A 3-dimensional computed tomographic analysis

Asakura T., Yamada Y., Namkoong H., Suzuki S., Niijima Y., Kamata H., Funatsu Y., Yagi K., Okamori S., Sugiura H., Ishii M., Jinzaki M., Betsuyaku T., Hasegawa N.

Respiratory Medicine （Respiratory Medicine） 126 9 - 16 2017年05月

研究論文（学術雑誌）, 共著, ISSN 09546111

Background and objectives Pulmonary Mycobacterium avium complex (pMAC) disease manifests as various types of lesions, such as infiltrates, nodules, cavities, and bronchiectasis. However, the important determinants for clinical parameters in lung involvement are poorly understood. The objective of this study was to obtain quantitative parameters by 3-dimensional CT, and investigate the relationship between these parameters and the pulmonary function tests (PFTs) and health-related quality of life. Material and methods Quantitative analysis using CT was performed in 67 pMAC patients. The relationship between new quantitative parameters for evaluating lung involvement using 3-dimensional CT and PFTs or St George's Respiratory Questionnaire (SGRQ) was evaluated. Results The ratio of infiltration to total lung volume showed significant correlation with the PFT results, especially the percent-predicted forced vital capacity (%FVC; ρ = −0.52), residual volume (ρ = −0.51), and total lung capacity (ρ = −0.59). The cavity volume was strongly correlated with the %FVC (ρ = −0.78) in the cavity group, while the ratio of infiltration to total lung volume was strongly correlated with the %FVC (ρ = −0.53) in the non-cavity group. The ratio of infiltration to total lung volume was significantly correlated with all SGRQ parameters (ρ = 0.41–0.52) in the non-cavity group. Conclusions Infiltration was an important parameter for the PFTs and SGRQ in pMAC patients according to the 3-dimensional CT analysis. Moreover, cavity volume was an important parameter of the PFTs in the cavity group. Therefore, infiltration and cavity volume are key features for the management of pMAC disease.

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Impact of Subclinical Vascular Complications Detected by Systematic Postprocedural Multidetector Computed Tomography After Transcatheter Aortic Valve Implantation Using Balloon-Expandable Edwards SAPIEN XT Heart Valve

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

American Journal of Cardiology （American Journal of Cardiology） 119 （ 7 ） 1100 - 1105 2017年04月

研究論文（学術雑誌）, 共著, ISSN 00029149

Complications after transcatheter aortic valve implantation (TAVI) remain an important issue. This study aimed to evaluate the impact of systematic postprocedural multidetector computed tomography (MDCT) to detect subclinical complications after TAVI. From October 2013 to August 2015, a total of 135 patients who underwent transfemoral TAVI (n = 116) or transapical TAVI (n = 19) with Sapien XT and MDCT preprocedure and postprocedure were enrolled. Postprocedural MDCT findings were compared with the preprocedural MDCT findings. Cardiovascular complications were observed in 25.9% of patients, including 6 cases (4.5%) with major complications. Of those, clinically apparent major complications were reported in 2 cases including rupture of the sinus of Valsalva and iliac rupture. The complications in the remaining 4 cases (3.0%) included aortic dissection, aortic intramural hematoma, and left ventricular apical pseudoaneurysm, which were totally asymptomatic and only detected by MDCT. The apical pseudoaneurysm required surgical repair. Minor complications were observed in 21.5% of patients, 50% of which were subclinical. Only 1 case with femoral pseudoaneurysm required an additional procedure. Noncardiovascular findings were detected in 27.4% of patients; the most frequent were pleural effusions and atelectasis, which were predominantly observed in those treated through a transapical approach. Contrast-induced acute kidney injury after postprocedural MDCT was reported in 1 patient whose clinical course was complicated by sepsis. In conclusion, postprocedural MDCT was useful in detecting important subclinical complications that may affect the clinical course without deterioration of renal function.

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Impact of baseline visceral fat accumulation on prognosis in patients with metastatic renal cell carcinoma treated with systemic therapy

Mizuno R., Miyajima A., Hibi T., Masuda A., Shinojima T., Kikuchi E., Jinzaki M., Oya M.

Medical Oncology （Medical Oncology） 34 （ 4 ） 47 2017年04月

研究論文（学術雑誌）, 共著, ISSN 13570560

The aim of this study was to evaluate the clinical significance of visceral fat accumulation as a prognostic factor in patients with metastatic renal cell carcinoma (mRCC) treated with systemic therapies. A total of 114 patients were retrospectively reviewed. All patients received systemic therapy for mRCC at Keio University hospital in Japan. The intra-abdominal visceral fat area was determined by computed tomography at the umbilical level. The visceral fat accumulation was defined as ≥100 cm2. The mean visceral fat area was 107.4 ± 62.8 cm2. In the whole cohort, the median follow-up was 29 months. According to the Memorial Sloan Kettering Cancer Center (MSKCC) classification, 27.2% patients were favorable risk, 53.5% were intermediate risk, and 19.3% were poor risk. Visceral fat accumulation correlated with improved progression-free (P = 0.0070) and overall survival (P = 0.0001). On multivariate analysis, visceral fat accumulation (P = 0.0290) and MSKCC classification (P = 0.0085) were independent indices to predict progression-free survival in first-line treatment. In addition, visceral fat accumulation (P = 0.0007) and MSKCC classification (P = 0.0005) independently predicted overall survival. Prognostic grouping using visceral fat accumulation was identified as an independent prognostic marker in patients with mRCC. The addition of visceral fat accumulation improved the prognostic value of MSKCC classification alone in predicting overall survival in patients treated with systemic therapy for mRCC.

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Time-Resolved Quantitative Analysis of the Diaphragms During Tidal Breathing in a Standing Position Using Dynamic Chest Radiography with a Flat Panel Detector System (“Dynamic X-Ray Phrenicography”): Initial Experience in 172 Volunteers

Yamada Y., Ueyama M., Abe T., Araki T., Abe T., Nishino M., Jinzaki M., Hatabu H., Kudoh S.

Academic Radiology （Academic Radiology） 4 （ 4 ） 393 - 400 2017年04月

研究論文（学術雑誌）, 共著, ISSN 10766332

Rationale and Objectives Diaphragmatic motion in a standing position during tidal breathing remains unclear. The purpose of this observational study was to evaluate diaphragmatic motion during tidal breathing in a standing position in a health screening center cohort using dynamic chest radiography in association with participants’ demographic characteristics. Materials and Methods One hundred seventy-two subjects (103 men; aged 56.3 ± 9.8 years) underwent sequential chest radiographs during tidal breathing using dynamic chest radiography with a flat panel detector system. We evaluated the excursions of and peak motion speeds of the diaphragms. Associations between the excursions and participants’ demographics (gender, height, weight, body mass index [BMI], smoking history, tidal volume, vital capacity, and forced expiratory volume) were investigated. Results The average excursion of the left diaphragm (14.9 ± 4.6 mm, 95% CI 14.2–15.5 mm) was significantly larger than that of the right (11.0 ± 4.0 mm, 95% CI 10.4–11.6 mm) (P < 0.001). The peak motion speed of the left diaphragm (inspiratory, 16.6 ± 4.2 mm/s; expiratory, 13.7 ± 4.2 mm/s) was significantly faster than that of the right (inspiratory, 12.4 ± 4.4 mm/s; expiratory, 9.4 ± 3.8 mm/s) (both P < 0.001). Both simple and multiple regression models demonstrated that higher BMI and higher tidal volume were associated with increased excursions of the bilateral diaphragm (all P < 0.05). Conclusions The average excursions of the diaphragms are 11.0 mm (right) and 14.9 mm (left) during tidal breathing in a standing position. The diaphragmatic motion of the left is significantly larger and faster than that of the right. Higher BMI and tidal volume are associated with increased excursions of the bilateral diaphragm.

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特集 Q & Aでおさえるvascular imaging最重要ポイント大動脈　炎症性動脈瘤と感染性動脈瘤の違いを教えてください

奥田茂男, 田村全, 中塚誠之, 陣崎雅弘

臨床画像（(株)メジカルビュー社） 33 （ 3 ） 286 - 288 2017年03月

ISSN 0911-1069

Extremely low prevalence of amyloid positron emission tomography positivity in Parkinson's disease without dementia

陣崎雅弘

European Neurology （European Neurology） 77 （ (5-6) ） 231 - 237 2017年03月

研究論文（学術雑誌）, 共著, ISSN 00143022

Background: Most cases of dementia with Lewy bodies (DLB) show Alzheimer's disease pathology-like senile plaques and neurofibrillary tangles. Several studies have also revealed a high prevalence of positive amyloid imaging with positron emission tomography (PET) in DLB and moderate prevalence in Parkinson's disease (PD) with dementia. However, it remains unclear in PD without dementia as to when the brain β amyloid (Aβ) burden begins and progresses. Our study aimed to determine the prevalence of Aβ deposition in PD without dementia using amyloid PET. Methods: This was a cross-sectional study on 33 patients with PD without dementia, of whom 21 had normal cognition and 12 met the criteria for PD-mild cognitive impairment. All subjects underwent neuropsychological assessment and [18F] florbetaben (FBB) PET. Results: All subjects had Lewy body-related disorders, displaying a significantly reduced myocardial [123I] metaiodobenzylguanidine uptake. The cortical FBB-binding pattern in all subjects, including APOE e4 carriers, suggested negative Aβ deposition. Conclusion: Patients with PD without dementia exhibit an extremely low prevalence of Aβ positivity compared with those reported in cognitively normal elderly controls. Further longitudinal imaging studies and long-term follow-up are needed; however, our findings provide novel insights for understanding Aβ metabolism in PD.

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画像による病変の由来部位の診断第4章胸部　2. 肺・胸壁

杉浦弘明, 陣崎雅弘

画像診断（学研メディカル秀潤社） 37 （ 4 ） s118 - s131 2017年03月

ISSN 0285-0524

Analysis of the venous channel within the clivus using multidetector computed tomography digital subtraction venography

陣崎雅弘

Neuroradiology （Neuroradiology） 59 （ 3 ） 213 - 219 2017年03月

研究論文（学術雑誌）, 共著, ISSN 00283940

Purpose: Although neuroradiologists and skull base neurosurgeons are aware of the existence of veins within the clivus, such vessels have seldom been described in the literature. The aim of the present study is to elucidate the detailed venous structure of the clivus. Methods: Computed tomography digital subtraction venography (CT-DSV) images of 50 unruptured aneurysm cases were examined retrospectively. Results: Eighteen emissary veins were identified in 14 (28.0%) cases. A half of the emissary veins connected the inferior petrosal sinus with the inferior petro-occipital vein (IPOV) in the middle clivus. The clival diploic vein (CDV) was identified in 14.0% of cases, 42.9% of which had the clivus of the presellar type. The CDV was connected to the posterior intercavernous sinus or the rostral end of the basilar plexus superiorly, and was connected to the IPOV, anterior condylar vein, marginal sinus, or the anterior condylar confluence. Conclusion: The CDV provides collateral channels between the cavernous sinus and the internal jugular vein and the inferior petrosal sinus and the IPOV. Understanding of the emissary veins in the clivus and the CDV is valuable for skull base surgery, especially for endonasal endoscopic skull base procedures.

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特集次の25年の放射線治療の進歩を見据えて X線、超音波、CT、MRI

陣崎雅弘

臨床放射線（金原出版） 62 （ 2 ） 233 - 236 2017年02月

ISSN 0009-9252

Diagnosis of Renal Angiomyolipomas: Classic, Fat-Poor, and Epithelioid Types

陣崎雅弘

Seminars in Ultrasound, CT and MRI （Seminars in Ultrasound, CT and MRI） 38 （ 1 ） 37 - 46 2017年02月

研究論文（学術雑誌）, 共著, ISSN 08872171

With the increasing discovery of small renal masses with cross-sectional imaging, there has been the concomitant rise in their treatment. With the intent of early curative surgery for a presumed renal cell carcinoma, many renal masses are being resected at surgery without a confirmed diagnosis. Many of them are benign, and some are angiomyolipomas. The diagnosis of renal angiomyolipoma using imaging is, therefore, is as important as ever. Although most, if not all angiomyolipomas with abundant fat are diagnosed readily, some have too little fat to be detected with imaging. This article reviews the current classification, imaging pitfalls, and diagnosis of angiomyolipoma with an emphasis on the fat-poor types. Proper imaging technique, a thorough search for fat, and the appropriate use of percutanoeus biopsy are all needed to eliminate the unnecessary treatment of these benign neoplasms.

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Difference in diaphragmatic motion during tidal breathing in a standing position between COPD patients and normal subjects: Time-resolved quantitative evaluation using dynamic chest radiography with flat panel detector system (“dynamic X-ray phrenicography”)

Yamada Y., Ueyama M., Abe T., Araki T., Abe T., Nishino M., Jinzaki M., Hatabu H., Kudoh S.

European Journal of Radiology （European Journal of Radiology） 87 76 - 82 2017年02月

研究論文（学術雑誌）, 共著, ISSN 0720048X

Objectives To quantitatively compare diaphragmatic motion during tidal breathing in a standing position between chronic obstructive pulmonary disease (COPD) patients and normal subjects using dynamic chest radiography. Materials and methods Thirty-nine COPD patients (35 males; age, 71.3 ± 8.4 years) and 47 normal subjects (non-smoker healthy volunteers) (20 males; age, 54.8 ± 9.8 years) underwent sequential chest radiographs during tidal breathing using dynamic chest radiography with a flat panel detector system. We evaluated the excursions and peak motion speeds of the diaphragms. The results were analyzed using an unpaired t-test and a multiple linear regression model. Results The excursions of the diaphragms in COPD patients were significantly larger than those in normal subjects (right, 14.7 ± 5.5 mm vs. 10.2 ± 3.7 mm, respectively, P < 0.001; left, 17.2 ± 4.9 mm vs. 14.9 ± 4.2 mm, respectively, P = 0.022). Peak motion speeds in inspiratory phase were significantly faster in COPD patients compared to normal subjects (right, 16.3 ± 5.0 mm/s vs. 11.8 ± 4.2 mm/s, respectively, P < 0.001; left, 18.9 ± 4.9 mm/s vs. 16.7 ± 4.0 mm/s, respectively, P = 0.022). The multivariate analysis demonstrated that having COPD and higher body mass index were independently associated with increased excursions of the bilateral diaphragm (all P < 0.05), after adjusting for other clinical variables. Conclusions Time-resolved quantitative evaluation of the diaphragm using dynamic chest radiography demonstrated that the diaphragmatic motion during tidal breathing in a standing position is larger and faster in COPD patients than in normal subjects.

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q-Space Myelin Map imaging for longitudinal analysis of demyelination and remyelination in multiple sclerosis patients treated with fingolimod: A preliminary study

Tanikawa M., Nakahara J., Hata J., Suzuki S., Fujiyoshi K., Fujiwara H., Momoshima S., Jinzaki M., Nakamura M., Okano H., Takahashi S., Suzuki N.

Journal of the Neurological Sciences （Journal of the Neurological Sciences） 15 （ 373 ） 352 - 357 2017年02月

研究論文（学術雑誌）, 共著, ISSN 0022510X

Background Fingolimod (FTY) is an oral sphingosine-1-phosphate receptor modulator that reduces relapse and slows brain atrophy in multiple sclerosis (MS) patients. In addition, FTY has been shown to enhance remyelination in certain animal models. Objective To analyze feasibility of a novel q-space Myelin Map imaging to monitor demyelination and remyelination under FTY treatment in MS patients. Methods Treatment outcomes of 24 consecutive MS patients treated with FTY were analyzed. A longitudinal analysis of q-space Myelin Map imaging was performed in a subset of these patients. Results During the treatment course (average of 16.1 months), 10 patients (42%) exhibited improvement on the Expanded Disability Status Scale (EDSS) or maintained disability-free state (“optimal responders”). The average baseline age and EDSS score were significantly younger and milder in optimal responders compared to the rest of patients. A pilot longitudinal q-space Myelin Map study in 8 patients (including 4 optimal responders) showed that optimal responders tended to show signs of remyelination while exhibiting no newly evolved demyelinated lesions. Conclusion FTY may improve disability in younger patients with milder MS, and absence of demyelination activity and presence of remyelination activity may in part be associated with such improvement. q-Space Myelin Map imaging is a clinically feasible modality to monitor demyelination and remyelination in MS patients.

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Radiation exposure to operators performing pharmacologic stress testing in 99Mtc myocardial perfusion imaging: A prospective study

Nakahara T., Iwabuchi Y., Katagiri M., Matsusaka Y., Itoh K., Ogata Y., Jinzaki M.

Radiation Protection Dosimetry （Radiation Protection Dosimetry） 176 （ 3 ） 235 - 241 2017年01月

研究論文（学術雑誌）, 共著, ISSN 01448420

This prospective study investigated radiation exposure dose (RED) to main operator (MO) and supervisory operator (SO) performing dypiridamole stress testing in a 1-d rest/stress 99mTc tetrofosmin single-photon emission computed tomography (SPECT) of consecutive 42 patients. MO was instructed to be close to the patients during the entire procedures including the vasodilator and radiotracer injection. SO mainly recorded the data on the procedures apart from the patients. RED, procedure time (PT) and internal radioactivity (IR) of patients were measured before and after a secondary tracer injection for stress SPECT, respectively. RED was significantly greater to MO than to SO (6.2 ± 2.7 vs 2.5 ± 2.1 μSV per stress procedure, p < 0.0001). Multivariate analyses revealed that IR and PT were significantly independent factors to predict RED to both operators. Operators performing pharmacologic stress procedure should be aware that IR and PT are independent factors for RED in 99mTc myocardial perfusion imaging.

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Natural course of asymptomatic abnormal prostate findings incidentally detected by CT after intravesical BCG therapy

Matsushima M., Kikuchi E., Akita H., Miyajima A., Oya M., Jinzaki M.

International Journal of Clinical Oncology （International Journal of Clinical Oncology） 22 （ 3 ） 554 - 562 2017年01月

研究論文（学術雑誌）, 共著, ISSN 13419625

Background: Detailed information is not currently available on the incidence, natural course, and management of asymptomatic abnormal prostate findings incidentally detected by radiologic evaluations after BCG therapy for non-muscle-invasive bladder cancer patients. Methods: We identified 38 patients who were evaluated by contrast-enhanced CT scans before TUR-BT and after BCG therapy between 2006 and 2012. We evaluated the clinical courses of patients with abnormal radiologic findings of the prostate gland after BCG therapy. Results: Abnormal findings on CT scans were found in the prostate glands of 11 of the 38 patients examined (28.9%), none of whom exhibited any sign or symptom associated with prostatitis. Abnormal findings included a low attenuation area (n = 6, 15.8%), contrast enhancement (n = 3, 7.9%), and a low attenuation area and contrast enhancement in the prostate gland (n = 2, 5.3%). During the follow-up, abnormal prostate findings disappeared spontaneously in most cases without any anti-bacterial or anti-tuberculous drug treatments. No significant differences were observed in patient clinical backgrounds, with the exception of post-BCG prostate volumes, between patients with and without abnormal CT findings. Furthermore, no significant differences were noted in the incidence of the adverse effects of BCG therapy, tumor recurrence rates, or progression rates between patients with and without abnormal CT findings of the prostate gland after BCG therapy. Conclusions: Asymptomatic abnormal prostate findings incidentally detected by CT after BCG therapy are not rare, and these disappear over time during the follow-up period without any treatment.

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The learning curve of laparoendoscopic single-site adrenalectomy: an analysis of over 100 cases

Fukumoto K., Miyajima A., Hattori S., Matsumoto K., Abe T., Kurihara I., Jinzaki M., Kikuchi E., Oya M.

Surgical Endoscopy （Surgical Endoscopy） 31 （ 1 ） 170 - 177 2017年01月

研究論文（学術雑誌）, 共著, ISSN 09302794

Background: Recently, laparoendoscopic single-site adrenalectomy (LESS-A) has been developed as an alternative treatment for adrenal tumors. Although LESS-A is more technically complex than conventional laparoscopic adrenalectomy, its learning curve and the factors associated with poor surgical outcomes are poorly understood. We analyzed the learning curve of LESS-A and attempted to identify risk factors associated with worse surgical outcomes. Methods: We identified 103 patients who underwent LESS-A [performed by the same surgeon (A.M.)] from 2009 to 2015. The learning curve was analyzed using the moving average method (the 10-case moving average), and we assessed potential risk factors for a prolonged pneumoperitoneum time. Results: The learning curve stabilized at 30 cases. The cases were divided into two groups, the learning stage (LS) (cases 1–29) and master stage (MS) (cases 30–103) groups. The percentage of females and the frequency of previous abdominal surgery were higher in the LS group (p = 0.022 and 0.001, respectively). In the LS group, the mean pneumoperitoneum time was 92 ± 35 min, which was significantly longer than the equivalent value for the MS group (55 ± 18 min, p < 0.001). In the LS group, univariate analysis revealed that tumor size (≥50 mm) and the visceral fat area (VFA)/total fat area (TFA) ratio (≥0.49) were significantly associated with a prolonged pneumoperitoneum time (p = 0.046 and 0.046, respectively). In the multivariate analysis, tumor size and the VFA/TFA ratio were confirmed to be associated with a prolonged pneumoperitoneum time (p = 0.029 and 0.029, odds ratio 20.83 and 20.83, respectively). On the other hand, none of the examined factors were found to be associated with a prolonged pneumoperitoneum time in the MS group. Conclusions: LESS-A was performed safely in most cases. However, surgeons who are learning the LESS-A procedure need to pay attention to tumor size and visceral obesity.

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腎囊胞のCT 画像に生じるpseudoenhancement effect の抑制に関わる撮影条件の検討：連続X 線と仮想単色X 線，画像再構成法，およびビーム幅の違いにおけるファントム検証

杉澤浩一, 市川勝弘, 南島一也, 長谷川雅一, 山田祥岳, 陣崎雅弘

日本放射線技術学会雑誌（公益社団法人日本放射線技術学会） 73 （ 8 ） 636 - 645 2017年

研究論文（学術雑誌）, 共著, ISSN 0369-4305

PURPOSE:

The purpose of this study was to evaluate the effect of the virtual monochromatic spectral images (VMSI) and the model-based iterative reconstruction (MBIR) images, to evaluate the influence of the aperture size (40- and 20-mm beam) on renal pseudoenhancement (PE) compared with the filtered back projection (FBP) images.

METHODS:

The renal compartment-CT phantom was filled with iodinated contrast material diluted to the attenuation of 180 Hounsfield units (HU) at 120 kV. The water-filled spherical structures, which simulate cyst, were inserted into the renal compartment. Those diameters were 7, 15 and 25 mm. These were scanned by conventional mode (helical scan, 120 kV-FBP) and dual energy mode. 70 keV-VMSI were reconstructed from the dual energy mode, and MBIR images were reconstructed from conventional mode at 40- and 20-mm aperture. Additionally, the phantom was scanned using non-helical mode with 20-mm aperture, and FBP images were reconstructed. The CT value of the PE for cyst areas was measured for these images.

RESULTS:

The CT values of the cysts were 20.0-14.3 HU on the FBP images, 12.8-12.7 HU on the 70 keV-VMSI (PE-inhibition ratio was 36.0-11.2%) and 16.2-14.0 HU on the MBIR images (19.0-2.1%), respectively, at 40-mm aperture. The PE-inhibition ratio scanned by 20-mm aperture was improved by 28.0% with FBP, 32.8% with 70 keV-VMSI and 29.6% with MBIR compared with 40-mm aperture. One of the FBP images with non-helical mode was 11.6 HU.

CONCLUSIONS:

The best CT technique to minimize PE was the combination of 70 keV-VMSI and 20-mm aperture.

コイル塞栓後に，瘤のネック近傍の再増大を認めた腎動脈瘤の1例

井上政則, 中塚誠之, 陣崎雅弘

日本インターベンショナルラジオロジー学会雑誌（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） 32 （ 3 ） 192 - 196 2017年

ISSN 1340-4520

Recently, endovascular treatment of visceral aneurysm has become popular. In most cases, recurrence following sac packing of visceral aneurysm is attributed to coil compaction; however aneurysm regrowth has also been proposed as a potential mechanism. We report a rare case of aneurysm regrowth after sack packing of renal artery aneurysm. After embolization, regrowth of aneurysm adjacent to the neck of the aneurysm occurred. Additional embolization of the parent artery as well as sack packing was performed.

精巣腫瘍と紛らわしい超音波所見を呈した結核性肉芽腫性精巣上体精巣炎の1例

成田啓一, 金田智, 陣崎雅弘

超音波医学（公益社団法人日本超音波医学会） 44 （ 3 ） 289 - 293 2017年

ISSN 1346-1176

症例は72歳男性で，1ヵ月前より陰嚢の無痛性腫大を自覚した．陰嚢超音波検査で右精巣上体頭部が腫大し不均一な低エコーを呈していた．低エコー域は右精巣に連続しており，精巣上体との境界が不明瞭であった．また，陰嚢内には結節状の低エコー域を散見した．中等量の陰嚢水腫，軽度の白膜肥厚や陰嚢壁の浮腫を伴っていた．カラードプラ上は精巣上体の辺縁にのみ血流信号を認めた．右精巣腫瘍を疑って，右高位精巣摘除術を実施した．病理組織診断で，膿瘍を伴う肉芽腫形成や炎症細胞浸潤を認めた．中心壊死やラングハンス巨細胞も見られたため，Ziehl-Neelsen染色を実施したが抗酸菌は検出できなかった．結核の既往歴はなく，術後の喀痰・尿培養検査ともに結核菌は検出されなかったが，インターフェロンγ放出試験陽性や胸部CTで陳旧性結核性胸膜炎を示唆する所見があり，最終的に結核性肉芽腫性精巣上体精巣炎と診断した．肉芽腫性精巣上体精巣炎と精巣腫瘍の鑑別は困難とされているが，自験例のように精巣上体の腫大や精巣内部に複数の低エコー結節，血流信号が辺縁のみで内部では乏しいことが診断に有用と考えられた．腫瘍よりも炎症性疾患を示唆する所見として，陰嚢壁肥厚，白膜肥厚，陰嚢水腫も参考になる．

Pylorus-Preserving Surgery Based on the Sentinel Node Concept in Early Gastric Cancer

Shimada A., Takeuchi H., Ono T., Kamiya S., Fukuda K., Nakamura R., Takahashi T., Wada N., Kawakubo H., Saikawa Y., Omori T., Nakahara T., Jinzaki M., Murakami K., Kitagawa Y.

Annals of Surgical Oncology （Annals of Surgical Oncology） 23 （ 13 ） 4247 - 4252 2016年12月

研究論文（学術雑誌）, 共著, ISSN 10689265

Background: In patients with early stage gastric cancer in the middle third of the stomach, pylorus-preserving gastrectomy (PPG) can be an option as function-preserving surgery, although its oncologic safety is not definitively defined. This issues may be overcome using the sentinel node (SN) concept. The aim of this study was to investigate the effectiveness of the SN concept in early gastric cancer patients who are candidates for PPG. Methods: One hundred fifty-six patients with middle-third location of cT1N0 gastric cancer (single lesion, <4 cm) underwent distal gastrectomy with SN mapping. As a tracer, technetium-99 tin colloid solution and blue dye were endoscopically injected into the submucosal layer surrounding the primary tumor. Results: SN detection rate was 100 % (156 of 156), and the accuracy of the nodal evaluation of metastasis was 99 % (155 of 156). Suprapyloric lymph node (LN; LN No. 5) and infrapyloric LN (LN No. 6) were detected as SNs in 6 and 14 % of the patients, respectively. We also found two cases with metastasis to LN No. 5 or LN No. 6. Discussion: When performing PPG, the possibility of LN metastasis, especially to LN No. 5 and LN No. 6, cannot be underestimated. SN mapping can play an important role to predict the possibility of metastasis to LN No. 5 and LN No. 6.

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Impact of underfilling and overfilling in balloon-expandable transcatheter aortic valve implantation assessed by multidetector computed tomography: Insights from the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) registry

Yashima F., Yamamoto M., Watanabe Y., Takagi K., Yamada Y., Inohara T., Yanagisawa R., Tanaka M., Arai T., Shimizu H., Jinzaki M., Kozuma K., Fukuda K., Suzuki T., Hayashida K.

International Journal of Cardiology （International Journal of Cardiology） 222 738 - 744 2016年11月

研究論文（学術雑誌）, 共著, ISSN 01675273

Background Underfilling or overfilling of balloon-expandable transcatheter heart valves (THVs) during transcatheter aortic valve implantation (TAVI) is commonly used to improve conformity to small or calcified annuli in order to avoid serious complications. However, little is known about this technique. This study assessed the effects of underfilling and overfilling of THVs. Methods and results Data from 213 consecutive TAVI patients treated with balloon-expandable THVs in 4 Japanese centers between October 2013 and December 2014 were prospectively analyzed; 23-mm and 26-mm THVs were implanted in 96 cases (56 underfilling, 22 nominal filling, and 18 overfilling) and 38 cases (23 underfilling and 15 nominal filling), respectively. Pre/postprocedural multidetector computed tomography (MDCT) and echocardiographic data were compared. MDCT revealed that the minimum area of the underfilled 23-mm THVs was significantly decreased compared to that of nominal filled and overfilled THVs (308.3 SD 26.1 vs. 333.9 SD 14.7 vs. 347.8 SD 21.3 mm2, respectively, p < 0.0001); analogous results were demonstrated for underfilled 26-mm THVs compared to nominal filled THVs (386.2 SD 34.6 vs. 423.6 SD 17.3 mm2, respectively, p = 0.0004). The postprocedural transvalvular gradient of underfilled 23-mm THVs was significantly higher than that of nominal filled and overfilled THVs, while there were no differences for 26-mm THVs. Conclusions Underfilling or overfilling of THVs is safe and feasible, conforming to the original annulus and covering a continuous range of annular sizes with limited THV size options. However, care should be taken when underfilling 23-mm THVs due to the potential for increased transvalvular gradient.

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Lymphatic intervention for various types of lymphorrhea: Access and treatment

Inoue M., Nakatsuka S., Yashiro H., Tamura M., Suyama Y., Tsukada J., Ito N., Oguro S., Jinzaki M.

Radiographics （Radiographics） 36 （ 7 ） 2199 - 2211 2016年11月

研究論文（学術雑誌）, 共著, ISSN 02715333

Traumatic lymphorrhea is a rare but potentially life-threatening complication. Postoperative lymphorrhea is the leading cause of traumatic lymphorrhea and can arise anywhere within the lymphatic system. Leaks arising from the aortoiliac region to the thoracic duct (TD) and from hepatic lymphatics can be identified with intranodal lymphangiography and transhepatic lymphangiography, respectively. Therefore, an appropriate lymphangiography technique is essential for identifying the sources of leaks. Chylothorax resulting from damage to the TD can be serious because the TD transports large amounts of lymphatic fluid from the gastrointestinal, hepatic, and aortoiliac regions. Percutaneous TD embolization—comprising access to the TD followed by embolization—has recently become a minimally invasive alternative to surgical TD ligation for high-output chylothorax. The selection of access routes to the TD depends on its anatomy. If the TD cannot be approached by such means, other options include TD needle interruption or drainage of lymphatic fluid adjacent to the leakage point followed by sclerotherapy. Most cases of abdominal lymphorrhea arise from the aorta-iliac lymphatic system, and lymphangiography alone or computed tomography–guided sclerotherapy might be useful. Rarely, leakage may arise from hepatic lymphatics due to a damaged gastroduodenal ligament and can be visualized and embolized transhepatically. This article comprehensively reviews clinically relevant anatomic TD variations, lymphangiography techniques and criteria for their selection, and treatment strategies for lymphorrhea.

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Single-energy metal artifact reduction in postimplant computed tomography for I-125 prostate brachytherapy: Impact on seed identification

Shiraishi Y., Yamada Y., Tanaka T., Eriguchi T., Nishimura S., Yoshida K., Hanada T., Ohashi T., Shigematsu N., Jinzaki M.

Brachytherapy （Brachytherapy） 15 （ 6 ） 768 - 773 2016年11月

研究論文（学術雑誌）, 共著, ISSN 15384721

Purpose To evaluate the effectiveness of the single-energy metal artifact reduction (SEMAR) technique for improving the accuracy of I-125 seed identification in postimplant computed tomography (CT) after prostate brachytherapy. Methods and Materials Postimplant CT images of 40 patients treated with I-125 prostate brachytherapy were acquired. For all patients, 2 data sets were reconstructed, 1 with SEMAR algorithms (SEMAR image), and the other without SEMAR algorithms (non-SEMAR image). Seed locations are automatically detected by the automatic seed finder tool, and their locations were compared between the SEMAR and non-SEMAR images. Dosimetric parameters using seed locations as detected were compared. Results The true-positive fraction of properly detected seeds on the SEMAR image as determined from a reference seed distribution defined by one investigator was significantly higher than the true-positive fraction on the non-SEMAR image (p = 0.011). The variabilities in D90 (p = 0.001), V100 (p = 0.007), and V150 (p = 0.007) were significantly reduced for seed location on the SEMAR image as compared with non-SEMAR image. Conclusions Prostate postimplant CT with SEMAR improved the accuracy of seed localization and postimplant dosimetric parameters.

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Postoperative Stroke after Debranching with Thoracic Endovascular Aortic Repair

Yoshitake A., Hachiya T., Okamoto K., Kitahara H., Kawaguchi S., Nakatsuka S., Inoue M., Jinzaki M., Shimizu H.

Annals of Vascular Surgery （Annals of Vascular Surgery） 36 132 - 138 2016年10月

研究論文（学術雑誌）, 共著, ISSN 08905096

Objectives This study aimed to analyze the perioperative stroke rate, stroke lesions, outcome, risk factors, and stroke prevention following debranching with thoracic endovascular aortic repair (TEVAR). Design Retrospective study. Methods Between February 2011 and February 2015, 74 consecutive patients underwent debranching with TEVAR at our institution. Of these, the TEVAR proximal landing zone was “zone 0” in 23 patients, “zone 1” in 28, and “zone 2” in 23. Left subclavian artery (LSA) occlusion with coil embolization, balloon occlusion, or vascular plugging was performed in 27 patients. Mean follow-up time was 19.2 months (range 2–52 months). Results The in-hospital mortality rate was 4.1%. Stroke developed in 7 patients (9.5%), zone 0 in 4 patients, zone 1 in 2, and zone 2 in 1. Six of these patients had stroke lesions arising from the vertebral/basilar artery. Univariate analysis revealed a significant increase in the risk of postoperative stroke in patients with intraluminal atheroma (P = 0.001), those who underwent prior percutaneous transluminal coronary angioplasty or coronary artery bypass graft (P = 0.002), and those with a long operative duration (P = 0.001). Additionally, LSA occlusion significantly decreased the incidence of stroke (P = 0.041). The postsurgical 1- and 2-year cumulative survival rates were 87.3% and 77.0%, respectively, in those without stroke, and 68.6% and 22.9%, respectively, in those with stroke (P = 0.012). Conclusions Stroke after debranching with TEVAR was associated with a high mortality. To prevent stroke, careful patient selection and protection of the vertebral artery are important. Prophylactic LSA occlusion at the time of stent-graft deployment might reduce the risk of perioperative stroke.

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Clinical significance of the anterosuperior lymph nodes along the common hepatic artery identified by sentinel node mapping in patients with gastric cancer

Shimada A., Takeuchi H., Kamiya S., Fukuda K., Nakamura R., Takahashi T., Wada N., Kawakubo H., Saikawa Y., Omori T., Nakahara T., Jinzaki M., Murakami K., Kitagawa Y.

Gastric Cancer （Gastric Cancer） 19 （ 4 ） 1088 - 1094 2016年10月

研究論文（学術雑誌）, 共著, ISSN 14363291

Background: The sentinel node (SN) concept is safely applied and validated in early gastric cancer. Gastric lymph nodes are divided into five basins with the main gastric arteries, and the anterosuperior lymph nodes with the common hepatic artery (No. 8a) are classified in the right gastric artery (r-GA) basin. Although No. 8a are considered to have lymphatic flow from the r-GA basin, there might be additional multiple lymphatic flows into No. 8a. The aim of this study is to analyze the lymphatic flows to No. 8a and to investigate the clinical significance of No. 8a as a sentinel node (SN No. 8a). Methods: Four hundred and twenty-nine patients with cT1N0 or cT2N0 gastric cancer underwent SN mapping. We used technetium-99 tin colloid solution and blue dye as a tracer. Results: We detected SN No. 8a in 35 (8.2 %) patients. In these patients, we detected SN No. 8a with SNs that belonged to the left gastric artery (l-GA) basin (66 %), right gastroepiploic artery (r-GEA) basin (54 %), and right gastric artery (r-GA) basin (46 %). In addition, celiac artery lymph nodes were detected as SNs significantly more frequently. Function-preserving surgery was performed significantly less often in patients with SN No. 8a (p =0.018). Conclusions: We found that SN No. 8a seemed to have lymphatic flow not only from the r-GA basin, but also from the l-GA basin or r-GEA basin. When SN No. 8a are detected, we should be careful to perform function-preserving surgery, even in SN-negative cases.

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Plasma fibrinogen level: an independent prognostic factor for disease-free survival and cancer-specific survival in patients with localised renal cell carcinoma

Obata J., Tanaka N., Mizuno R., Kanao K., Mikami S., Matsumoto K., Kosaka T., Kikuchi E., Jinzaki M., Oya M.

BJU International （BJU International） 118 （ 4 ） 598 - 603 2016年10月

研究論文（学術雑誌）, 共著, ISSN 14644096

Objectives: To investigate the impact of perioperative plasma fibrinogen level as a biomarker of oncological outcome in localised renal cell carcinoma (RCC). Patients and methods: We consecutively identified 601 patients with localised RCC who underwent curative surgery at a single institution. Subsequent disease recurrence and cancer-specific survival (CSS) were assessed using the Kaplan–Meier method. To evaluate the independent prognostic impact of plasma fibrinogen level, multivariate analysis was performed for these outcomes. Results: Using the defined threshold level of preoperative plasma fibrinogen of ≥420 mg/dL as elevated, we found 56 patients (9.3%) with an elevated plasma fibrinogen level preoperatively. In Kaplan–Meier analysis, there was a significant difference in disease-free survival and CSS rates between patients with and without preoperative plasma fibrinogen levels of ≥420 mg/dL. Multivariate analysis showed that elevated preoperative plasma fibrinogen level was an independent predictor of subsequent disease recurrence and cancer-specific mortality. In a subgroup analysis of the elevated preoperative plasma fibrinogen level group, postoperative normalisation of plasma fibrinogen level was significantly associated with CSS, showing that patients with non-normalised plasma fibrinogen levels tended to have a higher incidence of cancer-specific mortality after surgery. Conclusion: Patients with elevated preoperative plasma fibrinogen levels could be significantly predicted to have subsequent tumour metastasis and cancer-specific mortality, while there was a significant difference in CSS between patients in the normalised and non-normalised postoperative plasma fibrinogen groups. While these are hypothesis generating results, plasma fibrinogen levels may be a useful biomarker due to its low cost and ease of assessment.

Refresher Course 原発性アルドステロン症　診断から治療まで

小黒草太, 栗原勲, 宮下和季, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 12 ） 1206 - 1219 2016年09月

ISSN 0285-0524

軟部腫瘤の画像診断　−よくみる疾患から稀な疾患まで− 第5章腫瘍性病変　−平滑筋腫瘍　平滑筋肉腫

小黒草太, 村上康二, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 11 ） s152 - s153 2016年09月

ISSN 0285-0524

軟部腫瘤の画像診断　−よくみる疾患から稀な疾患まで− 第5章腫瘍性病変　−骨格筋腫瘍　横紋筋肉腫(胎児型、胞巣型、多形型)

小黒草太, 村上康二, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 11 ） s158 - s159 2016年09月

ISSN 0285-0524

軟部腫瘤の画像診断　−よくみる疾患から稀な疾患まで− 第5章腫瘍性病変　−血管周囲腫瘍　血管平滑筋腫

小黒草太, 村上康二, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 11 ） s156 - s157 2016年09月

ISSN 0285-0524

軟部腫瘤の画像診断　−よくみる疾患から稀な疾患まで− 第5章腫瘍性病変　−血管周囲腫瘍　グロムス腫瘍

小黒草太, 村上康二, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 11 ） s154 - s155 2016年09月

ISSN 0285-0524

軟部腫瘤の画像診断　−よくみる疾患から稀な疾患まで− 第5章腫瘍性病変　−脂肪性腫瘍　褐色脂肪腫

小黒草太, 村上康二, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 11 ） s116 - s117 2016年09月

ISSN 0285-0524

軟部腫瘤の画像診断　−よくみる疾患から稀な疾患まで− 第5章腫瘍性病変　−線維組織球性腫瘍　腱鞘巨細胞腫(限局型、びまん型)

小黒草太, 村上康二, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 11 ） s150 - s151 2016年09月

ISSN 0285-0524

Analysis of the Medial Opticocarotid Recess in Patients with Pituitary Macroadenoma Using Three-Dimensional Images

Kikuchi R., Toda M., Wakahara S., Fujiwara H., Jinzaki M., Yoshida K.

World Neurosurgery （World Neurosurgery） 93 139 - 143 2016年09月

研究論文（学術雑誌）, 共著, ISSN 18788750

Objective The medial opticocarotid recess (MOCR), which contains the lateral tubercular recess (LTR), is an important landmark for the cavernous internal carotid artery (ICA) and for accessing the parasellar and suprasellar regions. These microanatomic landmarks for endoscopic endonasal surgery can be observed using surgical simulation with three-dimensional images. The aim of this study was to analyze the MOCR in patients with pituitary macroadenoma using three-dimensional images. Methods We constructed three-dimensional computed tomography images of 20 patients with pituitary macroadenoma and 20 patients with unruptured aneurysms as a control. Using these images, we measured the distance between the left and right LTR, the midline and the unilateral LTR, and the left and right ICA. Results The distance between the left and right LTR was statistically longer in the pituitary adenoma group versus the control group. Tumor volumes were multivariate parameters for the distance between the left and right LTR, which was significantly longer in the group with tumor volumes >5 cm3 versus the other groups. This distance was also significantly correlated with the distance between the left and right ICA. Conclusions Pituitary macroadenomas expand the distance between the left and right MOCR together with the distance between the left and right ICA.

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特集非腫瘍性消化管疾患の画像診断　−beyond barium study and endoscopy− 炎症性腸疾患のCT診断

鈴木達也, 田村謙太郎, 陣崎雅弘, 白神伸之

画像診断（学研メディカル秀潤社） 36 （ 10 ） 1009 - 1018 2016年08月

ISSN 0285-0524

特集産婦人科病態への血管の診断と治療【診断編】総論 MRI、MRA

奥田茂男, 秋田大宇, 松本俊亮, 鈴木達也, 大堀訓明, 成田啓一, 陣崎雅弘

産婦人科の実際（金原出版） 65 （ 8 ） 895 - 901 2016年08月

ISSN 0558-4728

特集画像でみかける偶発的所見のマネジメント　−あなたならどう書く?− 序説

陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 9 ） 837 - 837 2016年07月

ISSN 0285-0524

特集画像でみかける偶発的所見のマネジメント　−あなたならどう書く?− 骨軟部　脂肪性腫瘍

松本俊亮, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 9 ） 914 - 915 2016年07月

ISSN 0285-0524

特集画像でみかける偶発的所見のマネジメント　−あなたならどう書く?− 血管　限局性大動脈解離

塚田実郎, 中塚誠之, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 9 ） 926 - 927 2016年07月

ISSN 0285-0524

特集画像でみかける偶発的所見のマネジメント　−あなたならどう書く?− 肝胆膵脾　脾腫瘤

松本俊亮, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 9 ） 886 - 887 2016年07月

ISSN 0285-0524

特集画像でみかける偶発的所見のマネジメント　−あなたならどう書く?− 泌尿器　嚢胞性小腎腫瘍

秋田大宇, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 9 ） 890 - 891 2016年07月

ISSN 0285-0524

特集画像でみかける偶発的所見のマネジメント　−あなたならどう書く?− 泌尿器　副腎腺腫

小黒草太, 陣崎雅弘, 宮下和季, 栗原勲

画像診断（学研メディカル秀潤社） 36 （ 9 ） 888 - 889 2016年07月

ISSN 0285-0524

特集画像でみかける偶発的所見のマネジメント　−あなたならどう書く?− 泌尿器　充実性小腎腫瘍

秋田大宇, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 9 ） 892 - 893 2016年07月

ISSN 0285-0524

特集胸部画像診断-症状や身体所見からのアプローチ呼吸器症状からみた胸部画像診断呼吸困難慢性血栓塞栓性肺高血圧症,肺水腫,急性呼吸窮迫症候群

杉浦弘明, 陣崎雅弘

medicina （株式会社医学書院） 53 （ 8 ） 1192 - 1194 2016年07月

ISSN 0025-7699

Comparison of the diagnostic accuracy of FBP, ASiR, and MBIR reconstruction during CT angiography in the evaluation of a vessel phantom with calcified stenosis in a distal superficial femoral artery in a cadaver extremity

Tsukada J., Yamada M., Yamada Y., Yamazaki S., Imanishi N., Tamura K., Hashimoto M., Nakatsuka S., Jinzaki M.

Medicine (United States) （Medicine (United States)） 95 （ 27 ） e4127 2016年07月

研究論文（学術雑誌）, 共著, ISSN 00257974

Purpose: To investigate whether adaptive statistical iterative reconstruction (ASiR) or model-based iterative reconstruction (MBIR) improves the diagnostic performance of computed tomography angiography (CTA) for small-vessel calcified lesions relative to filtered back projection (FBP) using cadaver extremities and a calcified stenosis phantom. Methods: A cadaver was used in accordance with our institutional regulations, and a calcified stenosis phantom simulating 4 grades of stenosis was prepared. The phantom was inserted within the distal superficial femoral artery of the cadaver leg. Ten CT images per reconstruction type and stenosis grade were acquired using a 64-slice multidetector-row CTA. As an objective measurement, the first and second derivatives of the CT value function profiles were calculated. As a subjective measurement, 2 blinded reviewers measured the stenosis ratio using a quantitative scale. The Wilcoxon rank-sum test was used to evaluate the data. Results: Objective measurements of both 25% and 50% stenosis differed significantly (P < 0.01) between MBIR (25/50%: 25.80/50.30 ± 3.88/3.86%) and FBP (25/50%: 35.60/83.80 ± 3.44/26.10%), whereas significant differences were not observed between ASiR and FBP. Reviewer 2's subjective measurements of 25% stenosis differed significantly (P < 0.01) between MBIR (35.13 ± 3.25%) and ASiR (40.89 ± 3.14%), and the measurements of 50% stenosis differed significantly (P < 0.01) between MBIR (reviewers 1/2, 62.36/54.78 ± 2.78/4.96%) and FBP (reviewers 1/2, 62.36/74.84 ± 2.78/18.10%). Significant differences in the subjective measurements were not observed between ASiR and FBP. Conclusion: MBIR improves the diagnostic performance of CTA for small-vessel calcified lesions relative to FBP.

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Optimal HMPAO α value for Lassen’s correction algorithm obscured by statistical noise

Kameyama M., Murakami K., Jinzaki M.

Annals of Nuclear Medicine （Annals of Nuclear Medicine） 30 （ 6 ） 445 - 449 2016年07月

研究論文（学術雑誌）, 共著, ISSN 09147187

Objective: [99mTc] d,l-hexamethyl-propyeneamine oxime (99mTc-HMPAO), a brain perfusion tracer, suffers significant underestimation of regional cerebral blood flow (rCBF). Lassen et al. developed their linearization algorithm to correct the influence of back-diffusion of the tracer, and proposed their parameter α as 1.5. Based on mathematical modeling and literature review, recently, a new α value of 0.5 has been proposed for Lassen’s correction algorithm for 99mTc-HMPAO, although correction using the old α value of 1.5 was confirmed to be sufficient. Inugami et al. reported that linearization correction gives a stable correlation coefficient over a wide range of α. Our hypotheses are that statistical noise is the source of the stable correlation coefficient presented by them and that the robustness of the correlation coefficient is the reason why many studies confirmed the value of α as 1.5. Methods: Statistical noise was added in silico to the count, whose relationship with flow was α = 0.5. Then, the count was corrected by Lassen’s linearization algorithm with a variety of α. Results: This study confirmed the hypothesis that smaller α values (strong correction) increase the noise at high flow values, leading to nominal increases in correlation coefficient as α decreases. Conclusion: Despite this, adoption of the new, smaller α value of 0.5 would be more useful clinically in regaining the contrast between low-flow and high-flow areas of the brain.

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今月の主題新しい小腸・大腸画像診断─現状と将来展望主題 PET/CT

村上康二, 岩渕雄, 中原理紀, 緒方雄史, 片桐真理, 松坂陽至, 伊藤一成, 陣崎雅弘

胃と腸（株式会社医学書院） 51 （ 7 ） 909 - 916 2016年06月

ISSN 0536-2180

特集膠原病と類縁疾患の肺病変急性・亜急性経過の間質性肺炎

杉浦弘明, 陣崎雅弘

画像診断（学研メディカル秀潤社） 36 （ 8 ） 743 - 753 2016年06月

ISSN 0285-0524

CT imaging before transcatheter aortic valve implantation (TAVI) using variable helical pitch scanning and its diagnostic performance for coronary artery disease

Matsumoto S., Yamada Y., Hashimoto M., Okamura T., Yamada M., Yashima F., Hayashida K., Fukuda K., Jinzaki M.

European Radiology （European Radiology） 27 （ 5 ） 1963 - 1970 2016年04月

研究論文（学術雑誌）, 共著, ISSN 09387994

Objectives: To evaluate the effectiveness of CT before TAVI using variable helical pitch (VHP) scanning and its diagnostic performance for coronary artery disease (CAD). Methods: Sixty patients (84.4 ± 4.6 years) scheduled for TAVI underwent CT using VHP scanning with the contrast material (CM) volume calculated as scanning time × weight [kg] × 0.06 mL. Retrospective electrocardiography (ECG)-gated scanning was utilized to examine the thorax, and non-ECG-gated scanning of the abdomen immediately followed. We analyzed CT attenuation values of the coronary arteries, aorta, iliac and femoral arteries. The coronary CT angiography images were evaluated for the presence of stenosis (≥50 %); invasive coronary angiography served as a reference standard. Results: The average attenuations of all of the arteries were greater than 400 HU. We could evaluate the peripheral access vessels and dimensions of the ascending aorta, aortic root, and aortic annulus in all patients. The average volume of CM was 38.7 ± 8.5 mL. On per-patient and vessel analysis, CT showed 91.7 % and 89.5 % sensitivity, and 91.3 % and 97.4 % negative predictive value (NPV). Conclusions: CT using VHP scanning with an average CM volume of 38.7 mL is useful before TAVI and had a high sensitivity and NPV in excluding obstructive CAD. Key Points: • TAVI-planning CT using variable helical pitch (VHP) scanning is useful. • The average volume of contrast material was 38.7 ± 8.5 mL. • The average attenuations of all the arteries were >400 HU. • This CT had a high sensitivity and NPV for excluding obstructive CAD.

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Radiation-dose-lowering effects of landiolol hydrochloride in coronary angiography using computed tomography (DELIGHT): A prospective multicenter study

Kido T., Mochizuki T., Hirano M., Yamada Y., Tanaka R., Kanzaki S., Higashi M., Jinzaki M., Yoshioka K., Kuribayashi S.

Circulation Journal （Circulation Journal） 80 （ 5 ） 1225 - 1231 2016年04月

研究論文（学術雑誌）, 共著, ISSN 13469843

Background: Controlling and decreasing the heart rate (HR) of patients during coronary computed tomography angiography (CCTA) is necessary to reduce radiation exposure and improve image quality. This prospective multicenter study aimed to investigate whether HR control with landiolol hydrochloride is useful for reducing radiation exposure during CCTA. Methods and Results: We investigated 219 patients with suspected ischemic heart disease whose pretest HRs were 50–80 beats/min. We measured the HR before and after administration of landiolol hydrochloride and compared the estimated exposure inferred from the HR before administration of landiolol hydrochloride with the actual dose. After administration of landiolol hydrochloride, the mean HR (59.9 ± 6.4 beats/min) at the time of CCTA was significantly lower than before administration (69.3 ± 7.3 beats/min; P<0.001); 80% of the patients had controlled HRs at ≤65 beats/min. HR and blood pressure of all the patients recovered after the scan. The mean radiation dose in all patients was approximately 50% derived from the inferred dose before use of landiolol hydrochloride (4.5 ± 3.2 vs. 9.0 ± 3.7 mSv; P<0.001). There were no adverse events during this study. Conclusions: The use of landiolol hydrochloride during CCTA was safe and resulted in approximately 50% decrease in radiation exposure dose, suggesting the clinical usefulness of this drug.

特集大腸癌肝転移-最新の治療ストラテジー総論大腸癌肝転移の画像診断

上野彰久, 陣崎雅弘

臨床外科（株式会社医学書院） 71 （ 4 ） 393 - 403 2016年04月

ISSN 0386-9857

Role of computed tomography urography in the clinical evaluation of upper tract urothelial carcinoma

Jinzaki M., Kikuchi E., Akita H., Sugiura H., Shinmoto H., Oya M.

International Journal of Urology （International Journal of Urology） 23 （ 4 ） 284 - 298 2016年04月

研究論文（学術雑誌）, 共著, ISSN 09198172

Intravenous urography has been widely used for the evaluation of upper tract urothelial carcinoma. However, computed tomography urography presently has a higher diagnostic accuracy for upper tract urothelial carcinoma (94.2-99.6%) than intravenous urography (80.8-84.9%), and has replaced intravenous urography as the first-line imaging test for investigating patients with a high risk of upper tract urothelial carcinoma. Although the detection rate for bladder tumors using standard computed tomography urography is not yet high enough to replace cystoscopy, the addition of a 60- to 80-s delayed scan after the administration of contrast material for the whole pelvis improves the detection rate. A drawback to computed tomography urography is the higher radiation dose of 15-35 mSv, compared with a mean effective dose of 5-10 mSv for intravenous urography. Among several approaches to reducing the radiation dose, the use of an iterative reconstruction algorithm is most likely to become an effective solution because of its simplicity. One advantage of computed tomography urography over intravenous urography is its ability to reliably differentiate between upper tract urothelial carcinoma and calculi or blood clots. Computed tomography urography also shows characteristic findings of other benign conditions. These findings, in combination with negative cytology, are very important diagnostic clues for avoiding an unnecessary nephroureterectomy. For the clinical staging, a recent study has reported the high diagnostic accuracy of computed tomography urography with respect to ≥pT3 tumors. The present review shows the current status of computed tomography urography for the evaluation of upper tract urothelial carcinoma.

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Application of q-space diffusion MRI for the visualization of white matter

Fujiyoshi K., Hikishima K., Nakahara J., Tsuji O., Hata J., Konomi T., Nagai T., Shibata S., Kaneko S., Iwanami A., Momoshima S., Takahashi S., Jinzaki M., Suzuki N., Toyama Y., Nakamura M., Okano H.

Journal of Neuroscience （Journal of Neuroscience） 36 （ 9 ） 2796 - 2808 2016年03月

研究論文（学術雑誌）, 共著, ISSN 02706474

White matter abnormalities in the CNS have been reported recently in various neurological and psychiatric disorders. Quantitation of non-Gaussianity for water diffusion by q-space diffusional MRI (QSI) renders biological diffusion barriers such as myelin sheaths; however, the time-consuming nature of this method hinders its clinical application. In the current study, we aimed to refine QSI protocols to enable their clinical application and to visualize myelin signals in a clinical setting. For this purpose, animal studies were first performed to optimize the acquisition protocol of a non-Gaussian QSI metric. The heat map of standardized kurtosis values derived from optimal QSI (myelin map) was then created. Histological validation of the myelin map was performed in myelin-deficient mice and in a nonhuman primate by monitoring its variation during demyelination and remyelination after chemical spinal cord injury. The results demonstrated that it was sensitive enough to depict dysmyelination, demyelination, and remyelination in animal models. Finally, its utility in clinical practice was assessed by a pilot clinical study in a selected group of patients with multiple sclerosis (MS). The human myelin map could be obtained within 10 min with a 3 T MR scanner. Use of the myelin map was practical for visualizing white matter and it sensitively detected reappearance of myelin signals after demyelination, possibly reflecting remyelination inMSpatients. Our results together suggest that the myelin map, a kurtosis-related heat map obtainable with time-saving QSI, may be a novel and clinically useful means of visualizing myelin in the human CNS.

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Transhepatic Arterial Approach for Successful Embolization of Hepatic Hilar Pseudoaneurysm Fed by Tortuous Collateral Vessels.

Tamura M, Nakatsuka S, Shimizu Y, Oguro S, Inoue M, Jinzaki M.

Journal of Vascular and Interventional Radiology 27 （ 5 ） 768 - 770 2016年03月

研究論文（学術雑誌）, 共著

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Significant reduction of left atrial volume concomitant with clinical improvement after percutaneous transluminal septal myocardial ablation for drug-refractory hypertrophic obstructive cardiomyopathy, and its precise detection with multidetector CT

Maekawa Y., Akita K., Tsuruta H., Yamada Y., Hayashida K., Yuasa S., Murata M., Jinzaki M., Fukuda K.

Open Heart （Open Heart） 3 （ 1 ） e000359 2016年01月

研究論文（学術雑誌）, 共著

Objective: In patients with hypertrophic obstructive cardiomyopathy (HOCM), left atrial (LA) volume measurement is very important to provide prognostic information. Recent studies demonstrated that multidetector CT (MDCT) is useful to assess the changes in LA volume. Our aim was to examine the utility of a follow-up cardiac MDCT for long-term evaluation of the effect of percutaneous transluminal septal myocardial ablation (PTSMA) on LA volume. Methods: We studied a consecutive cohort of 20 patients with drug-refractory symptomatic HOCM after PTSMA. We evaluated LA volume analyses with cardiac MDCT on patients who underwent PTSMA as compared to echocardiography. Results: Before PTSMA, 75% of all patients had heart failure-associated symptoms in the New York Heart Association functional class III/IV. All patients experienced relief from heart failure-associated symptoms after PTSMA. Cardiac MDCT showed significant reduction in the index of maximum LA volume during follow-up compared to before PTSMA in the same way as in echocardiography (93.634.1 mL/m2 vs 82.635.3 mL/m2, p=0.035). A Bland-Altman plot showed small mean differences and limits of agreement in the measurements of the index of maximum LA volume before and after PTSMA between echocardiography and MDCT. Conclusions: The follow-up cardiac MDCT was a useful tool to evaluate the effectiveness of PTSMA on reduction of LA volume. Cardiac MDCT might provide comparable measurements of the LA volume in patients with drug-refractory symptomatic HOCM before and after PTSMA compared to echocardiography.

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Comparison of [(15)O] H2O Positron Emission Tomography and Functional Magnetic Resonance Imaging in Activation Studies.

Kameyama M, Murakami K, Jinzaki M

World journal of nuclear medicine 15 （ 1 ） 3 - 6 2016年01月

研究論文（学術雑誌）, 共著

[(15)O] H2O positron emission tomography (PET) has long been out of use in activation studies on the brain. Indeed, it is true that blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) has better spatial resolution and temporal resolution than PET, as well as no radiation exposure. However, PET and fMRI differ in their scope. Compared to fMRI, [(15)O] H2O PET offers advantages such as being quantifiable, less deteriorated by movement, and allowing for longitudinal studies. This article aimed to reassess the merits of PET in this context.

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"Moving left ventricular obstruction" due to stress cardiomyopathy in a patient with hypertrophic obstructive cardiomyopathy treated with percutaneous transluminal septal myocardial ablation

Akita K., Maekawa Y., Tsuruta H., Okuda S., Yanagisawa R., Kageyama T., Kawakami T., Kanazawa H., Hayashida K., Yuasa S., Murata M., Jinzaki M., Fukuda K.

International Journal of Cardiology （International Journal of Cardiology） 1 （ 202 ） 194 - 195 2016年01月

研究論文（学術雑誌）, 共著, ISSN 01675273

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

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

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

研究論文（学術雑誌）, 共著, ISSN 1936878X

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

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

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

Interventional Radiology （一般社団法人日本インターベンショナルラジオロジー学会） 1 （ 2 ） 39 - 44 2016年

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

機械学習を用いた読影レポート解読手法の構築

田中佑岳, 橋本正弘, 伊藤詩乃, 奧田茂男, 陣崎雅弘, 榊原康文

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

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

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

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

研究論文（学術雑誌）, 共著

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

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

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

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

研究論文（学術雑誌）, 共著

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

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Advance in cardiac CT

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

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

ISSN 04523458

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

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

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

研究論文（学術雑誌）, 共著

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

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

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

研究論文（学術雑誌）, 共著, ISSN 1173-2563

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

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

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

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

研究論文（学術雑誌）, 共著, ISSN 19368798

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

陣崎雅弘

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

研究論文（学術雑誌）, 共著

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

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

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

研究論文（学術雑誌）, 共著, ISSN 0730-725X

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

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

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

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

研究論文（学術雑誌）, 共著

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

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

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

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

研究論文（学術雑誌）, 共著

PURPOSE:

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

METHODS:

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

RESULT:

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

CONCLUSION:

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

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

奥田茂男, 中塚誠之, 陣崎雅弘

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

ISSN 0285-0524

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

塚田実郎, 奥田茂男, 中塚誠之, 陣崎雅弘

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

ISSN 0285-0524

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

田村全, 奥田茂男, 中塚誠之, 陣崎雅弘

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

ISSN 0285-0524

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

田村全, 奥田茂男, 中塚誠之, 陣崎雅弘

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

ISSN 0285-0524

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

須山陽介, 奥田茂男, 中塚誠之, 陣崎雅弘

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

ISSN 0285-0524

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

須山陽介, 奥田茂男, 中塚誠之, 陣崎雅弘

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

ISSN 0285-0524

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

塚田実郎, 奥田茂男, 中塚誠之, 陣崎雅弘

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

ISSN 0285-0524

Interventional therapeutic strategy for hemoptysis originating from infectious pulmonary artery pseudoaneurysms

Tsukada Jitsuro, Hasegawa Ichiro, Torikai Hideyuki, Sayama Koichi, Jinzaki Masahiro, Narimatsu Yoshiaki

Journal of Vascular and Interventional Radiology 26 （ 7 ） 1046 - 1051.e1 2015年07月

研究論文（学術雑誌）, 共著, ISSN 1051-0443

This study reports 6 cases of hemoptysis originating from infectious pulmonary artery pseudoaneurysms (PAPs). Selective pulmonary angiography revealed PAPs in 5 cases, and segmental pulmonary artery embolization was performed using coils and gelatin sponge particles. Systemic arterial embolization also was performed in 5 cases because of inadequate initial control or for shunts from systemic to pulmonary arteries. At a median follow-up time of 9 months (range, 25 d to 25 mo), no recurrence occurred, although 2 patients died of respiratory failure. Segmental artery embolization combined with systemic artery embolization may be useful in patients with hemoptysis secondary to PAPs.

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Interventional therapeutic strategy for hemoptysis originating from infectious pulmonary artery pseudoaneurysms.

陣崎雅弘

Journal of Vascular and Interventional Radiology （Elsevier） 26 （ 7 ） 1046 - 1051 2015年07月

研究論文（学術雑誌）, 共著

This study reports 6 cases of hemoptysis originating from infectious pulmonary artery pseudoaneurysms (PAPs). Selective pulmonary angiography revealed PAPs in 5 cases, and segmental pulmonary artery embolization was performed using coils and gelatin sponge particles. Systemic arterial embolization also was performed in 5 cases because of inadequate initial control or for shunts from systemic to pulmonary arteries. At a median follow-up time of 9 months (range, 25 d to 25 mo), no recurrence occurred, although 2 patients died of respiratory failure. Segmental artery embolization combined with systemic artery embolization may be useful in patients with hemoptysis secondary to PAPs.

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特集知っておきたい循環器疾患のCT・MRI(1)-心臓・頸部血管疾患Case Review- 心臓　FFR測定

山田祥岳, 陣崎雅弘, 山田稔

画像診断（学研メディカル秀潤社） 35 （ 8 ） 980 - 981 2015年06月

ISSN 0285-0524

Usefulness of 3D SPECT/CT fusion image in CTEPH

Kawakami Takashi, Kataoka Masaharu, Nakahara Tadaki, Yamada Yoshitake, Takei Makoto, Jinzaki Masahiro, Fukuda Keiichi

International Journal of Cardiology 194 39 - 40 2015年06月

研究論文（学術雑誌）, 共著, ISSN 0167-5273

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Direct assessment of 3D foot bone kinematics using biplanar X-ray fluoroscopy and an automatic model registration method.

陣崎雅弘

Journal of Foot and Ankle Research （Biomed Central） 8 21 2015年06月

研究論文（学術雑誌）, 共著

BACKGROUND:

Quantifying detailed 3-dimensional (3D) kinematics of the foot in contact with the ground during locomotion is crucial for understanding the biomechanical functions of the complex musculoskeletal structure of the foot. Biplanar X-ray fluoroscopic systems and model-based registration techniques have recently been employed to capture and visualise 3D foot bone movements in vivo, but such techniques have generally been performed manually. In the present study, we developed an automatic model-registration method with biplanar fluoroscopy for accurate measurement of 3D movements of the skeletal foot.

METHODS:

Three-dimensional surface models of foot bones were generated prior to motion measurement based on computed tomography. The bone models generated were then registered to biplanar fluoroscopic images in a frame-by-frame manner using an optimisation technique, to maximise similarity measures between occluding contours of the bone surface models with edge-enhanced fluoroscopic images, while avoiding mutual penetration of bones. A template-matching method was also introduced to estimate the amount of bone translation and rotation prior to automatic registration.

RESULTS:

We analysed 3D skeletal movements of a cadaver foot mobilized by a robotic gait simulator. The 3D kinematics of the calcaneus, talus, navicular and cuboid in the stance phase of the gait were successfully reconstructed and quantified using the proposed model-registration method. The accuracy of bone registration was evaluated as 0.27 ± 0.19 mm and 0.24 ± 0.19° (mean ± standard deviation) in translation and rotation, respectively, under static conditions, and 0.36 ± 0.19 mm and 0.42 ± 0.30° in translation and rotation, respectively, under dynamic conditions.

CONCLUSIONS:

The measurement was confirmed to be sufficiently accurate for actual analysis of foot kinematics. The proposed method may serve as an effective tool for understanding the biomechanical function of the human foot during locomotion.

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Direct assessment of 3D foot bone kinematics using biplanar X-ray fluoroscopy and an automatic model registration method

Ito Kohta, Hosoda Koh, Shimizu Masahiro, Ikemoto Shuhei, Kume Shinnosuke, Nagura Takeo, Imanishi Nobuaki, Aiso Sadakazu, Jinzaki Masahiro, Ogihara Naomichi

Journal of Foot and Ankle Research 8 （ 1 ） 2015年06月

研究論文（学術雑誌）, 共著

Background: Quantifying detailed 3-dimensional (3D) kinematics of the foot in contact with the ground during locomotion is crucial for understanding the biomechanical functions of the complex musculoskeletal structure of the foot. Biplanar X-ray fluoroscopic systems and model-based registration techniques have recently been employed to capture and visualise 3D foot bone movements in vivo, but such techniques have generally been performed manually. In the present study, we developed an automatic model-registration method with biplanar fluoroscopy for accurate measurement of 3D movements of the skeletal foot. Methods: Three-dimensional surface models of foot bones were generated prior to motion measurement based on computed tomography. The bone models generated were then registered to biplanar fluoroscopic images in a frame-by-frame manner using an optimisation technique, to maximise similarity measures between occluding contours of the bone surface models with edge-enhanced fluoroscopic images, while avoiding mutual penetration of bones. A template-matching method was also introduced to estimate the amount of bone translation and rotation prior to automatic registration. Results: We analysed 3D skeletal movements of a cadaver foot mobilized by a robotic gait simulator. The 3D kinematics of the calcaneus, talus, navicular and cuboid in the stance phase of the gait were successfully reconstructed and quantified using the proposed model-registration method. The accuracy of bone registration was evaluated as 0.27 ± 0.19 mm and 0.24 ± 0.19° (mean ± standard deviation) in translation and rotation, respectively, under static conditions, and 0.36 ± 0.19 mm and 0.42 ± 0.30° in translation and rotation, respectively, under dynamic conditions. Conclusions: The measurement was confirmed to be sufficiently accurate for actual analysis of foot kinematics. The proposed method may serve as an effective tool for understanding the biomechanical function of the human foot during locomotion.

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CT dose reduction for visceral adipose tissue measurement

Yamada Yoshitake, Jinzaki Masahiro, Niijima Yuki, Hashimoto Masahiro, Yamada Minoru, Abe Takayuki, Kuribayashi Sachio

American Journal of Roentgenology 204 （ 6 ） W677 - W683 2015年06月

研究論文（学術雑誌）, 共著, ISSN 0361-803X

OBJECTIVE. The objective of our study was to evaluate the effects of radiation dose reduction and the reconstruction algorithm used-filtered back projection (FBP), adaptive statistical iterative reconstruction (ASIR), or model-based iterative reconstruction (MBIR)-on the measurement of abdominal visceral fat using CT. SUBJECTS AND METHODS. Standard-dose and low-dose abdominal CT examinations were performed simultaneously with automatic exposure control in 59 patients; the noise index for a 5-mm slice thickness was 12 for routine-dose CT and 24 for low-dose CT. The routine-dose CT images were reconstructed using FBP (reference standard), and the low-dose CT images were reconstructed using FBP, ASIR (so-called hybrid iterative reconstruction [IR]), and MBIR (so-called pure IR). In the 236 image series obtained, the visceral fat area was measured. Data were analyzed by the Pearson correlation coefficient test and a Bland-Altman difference analysis. RESULTS. The radiation dose of the low-dose abdominal CT examinations was 73.0% (mean) lower than that of routine-dose CT examinations. Excellent correlations were observed between the visceral fat areas measured on the routine-dose FBP images and those measured on the low-dose FBP, low-dose ASIR, and low-dose MBIR images (r = 0.998, 0.998, and 0.998, respectively; p < 0.001). A Bland-Altman difference analysis revealed excellent agreements, with mean biases of-0.47,-0.41, and 0.18 cm2 for the visceral fat area between the routine-dose FBP images and the low-dose FBP, low-dose ASIR, and low-dose MBIR images, respectively. CONCLUSION. A 73.0% reduction of the radiation dose would be possible in CT for the measurement of the abdominal visceral fat regardless of which reconstruction algorithm is used (i.e., FBP, hybrid IR, or pure IR).

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CT during arteriography to visualize the right adrenal vein for adrenal venous sampling

Oguro Sota, Nakatsuka Seishi, Yashiro Hideki, Hashimoto Subaru, Miyashita Kazutoshi, Kurihara Isao, Itoh Hiroshi, Jinzaki Masahiro

Journal of Vascular and Interventional Radiology 26 （ 6 ） 910 - 914 2015年06月

研究論文（学術雑誌）, 共著, ISSN 1051-0443

The present report describes 6 cases of adrenal venous sampling (AVS) in patients who underwent computed tomography (CT) during arteriography because cannulation of right adrenal veins was otherwise difficult. CT was performed during arteriography to obtain information on the location and direction of the right adrenal vein. Two right adrenal veins were visualized in 1 case. The right central adrenal vein was not visualized in 1 case owing to an injury from a previous unsuccessful AVS procedure, but the right renal capsular vein was well visualized. CT during arteriography could contribute to a high AVS success rate.

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CT during Arteriography to Visualize the Right Adrenal Vein for Adrenal Venous Sampling.

陣崎雅弘

26 （ 6 ） 910 - 914 2015年06月

研究論文（学術雑誌）, 共著

The present report describes 6 cases of adrenal venous sampling (AVS) in patients who underwent computed tomography (CT) during arteriography because cannulation of right adrenal veins was otherwise difficult. CT was performed during arteriography to obtain information on the location and direction of the right adrenal vein. Two right adrenal veins were visualized in 1 case. The right central adrenal vein was not visualized in 1 case owing to an injury from a previous unsuccessful AVS procedure, but the right renal capsular vein was well visualized. CT during arteriography could contribute to a high AVS success rate.

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特集腫瘍に対する分子標的療法の現状と画像評価序説

陣崎雅弘

画像診断（学研メディカル秀潤社） 35 （ 7 ） 763 - 763 2015年05月

ISSN 0285-0524

Renal cyst pseudoenhancement: Intraindividual comparison between virtual monochromatic spectral images and conventional polychromatic 120-kVp images obtained during the same CT examination and comparisons among images reconstructed using filtered back projection, adaptive statistical iterative reconstruction, and model-based iterative reconstruction

Yamada Y., Yamada M., Sugisawa K., Akita H., Shiomi E., Abe T., Okuda S., Jinzaki M.

Medicine (United States) （Medicine (United States)） 94 （ 15 ） 2015年04月

研究論文（学術雑誌）, 共著, ISSN 0025-7974

The purpose of this study was to compare renal cyst pseudoenhancement between virtual monochromatic spectral (VMS) and conventional polychromatic 120-kVp images obtained during the same abdominal computed tomography (CT) examination and among images reconstructed using filtered back projection (FBP), adaptive statistical iterative reconstruction (ASIR), and model-based iterative reconstruction (MBIR). Our institutional review board approved this prospective study; each participant provided written informed consent. Thirty-one patients (19 men, 12 women; age range, 59-85 years; mean age, 73.2±5.5 years) with renal cysts underwent unenhanced 120-kVp CT followed by sequential fast kVp-switching dual-energy (80/140kVp) and 120-kVp abdominal enhanced CT in the nephrographic phase over a 10-cm scan length with a random acquisition order and 4.5-second intervals. Fifty-one renal cysts (maximal diameter, 18.0±14.7mm [range, 4-61mm]) were identified. The CT attenuation values of the cysts as well as of the kidneys were measured on the unenhanced images, enhanced VMS images (at 70keV) reconstructed using FBP and ASIR from dual-energy data, and enhanced 120-kVp images reconstructed using FBP, ASIR, and MBIR. The results were analyzed using the mixed-effects model and paired t test with Bonferroni correction. The attenuation increases (pseudoenhancement) of the renal cysts on the VMS images reconstructed using FBP/ASIR (least square mean, 5.0/6.0Hounsfield units [HU]; 95% confidence interval, 2.6-7.4/3.6-8.4HU) were significantly lower than those on the conventional 120-kVp images reconstructed using FBP/ASIR/MBIR (least square mean, 12.1/12.8/11.8HU; 95% confidence interval, 9.8-14.5/10.4-15.1/9.4-14.2HU) (all P<.001); on the other hand, the CT attenuation values of the kidneys on the VMS images were comparable to those on the 120-kVp images. Regardless of the reconstruction algorithm, 70-keV VMS images showed a lower degree of pseudoenhancement of renal cysts than 120-kVp images, while maintaining kidney contrast enhancement comparable to that on 120-kVp images.

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Evaluation of velopharyngeal closure by 4D imaging using 320-detector-row computed tomography

Sakamoto Y., Soga S., Jinzaki M., Yamada Y., Ogata H., Kishi K.

Journal of Plastic, Reconstructive and Aesthetic Surgery （Journal of Plastic, Reconstructive and Aesthetic Surgery） 68 （ 4 ） 479 - 484 2015年04月

研究論文（学術雑誌）, 共著, ISSN 1748-6815

Objective Current imaging techniques for velopharyngeal closure (VPC) evaluation are two-dimensional, static, or distressing, thus necessitating multiple procedures to understand this three-dimensional and dynamic area. We validated the use of a novel four-dimensional (4D) computed tomography (CT) technique for the morphological and kinematic evaluation of VPC in cleft palate patients based on dynamic volume scanning with 320-detector-row CT. Methods Five patients aged 4-10 years (40% males) with persistent velopharyngeal insufficiency post palatoplasty underwent conventional tests (cephalometry and video-nasal endoscopy) and 4D-CT. For each patient, complete multiplanar reconstruction, 4D airway CT, and 4D-CT endoscopy data for all scanning phases were compared with cephalometric and video-nasal endoscopy data. The movements of the velum and posterior pharyngeal walls were graded by each modality. Results 4D airway CT revealed higher anatomical detail than cephalometry, additionally providing dynamic images. 4D-CT endoscopy and video-nasal endoscopy were in agreement for all patients regarding the patterns of VPC, with complete visualization of VPC in five versus one patient, respectively. 4D airway CT and cephalometry showed a discrepancy in one case, wherein grading by cephalometry was overestimated. 4D-CT was also useful in determining the width and length of a proposed pharyngeal flap. The examination time (mean ± standard deviation (SD), seconds), including patient preparation time, was 224 ± 73, 492 ± 145, and 718 ± 123 for cephalometric radiographs, CT, and video-nasal endoscopy, respectively. The mean estimated radiation dose during 4D-CT was 4.44 ± 1.64 mSv. Conclusions 4D-CT provides detailed morphological and kinematic analysis of VPC and may offer advantages over conventional procedures.

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How does visceral obesity affect surgical performance in laparoscopic radical nephrectomy?

Yuge K., Miyajima A., Jinzaki M., Kaneko G., Hagiwara M., Hasegawa M., Takeda T., Kikuchi E., Nakagawa K., Oya M.

Japanese Journal of Clinical Oncology （Japanese Journal of Clinical Oncology） 45 （ 4 ） 373 - 377 2015年04月

研究論文（学術雑誌）, 共著, ISSN 0368-2811

Objective: In a previous study, we described the relationship between operating time and obesity, particularly visceral obesity, in laparoscopic surgery. Operating time in laparoscopic surgery is affected by the experience and technique of the surgeon. Here, we investigated whether a difference in the surgeon's experience affects the operating time for laparoscopic radical nephrectomy in patients with visceral obesity. Methods: From January 2006 to February 2012, 167 laparoscopic radical nephrectomies were performed at our institution. Visceral fat areawas measured at the level of the umbilicus using computed tomography. A visceral fat area ≥ 100 cm2 was used as the definition of visceral obesity. All laparoscopic radical nephrectomies were performed by six surgeons. Two of the six surgeons perform 50 cases or more laparoscopic surgeries every year and they were defined as the expert group. We analyzed the relationships between clinical findings, methods, surgeon experience, body mass index or visceral fat area and operating time. Results: The expert and non-expert surgeons performed 77 and 90 laparoscopic radical nephrectomies, respectively, and the median operating timewas 167.0 ± 44.0 and 227.5 ± 60.6 min. Twenty-five patients underwent laparoendoscopic single-site nephrectomy by the expert surgeons. For all surgeons, visceral obesity was a significant factor for prolonged operating time. Multivariate analysis showed that visceral obesity and clinical T stage were independent risk factors for prolonged operating time for the non-expert surgeons [P = 0.004, hazard ratio (HR):5.15, P = 0.037, HR:10.41]. However, for the expert surgeons, clinical T stage was the only independent risk factor for prolonged operating time (P = 0.039, HR:4.33). Conclusion: Visceral obesity was a factor of prolonged operating time in laparoscopic radical nephrectomy. The non-expert surgeons were particularly affected by visceral obesity.

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Lack of Association between Epicardial Fat Volume and Extent of Coronary Artery Calcification, Severity of Coronary Artery Disease, or Presence of Myocardial Perfusion Abnormalities in a Diverse, Symptomatic Patient Population: Results from the CORE320 Multicenter Study

Tanami Y., Jinzaki M., Kishi S., Matheson M., Vavere A.L., Rochitte C.E., Dewey M., Chen M.Y., Clouse M.E., Cox C., Kuribayashi S., Lima J.A.C., Arbab-Zadeh A.

Circulation: Cardiovascular Imaging （Circulation: Cardiovascular Imaging） 8 （ 3 ） 2015年03月

研究論文（学術雑誌）, 共著, ISSN 1941-9651

Background-Epicardial fat may play a role in the pathogenesis of coronary artery disease (CAD). We explored the relationship of epicardial fat volume (EFV) with the presence and severity of CAD or myocardial perfusion abnormalities in a diverse, symptomatic patient population. Methods and Results-Patients (n=380) with known or suspected CAD who underwent 320-detector row computed tomographic angiography, nuclear stress perfusion imaging, and clinically driven invasive coronary angiography for the CORE320 international study were included. EFV was defined as adipose tissue within the pericardial borders as assessed by computed tomography using semiautomatic software. We used linear and logistic regression models to assess the relationship of EFV with coronary calcium score, stenosis severity by quantitative coronary angiography, and myocardial perfusion abnormalities by single photon emission computed tomography (SPECT). Median EFV among patients (median age, 62.6 years) was 102 cm3 (interquartile range: 53). A coronary calcium score of ≥1 was present in 83% of patients. Fifty-nine percent of patients had ≥1 coronary artery stenosis of ≥50% by quantitative coronary angiography, and 49% had abnormal myocardial perfusion results by SPECT. There were no significant associations between EFV and coronary artery calcium scanning, presence severity of ≥50% stenosis by quantitative coronary angiography, or abnormal myocardial perfusion by SPECT. Conclusions-In a diverse population of symptomatic patients referred for invasive coronary angiography, we did not find associations of EFV with the presence and severity of CAD or with myocardial perfusion abnormalities. The clinical significance of quantifying EFV remains uncertain but may relate to the pathophysiology of acute coronary events rather than the presence of atherosclerotic disease.

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Visceral obesity is associated with better recurrence-free survival after curative surgery for Japanese patients with localized clear cell renal cell carcinoma

Kaneko G., Miyajima A., Yuge K., Yazawa S., Mizuno R., Kikuchi E., Jinzaki M., Oya M.

Japanese Journal of Clinical Oncology （Japanese Journal of Clinical Oncology） 45 （ 2 ） 210 - 216 2015年02月

研究論文（学術雑誌）, 共著, ISSN 0368-2811

Objective: To investigate the prognostic significance of visceral obesity to predict recurrence after curative surgery for Japanese patients with localized renal cell carcinoma. Methods: The data of 285 patients who underwent curative surgery for localized renal cell carcinoma were retrospectively reviewed. Median follow-up was 36.7 months. The association between visceral obesity and recurrence-free survival rate was evaluated using the Kaplan-Meier method and Cox regression models. Visceral fat area at the level of the umbilicus measured using pre-operative computed tomography was used as an index of visceral obesity. Results: Twenty-nine patients (10.2%) experienced recurrence. Five-year recurrence-free survival rates were 91.3% in high visceral fat area group (≥120 cm2) and 76.9% in low visceral fat area group (<120 cm2) (P = 0.037); however, visceral fat area was not an independent predictor of recurrence- free survival in multivariate analysis. In the patients with clear cell renal cell carcinoma, 28 patients (11.6%) experienced recurrence. Five-year recurrence-free survival rates were 88.7% in high visceral fat area group and 71.0% in low visceral fat area group (P = 0.043), and visceral fat area was an independent predictor of recurrence-free survival (hazard ratio: 1.974, P = 0.042) as well as C-reactive protein, Fuhrman nuclear grade, tumor size and microvascular invasion. In patients with organ confined clear cell renal cell carcinoma in particular, visceral fat area was also a useful and independent predictor of recurrence-free survival (hazard ratio: 2.807, P = 0.038). Body mass index was not useful in either cohort. Conclusions: High visceral fat area was a positive predictive biomarker for better recurrence-free survival after curative surgeries for localized clear cell renal cell carcinomas; however, body mass index was not a predictor.

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Thrombus in acute aortic dissection with atrial fibrillation: A treatment dilemma

Shiraishi Y., Kohno T., Egashira T., Maekawa Y., Yamada Y., Yoshitake A., Shimizu H., Sano M., Jinzaki M., Fukuda K.

American Journal of Emergency Medicine （American Journal of Emergency Medicine） 33 （ 2 ） 308.e3 - 308.e4 2015年02月

研究論文（学術雑誌）, 共著, ISSN 07356757

Type B acute aortic dissection (AAD) is often successfully managed with medical therapy, with a lower mortality rate, compared with type A AAD. Although the number of AAD patients complicated with atrial fibrillation (AF) has increased, reflecting an aging society, there have only been a few reports regarding the association of AAD and AF. Furthermore, there is no consensus on anticoagulation therapy in ADD patients complicated with AF, despite the importance of anticoagulation therapy in AF treatment. Here, we discuss a 79-year-old man with type B AAD and chronic AF complicated with the rapid left atrial appendage (LAA) thrombus formation after discontinuation of anticoagulation therapy. Emergent contrast-enhanced computed tomography revealed type B AAD with a partially thrombosed false lumen from the bifurcation of the aorta and the left subclavian artery to above the diaphragm. Ulcer-like projection was observed in the proximal thrombosed false lumen. Ten days after discontinuation of anticoagulation therapy, LAA thrombus was detected on contrast-enhanced computed tomography, which was not observed on admission. After anticoagulation therapy was resumed, the LAA thrombus disappeared, but the partially thrombosed false lumen was enlarged. The second discontinuation of anticoagulation therapy stabilized the dissected aorta and did not cause recurrence of LAA thrombus. In conclusion, clinicians need to balance the prevention of LAA thrombus formation with the complete thrombosis of a false lumen in patients with AAD and AF.

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Improved renal function in a patient with hypertrophic obstructive cardiomyopathy after multidetector computed tomography-guided percutaneous transluminal septal myocardial ablation

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

International Journal of Cardiology （International Journal of Cardiology） 15 （ 181 ） 349 - 350 2015年02月

研究論文（学術雑誌）, 共著, ISSN 01675273

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Non-invasive computed fractional flow reserve from computed tomography (Ct) for diagnosing coronary artery disease; japanese results from nxt trial (analysis of coronary blood flow using ct angiography: Next steps)

Miyoshi T., Osawa K., Ito H., Kanazawa S., Kimura T., Shiomi H., Kuribayashi S., Jinzaki M., Kawamura A., Bezerra H., Nørgaard B.L.

Circulation Journal （Circulation Journal） 79 （ 2 ） 406 - 412 2015年01月

研究論文（学術雑誌）, 共著, ISSN 1346-9843

Background: Recently, a non-invasive method using computational fluid dynamics to calculate vessel-specific fractional flow reserve (FFRct) from routinely acquired coronary computed tomography angiography (CTA) was described. The Analysis of Coronary Blood Flow Using CT Angiography: Next Steps (NXT) trial, which was a prospective, multicenter trial including 254 patients with suspected coronary artery disease, noted high diagnostic performance of FFRct compared with invasive FFR. The aim of this post-hoc analysis was to assess the diagnostic performance of non-invasive FFRct vs. standard stenosis quantification on coronary CTA in the Japanese subset of the NXT trial.

CT Dose Reduction for Visceral Adipose Tissue Measurement: Effects of Model-Based and Adaptive Statistical Iterative Reconstructions and Filtered Back Projection.

陣崎雅弘

American Journal of Roentgenology （American Roentgen Ray Society） 204 （ 6 ） W677 - W683 2015年01月

研究論文（学術雑誌）, 共著

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Evidenced-based clinical practice guideline for upper tract urothelial carcinoma (summary--Japanese Urological Association, 2014 edition).

Oya M, Kikuchi E; Committee for Establishment of Clinical Practice Guideline for Management of Upper Tract Urothelial Carcinoma; Japanese Urological Association.

International Journal of Urology 22 （ 1 ） 3 - 13 2015年01月

研究論文（学術雑誌）, 共著

Upper tract urothelial carcinoma is more rare than bladder cancer, although they are both categorized as urothelial carcinoma. Because of the low incidence, little clinical evidence is available regarding the treatment of the former. However, recently such evidence has slowly begun to accumulate. The guideline presented herein was compiled for the purpose of ensuring proper diagnosis and treatment by physicians involved in the treatment of upper tract urothelial carcinoma. We carefully selected 16 clinical questions essential for daily clinical practice and grouped them into four major categories: epidemiology, diagnosis, surgery and systemic chemotherapy/other matters. Related literature was searched using PubMed and Japan Medical Abstracts Society databases for articles published between 1987 and 2013. If the judgment was made on the basis of insufficient or inadequate evidence, the grade of recommendation was determined on the basis of committee discussions and resultant consensus statements. Here, we present a short English version of the original guideline, and overview its key clinical issues.

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New classification of renal angiomyolipoma

Jinzaki M.

Japanese Journal of Clinical Radiology （Japanese Journal of Clinical Radiology） 60 （ 8 ） 991 - 999 2015年

研究論文（学術雑誌）, 共著, ISSN 0009-9252

Angiomyolipoma (AML) is the most common benign solid renal neoplasm observed in clinical practice. Once thought to be a hamartoma, this neoplasm now considered among the family of PEComa. We recently provided a new radiological classification of AMLs that helps physicians understand the recent development and variety of its pathology, imaging features and its management. AMLs are divided into triphasic benign AML and epithelioid AML with malignant potential. Triphasic benign AMLs are consisted of classic AML which can be diagnosed by the detection of fat on imaging, and fat poor AML which can not. A hyperat-tenuating appearance on unenhanced CT and a T2-hypointense appearance at MRI both correspond to the smooth muscle component, are important diagnostic clues to the types of AMLs that contain few or no fat cells.

循環器・大動脈領域におけるAquilion ONE/ViSION Editionの有用性.

山田祥岳, 陣崎雅弘

INNERVISION. 30 86 - 87 2015年

CiNii Research

Retroperitoneal low-flow vascular malformations

Akita Hirotaka, Yamada Yoshitake, Ito Yoshiaki, Mikami Shuji, Sugiura Hiroaki, Okuda Shigeo, Jinzaki Masahiro

Abdominal Imaging 40 （ 6 ） 1713 - 1720 2014年12月

研究論文（学術雑誌）, 共著, ISSN 0942-8925

Purpose: To evaluate the MRI findings of retroperitoneal low-flow vascular malformations (RLVMs) correlated with histopathological findings. Methods: Two radiologists reviewed the MRI findings of 4 RLVMs (3 with capillary malformations and 1 with a venous malformation). First, they evaluated the visibility, signal intensities, and signal homogeneity of each lesion on non-fat-suppressed breath-hold T2-weighted single-shot fast spin-echo (non-FS SSFSE) images and fat-suppressed T2-weighted fast spin-echo (FS T2-weighted FSE) images. Second, the kinetic patterns and the internal enhancement patterns were analyzed for each lesion on multi-phasic contrast-enhanced (CE) images. After these image analyses, the MRI findings were correlated with the histopathological findings. Result: Histopathologically, the 4 RLVMs did not exhibit remarkable degeneration and were present in the retroperitoneal fat tissue without clear capsules. On the non-FS SSFSE images, 3 of the 4 RLVMs could not be discriminated from the surrounding retroperitoneal fat tissue (invisible), and the remaining lesion was barely visible with an indistinct margin. On the FS T2-weighted FSE images, however, all the RLVMs were clearly visualized as homogeneous high-signal intensities. On the multi-phasic CE images, all the capillary malformations exhibited fast enhancement, while a venous malformation showed slow enhancement. Furthermore, the RLVMs tended to exhibit a centripetal filling pattern. Conclusion: The RLVMs blended in with the surrounding retroperitoneal fat tissue on non-FS SSFSE images, like phantoms, whereas they were clearly visualized on FS T2-weighted FSE images. On multi-phasic CE images, the RLVMs tended to exhibit a centripetal filling pattern. These imaging features may be useful diagnostic clues for RLVMs.

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Pericardial endoscopy-guided left atrial appendage ligation: A pilot study in a canine model

Kimura T., Takatsuki S., Miyoshi S., Katsumata Y., Nishiyama T., Nishiyama N., Tanimoto Y., Aizawa Y., Jinzaki M., Fukuda K.

Circulation: Cardiovascular Interventions （Circulation: Cardiovascular Interventions） 7 （ 6 ） 844 - 850 2014年12月

研究論文（学術雑誌）, 共著, ISSN 1941-7640

Background-Approaches for closing the left atrial appendage (LAA) have been developed for stroke prevention. However, the prevailing maneuvers require an open-chest surgery, intravascular access, or transseptal puncture. We evaluated the feasibility and safety of pericardial endoscopy-guided LAA ligation in a canine model. Methods and Results-We used a total of 8 canines and computed tomography was performed before the procedures. After a double percutaneous pericardiocentesis, a transurethral rigid endoscope was inserted into the pericardial space. The ENDOLOOP ligature was advanced to the ostium of the LAA by counter pulling the tip of the LAA with forceps. After confirming the positioning guided by transesophageal echocardiography, the ligature was securely tightened. Acute success was evaluated by transesophageal echocardiography and chronic success was evaluated by blood testing, computed tomography, and transesophageal echocardiography. The LAA ligation was safely achieved in all canines without major complications. One month after the ligation, the ligated LAA was replaced by fibrotic tissue, and both the transesophageal echocardiography and computed tomographic images revealed no residual shunt. There was only a localized adhesion of the pericardium, where the original LAA was located, without the need for antibiotic or steroid administration. The postprocedural internal surface of the ligated LAA was smooth by virtue of intimal growth. Blood tests showed a slight elevation of the inflammatory markers, but this normalized spontaneously. Conclusions-Pericardial endoscopy-guided LAA ligation could provide an alternative, minimally invasive, and feasible solution for LAA closure that does not require vascular access or a transseptal puncture.

Visualization of the right adrenal vein using CT during right inferior phrenic arteriography in hepatocellular carcinoma patients

Oguro S., Nakatsuka S., Jinzaki M., Misu M., Yashiro H., Hashimoto S., Kuribayashi S.

Japanese Journal of Radiology （Japanese Journal of Radiology） 32 （ 11 ） 630 - 636 2014年11月

研究論文（学術雑誌）, 共著, ISSN 1867-1071

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Successful second attempt multidetector computed tomography-guided percutaneous transluminal septal myocardial ablation for an octogenarian with hypertrophic obstructive cardiomyopathy

Maekawa Y., Jinzaki M., Anzai A., Tsuruta H., Matsumura K., Yamada Y., Tabei R., Kawakami T., Hayashida K., Yuasa S., Murata M., Suzuki M., Kuribayashi S., Fukuda K.

International Journal of Cardiology （International Journal of Cardiology） 176 （ 3 ） e131 - e132 2014年10月

研究論文（学術雑誌）, 共著, ISSN 0167-5273

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A Multi-Institutional Validation of the Prognostic Value of the Neutrophil-to-Lymphocyte Ratio for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy

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

Annals of Surgical Oncology （Annals of Surgical Oncology） 21 （ 12 ） 4041 - 4048 2014年10月

研究論文（学術雑誌）, 共著, ISSN 1068-9265

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Abdominal CT: An intra-individual comparison between virtual monochromatic spectral and polychromatic 120-kVp images obtained during the same examination

Yamada Y., Jinzaki M., Hosokawa T., Tanami Y., Abe T., Kuribayashi S.

European Journal of Radiology （European Journal of Radiology） 83 （ 10 ） 1715 - 1722 2014年10月

研究論文（学術雑誌）, 共著, ISSN 0720048X

Objectives To compare quantitative and subjective image quality between virtual monochromatic spectral (VMS) and conventional polychromatic 120-kVp imaging performed during the same abdominal computed tomography (CT) examination. Materials and methods Our institutional review board approved this prospective study; each participant provided written informed consent. 51 patients underwent sequential fast kVp-switching dual-energy (80/140 kVp, volume CT dose index: 12.7 mGy) and single-energy (120-kVp, 12.7 mGy) abdominal enhanced CT over an 8 cm scan length with a random acquisition order and a 4.3-s interval. VMS images with filtered back projection (VMS-FBP) and adaptive statistical iterative reconstruction (so-called hybrid IR) (VMS-ASIR) (at 70 keV), as well as 120-kVp images with FBP (120-kVp-FBP) and ASIR (120-kVp-ASIR), were generated from dual-energy and single-energy CT data, respectively. The objective image noises, signal-to-noise ratios and contrast-to-noise ratios of the liver, kidney, pancreas, spleen, portal vein and aorta, and the lesion-to-liver and lesion-to-kidney contrast-to-noise ratios were measured. Two radiologists independently and blindly assessed the subjective image quality. The results were analyzed using the paired t-test, Wilcoxon signed rank sum test and mixed-effects model with Bonferroni correction. Results VMS-ASIR images were superior to 120-kVp-FBP, 120-kVp-ASIR and VMS-FBP images for all the quantitative assessments and the subjective overall image quality (all P < 0.001), while VMS-FBP images were superior to 120-kVp-FBP and 120-kVp-ASIR images (all P < 0.004). Conclusions VMS images at 70 keV have a higher image quality than 120-kVp images, regardless of the application of hybrid IR. Hybrid IR can further improve the image quality of VMS imaging. © 2014 Elsevier Ireland Ltd.

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泌尿器疾患のガイドライン-診療の流れと画像検査の位置づけ- 腎腫瘍

秋田大宇, 陣崎雅弘

画像診断（学研メディカル秀潤社） 34 （ 12 ） 1285 - 1295 2014年09月

ISSN 0285-0524

Feasibility of coronary artery calcium scoring on virtual unenhanced images derived from single-source fast kVp-switching dual-energy coronary CT angiography

Yamada Y., Jinzaki M., Okamura T., Yamada M., Tanami Y., Abe T., Kuribayashi S.

Journal of Cardiovascular Computed Tomography （Journal of Cardiovascular Computed Tomography） 8 （ 5 ） 391 - 400 2014年09月

研究論文（学術雑誌）, 共著, ISSN 1934-5925

Background: Dual-energy CT technology enables acquisition of virtual unenhanced (VUE) images from contrast-enhanced scans. Objective: To assess the feasibility of coronary artery calcium (CAC) scoring on VUE images derived from fast kVp-switching dual-energy coronary CT angiography. Methods: Twenty-seven patients underwent true noncontrast CAC-scoring CT followed by routine single-energy (120-kVp) and fast kVp-switching dual-energy coronary CT angiography, in a random acquisition order on the same day. We calculated the CAC scores on true noncontrast and VUE images. The image noises and the signal-to-noise and contrast-to-noise ratios of the aorta and coronary arteries were measured on both the single-energy coronary CT angiography images and dual-energy coronary CT angiography images (70 keV virtual monochromatic spectral images). The Pearson correlation coefficient test and paired t test were used for statistical analysis. Results: Excellent correlation was observed between the CAC scores on the true noncontrast and those on the VUE images (. r = 0.88; P <001). Compared with single-energy coronary CT angiography, dual-energy coronary CT angiography showed significantly reduced image noise and increased signal-to-noise and contrast-to-noise ratios in all regions (all P <001). The effective dose of dual-energy coronary CT angiography (4.3 ± 0.3 mSv) was significantly lower than that of true noncontrast CAC-scoring CT plus single-energy coronary CT angiography (5.4 ± 0.7 mSv; P <0001). Conclusions: Excellent correlation was observed between the CAC scores on the VUE images and true noncontrast images. Thus, fast kVp-switching dual-energy coronary CT angiography could allow prediction of the true CAC scores, potentially reducing the total radiation exposure and image acquisition time by obviating the need for true noncontrast CAC-scoring CT.

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Utility of the reverse wire technique in multidetector computed tomography-guided percutaneous transluminal septal myocardial ablation

Maekawa Y., Jinzaki M., Anzai A., Matsumura K., Tsuruta H., Kawakami T., Hayashida K., Yuasa S., Murata M., Suzuki M., Kuribayashi S., Fukuda K.

International Journal of Cardiology （International Journal of Cardiology） 173 （ 3 ） 2014年05月

研究論文（学術雑誌）, 共著, ISSN 0167-5273

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放射線科医が診断すべき日常診療で迷う症例 (第11章)泌尿器　腎・上部尿路・膀胱・副腎で迷う症例の鑑別

陣崎雅弘, 秋田大宇, 谷本伸弘

画像診断（学研メディカル秀潤社） 34 （ 4 ） s212 - s221 2014年03月

ISSN 0285-0524

Multidetector computed tomography-guided percutaneous transluminal septal myocardial ablation in a Noonan syndrome patient with hypertrophic obstructive cardiomyopathy

Maekawa Y., Jinzaki M., Tsuruta H., Yamada Y., Kishino Y., Kawakami T., Hayashida K., Yuasa S., Murata M., Kawamura A., Sano M., Kuribayashi S., Fukuda K.

International Journal of Cardiology （International Journal of Cardiology） 172 （ 1 ） 2014年03月

研究論文（学術雑誌）, 共著, ISSN 0167-5273

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Metastatic behavior of upper tract urothelial carcinoma after radical nephroureterectomy: Association with primary tumor location

Tanaka N., Kikuchi E., Kanao K., Matsumoto K., Kobayashi H., Ide H., Miyazaki Y., Obata J., Hoshino K., Shirotake S., Akita H., Kosaka T., Miyajima A., Momma T., Nakagawa K., Hasegawa S., Nakajima Y., Jinzaki M., Oya M.

Annals of Surgical Oncology （Annals of Surgical Oncology） 21 （ 3 ） 1038 - 1045 2014年03月

研究論文（学術雑誌）, 共著, ISSN 1068-9265

Purpose: To investigate the site-specific pattern of disease recurrence and/or metastasis and the associated patient outcomes after radical nephroureterectomy (RNU) in upper tract urothelial carcinoma (UTUC). Methods: A total of 733 patients with UTUC from a retrospective multi-institutional cohort were included, with a median follow-up of 34 months. Associated patient outcomes were analyzed by multivariate analysis. To evaluate the influence of primary tumor location, we divided it into four areas: renal pelvis, and upper, middle, and lower ureter. Results: A total of 218 patients experienced disease recurrence, with the majority of relapses occurring within the first 3 years. Cumulative incidence rates of first disease recurrence at 1 and 3 years were 18.9 and 29.8 %, respectively. Of these patients, 38.5 % developed distant recurrence; 17.4 % experienced both local and distant recurrences; and 44.0 % developed isolated local recurrence. The predominant sites of distant metastasis were lung, liver, and bone. Multivariate analysis revealed that the prevalence of local recurrence and lung metastasis was significantly associated, with primary tumor location being independent of other clinicopathological variables. Lower/middle ureter tumors had a higher rate of local recurrence in the pelvic cavity, and renal pelvic tumors had a higher prevalence of distant relapse in the lungs. Similar results were obtained when rerunning the data set by excluding patients who received adjuvant chemotherapy (n = 131). Conclusions: This multi-institutional study provided a detailed picture of metastatic behavior after RNU, and primary tumor locations were associated with unique patterns of metastatic spread in UTUC patients. © 2013 Society of Surgical Oncology.

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The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma: A multi-institutional study11This work was supported in part by Grants-in-Aid for Scientific Research (#24791671 to Tanaka N.) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.

Tanaka N., Kikuchi E., Kanao K., Matsumoto K., Shirotake S., Kobayashi H., Miyazaki Y., Ide H., Obata J., Hoshino K., Hayakawa N., Kosaka T., Oyama M., Miyajima A., Momma T., Nakagawa K., Jinzaki M., Nakajima Y., Oya M.

Urologic Oncology: Seminars and Original Investigations （Urologic Oncology: Seminars and Original Investigations） 32 （ 1 ） 48.e19 - 48.e26 2014年01月

研究論文（学術雑誌）, 共著, ISSN 1078-1439

Background and objective: Few studies have addressed the predictive value of positive urine cytology for prognosis in patients with upper tract urothelial carcinoma (UTUC). We investigated whether the status of preoperative urine cytology could provide additional prognostic information following radical nephroureterectomy (RNU). Materials and methods: The study included 474 patients with primary nonmetastatic UTUC (pTa-4N0M0) from a retrospective multi-institutional cohort. The median follow-up period was 35 months. Associations between the status of urine cytologic evaluation and outcomes were analyzed using multivariate Cox regression models. Urine cytology was evaluated preoperatively using voided samples. Disease recurrence was defined as any relapse in nonbladder lesions and was coded separately from intravesical recurrence. Results: Positive urine cytology was detected in 184 patients (38.8%) preoperatively. Disease recurrence occurred in 127 patients, while intravesical recurrence occurred in 219 patients; 83 patients died of UTUC during follow-up. Kaplan-Meier analysis revealed that only the incidence of intravesical recurrence was significantly associated with the status of urine cytologic evaluation (P = 0.024); the intravesical recurrence-free survival rates at 1 and 3 years following RNU were 61.4% and 46.2% in patients with positive urine cytology and 71.1% and 51.6% in their counterparts, respectively. Multivariate analysis showed that gender (hazard ratio [HR] = 1.74, 95% confidence interval [CI]; 1.28-2.43), tumor multifocality in RNU specimens (HR = 1.64, 95% CI; 1.09-2.47), and positive urine cytology (HR = 1.41, 95% CI; 1.08-1.85) were independent risk factors for subsequent intravesical recurrence. Conclusions: The results showed the prognostic value of positive urine cytology in patients with primary UTUC, and preoperative positive urine cytology may be associated with a significant increase in the prevalence of intravesical recurrence following RNU. © 2014 Elsevier Inc.

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

Nakahara T., Jinzaki M., Niwamae N., Saito Y., Arai M., Tsushima Y., Kuribayashi S., Kurabayashi M.

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

研究論文（学術雑誌）, 共著, ISSN 1934-5925

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

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Surgical anatomy imaging associated with cervical cancer treatment: A cadaveric study

Nakamura M., Fujii T., Imanishi N., Jinzaki M., Yamada M., Kuribayashi S., Aoki D.

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

研究論文（学術雑誌）, 共著, ISSN 0897-3806

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

Renal angiomyolipoma: A radiological classification and update on recent developments in diagnosis and management

Jinzaki M., Silverman S.G., Akita H., Nagashima Y., Mikami S., Oya M.

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

研究論文（学術雑誌）, 共著, ISSN 0942-8925

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

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

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

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

研究論文（学術雑誌）, 共著, ISSN 0009-9252

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

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

Hattori S., Kosaka T., Mizuno R., Kanao K., Miyajima A., Yasumizu Y., Yazawa S., Nagata H., Kikuchi E., Mikami S., Jinzaki M., Nakagawa K., Tanimoto A., Oya M.

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

研究論文（学術雑誌）, 共著, ISSN 1464-4096

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

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Relationship between body mass index and pancreas volume in japanese adults

Kou K., Saisho Y., Jinzaki M., Itoh H.

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

研究論文（学術雑誌）, 共著, ISSN 1590-8577

Renal cell carcinoma in patients with acquired cystic disease of the kidney: Assessment using a combination of T2-weighted, diffusion-weighted, and chemical-shift MRI without the use of contrast material

Akita H., Jinzaki M., Akita A., Mikami S., Oya M., Kuribayashi S.

Journal of Magnetic Resonance Imaging （Journal of Magnetic Resonance Imaging） 39 （ 4 ） 924 - 930 2014年

研究論文（学術雑誌）, 共著, ISSN 1053-1807

Purpose To evaluate the MRI findings of renal cell carcinoma (RCC), including findings on diffusion-weighted images (DWIs) and chemical shift images (CSIs), in patients with acquired cystic disease of the kidney (ACDK) in relation to the histopathologic findings. Materials and Methods Two radiologists retrospectively reviewed the MRI findings of 10 RCCs in seven consecutive patients with ACDK. They evaluated the signal intensities (SIs) and signal homogeneity of the lesions on T2-weighted images, DWIs, and T1-weighted images. Thereafter, they evaluated the cytoplasmic fat in the lesions by CSIs. After image analyses, the MRI findings were correlated with the histopathologic findings. Results The RCCs tended to show heterogeneous high SIs on T2-weighted images and DWIs. The high SIs on DWIs were mainly attributable to the viable parts, and the heterogeneity was due to the various SIs arising from the intratumoral degenerative components. Unlike the reported findings for hemorrhagic cysts, the RCCs did not show homogeneous high SIs or fluid-iron levels on T1-weighted images. The four lesions, in which the presence of cytoplasmic fat was suggested on CSIs, were clear cell RCCs. Conclusion The MRI findings, including findings on DWIs and CSIs, well reflected the histopathologic findings of RCC in patients with ACDK. © 2013 Wiley Periodicals, Inc.

Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: The CORE320 study

Rochitte C.E., George R.T., Chen M.Y., Arbab-Zadeh A., Dewey M., Miller J.M., Niinuma H., Yoshioka K., Kitagawa K., Nakamori S., Laham R., Vavere A.L., Cerci R.J., Mehra V.C., Nomura C., Kofoed K.F., Jinzaki M., Kuribayashi S., De Roos A., Laule M., Tan S.Y., Hoe J., Paul N., Rybicki F.J., Brinker J.A., Arai A.E., Cox C., Clouse M.E., Di Carli M.F., Lima J.A.C.

European Heart Journal （European Heart Journal） 35 （ 17 ） 1120 - 1130 2014年

研究論文（学術雑誌）, 共著, ISSN 0195-668X

Aims To evaluate the diagnostic power of integrating the results of computed tomography angiography (CTA) and CT myocardial perfusion (CTP) to identify coronary artery disease (CAD) defined as a flow limiting coronary artery stenosis causing a perfusion defect by single photon emission computed tomography (SPECT). Methods and results We conducted a multicentre study to evaluate the accuracy of integrated CTA-CTP for the identification of patients with flow-limiting CAD defined by ≥50% stenosis by invasive coronary angiography (ICA) with a corresponding perfusion deficit on stress single photon emission computed tomography (SPECT/MPI). Sixteen centres enroled 381 patients who underwent combined CTA-CTP and SPECT/MPI prior to conventional coronary angiography. All four image modalities were analysed in blinded independent core laboratories. The prevalence of obstructive CAD defined by combined ICA-SPECT/MPI and ICA alone was 38 and 59%, respectively. The patient-based diagnostic accuracy defined by the area under the receiver operating characteristic curve (AUC) of integrated CTA-CTP for detecting or excluding flow-limiting CAD was 0.87 [95% confidence interval (CI): 0.84-0.91]. In patients without prior myocardial infarction, the AUC was 0.90 (95% CI: 0.87-0.94) and in patients without prior CAD the AUC for combined CTA-CTP was 0.93 (95% CI: 0.89-0.97). For the combination of a CTA stenosis ≥50% stenosis and a CTP perfusion deficit, the sensitivity, specificity, positive predictive, and negative predicative values (95% CI) were 80% (72-86), 74% (68-80), 65% (58-72), and 86% (80-90), respectively. For flow-limiting disease defined by ICA-SPECT/MPI, the accuracy of CTA was significantly increased by the addition of CTP at both the patient and vessel levels. Conclusions The combination of CTA and perfusion correctly identifies patients with flow limiting CAD defined as ≥50 stenosis by ICA causing a perfusion defect by SPECT/MPI. © The Author 2013.

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A randomized, double-blind, placebo-controlled, phase III study of the short-acting β<inf>1</inf>-adrenergic receptor blocker Landiolol hydrochloride for coronary computed tomography angiography in Japanese patients with suspected ischemic cardiac disease

Hirano M., Yamashina A., Hara K., Ikari Y., Jinzaki M., Iino M., Yamaguchi T., Tanimoto M., Kuribayashi S.

Clinical Drug Investigation （Clinical Drug Investigation） 34 （ 1 ） 53 - 62 2014年

研究論文（学術雑誌）, 共著, ISSN 1173-2563

Objectives and Background: The objective of this study was to investigate the image quality-improving and heart rate-lowering effects of landiolol hydrochloride (a short-acting β1-adrenergic receptor blocker) on coronary computed tomography angiography (CCTA). During CCTA, β-adrenergic receptor blockers have been commonly used to lower heart rate and improve image quality. Methods: A total of 258 subjects suspected of having ischemic cardiac disease and requiring CCTA were randomized to either a landiolol hydrochloride 0.125 mg/kg group or placebo group to study the efficacy and safety of landiolol hydrochloride in a multicenter, double-blind, randomized parallel study. The primary endpoint was the diagnosable proportion (proportion of subjects whose coronary stenosis was diagnosable). Results: The diagnosable proportions about the reconstruction images at mid-diastole were 68.2 and 38.2 % in the landiolol hydrochloride and placebo group, respectively, indicating significant superiority of landiolol hydrochloride over placebo (p < 0.0001). The diagnosable proportions about the optimal reconstruction images were 81.4 and 54.2 % in the landiolol hydrochloride and placebo group, respectively, indicating significant superiority of landiolol hydrochloride over placebo (p < 0.0001). The mean heart rate-lowering effect was first observed soon after administration of landiolol hydrochloride, was most marked at 3-5 min, and disappeared 30 min after completion of administration. The mean heart rate-lowering proportion at that time was -19.1 ± 8.1 % and -5.9 ± 9.7 % in the landiolol hydrochloride and placebo groups, respectively, showing a significantly higher proportion in the landiolol hydrochloride group. Conclusions: Landiolol hydrochloride was confirmed to significantly and rapidly lower heart rate after intravenous injection, suggesting that it is a safe and useful agent for improving the image quality of CCTA. © 2013 The Author(s).

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Independent predictors for bladder outcomes after treatment of intravesical recurrence following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma

Tanaka N., Kikuchi E., Kanao K., Matsumoto K., Shirotake S., Kobayashi H., Miyazaki Y., Ide H., Obata J., Hoshino K., Hayakawa N., Hagiwara M., Kosaka T., Oyama M., Miyajima A., Momma T., Nakagawa K., Jinzaki M., Hasegawa S., Nakajima Y., Oya M.

Annals of Surgical Oncology （Annals of Surgical Oncology） 21 （ 9 ） 3151 - 3158 2014年

研究論文（学術雑誌）, 共著, ISSN 1068-9265

Background. Few studies have described the clinical courses and outcomes in the bladder after treatment of intravesical recurrence after radical nephroureterectomy (RNU) in patients with primary upper tract urothelial carcinoma (UTUC). We investigated the indicators for predicting subsequent bladder outcomes after treatment of intravesical recurrence after RNU. Methods. A total of 241 patients with primary UTUC (pTa-4N0M0) who experienced intravesical recurrence after RNU were included. Of these patients, 101 (41.9 %) underwent Bacillus Calmette-Guérin treatments, whereas 49 (20.3 %) underwent intravesical chemotherapy. The median follow-up period after initial transurethral resection of the bladder tumor was 33 months. Relationships with bladder outcomes were analyzed by using multivariable analysis. Results. Ninety-six patients experienced intravesical recurrence, and bladder progression was observed in 13. Cumulative incidence rates of intravesical recurrence at 1 and 5 years after treatment of the first intravesical recurrence were 31.0 and 48.4 %, whereas those of bladder progression at 1 and 5 years thereafter were 2.4 and 8.0 %. Multivariate analysis showed that the number of recurrent tumors and pT1 tumors at the time of the first intravesical relapse were independent risk factors for subsequent intravesical recurrence. With respect to bladder progression, multivariate analysis showed that pT1 tumors, the appearance of concomitant carcinoma-in situ at the time of the first intravesical relapse, and the absence of the Bacillus Calmette-Guérin treatment were independent risk factors. Conclusions. This retrospective study presents a detailed picture of further bladder outcomes after intravesical recurrence after RNU in primary UTUC patients. The results may assist physicians to develop a more rational protocol in bladder surveillance. © 2014 Society of Surgical Oncology.

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Cryoablation of early-stage primary lung cancer

Inoue M., Nakatsuka S., Jinzaki M.

BioMed Research International （BioMed Research International） 2014 1 - 8 2014年

研究論文（学術雑誌）, 共著, ISSN 2314-6133

Worldwide, lung cancer is the most commonly diagnosed cancer, and lobectomy is the gold-standard treatment for early-stage non-small cell lung cancer (NSCLC). However, many patients are poor surgical candidates for various reasons. Recently, image-guided ablation is being used for lung tumors. Cryoablation has been applied for the treatment of cancer in various nonaerated organs; recently it has been adapted to the treatment of lung tumors. Since an ice ball can be detected by computed tomography (CT), cryoablation of lung tumors is performed under CT guidance. Its first clinical application was reported in 2005, and it has been reported to be feasible in a few studies. Minor complications occurred at a high frequency (up to 70.5%), but major complications were rare (up to 1%). The most common complication is pneumothorax, and most cases need no further intervention. Local efficacy depends on tumor size and presence of a thick vessel close to the tumor. Midterm survival after cryoablation is 77%-88% at 3 years in patients with early-stage NSCLC. Although surgery is the gold-standard treatment for such patients, the initial results of cryoablation are promising. In this paper, the current status of cryoablation for primary lung tumors is reviewed. © 2014 Masanori Inoue et al.

1P2-U04 ヒト足部機能解明のための屍体足人工筋骨格歩行シミュレータの開発(移動知と身体性システム科学)

久米真之介, 伊藤幸太, 細田耕, 荻原直道, 清水正宏, 池本周平, 陣崎雅弘, 名倉武雄, 中村俊康, 今西宣晶, 相磯貞和

ロボティクス・メカトロニクス講演会講演概要集（一般社団法人日本機械学会） 2014 （ 0 ） _1P2-U04_1 - _1P2-U04_4 2014年

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

いま、注目の疾患2014 泌尿器・男性生殖器(症例1)　類上皮血管筋脂肪腫

塚田実郎, 陣崎雅弘, 栗林幸夫

画像診断（学研メディカル秀潤社） 34 （ 1 ） 68 - 69 2013年12月

ISSN 0285-0524

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

秋田大宇, 陣崎雅弘

画像診断（学研メディカル秀潤社） 34 （ 1 ） 70 - 71 2013年12月

ISSN 0285-0524

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

Hasegawa M., Miyajima A., Jinzaki M., Maeda T., Takeda T., Kikuchi E., Shibata H., Oya M.

Urology （Urology） 82 （ 6 ） 1312 - 1318 2013年12月

研究論文（学術雑誌）, 共著, ISSN 0090-4295

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

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

Kaneko G., Miyajima A., Yuge K., Hasegawa M., Takeda T., Jinzaki M., Kikuchi E., Nakagawa K., Oya M.

Urology （Urology） 82 （ 6 ） 1304 - 1309 2013年12月

研究論文（学術雑誌）, 共著, ISSN 0090-4295

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

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Epithelioid angiomyolipoma of the kidney: Radiological imaging

Tsukada J., Jinzaki M., Yao M., Nagashima Y., Mikami S., Yashiro H., Nozaki M., Mizuno R., Oya M., Kuribayashi S.

International Journal of Urology （International Journal of Urology） 20 （ 11 ） 1105 - 1111 2013年11月

研究論文（学術雑誌）, 共著, ISSN 0919-8172

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

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Differential diagnosis of upper urinary tract disorders

Yazawa S., Kikuchi E., Oya M., Jinzaki M.

Japanese Journal of Clinical Urology （Japanese Journal of Clinical Urology） 67 （ 11 ） 863 - 870 2013年10月

研究論文（学術雑誌）, 共著, ISSN 0385-2393

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

秋田大宇, 陣崎雅弘, 大家基嗣

画像診断（学研メディカル秀潤社） 33 （ 11 ） s163 - s166 2013年09月

ISSN 0285-0524

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

秋田大宇, 陣崎雅弘, 大家基嗣

画像診断（学研メディカル秀潤社） 33 （ 11 ） s158 - s162 2013年09月

ISSN 0285-0524

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

秋田大宇, 陣崎雅弘, 大家基嗣

画像診断（学研メディカル秀潤社） 33 （ 11 ） s152 - s157 2013年09月

ISSN 0285-0524

Dose-Finding study of landiolol hydrochloride: A short-acting Β<inf>1</inf>-Blocker for controlling heart rate during coronary computed-Tomography angiography in japan

Hirano M., Hara K., Ikari Y., Jinzaki M., Iino M., Hamada C., Kuribayashi S.

Advances in Therapy （Advances in Therapy） 30 （ 9 ） 803 - 818 2013年09月

研究論文（学術雑誌）, 共著, ISSN 0741-238X

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

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Tomosynthesis for the early detection of pulmonary emphysema: Diagnostic performance compared with chest radiography, using multidetector computed tomography as reference

Yamada Y., Jinzaki M., Hashimoto M., Shiomi E., Abe T., Kuribayashi S., Ogawa K.

European Radiology （European Radiology） 23 （ 8 ） 2118 - 2126 2013年08月

研究論文（学術雑誌）, 共著, ISSN 0938-7994

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

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

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

Diseases of the Esophagus （Diseases of the Esophagus） 26 （ 6 ） 616 - 622 2013年08月

研究論文（学術雑誌）, 共著, ISSN 1120-8694

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

Three-dimensional imaging and mapping of the right and left phrenic nerves: Relevance to interventional cardiovascular therapy

Fukumoto K., Takatsuki S., Jinzaki M., Yamada M., Tanimoto K., Nishiyama N., Aizawa Y., Hagiwara Y., Fukuda Y., Kimura T., Miyoshi S., Kuribayashi S., Fukuda K.

Europace （Europace） 15 （ 7 ） 937 - 943 2013年07月

研究論文（学術雑誌）, 共著, ISSN 1099-5129

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

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Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores

Kimura T., Takatsuki S., Inagawa K., Katsumata Y., Nishiyama T., Nishiyama N., Fukumoto K., Aizawa Y., Tanimoto Y., Tanimoto K., Jinzaki M., Fukuda K.

Heart Rhythm （Heart Rhythm） 10 （ 6 ） 921 - 925 2013年06月

研究論文（学術雑誌）, 共著, ISSN 1547-5271

BACKGROUND Strokes develop even in patients with low CHADS2 scores, and the left atrial appendage (LAA) is the embolic source 90% of the time. We focused on the LAA morphology as a new predictor of strokes. OBJECTIVE To clarify the anatomical characteristics of the LAA for risk stratification of strokes in patients with nonvalvular atrial fibrillation (AF) who have low CHADS2 scores. METHODS Among 80 patients who underwent catheter ablation of AF with contrast-enhanced computed tomography, the LAA characteristics were compared between 30 patients with histories of strokes and 50 age-matched controls. The LAA anatomy was classified into 4 types-"cactus," "cauliflower," "chicken wing," and "windsock"- discriminated by the computed tomography measurements of the length, angle, and number of lobes of the LAA. RESULTS The average CHADS2 score did not differ significantly between patients with stroke and controls (0.8 ± 0.8 vs 0.6 ± 0.7; P = .277). Eight (26.7%) patients with stroke had CHA2DS2-VASc scores of 0. The left atrial size, LAA flow velocity, left ventricular function, and serum brain natriuretic peptide level were also unable to predict strokes. However, a "cauliflower" LAA, defined as a main lobe of less than 4 cm long without forked lobes, was significantly more common in patients with stroke (odds ratio 3.857; 95% confidence interval 1.482-10.037; P = .005). The CHA 2DS2-VASc score-adjusted logistic regression analysis revealed the cauliflower LAA as an independent predictor of a stroke (odds ratio 3.355; 95% confidence interval 1.243-9.055; P = .017). CONCLUSIONS The LAA anatomy might be useful for predicting strokes in patients with nonvalvular AF who have low CHADS2 scores. © 2013 Heart Rhythm Society. All rights reserved.

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A randomized, double-blind, placebo-controlled, phase II dose-finding study of the short acting β<inf>1</inf>-blocker, landiolol hydrochloride, in patients with suspected ischemic cardiac disease

Jinzaki M., Hirano M., Hara K., Suzuki T., Yamashina A., Ikari Y., Iino M., Yamaguchi T., Kuribayashi S.

International Journal of Cardiovascular Imaging （International Journal of Cardiovascular Imaging） 29 （ 1 SUPPL. ） 7 - 20 2013年06月

研究論文（学術雑誌）, 共著, ISSN 1569-5794

The purpose of this study was to compare the safety and efficacy of the short-acting β1-receptor blocker, landiolol hydrochloride (0.06 and 0.125-mg/kg), to placebo during coronary computed tomography angiography (CTA) in a phase 2 dose-finding study. A total of 183 patients suspected of having ischemic cardiac disease and scheduled to undergo an invasive coronary angiography were randomized to groups treated with landiolol hydrochloride (0.06 or 0.125-mg/kg) or placebo. The heart rate, safety, and the performance of coronary diagnosis using landiolol hydrochloride were evaluated in a multicenter, doubleblind, randomized, parallel study. The patients' heart rates during the coronary CTA were 67.6 ± 8.7 and 62.6 ± 7.8 beats/min in the 0.06 and 0.125-mg/kg landiolol hydrochloride groups, respectively, both of which were significantly lower than the heat rate of 73.7 ± 11.8 beats/min in the placebo group (P = 0.003 and P<0.001, respectively). No adverse events or reactions occurred at an incidence of 5 % or greater, confirming the safety of landiolol hydrochloride. The proportion of correctly classified patients was significantly higher in the 0.125-mg/kg landiolol hydrochloride group than in the placebo group (73.6 vs. 50.0 %). Landiolol hydrochloride at doses of 0.06 and 0.125-mg/kg significantly decreased the heart rate compared with a placebo. The present findings suggest that landiolol hydrochloride is safe and useful at a dose of 0.125-mg/kg to improve coronary diagnostic performance during coronary CTA. © Springer Science+Business Media Dordrecht 2013.

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Three-dimensional demonstration of the lymphatic system in the lower extremities with multi-detector-row computed tomography: A study in a cadaver model

Yamazaki S., Suami H., Imanishi N., Aiso S., Yamada M., Jinzaki M., Kuribayashi S., Chang D.W., Kishi K.

Clinical Anatomy （Clinical Anatomy） 26 （ 2 ） 258 - 266 2013年

研究論文（学術雑誌）, 共著, ISSN 0897-3806

Sentinel lymph node biopsy (SLNB) has had a great impact on the staging and treatment of cancer. The purpose of this study was to study the lymphatic anatomy of the lower extremities by constructing three-dimensional images using multi-detector-row computed tomography (MDCT). To select appropriate contrast media for MDCT lymphatic imaging in a cadaver, we tested four kinds of contrast media by injecting them into fresh swine kidneys. After the suitable contrast medium was selected, 10 lower extremities from 5 fresh cadavers were studied. After injection of the contrast medium, each lower extremity was scanned with high-spatial-resolution MDCT. The zinc oxide mixture was found to be the most appropriate contrast formula for MDCT imaging of cadaver lymphatics in terms of CT value and no extravasation. The high-resolution MDCT imaging revealed two different superficial lymphatic pathways in the legs. One lymphatic pathway accompanying the great saphenous vein had a constant course and was connected to the superficial inguinal lymph nodes. However, another pathway, along the small saphenous vein, was variable. Some of the deep lymphatic vessels bypassed the inguinal lymph nodes. Using a new protocol, we were able to construct three-dimensional images of the lower extremity lymphatics in a cadaver model. MDCT imaging provided novel information about two different superficial lymphatic pathways in the lower extremities. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.

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What is the most effective tool for detecting prostate cancer using a standard MR scanner?

Osugi K., Tanimoto A., Nakashima J., Shinoda K., Hashiguchi A., Oya M., Jinzaki M., Kuribayashi S.

Magnetic Resonance in Medical Sciences （Magnetic Resonance in Medical Sciences） 12 （ 4 ） 271 - 280 2013年

研究論文（学術雑誌）, 共著, ISSN 1347-3182

Purpose: We aimed to determine which of the following magnetic resonance (MR) imaging sequences is most effective for detecting prostate cancer: T2-weighted (T2W), dynamic contrast-enhanced (DCE) T1-weighted (T1W), or diffusion-weighted (DWI) imaging or apparent diffusion coefficient (ADC) mapping. Materials and Methods: We included 37 male patients with prostate cancer who underwent MR imaging before radical prostatectomy in this retrospective study. Sixty-four foci (>5 mm in size; 35 in the peripheral zone [PZ], 29 in the transitional zone [TZ]) were histopathologically determined to be prostate cancer. We determined the capacity of T2W, DCE-T1W, DWI, ADC mapping alone, and the combination of ADC mapping with DWI, and conventional MR sequences to detect prostate cancer, including their sensitivity and positive predictive value (PPV), with reference to the results obtained in histopathological examinations of whole-mount sections. Results: In the PZ, sensitivities were 31.4% (T2W), 37.1% (DCE-T1W), 51.4% (DWI), and 71.4% (ADC mapping); PPVs were 78.6% (T2W), 92.9% (DCE-T1W), 94.7% (DWI), and 96.0% (ADC mapping). Sensitivity was significantly higher of ADC mapping than other sequences. In the TZ, sensitivities were 55.1% (T2W), 44.8% (DCE-T1W), 82.8% (DWI), and 89.7% (ADC mapping); PPVs were 64.0% (T2W), 46.4% (DCE-T1W), 70.6% (DWI), and 72.2% (ADC mapping). Sensitivity was significantly higher of ADC mapping and DWI than conventional MR imaging, but there was no significant correlation between DWI/ADC mapping and T2W/DCE-T1W with respect to PPVs. Combining sequences did not improve sensitivity; only the PPV in the TZ improved when ADC mapping was combined with DCE-T1W. Conclusion: ADC mapping is the most effective standard MR imaging tool for detecting prostate cancer. The addition of DCE-T1W may improve the PPV of ADC mapping for diagnosing cancer in the TZ. © 2013 Japanese Society for Magnetic Resonance in Medicine.

1P1-N03 解剖学的に詳細なヒト足部の3次元FEモデルによる歩行時のGRF解析(筋骨格モデリング)

小林太樹, 清水正宏, 荻原直道, 名倉武雄, 中村俊康, 陣崎雅弘, 細田耕

ロボティクス・メカトロニクス講演会講演概要集（一般社団法人日本機械学会） 2013 （ 0 ） _1P1-N03_1 - _1P1-N03_4 2013年

Humans can walk stably and efficiently. One of the most distinctive characteristics of human waking is two-peaked vertical ground force (GRF), which generate efficient human walking. A part of such characteristics is brought by the mechanical characteristics of the human foot, that is the mechanical compliance and its complex structure consisting of skins, muscles, ligaments, and bones. The goal of this study is to clarify the generation mechanism of two-peaked GRF of human walking. In this study, we particularly focused on phalangeal ligaments and plantar fascia and analyze their contribution to GRF. To this end, we dealt with anatomically detailed threedimensional dynamical finite element analysis of the human foot. The GRF profiles and plantar pressure distribution was analyzed changing the existence condition of phalangeal ligaments and/or plantar fascia. From the results, it was revealed that phalangeal ligaments and plantar fascia are important to reproduce a two-peaked GRF profiles.

2A1-I02 CTデータに基づく詳細な足モデルおよび人工筋骨格歩行シミュレータの開発(移動知と身体性基盤)

久米真之介, 成岡健一, 細田耕, 荻原直道, 陣崎雅弘, 名倉武雄, 中村俊康, 今西宣晶, 相磯貞和

ロボティクス・メカトロニクス講演会講演概要集（一般社団法人日本機械学会） 2013 （ 0 ） _2A1-I02_1 - _2A1-I02_4 2013年

A human foot complex consists of a flexible flesh and many muscles, ligaments, and bones. Structured compliance provided by the complex structure is supposed to contribute to efficient and stable bipedal locomotion. Detailed behavior of the foot complex during walking, however, is not well understood . We built a gait simulator driven by pneumatic musculoskeletal system in order to clarify the mechanism of a human walking by using the gait simulator with a cadaver foot. This gait simulator duplicates the double support phase in experiment environment. We also made realistic foot model with bones and artificial skin as a test model of new robot foot for testing the performance of the gait simulator.

X線の発明から今日まで-2重エネルギーCTの現状-

陣崎雅弘

臨床画像 12 1454 - 8 2013年

CiNii Research

Dose reduction in chest CT: Comparison of the adaptive iterative dose reduction 3D, adaptive iterative dose reduction, and filtered back projection reconstruction techniques

Yamada Y., Jinzaki M., Hosokawa T., Tanami Y., Sugiura H., Abe T., Kuribayashi S.

European Journal of Radiology （European Journal of Radiology） 81 （ 12 ） 4185 - 4195 2012年12月

研究論文（学術雑誌）, 共著, ISSN 0720-048X

Objectives: To assess the effectiveness of adaptive iterative dose reduction (AIDR) and AIDR 3D in improving the image quality in low-dose chest CT (LDCT). Materials and methods: Fifty patients underwent standard-dose chest CT (SDCT) and LDCT simultaneously, performed under automatic exposure control with noise index of 19 and 38 (for a 2-mm slice thickness), respectively. The SDCT images were reconstructed with filtered back projection (SDCT-FBP images), and the LDCT images with FBP, AIDR and AIDR 3D (LDCT-FBP, LDCT-AIDR and LDCT-AIDR 3D images, respectively). On all the 200 lung and 200 mediastinal image series, objective image noise and signal-to-noise ratio (SNR) were measured in several regions, and two blinded radiologists independently assessed the subjective image quality. Wilcoxon's signed rank sum test with Bonferroni's correction was used for the statistical analyses. Results: The mean dose reduction in LDCT was 64.2% as compared with the dose in SDCT. LDCT-AIDR 3D images showed significantly reduced objective noise and significantly increased SNR in all regions as compared to the SDCT-FBP, LDCT-FBP and LDCT-AIDR images (all, P ≤ 0.003). In all assessments of the image quality, LDCT-AIDR 3D images were superior to LDCT-AIDR and LDCT-FBP images. The overall diagnostic acceptability of both the lung and mediastinal LDCT-AIDR 3D images was comparable to that of the lung and mediastinal SDCT-FBP images. Conclusions: AIDR 3D is superior to AIDR. Intra-individual comparisons between SDCT and LDCT suggest that AIDR 3D allows a 64.2% reduction of the radiation dose as compared to SDCT, by substantially reducing the objective image noise and increasing the SNR, while maintaining the overall diagnostic acceptability. © 2012 Elsevier Ireland Ltd© 2011 Elsevier Ireland Ltd. All rights reserved.

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Visceral obesity is a strong predictor of perioperative outcome in patients undergoing laparoscopic radical nephrectomy

Hagiwara M., Miyajima A., Hasegawa M., Jinzaki M., Kikuchi E., Nakagawa K., Oya M.

BJU International （BJU International） 110 （ 11 C ） 2012年12月

研究論文（学術雑誌）, 共著, ISSN 1464-4096

OBJECTIVE • To examine the impact of visceral fat on surgical complexity in patients undergoing laparoscopic nephrectomy. PATIENTS AND METHODS • We reviewed the medical records of 121 patients who underwent laparoscopic nephrectomy from 2006 to 2010 at our institution. • The total fat area, visceral fat area (VFA) and subcutaneous fat area were measured at the level of the umbilicus using computed tomography (CT). • To identify the type of obesity, we divided VFA into ≥ 100 cm 2 and < 100 cm 2 . A VFA ≥ 100 cm 2 was used as the definition of visceral obesity. • We evaluated the impact of the VFA on technical difficulties encountered during laparoscopic nephrectomy by measuring operating time. RESULTS • A significant correlation was observed between body mass index (BMI) and operating time ( P < 0.001, r =0.316) in the patients undergoing laparoscopic nephrectomy. • VFA was also significantly correlated with operating time ( P < 0.001, r =0.348), and the correlation coefficient of VFA was higher than that of BMI. • Multivariate analysis showed that a high VFA was an independent risk factor for prolonged operating time ( P =0.009, odds ratio; 3.70), whereas BMI was not found to be a risk factor. CONCLUSIONS • The present data indicate that measurement of VFA by CT is of benefit for predicting the technical difficulty associated with laparoscopic radical nephrectomy. • Visceral obesity, which is one factor involved in metabolic syndrome, has a greater impact than BMI on the complexity of laparoscopic radical nephrectomy. © 2012 THE AUTHORS.

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Model-based iterative reconstruction technique for ultralow-dose computed tomography of the lung: A pilot study

Yamada Y., Jinzaki M., Tanami Y., Shiomi E., Sugiura H., Abe T., Kuribayashi S.

Investigative Radiology （Investigative Radiology） 47 （ 8 ） 482 - 489 2012年08月

研究論文（学術雑誌）, 共著, ISSN 0020-9996

Objectives: The aim of this study was to assess the effectiveness of a model-based iterative reconstruction (MBIR) in improving image quality and diagnostic performance of ultralow-dose computed tomography (ULDCT) of the lung. Materials and Methods: The institutional review board approved this study, and all patients provided written informed consent. Fifty-two patients underwent low-dose computed tomography (LDCT) (screening-dose, 50 mAs) and ULDCT (4 mAs) of the lung simultaneously. The LDCT images were reconstructed with filtered back projection (LDCT-FBP images) and ULDCT images were reconstructed with both MBIR (ULDCT-MBIR images) and FBP (ULDCT-FBP images). On all the 156 image series, objective image noise was measured in the thoracic aorta, and 2 blinded radiologists independently assessed subjective image quality. Another 2 blinded radiologists independently evaluated the ULDCT-MBIR and ULDCT-FBP images for the presence of noncalcified and calcified pulmonary nodules; LDCT-FBP images served as the reference. Paired t test, Wilcoxon signed rank sum test, and free-response receiver-operating characteristic analysis were used for statistical analysis of the data. Results: Compared with LDCT-FBP and ULDCT-FBP, ULDCT-MBIR had significantly reduced objective noise (both P <; 0.001). Subjective noise on the ULDCT-MBIR images was comparable with that on the LDCT-FBP images but lower than that on the ULDCT-FBP images (P <; 0.001). Artifacts on ULDCT-MBIR images were more numerous than those on the LDCT-FBP images (P = 0.007) but fewer than those on the ULDCT-FBP images (P <; 0.001). Compared with the LDCT-FBP images, ULDCT-MBIR and ULDCT-FBP images showed reduced image sharpness (both P <; 0.001). All the ULDCT-MBIR images showed a blotchy pixelated appearance; however, the performance of ULDCT-MBIR was significantly superior to that of ULDCT-FBP for the detection of noncalcified pulmonary nodules (P = 0.002). The average true-positive fractions for significantly sized noncalcified nodules (≈4 mm) and small noncalcified nodules (<4 mm) on the ULDCT-MBIR images were 0.944 and 0.884, respectively, when LDCT-FBP images were used as reference. All of the calcified nodules were detected by both the observers on both the ULDCT-MBIR and ULDCT-FBP images. Conclusion: As compared with FBP, MBIR enables significant reduction of the image noise and artifacts and also better detection of noncalcified pulmonary nodules on ULDCT of the lung. Compared with LDCT-FBP images, ULDCT-MBIR images showed significantly reduced objective noise and comparable subjective image noise. Almost all of the noncalcified nodules and all of the calcified nodules could be detected on the ULDCT-MBIR images, when LDCT-FBP images were used as the reference. © 2012 by Lippincott Williams & Wilkins.

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Virtual monochromatic spectral imaging for the evaluation of hypovascular hepatic metastases: The optimal monochromatic level with fast kilovoltage switching dual-energy computed tomography

Yamada Y., Jinzaki M., Tanami Y., Abe T., Kuribayashi S.

Investigative Radiology （Investigative Radiology） 47 （ 5 ） 292 - 298 2012年05月

研究論文（学術雑誌）, 共著, ISSN 0020-9996

Objectives: The purpose of this study was to select the optimal monochromatic level for virtual monochromatic spectral (VMS) imaging to minimize the image noise of the liver parenchyma and to acquire a high contrast-to-noise ratio (CNR) of hypovascular hepatic metastases in the portal-dominant phase. Materials and Methods: This study was conducted with the approval of our institutional review board, and written informed consent was obtained from all the participating patients. Ninety patients with hepatic metastases were scanned by fast kilovoltage switching dual-energy computed tomography in the portal-dominant phase. One hundred one sets of VMS images in the range of 40 to 140 keV at 1-keV intervals were reconstructed. The image noise of the liver parenchyma in each patient and the CNR of each metastasis (n = 303) were measured on all the 101 VMS image sets. Data were analyzed by the paired t test and mixed-effects model. Bonferroni's method was used for multiple comparisons. Results: The lowest noise of the liver parenchyma was obtained in 6, 15, 31, 29, 7, 1, and 1 patient at 67, 68, 69, 70, 71, 72, and 73 keV, respectively. The mean noise of the liver parenchyma on the 69-keV VMS images in all 90 patients was significantly lower than that on the 67-, 68-, 71-, 72-, and 73-keV VMS images (P < 0.001); however, there was no significant difference in the mean noise of the liver parenchyma between the 69-keV and 70-keV VMS images (P = 0.279). For 95% of the hepatic metastases (288/303 metastases), the highest metastasis-to-liver CNR was obtained in the 66-to 71-keV VMS images. The mean metastasis-to-liver CNR for the 303 metastases was numerically highest at 68 keV; however, there was no significant difference in the mean metastasis-to-liver CNR between the 68-keV and 69-keV images (P = 0.737) or between the 68-keV and 70-keV images (P = 0.103). Conclusions: VMS imaging at approximately 70 keV (69-70 keV) yielded the lowest image noise of the liver parenchyma and a high CNR for hypovascular hepatic metastases in the portal-dominant phase. © 2012 by Lippincott Williams & Wilkins.

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Effect of preoperative evaluation by multidetector computed tomography in percutaneous coronary interventions of chronic total occlusions

Ueno K., Kawamura A., Onizuka T., Kawakami T., Nagatomo Y., Hayashida K., Yuasa S., Maekawa Y., Anzai T., Jinzaki M., Kuribayashi S., Ogawa S.

International Journal of Cardiology （International Journal of Cardiology） 156 （ 1 ） 76 - 79 2012年04月

研究論文（学術雑誌）, 共著, ISSN 0167-5273

Background: The prevalence of success of percutaneous coronary interventions (PCIs) of chronic total occlusions (CTOs) remains relatively low. We determined the effect of preoperative multidetector computed tomography coronary angiography (CTCA) in PCIs of CTOs. Methods: The study population was 100 consecutive patients who underwent PCIs of CTOs from January 2005 to December 2007 at Keio University School of Medicine. They were divided into two groups according to the absence (non-CT group, n = 60) or presence (CT group, n = 40) of preoperative CTCA. The effect of preoperative CTCA was assessed in the prevalence of success of the procedure, prevalence of complications, irradiation time, and the dose of contrast agents. Results: The prevalence of procedural success was similar in both groups (non-CT group vs CT group 80.0% vs 77.5%, p = 0.76). Irradiation time and the dose of contrast agents were also similar between these groups. The prevalence of complications was significantly reduced in the CT group (23.3% vs 7.5%, p = 0.039), especially coronary perforations, which required treatment only in the non-CT group (10.0% vs 0.0%, p = 0.039). Multiple logistic regression analysis revealed that use of a rotablator (odds ratio [OR]: 4.40, 95% confidence interval [CI]: 1.19-16.27, p = 0.027) and absence of preoperative CTCA (OR: 4.26, 95% CI: 1.04-17.49, p = 0.044) were independent determinants of complications. Conclusion: Preoperative CTCA does not affect the prevalence of procedural success, irradiation time and the dose of contrast agents, but may be useful to reduce the prevalence of complications during PCIs of CTOs. © 2009 Elsevier Ireland Ltd. All rights reserved.

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Extrapancreatic solid pseudopapillary tumor: Case report and review of the literature

Miyazaki Y., Miyajima A., Maeda T., Yuge K., Hasegawa M., Kosaka T., Kikuchi E., Kameyama K., Jinzaki M., Nakagawa K., Oya M.

International Journal of Clinical Oncology （International Journal of Clinical Oncology） 17 （ 2 ） 165 - 168 2012年04月

研究論文（学術雑誌）, 共著, ISSN 1341-9625

A 22-year-old woman complained of abdominal discomfort. Ultrasonography, computed tomography, and an endocrinologic work-up revealed a 7-cm nonfunctional tumor at the left adrenal lesion. A transumbilical laparo-endoscopic single-site adrenalectomy was successfully completed in 166 min. The postoperative period was uneventful. The pathologic examination confirmed the solid pseudopapillary tumor occurred in the retroperito-neum. There are only five previous reports of extrapan-creatic solid pseudopapillary tumors. In this case, the tumor was separated from the pancreas and no ectopic pancreas was histologically observed. To the best of our knowledge, this case is the first report of a solid pseudopapillary tumor of the retroperitoneum. © 2011 CARS.

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Preoperative hydronephrosis: Independent predictor for changes in renal function following nephroureterectomy

Hoshino K., Kikuchi E., Tanaka N., Akita H., Ito Y., Miyajima A., Jinzaki M., Oya M.

Japanese Journal of Clinical Oncology （Japanese Journal of Clinical Oncology） 42 （ 3 ） 202 - 207 2012年03月

研究論文（学術雑誌）, 共著, ISSN 0368-2811

Objective: Partial or complete urinary obstruction caused by a tumor itself may affect renal function and the eligibility for perioperative cisplatin-based chemotherapy in patients with upper tract urothelial carcinoma. We investigated whether the status of preoperative hydronephrosis provides additional predictive information concerning changes in perioperative renal function. Methods: A total of 155 patients who underwent nephroureterectomy for upper tract urothelial carcinoma from 1997 to 2010 were identified. The association between preoperative parameters including the grade of hydronephrosis and perioperative renal function was analyzed. Results: Hydronephrosis was observed in 104 patients. The grade of hydronephrosis was 1, 2, 3 and 4 in 6 (3.9%), 25 (16.1%), 42 (27.1%) and 31 (20.0%) cases. Using a defined cut-off creatinine clearance value of ≥50 ml/min indicating eligibility for cisplatin-based chemotherapy, only 94 patients (60.6%) were eligible in the neoadjuvant setting. Of these 94 patients, 30 (31.9%) were judged to be ineligible in the adjuvant setting. Multivariate analysis demonstrated that patient age ≥70 years [P < 0.001, hazard ratio (HR) 27.9] and the absence of a higher grade hydronephrosis (P = 0.013, HR 7.40) were independent risk factors for predicting patients ineligible to receive adjuvant cisplatin-based chemotherapy. The proportion of patients ineligible to receive cisplatin-based chemotherapy changed from 40.9 to 88.6% following nephroureterectomy in patients aged ≥70 years and those with no or a lower grade hydronephrosis. Conclusions: The status of hydronephrosis is an independent predictor of eligibility to receive adjuvant cisplatin-based chemotherapy. The information on preoperative hydronephrosis and patient age may assist in part of the decision-making when considering neoadjuvant cisplatin-based chemotherapy. © The Author 2012. Published by Oxford University Press. All rights reserved.

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Acute exacerbation of usual interstitial pneumonia after resection of lung cancer

Sugiura H., Takeda A., Hoshi T., Kawabata Y., Sayama K., Jinzaki M., Kuribayashi S.

Annals of Thoracic Surgery （Annals of Thoracic Surgery） 93 （ 3 ） 937 - 943 2012年03月

研究論文（学術雑誌）, 共著, ISSN 0003-4975

Background: Acute exacerbation of usual interstitial pneumonia is one of the most life-threatening complications after resection of lung cancer. It is important to detect patients at high risk for acute exacerbation. The purpose of this study was to investigate the incidence of postoperative acute exacerbation and the importance of the finding of honeycombing in predicting the risk of it. Methods: From 992 consecutive pulmonary resections for lung cancer, the background lung was retrospectively assessed histologically. Preoperative chest computed tomographic images of those patients with histologically proven usual interstitial pneumonia were retrospectively reassessed and classified into three groups: typical honeycombing, possible honeycombing, and no honeycombing. Records of patients who experienced postoperative acute exacerbation were extracted from the clinical database, and the correlation between computed tomographic findings and incidence of acute exacerbation was analyzed. Results: Of the 992 lung cancer patients, 12 (1.2%) experienced postoperative acute exacerbation. Usual interstitial pneumonia was histologically confirmed in 249 patients, and 4.8% of them experienced postoperative acute exacerbation. No patient without usual interstitial pneumonia experienced it. Preoperative computed tomographic images were available in 205 of the 249 patients. Postoperative acute exacerbation developed in 13.6% of patients (6 of 44 patients) in the typical honeycombing group, 6.4% of patients (5 of 78 patients) in the possible honeycombing group, and 0% of patients (0 of 83 patients) in the no-honeycombing group. Compared with the no-honeycombing group, the incidence of acute exacerbation in the typical and possible honeycombing groups was significantly higher (p = 0.001, p = 0.025, respectively). Conclusions: Physicians should consider the finding of possible honeycombing, as well as typical honeycombing, a potential risk factor for acute exacerbation after pulmonary resection for lung cancer. © 2012 The Society of Thoracic Surgeons.

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Estimation of the left ventricular diastolic function with cardiac MDCT: Correlation of the slope of the time-enhancement-curve with the mitral annulus diastolic velocity

Nakahara T., Jinzaki M., Fukuda N., Takahashi Y., Ishihara T., Takada A., Suzuki K., Manita M., Imanari T., Kanesawa N., Kuribayashi S., Kurabayashi M.

European Journal of Radiology （European Journal of Radiology） 81 （ 2 ） 234 - 238 2012年02月

研究論文（学術雑誌）, 共著, ISSN 0720-048X

Patients with diastolic heart failure tend to have a poor outcome, similar to that for patients with systolic heart failure. The aim of this study was to explore the ability of MDCT to estimate the left ventricular diastolic function. Thirty patients with suspected coronary artery disease underwent MDCT and echocardiography. The early transmitral flow velocities (E) and the velocity of mitral annulus early diastolic motion (e') were measured in order to evaluate the diastolic function. The scanning delay of CT was determined using a test injection technique. The aortic enhancement was measured over the aortic-root lumen, and it was plotted over time to yield a time-enhancement-curve. A gamma variate function was then fit to the time-enhancement-curve and thereafter both the 'slope' of enhancement for each patient and the region of interest [ROI] were calculated. According to a univariate analysis, the slope of the time-enhancement-curve was found to correlate with the e' (r = 0.686, P = 0.000) and E/e' (r = -0.482, P = 0.007), however, no significant correlation was observed with the systolic parameters of the left ventricle. These results indicate that the slope of the time-enhancement-curve in the aorta significantly correlates with e', i.e. the diastolic parameters, which are independent of the systolic parameters. Based on these findings, we propose that the slope of the time-enhancement-curve may serve as a parameter for the left ventricular diastolic function on MDCT. © 2010 Elsevier Ireland Ltd. All rights reserved.

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Improvement of in-stent lumen measurement accuracy with new High-Definition CT in a phantom model: Comparison with conventional 64-detector row CT

Tanami Y., Jinzaki M., Yamada M., Imai Y., Segawa K., Kuribayashi S.

International Journal of Cardiovascular Imaging （International Journal of Cardiovascular Imaging） 28 （ 2 ） 337 - 342 2012年02月

研究論文（学術雑誌）, 共著, ISSN 1569-5794

The purpose of this study was to evaluate improvement of measurement accuracy of in-stent lumen using coronary stent phantoms on new High-Definition CT (HDCT) compared with conventional 64 detector-row CT (MDCT). To estimate the spatial resolution, a high-resolution insert of CATPHAN (The Phantom Laboratory, NY, USA) was scanned by both HDCT (DiscoveryCT750HD) andMDCT(LightSpeed VCT). Also, we developed six types of stent phantom, which have 2.5- and 3.0-mm-diameter with three different types of stents (Velocity: Johnson & Johnson, Driver: Medtronic, Multilink-Rx: Guidant). A 50% stenotic segment made of acrylic resin was built at the center inside the stent. Those coronary vessel phantoms were made of acrylic resin and filled with diluted Iodine (350 HUin 120 kVp), and each stent was fixed inside of those vessels. Those phantoms in water-filled tank were scanned on both HDCT and MDCT. The luminal diameter obtained using digital calipers at five different points and the mean luminal diameter (MLD) were calculated. The underestimate ratio (UR) and ΔUR was defined as follows: UR = [True diameter of stent - MLD]/True diameter of stent; ΔUR = [MLD at HDCT - MLD at MDCT]/True diameter of stent. The spatial resolution was estimated to be 0.71 mm on MDCT and 0.50 mm on HDCT. At the non-stenotic segments, the ΔURs were 11.6% (Velocity), 16.4% (Driver) and 7.2%(Multilink) for the 2.5-mmstents, and 14.0% (Velocity), 16.3% (Driver) and 13.3% (Multi-link) for the 3.0-mm stents. At the stenotic segment, the ΔURs were 23.2% (Velocity), 8.0% (Driver) and 13.6% (Multilink) for the 2.5-mm stents, and 20.0% (Velocity), 14.7% (Driver) and 15.3% (Multilink) for the 3.0-mm stents. Superior spatial resolution of HDCT could be promising for more accurate measurement of in-stent diameter. © Springer Science+Business Media, B.V. 2011.

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Radiological findings of primary localized amyloidosis of the ureter

Tsujioka Y., Jinzaki M., Tanimoto A., Nakagawa K., Akita H., Kikuchi E., Okuda S., Mikami S., Oya M., Kuribayashi S.

Journal of Magnetic Resonance Imaging （Journal of Magnetic Resonance Imaging） 35 （ 2 ） 431 - 435 2012年

研究論文（学術雑誌）, 共著, ISSN 1053-1807

Localized amyloidosis is a rare condition, especially that involving the ureter. Because of its rarity and the difficulty in differentiating this condition from urothelial carcinoma by intravenous urography and computed tomography, nephroureterectomy has often been performed unnecessarily for this disease. The authors encountered two cases of this disease, both of which showed a negative urine cytology, no obvious mass effect, and a hypointensity on T2-weighted imaging. Because these findings are very rare in urothelial carcinoma, ureteroscopy-guided biopsy was performed, which yielded the diagnosis of amyloidosis. The patients were then treated and followed up at our institute. Primary localized amyloidosis of the ureter should be considered when evaluating ureteric lesions visualized as hypointensities on T2-weighted images that do not show an obvious mass effect, which could help in the avoidance of unnecessary surgery. © 2011 Wiley Periodicals, Inc.

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Reduction in the vascular bed volume of uterine fibroids after hormonal treatment: Evaluation with dynamic double-echo R<inf>2</inf>* imaging

Okuda S., Oshio K., Asada H., Tanimoto A., Jinzaki M., Furuya M., Yoshimura Y., Kuribayashi S.

Magnetic Resonance in Medical Sciences （Magnetic Resonance in Medical Sciences） 11 （ 4 ） 283 - 289 2012年

研究論文（学術雑誌）, 共著, ISSN 1347-3182

Purpose: To demonstrate the reduction in vascular bed volume (VBV) of uterine fibroids after administration of gonadotropin-releasing hormone analogue (GnRHa) using magnetic resonance (MR) imaging including dynamic double-echo R2* imaging (DDE-R2*I) and to assess the value of DDE-R2*I as a predictor of such reduction. Methods: Twenty-one women with uterine intramural fibroids underwent MR imaging including DDE-R2*I before GnRHa treatment. DDE-R2*I was acquired using a single-section, double-echo, fast spoiled gradient recalled acquisition in the steady state (SPGR) sequence. We calculated the area under the curve (AUC) of the signal intensity on R2*I within a 3×3-cm2 region of interest that served to represent the VBV. We repeated MR imaging after 2 administrations of GnRHa and repeated image analyses. We statistically analyzed correlations between (A) pre-treatment AUC (AUC(pre)) and AUC reduction and (B) AUC(pre) and volume reduction. Results: The interval between the 2 MR studies ranged from 56 to 119 days (mean: 80.4 days). The average volume of the fibroids before GnRHa treatment was 647.8 mL compared with 463.4 mL after the therapy (decreased by an average of 28.5z; P<0.0001). Meanwhile, measured AUC was reduced by 55.3z(483.4 vs. 206.5; P<0.0001). AUC(pre) correlated with volume reduction (r=0.68), but not AUC reduction. Conclusions: We confirmed reduction in the VBV of fibroids using DDE-R2*I. The measurement of AUC(pre) on DDE-R2*I aids prediction of fibroid volume reduction but correlates poorly with the percentage of AUC reduction.

Beam-hardening correction for virtual monochromatic imaging of myocardial perfusion via fast-switching dual-kVp 64-slice computed tomography: - A pilot study using a human heart specimen -

Yamada M., Jinzaki M., Kuribayashi S., Imanishi N., Funato K., Aiso S.

Circulation Journal （Circulation Journal） 76 （ 7 ） 1799 - 1801 2012年

研究論文（学術雑誌）, 共著, ISSN 1346-9843

Background: Investigate the effectiveness of beam-hardening (BH) correction using ECG-gated dual-kVp computed tomography (CT) for myocardial imaging. Methods and Results: A human heart specimen and artificial descending aorta were scanned using both dual-kVp and single 120-kVp modes. The myocardial CT values at the anterior and posterobasal walls were 89.4±6.2 and 87.1±6.9 HU (P=0.59) for the 69-keV images, and 88.3±5.9 and 49.9±13.5 HU (P=0.002) for the 120-kVp images, respectively. Conclusions: Fast-switching dual-kVp technology is feasible for the correction of CT value deficits induced by BH that mimics perfusion defects.

Detection of attenuated plaque in stable angina with 64-multidetector computed tomography: A comparison with intravascular ultrasound

Jinzaki M., Okabe T., Endo A., Kawamura A., Koga S., Yamada M., Fukuda K., Kuribayashi S.

Circulation Journal （Circulation Journal） 76 （ 5 ） 1182 - 1189 2012年

研究論文（学術雑誌）, 共著, ISSN 1346-9843

Background: To clarify multidetector computed tomography (MDCT) findings of attenuated plaque detected by intravascular ultrasound (IVUS). Methods and Results: One hundred and fifty-four patients with stable angina underwent MDCT before IVUS. The attenuated plaque was identified in the targeted artery with IVUS, and the same artery was analyzed with MDCT for the presence of a high density area (HDA) >130 Hounsfield units (HU), and a low density area (LDA) <30 HU. A HDA in attenuated plaque was compared with that in calcified plaque. Ten attenuated plaques and 15 calcified plaques were identified in 9 of 154 patients (males=9, 66.2±9.5 years). Eight of the 10 attenuated plaques and all 15 calcified plaques were accompanied with a HDA on MDCT. The HDA ranged from 174 to 667 HU (mean 389.0±148.3 HU) in the 8 attenuated plaques, and from 545 to 1,205 HU (mean 920.9±215.9 HU) in 15 calcified plaques. There was a significant difference in CT density of the HDA between the attenuated and calcified plaque (P<0.001). All attenuated plaques contained LDA <30 HU in the portions without HDA. Conclusions: MDCT has the ability to demonstrate attenuated plaque as the combination of HDA (approximately 400 HU on average) and LDA <30 HU. The HDA can be differentiated from calcified plaque by its lower CT density value.

Multislice CT 2012 BOOK臨床:Dual energy CTの臨床応用-fast kVp switching法を中心に-

陣崎雅弘

映像情報Medical 44 116 - 20 2012年

CiNii Research

Editorial comment to Impact of the tumor enhancement pattern in computed tomography for the differential diagnosis of renal cell carcinoma and benign renal tumor

Jinzaki Masahiro

International Journal of Urology 18 （ 12 ） 867 - 868 2011年12月

研究論文（学術雑誌）, 共著, ISSN 0919-8172

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Preoperative T categorization and prediction of histopathologic grading of urothelial carcinoma in renal pelvis using diffusion-weighted MRI

Akita H., Jinzaki M., Kikuchi E., Sugiura H., Akita A., Mikami S., Kuribayashi S.

American Journal of Roentgenology （American Journal of Roentgenology） 197 （ 5 ） 1130 - 1136 2011年11月

研究論文（学術雑誌）, 共著, ISSN 0361-803X

OBJECTIVE. The purpose of our study was to evaluate the utility of diffusion-weighted MRI (DWI) for preoperative T categorization and prediction of the histopathologic grade of renal pelvic cancer. MATERIALS AND METHODS. We retrospectively evaluated 40 renal pelvic cancers from 40 patients. The MRI included T2-weighted single-shot fast spin-echo, DWI, and contrast-enhanced imaging. Two radiologists independently reviewed three image sets (T2- weighted images alone, T2-weighted plus DWI, and T2-weighted plus contrast-enhanced images) regarding tumor detection and the discrimination of locally advanced tumors. The diagnostic performance among the three image sets were compared using Cochrane test followed by McNemar tests. The apparent diffusion coefficients between two histopathologic grades were compared using the Mann-Whitney U test. RESULTS. T2-weighted imaging plus DWI enabled a high detection rate (98%, 39/40) without significant differences. For the diagnosis of T3 or higher categories, the accuracies were relatively low in all three image sets (70% each for T2-weighted imaging plus DWI and T2-weighted imaging plus contrast-enhanced imaging and 58% for T2-weighted imaging alone, p > 0.05), with sensitivities of 58%, 65%, and 54%, respectively. For discriminating tumors with macroscopic renal invasion from those with microscopic renal invasion or less, T2-weighted imaging plus DWI (93%) was significantly more accurate than T2-weighted imaging alone (75%) (p = 0.016). The mean apparent diffusion coefficient of the high-grade tumors was significantly lower than that of the low-grade tumors (p < 0.01). CONCLUSION. DWI could be used for preoperative T categorization and prediction of the histopathologic grade of renal pelvic cancer without contrast material. © American Roentgen Ray Society.

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[Advancement and current status of coronary CT angiography].

Jinzaki M., Tanami Y., Kuribayashi S., Yamada M.

Nihon rinsho. Japanese journal of clinical medicine （Nihon rinsho. Japanese journal of clinical medicine） 69 Suppl 7 226 - 232 2011年09月

研究論文（学術雑誌）, 共著, ISSN 0047-1852

Response

Jinzaki Masahiro, Matsumoto Kazuhiro, Tanami Yutaka, Ueno Akihisa, Yamada Minoru, Kuribayashi Sachio

Radiology 260 （ 3 ） 917 2011年09月

研究論文（学術雑誌）, 共著, ISSN 0033-8419

Detection of a coronary artery vessel wall: Performance of 0.3 mm fine-cell detector computed tomography - A phantom study

Yamada M., Jinzaki M., Tanami Y., Matsumoto K., Ueno A., Nukui M., Imai Y., Ishihara Y., Nishide A., Sasaki K., Kuribayashi S.

Physics in Medicine and Biology （Physics in Medicine and Biology） 56 （ 16 ） 5235 - 5247 2011年08月

研究論文（学術雑誌）, 共著, ISSN 0031-9155

The purpose of this study was to evaluate whether experimental fine-cell detector computed tomography with a 0.3125 mm cell (0.3 mm cell CT) can improve the detection of coronary vessel walls compared with conventional 64-slice computed tomography with a 0.625 mm cell (0.6 mm cell CT). A coronary vessel wall phantom was scanned using 0.6 mm cell CT and 0.3 mm cell CT. The data for 0.3 mm cell CT were obtained using four protocols: a radiation dose equal, double, triple or quadruple that were used in the 0.6 mm cell CT protocol. The detectable size of the vessel wall was assessed based on the first and second derivative functions, and the minimum measurable values were compared using a paired t-test. As a result, the minimum detectable wall thickness of 0.6 mm cell CT (1.5 mm) was significantly larger than that of 0.3 mm cell CT performed using the triple- and quadruple-dose protocols (0.9 mm) and the double-dose protocol (1.1 mm). The difference in the minimum detectable vessel wall thickness measured using 0.6 mm cell CT (1.5 0.1 mm) and 0.3 mm cell CT (0.9 0.1 mm, 1.1 0.2 mm) was significant (p < 0.01). We concluded that 0.3 mm cell CT improved the detection of coronary vessel walls when a more than double-dose protocol was used compared with 0.6 mm cell CT. © 2011 Institute of Physics and Engineering in Medicine.

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Comparison of CT urography and excretory urography in the detection and localization of urothelial carcinoma of the upper urinary tract

Jinzaki M., Matsumoto K., Kikuchi E., Sato K., Horiguchi Y., Nishiwaki Y., Silverman S. G.

International Braz J Urol 37 （ 3 ） 402 2011年05月

研究論文（学術雑誌）, 共著, ISSN 1677-5538

Objective: The purpose of this study was to compare the accuracy of CT urography and excretory urography for the detection and localization of upper urinary tract urothelial carcinoma. Materials and Methods: Of 128 patients at high risk for upper tract urothelial carcinoma who were examined with both CT urography and excretory urography between 2002 and 2007, 24 were undiagnosed and excluded. CT urography and excretory urography results of the remaining 104 patients and 552 urinary tract segments were compared with histopathologic examination or follow-up imaging at 1 year. Two readers independently scored the confidence levels for the presence or absence of upper urinary tract urothelial carcinoma in each of six upper urinary tract segments on both CT urography and excretory urography; differences were resolved by consensus. Results: Upper urinary tract urothelial carcinoma was diagnosed in 77 (14%) segments of 46 (44%) patients. Per-patient sensitivity, specificity, overall accuracy, and area under the receiver operating characteristic curves for detecting carcinomas with CT urography (93.5% [43/46], 94.8% [55/58], 94.2% [98/104], and 0.963, respectively) were significantly greater than those for excretory urography (80.4% [37/46], 81.0% [47/58], 80.8% [84/104], and 0.831, respectively) (p = 0.041, p = 0.027, p = 0.001, and p < 0.001, respectively). Persegment sensitivity and overall accuracy for the localization of upper urinary tract urothelial carcinoma were significantly greater with CT urography (87.0% [67/77] and 97.8% [540/552]) than with excretory urography (41.6% [32/77] and 91.5% [505/552]) (p < 0.0001). Conclusion: CT urography was more accurate than excretory urography in the detection and localization of upper urinary tract urothelial carcinoma and should be considered as the initial examination for the evaluation of patients at high risk for upper urinary tract urothelial carcinoma.

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Preoperative hydronephrosis grade independently predicts worse pathological outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma

Ito Y., Kikuchi E., Tanaka N., Miyajima A., Mikami S., Jinzaki M., Oya M.

Journal of Urology （Journal of Urology） 185 （ 5 ） 1621 - 1626 2011年05月

研究論文（学術雑誌）, 共著, ISSN 0022-5347

Purpose: We analyzed the prognostic impact of hydronephrosis grade on disease specific survival and evaluated whether hydronephrosis grade could preoperatively predict worse pathological outcomes in cases of upper tract urothelial carcinoma treated surgically. Materials and Methods: We identified and retrospectively reviewed the records of 91 patients who were evaluated by multidetector computerized tomography and/or magnetic resonance imaging preoperatively, and treated with nephroureterectomy at our institution from 2000 to 2009. Ipsilateral hydronephrosis was graded 0 to 4 by 2 urological radiologists blinded to clinical outcomes. We analyzed the associations between hydronephrosis grade, and pathological findings and patient outcomes. Results: Preoperatively 67 patients (73.6%) had ipsilateral hydronephrosis. Grade was 1 to 4 in 3 (3.3%), 17 (18.7%), 23 (25.3%) and 24 cases (26.4%), respectively. Higher hydronephrosis grade was significantly associated with a ureteral tumor (p = 0.0307), higher pT stage (p = 0.0002) and lymphovascular invasion (p = 0.0014). Higher hydronephrosis grade was not associated with disease specific or metastasis-free survival. On preoperative multivariate analysis high hydronephrosis grade predicted pathological T stage (T3 or greater) (HR 4.98, p = 0.0228), positive lymphovascular invasion (HR 6.37, p = 0.0022) and grade 3 (HR 2.98, p = 0.0311). Conclusions: On image analysis preoperative hydronephrosis grade was associated with features of aggressive disease and predicted an advanced pathological outcome in patients with upper tract urothelial carcinoma. This information could prove useful to select candidates for neoadjuvant chemotherapy and make decisions concerning surgical options. © 2011 American Urological Association Education and Research, Inc.

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Comparison of CT urography and excretory urography in the detection and localization of urothelial carcinoma of the upper urinary tract

Jinzaki Masahiro, Matsumoto Kazuhiro, Kikuchi Eiji, Sato Kozo, Horiguchi Yutaka, Nishiwaki Yuji, Silverman Stuart G.

American Journal of Roentgenology 196 （ 5 ） 1102 - 1109 2011年05月

研究論文（学術雑誌）, 共著, ISSN 0361-803X

OBJECTIVE. The purpose of this study was to compare the accuracy of CT urography and excretory urography for the detection and localization of upper urinary tract urothelial carcinoma. MATERIALS AND METHODS. Of 128 patients at high risk for upper tract urothelial carcinoma who were examined with both CT urography and excretory urography between 2002 and 2007, 24 were undiagnosed and excluded. CT urography and excretory urography results of the remaining 104 patients and 552 urinary tract segments were compared with histopathologic examination or followup imaging at 1 year. Two readers independently scored the confidence levels for the presence or absence of upper urinary tract urothelial carcinoma in each of six upper urinary tract segments on both CT urography and excretory urography; differences were resolved by consensus. RESULTS. Upper urinary tract urothelial carcinoma was diagnosed in 77 (14%) segments of 46 (44%) patients. Perpatient sensitivity, specificity, overall accuracy, and area under the receiver operating characteristic curves for detecting carcinomas with CT urography (93.5% [43/46], 94.8% [55/58], 94.2% [98/104], and 0.963, respectively) were significantly greater than those for excretory urography (80.4% [37/46], 81.0% [47/58], 80.8% [84/104], and 0.831, respectively) (p = 0.041, p = 0.027, p = 0.001, and p < 0.001, respectively). Persegment sensitivity and overall accuracy for the localization of upper urinary tract urothelial carcinoma were significantly greater with CT urography (87.0% [67/77] and 97.8% [540/552]) than with excretory urography (41.6% [32/77] and 91.5% [505/552]) (p < 0.0001). CONCLUSION. CT urography was more accurate than excretory urography in the detection and localization of upper urinary tract urothelial carcinoma and should be considered as the initial examination for the evaluation of patients at high risk for upper urinary tract urothelial carcinoma. © American Roentgen Ray Society.

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Evaluation of severely calcified coronary artery using fast-switching dual-kVp 64-slice computed tomography

Yamada M., Jinzaki M., Imai Y., Yamazaki S., Imanishi N., Tanami Y., Yamazaki A., Aiso S., Kuribayashi S.

Circulation Journal （Circulation Journal） 75 （ 2 ） 472 - 473 2011年02月

研究論文（学術雑誌）, 共著, ISSN 1346-9843

Radiation exposure in Cardiac CT

Tanami Y., Jinzaki M., Kuribayashi Y.

Japanese Journal of Clinical Radiology （Japanese Journal of Clinical Radiology） 56 （ 1 ） 19 - 28 2011年01月

研究論文（学術雑誌）, 共著, ISSN 0009-9252

Cardiac computed tomography angiography (CCTA) has emerged as a useful diagnostic imaging modality in the assessment of coronary artery disease. However, the potential risks due to exposure to ionizing radiation associated with CCTA have raised concerns. Several techniques such as "lower kVp", "step and shoot method" and "interative reconstruction" significantly reduce radiation dose without impairing image quality when compared with the standard retrospective helical data acquisition. These effective strategies to reduce radiation dose are available but some strategies are not frequently used. It is important to increase the use of dose-saving strategies in adequately selected patients.

Recurrence of bladder cancer in remnant urethra and inguinal lymph node metastasis nine years after total cystectomy

Obata Jun, Kikuchi Eiji, Kaneko Gou, Miyajima Akira, Kameyama Kaori, Jinzaki Masahiro, Oya Mototsugu

Japanese Journal of Urology 102 （ 1 ） 34 - 38 2011年01月

研究論文（学術雑誌）, 共著, ISSN 0021-5287

A 68-year-old man underwent total cystectomy, urethrectomy preserving fossa naviculars, and an Indiana pouch urinary diversion in 1997. The histopathology was UC, G3, pT4 (prostate). Nine years after the operation, he had multiple metastases to the inguinal and paraaortic lymph nodes (LNs), and he complained of erosion around the glans. Histological diagnosis of the glans revealed recurrent UC to the urethra of the glans. We considered the possibility that the inguinal LN metastasis was due to lymphatic spread from a remnant urethral recurrence. Thus, a partial penectomy and inguinal LN dissection were undertaken. Systemic chemotherapy was administered. Remnant urethral recurrence after urethrectomy preserving the fossa navicularis and inguinal LN metastasis are rare. © 2011 Japanese Urological Association.

Prospective study of combination therapy with low-dose thalidomide plus prednisolone ameliorating cytopenia in primary myelofibrosis

Hattori Y., Miyakawa Y., Yokoyama K., Yamada T., Du W., Jinzaki M., Shinmoto H., Okamoto S.

International Journal of Hematology （International Journal of Hematology） 93 （ 1 ） 129 - 131 2011年01月

研究論文（学術雑誌）, 共著, ISSN 0925-5710

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Body weight-tailored contrast material injection protocol for 64-detector row computed tomography coronary angiography

Isogai T., Jinzaki M., Tanami Y., Kusuzaki H., Yamada M., Kuribayashi S.

Japanese Journal of Radiology （Japanese Journal of Radiology） 29 （ 1 ） 33 - 38 2011年01月

研究論文（学術雑誌）, 共著, ISSN 1867-1071

Purpose: The aim of this study was to assess the body weight-tailored contrast material injection protocol for 64-detector computed tomography (CT) to maintain optimal coronary CT attenuation. Materials and methods: A total of 60 patients who underwent CT coronary angiography were assigned to one of three groups: protocol A, total of 0.7 ml kg-1 with 300 mg I/ml iodine concentration; protocol B, total of 0.6 ml kg-1 with 350 mg I/ml; protocol C, total of 0.7 ml kg-1 with 350 mg I/ml. The injection duration was 10 s in all patients. The proportion of intracoronary attenuation values >325 HU was compared on a pervessel and per-patient basis. Results: The attenuation value was significantly more likely to exceed 325 HU with protocol C (95% for reader 1 and 90% for reader 2) than with protocol A or B on the per-vessel analysis (P < 0.05). The attenuation value also signifi cantly exceeded 325 HU with protocol C (95% and 90%, respectively) more often than with protocol A or B on the per-patient analysis (P < 0.05). Conclusion: A total of at least 0.7 ml kg-1 contrast material with 350 mg/ml iodine concentration is required to achieve optimal coronary CT attenuation (>325 HU) with 64-detector CT when using an injection duration of 10 s. © 2011 Japan Radiological Society.

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Recurrence of bladder cancer in remnant urethra and inguinal lymph node metastasis nine years after total cystectomy: A case report

Obata J., Kikuchi E., Kaneko G., Miyajima A., Kameyama K., Jinzaki M., Oya M.

Japanese Journal of Urology （Japanese Journal of Urology） 102 （ 1 ） 34 - 38 2011年01月

ISSN 00215287

A 68-year-old man underwent total cystectomy, urethrectomy preserving fossa naviculars, and an Indiana pouch urinary diversion in 1997. The histopathology was UC, G3, pT4 (prostate). Nine years after the operation, he had multiple metastases to the inguinal and paraaortic lymph nodes (LNs), and he complained of erosion around the glans. Histological diagnosis of the glans revealed recurrent UC to the urethra of the glans. We considered the possibility that the inguinal LN metastasis was due to lymphatic spread from a remnant urethral recurrence. Thus, a partial penectomy and inguinal LN dissection were undertaken. Systemic chemotherapy was administered. Remnant urethral recurrence after urethrectomy preserving the fossa navicularis and inguinal LN metastasis are rare. © 2011 Japanese Urological Association.

Fast scanning tomosynthesis for the detection of pulmonary nodules: Diagnostic performance compared with chest radiography, using multidetector-row computed tomography as the reference

Yamada Y., Jinzaki M., Hasegawa I., Shiomi E., Sugiura H., Abe T., Sato Y., Kuribayashi S., Ogawa K.

Investigative Radiology （Investigative Radiology） 46 （ 8 ） 471 - 477 2011年

研究論文（学術雑誌）, 共著, ISSN 0020-9996

Objectives: To evaluate the diagnostic performance of fast scanning tomosynthesis in comparison with that of chest radiography for the detection of pulmonary nodules, using multidetector-row computed tomography (MDCT) as the reference, and to assess the association of the true-positive fraction (TPF) with the size, CT attenuation value, and location of the nodules. Materials and methods: The institutional review board approved this study, and written informed consent was obtained from all patients. Fifty-seven patients with and 59 without pulmonary nodules underwent chest MDCT, fast scanning tomosynthesis, and radiography. The images of tomosynthesis and radiography were randomly read by 3 blinded radiologists; MDCT served as the reference standard. Free-response receiver-operating characteristic (FROC) and receiver-operating characteristic (ROC) analyses, Cochran-Armitage trend or Fisher exact test, a conditional logistic regression model, and McNemar test were used. Results: Both FROC and ROC analyses revealed significantly better performance (P < 0.01) of fast scanning tomosynthesis than radiography for the detection of pulmonary nodules. For fast scanning tomosynthesis, the average TPF and false-positive rate as determined by FROC analysis were 0.80 and 0.10, respectively. For both fast scanning tomosynthesis and radiography, the average TPF increased with increasing nodule size and CT attenuation values, and was lower for subpleural nodules (all P < 0.01). Conclusions: The diagnostic performance of fast scanning tomosynthesis for the detection of pulmonary nodules was significantly superior to that of radiography. The TPF was affected by the size, CT attenuation value, and location of the nodule, in both fast scanning tomosynthesis and radiography. © 2011 Lippincott Williams & Wilkins.

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Virtual monochromatic spectral imaging with fast kilovoltage switching: Improved image quality as compared with that obtained with conventional 120-kVp CT

Matsumoto K., Jinzaki M., Tanami Y., Ueno A., Yamada M., Kuribayashi S.

Radiology （Radiology） 259 （ 1 ） 257 - 262 2011年

研究論文（学術雑誌）, 共著, ISSN 0033-8419

Purpose: To compare image quality obtained in phantoms with virtual monochromatic spectral (VMS) imaging with that obtained with conventional 120-kVp computed tomography (CT) for a given radiation dose. Materials and Methods: Three syringes were filled with a diluted contrast medium (each syringe contained a contrast medium with a different iodine concentration [5, 10, or 15 mg of iodine per milliliter]), and a fourth syringe was filled with water. These syringes were placed in a torso phantom meant to simulate the standard human physique. The phantom was examined with a CT system and use of the fast kilovoltage switching (80 and 140 kVp) and conventional (120 kVp) modes. Image noise and contrast-to-noise (CNR) ratio were analyzed on VMS images and 120-kVp CT images. Results: Image noise on VMS images in the range of 67-72 keV was significantly lower than that on the 120-kVp CT images (P < .014). Image noise was lowest at 69 keV and was 12% lower when compared with that on 120-kVp CT images. CNR on the VMS images was highest at 68 keV. CNR on the VMS images obtained at 68 keV in the syringes filled with diluted contrast material (5, 10, and 15 mg of iodine per milliliter) was 28%, 31%, and 30% higher, respectively, compared with that on the 120-kVp CT images (P < .001). Conclusion: VMS imaging at approximately 70 keV yielded lower image noise and higher CNR than did 120-kVp CT for a given radiation dose. VMS imaging has the potential to replace 120-kVp CT as the standard CT imaging modality, since optimal VMS imaging may be expected to yield improved image quality in a patient with standard body habitus. © RSNA, 2011.

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Evaluation of In-Stent Restenosis by High Spatial Resolution CT

Jinzaki M., Yamada M., Tanami Y., Kuribayashi S.

Current Cardiovascular Imaging Reports （Current Cardiovascular Imaging Reports） 4 （ 6 ） 431 - 436 2011年

研究論文（学術雑誌）, 共著, ISSN 1941-9066

Multidetector row CT has been established as a noninvasive method for the detection of coronary artery disease. In previous studies, the diagnostic accuracy of 64-slice CT for the detection of in-stent restenosis usually displayed high sensitivity and negative predictive value, while specificity and positive predictive values were too low to allow its utilization in clinical practice. Especially in small stents-with a diameter below 3. 0 mm-the accuracy of CT angiography to detect in stent stenosis has been low. Recently, CT systems with improved in-plane spatial resolution (high-definition CT, HDCT) have become commercially available. Furthermore, an experimental CT (fine-cell detector CT, FDCT) has been developed using half pitch dimension detector cells in both X and Z directions compared with 64-slice CT. Compared with that in conventional 64-slice CT, the spatial resolution was 30% improved in HDCT and 60% improved in FDCT, and the lumen visibility was 1. 3 times improved in HDCT and 1. 5 times improved in FDCT. The diagnostic accuracy of in-stent restenosis with HDCT was higher than 90% in both sensitivity and specificity, moderate (77%) in positive predictive value, and very high (98%) in negative predictive value. FDCT is not yet applicable to patients, however, further improvement of diagnostic accuracy in the evaluation of in-stent restenosis is expected in FDCT. In the near future, cardiac CT could reach the diagnostic performance to replace invasive catheter angiography, and would be the appropriate noninvasive technique for diagnosis of in-stent restenosis. © 2011 Springer Science+Business Media, LLC.

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食道癌に対するナビゲーションサージャリー

竹内裕也, 大山隆史, 才川義朗, 和田剛幸, 高橋常浩, 和田則仁, 中村理恵子, 中原理紀, 陣崎雅弘, 栗林幸夫, 北川雄光

日本気管食道科学会会報（特定非営利活動法人日本気管食道科学会） 62 （ 2 ） 122 - 124 2011年

ISSN 0029-0645

OP-074 上部尿路上皮腫瘍における水腎症の存在意義(腎盂・尿管腫瘍,一般演題口演,第99回日本泌尿器科学会総会)

菊地栄次, 陣崎雅弘, 秋田大宇, 伊藤祐二郎, 宮嶋哲, 中川健, 栗林幸夫, 大家基嗣

日本泌尿器科学会雑誌（一般社団法人日本泌尿器科学会） 102 （ 2 ） 353 2011年

ISSN 0021-5287

Progress and Current State of Coronary CT

Jinzaki Masahiro, Tanami Yutaka, Yamada Minoru, Kuribayashi Sachio

Annals of Vascular Diseases （Annals of Vascular Diseases 編集委員会） 4 （ 1 ） 7 - 18 2011年

ISSN 1881-641X

Imaging findings of renal angiomyolipoma with epithelial cysts

Akita Hirotaka, Jinzaki M., Tanimoto A., Sugiura H., Osugi K., Kuribayashi S., Mikami S., Oya M.

Japanese Journal of Clinical Radiology 55 （ 13 ） 1695 - 1698 2010年12月

研究論文（学術雑誌）, 共著, ISSN 0009-9252

Imaging findings of renal angiomyolipoma with epithelial cysts: A case report

Akita H., Jinzaki M., Tanimoto A., Sugiura H., Osugi K., Kuribayashi S., Mikami S., Oya M.

Japanese Journal of Clinical Radiology （Japanese Journal of Clinical Radiology） 55 （ 13 ） 1695 - 1698 2010年12月

ISSN 00099252

ASCI 2010 standardized practice protocol for cardiac magnetic resonance imaging: A report of the Asian society of cardiovascular imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline working group

Chan C.W.S., Choi B.W., Jinzaki M., Kitagawa K., Tsai I.C., Yong H.S., Yu W.

International Journal of Cardiovascular Imaging （International Journal of Cardiovascular Imaging） 26 （ SUPPL. 2 ） 187 - 202 2010年12月

研究論文（学術雑誌）, 共著, ISSN 1569-5794

These practice guidelines are recommended by the Asian Society of Cardiovascular Imaging (ASCI), the sole society in Asia designated for cardiovascular imaging, to provide a framework to healthcare providers for suggested essential elements in cardiac magnetic resonance (CMR) examinations of different disease spectra. The guideline is composed of recommendations on the general technique, acquisition of some basic modules, and protocols on stress tests. The protocols for specific diseases are provided in a table format for quick reference to be easily utilized for everyday clinical CMR. © 2010 The Author(s).

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ASCI 2010 appropriateness criteria for cardiac magnetic resonance imaging: A report of the Asian Society of Cardiovascular Imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline working group

Kitagawa K., Choi B.W., Chan C., Jinzaki M., Tsai I.C., Yong H.S., Yu W.

International Journal of Cardiovascular Imaging （International Journal of Cardiovascular Imaging） 26 （ SUPPL. 2 ） 173 - 186 2010年12月

研究論文（学術雑誌）, 共著, ISSN 1569-5794

There has been a growing need for standard Asian population guidelines for cardiac CT and cardiac MR due to differences in culture, healthcare system, ethnicity and disease prevalence. The Asian Society of Cardiovascular Imaging, as the only society dedicated to cardiovascular imaging in Asia, formed a cardiac CT and cardiac MR guideline working group in order to help Asian practitioners to establish cardiac CT and cardiac MR services. In this ASCI cardiac MR appropriateness criteria report, 23 Technical Panel members representing various Asian countries were invited to rate 50 indications that can frequently be encountered in clinical practice in Asia. Indications were rated on a scale of 1-9 to be categorized into 'appropriate' (7-9), 'uncertain' (4-6), or 'inappropriate' (1-3). According to median scores of the 23 members, the final ratings for indications were 24 appropriate, 18 uncertain and 8 inappropriate with 22 'highly-agreed' (19 appropriate and 3 inappropriate) indications. This report is expected to have a significant impact on the cardiac MR practices in many Asian countries by promoting the appropriate use of cardiac MR. © 2010 The Author(s).

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ASCI 2010 contrast media guideline for cardiac imaging: A report of the Asian Society of Cardiovascular Imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline working group

Jinzaki M., Kitagawa K., Tsai I.C., Chan C., Yu W., Yong H.S., Choi B.W.

International Journal of Cardiovascular Imaging （International Journal of Cardiovascular Imaging） 26 （ SUPPL. 2 ） 203 - 212 2010年12月

研究論文（学術雑誌）, 共著, ISSN 1569-5794

The use of contrast media for cardiac imaging becomes increasing as the widespread of cardiac CT and cardiac MR. A radiologist needs to carefully consider the indication and the injection protocol of contrast media to be used as well as the possibility of adverse effect. There are several guidelines for contrast media in western countries. However, these are focusing the adverse effect of contrast media. The Asian Society of Cardiovascular Imaging, the only society dedicated to cardiovascular imaging in Asia, formed a Working Group and created a guideline, which summarizes the integrated knowledge of contrast media for cardiac imaging. In cardiac imaging, coronary artery evaluation is feasible by non-contrast MR angiography, which can be an alternative examination in high risk patients for the use of iodine contrast media. Furthermore, the body habitus of Asian patients is usually smaller than that of their western counterparts. This necessitates modifications in the injection protocol and in the formula for calculation of estimated glomerular filtration rate. This guideline provided fundamental information for the use of contrast media for Asian patients in cardiac imaging. © 2010 The Author(s).

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今月の主題虚血性心疾患-プライマリケアは内科医が担う虚血性心疾患の診断冠動脈CT検査の進歩

陣崎雅弘, 田波穣, 栗林幸夫

medicina （株式会社医学書院） 47 （ 9 ） 1556 - 1559 2010年09月

ISSN 0025-7699

Guidelines for coronary CT angiography

Jinzaki Masahiro, Kuribayashi Sachio

Respiration and Circulation 58 （ 5 ） 489 - 494 2010年05月

研究論文（学術雑誌）, 共著, ISSN 0452-3458

今月の主題スキルス胃癌と鑑別を要する疾患主題スキルス胃癌の特徴と診断の基本-CTの立場から

奥田茂男, 杉野吉則, 陣崎雅弘, 屋代香絵, 栗林幸夫, 和田則仁, 北川雄光, 向井万起男

胃と腸（株式会社医学書院） 45 （ 4 ） 469 - 476 2010年04月

ISSN 0536-2180

ASCI 2010 appropriateness criteria for cardiac computed tomography: A report of the Asian Society of Cardiovascular Imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline Working Group

Tsai I.C., Choi B.W., Chan C., Jinzaki M., Kitagawa K., Yong H.S., Yu W.

International Journal of Cardiovascular Imaging （International Journal of Cardiovascular Imaging） 26 （ SUPPL. 1 ） 1 - 15 2010年02月

研究論文（学術雑誌）, 共著, ISSN 1569-5794

In Asia, the healthcare system, populations and patterns of disease differ from Western countries. The current reports on the criteria for cardiac CT scans, provided by Western professional societies, are not appropriate for Asian cultures. The Asian Society of Cardiovascular Imaging, the only society dedicated to cardiovascular imaging in Asia, formed a Working Group and invited 23 Technical Panel members representing a variety of Asian countries to rate the 51 indications for cardiac CT in clinical practice in Asia. The indications were rated as 'appropriate' (7-9), 'uncertain' (4-6), or 'inappropriate' (1-3) on a scale of 1-9. The median score was used for the final result if there was no disagreement. The final ratings for indications were 33 appropriate, 14 uncertain and 4 inappropriate. And 20 of them are highly agreed (19 appropriate and 1 inappropriate). Specifically, the Asian representatives considered cardiac CT as an appropriate modality for Kawasaki disease and congenital heart diseases in follow up and in symptomatic patients. In addition, except for some specified conditions, cardiac CT was considered to be an appropriate modality for one-stop shop ischemic heart disease evaluation due to its general appropriateness in coronary, structure and function evaluation. This report is expected to have a significant impact on the clinical practice, research and reimbursement policy in Asia. © 2010 Springer Science+Business Media, B.V.

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Computed tomographic attenuation value of coronary atherosclerotic plaques with different tube voltage: An ex vivo study

Tanami Y., Ikeda E., Jinzaki M., Satoh K., Nishiwaki Y., Yamada M., Okada Y., Kuribayashi S.

Journal of Computer Assisted Tomography （Journal of Computer Assisted Tomography） 34 （ 1 ） 58 - 63 2010年01月

研究論文（学術雑誌）, 共著, ISSN 0363-8715

Objectives: To compare the diagnostic performance of computed tomographic (CT) attenuation and CT attenuation ratio at different tube voltages for ex vivo plaque characterization. Materials and Methods: Human coronary arteries were obtained at the time of autopsy in 15 subjects. The coronary arteries were serially cut into 5-mm-long segments and scanned ex vivo using 4 sets of tube voltages and tube currents (80 kV, 660 mA; 100 kV, 500 mA; 120 kV, 400 mA; and 140 kV, 340 mA). The CT attenuation value at the center of each plaque was obtained, and the ratio of the CT attenuation value at the 80-kV setting divided by that at the 140-kV setting (Hounsfield ratio [HR], 80:140) was calculated. Separate receiver operating characteristic (ROC) analyses were used to assess the usefulness of the CT attenuation value and the 80:140 HR for the differential diagnosis of lipid-rich plaques from other types of plaques. Results: A total of 93 coronary plaques were detected macroscopically. Histological examination revealed 39 lipid-rich, 24 calcified, and 30 fibrotic plaques. At all the tube voltages, the CT attenuation values of the lipid-rich plaques were lower than those of the calcified plaques, whereas the CT attenuation values of the lipid-rich and fibrotic plaques overlapped. An ROC analysis showed that the area under the curve (AUC) for the differential diagnosis of lipid-rich plaques from fibrotic plaques was 0.813 at 80 kV, 0.772 at 100 kV, 0.682 at 120 kV, or 0.651 at 140 kV. Regarding the 80:140 HR, the AUC was 0.952 (0.029). The AUC was significantly larger at 80 and 100 kV and 80:140 HR compared with the AUC at 120 kV. Conclusions: The diagnostic performance of CT analysis for ex vivo plaque characterization was superior at lower energy settings and using the dual-energy method. Copyright © 2010 by Lippincott Williams & Wilkins.

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Imaging methods of CT in diagnosis of urological disease

Joishi D., Jinzaki M., Nakatsuka S.

Japanese Journal of Clinical Urology （Japanese Journal of Clinical Urology） 64 （ 4 ） 190 - 193 2010年

研究論文（学術雑誌）, 共著, ISSN 0385-2393

Staging of renal cell carcinoma

Koga S., Jinzaki M., Kuribayashi S.

Japanese Journal of Clinical Urology （Japanese Journal of Clinical Urology） 64 （ 4 ） 194 - 196 2010年

研究論文（学術雑誌）, 共著, ISSN 0385-2393

64-slice multidetector computed tomography evaluation of gastrointestinal tract perforation site: Detectability of direct findings in upper and lower GI tract

Oguro S., Funabiki T., Hosoda K., Inoue Y., Yamane T., Sato M., Kitano M., Jinzaki M.

European Radiology （European Radiology） 20 （ 6 ） 1396 - 1403 2010年

研究論文（学術雑誌）, 共著, ISSN 0938-7994

Objective: To evaluate wall discontinuity, as observed using 64-slice multidetector-row computed tomography (64-MDCT), as a direct finding (DF) indicating the perforation site in patients with gastrointestinal (GI) tract perforations. Methods: We retrospectively studied 41 consecutive patients presenting with acute abdomen and exhibiting extraluminal air (EA) on 64-MDCT. Three readers evaluated the distribution of EA, extraluminal faeces, dirty mass, dirty fat sign, extraluminal fluid collection and bowel wall thickening (i.e. conventional findings, CFs) as well as DFs. Results: Twenty-two cases were surgically or endoscopically confirmed to have upper GI tract perforations, and 19 had lower GI tract perforations. The DFs correctly identified the sites of perforation in 80.5% of patients when 2-mm-thick imaging slices were used. For the detection of upper GI tract perforations, the sensitivity, specificity and accuracy were 95.5%, 94.7% and 95.1% for the DFs and 50.0%, 100% and 73.2% for the CFs, respectively. Significant differences in sensitivity (p<0.001) and diagnostic accuracy (p<0.05) were observed between the DFs and CFs for upper GI perforations but not for lower GI tract perforations. Conclusion: DFs of the perforation site by using 64-MDCT were more sensitive and accurate than CFs for the detection of upper GI tract perforations. © 2009 European Society of Radiology.

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Multidetector-row CT Angiography of Lower Extremities: Usefulness in the Diagnosis of and Intervention for Peripheral Arterial Disease

Matsumoto Kazuhiro, Jinzaki Masahiro, Sato Kozo, Tanami Yutaka, Nakatsuka Seishi, Hashimoto Subaru, Kuribayashi Sachio

Annals of Vascular Diseases （Annals of Vascular Diseases 編集委員会） 3 （ 3 ） 202 - 208 2010年

ISSN 1881-641X

CT angiography (CTA) based on the data acquired by multidetector-row CT (MDCT) is an established, minimally invasive modality for imaging peripheral arteries. CTA has been used to assess peripheral arterial disease before treatment, and it has replaced conventional angiography for the diagnostic evaluation of peripheral arteries. MDCT can optimize both the long scan length and spatial resolution. CTA using MDCT depicts the fine structures of vessels. Recently, automated CTA analysis software has been developed for measurement of the vascular lumen. The software can automatically measure the diameters of short axial sections at the post-processing workstation. Measurement of the vascular lumen is useful in the planning of intravascular treatment for peripheral arterial disease. CTA is also utilized in assessing the intravascular lumen after metallic stent placement.

PP-127 水腎症の有無が上部尿路腫瘍の臨床に与える影響(発表・討論,一般演題ポスター,第98回日本泌尿器科学総会)

伊藤祐二郎, 菊地栄次, 宮嶋哲, 中川健, 大家基嗣, 陣崎雅弘, 秋田大宇, 栗林幸夫

日本泌尿器科学会雑誌（一般社団法人日本泌尿器科学会） 101 （ 2 ） 400 2010年

ISSN 0021-5287

OP-309 腎孟腫瘍の術前診断能における拡散強調像を用いたMRIの有用性(腎孟・尿管腫瘍/臨床1,一般演題口演,第98回日本泌尿器科学会総会)

菊地栄次, 陣崎雅弘, 秋田大宇, 伊藤祐二郎, 早川望, 鈴木賢次郎, 宮嶋哲, 中川健, 栗林幸夫, 大家基嗣

日本泌尿器科学会雑誌（一般社団法人日本泌尿器科学会） 101 （ 2 ） 310 2010年

ISSN 0021-5287

Progression of Late Stent Malapposition Beyond 2 Years After Sirolimus-Eluting Stent Implantation

Ueno K., Kawamura A., Mintz G.S., Weissman N.J., Jinzaki M., Okabe T., Kobayakawa N., Yamada M., Kuribayashi S., Ogawa S.

JACC: Cardiovascular Interventions （JACC: Cardiovascular Interventions） 2 （ 12 ） 1288 - 1289 2009年12月

研究論文（学術雑誌）, 共著, ISSN 1936-8798

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特集 CT・MRIアトラス Update-正常解剖と読影のポイント腹部各論腎臓

秋田大宇, 陣崎雅弘

medicina （株式会社医学書院） 46 （ 12 ） 324 - 332 2009年11月

ISSN 0025-7699

Extracardiac structures are frequently present within close proximity to the left atrium: Relevance to catheter ablation

Takatsuki S., Yamada M., Fukumoto K., Tanimoto K., Jinzaki M., Kuribayashi S., Ogawa S.

Heart Rhythm （Heart Rhythm） 6 （ 11 ） 1559 - 1564 2009年11月

研究論文（学術雑誌）, 共著, ISSN 1547-5271

Background: The coronary sinus (CS) including the great cardiac vein is an important anatomic structure that is considered a landmark for the mitral annulus (MA) and also a target for catheter ablation. Objective: This study evaluated the anatomical relationship between the CS and its surrounding structures visualized by multi-detector computed tomography (MDCT). Methods: We performed MDCT on 42 patients, and the ranges of the coronary arteries (CAs) and esophagus that ran closest (<5 mm) to the CS were examined. In addition, the distances between the CS and the MA and left ventricle and left atrium were compared with the amplitudes of the local atrial and ventricular electrograms in the CS at the most lateral point (3 o'clock) and the inferior point (6 o'clock) in the CS. Results: The distal portion of the right CA ran near the antero-inferior side of the CS ostium in 92% of the patients. The esophagus and the left circumflex CA proximity to the CS ran from 15 to 41 mm and from 53 to 104 mm from the ostium in all patients. At the 3 o'clock and 6 o'clock position of the MA, the distance between the center of the CS and MA was 12 and 13 mm, respectively, and showed negative correlation with the ratio of atrial and ventricular electrograms. Conclusion: The right CA, the left circumflex CA, and the esophagus were frequently located near the CS. The CS was shifted away from the MA, and the CS-MA distance could be predicted with intracardiac electrograms. © 2009 Heart Rhythm Society.

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Increased epicardial fat volume quantified by 64-multidetector computed tomography is associated with coronary atherosclerosis and totally occlusive lesions

Ueno K., Anzai T., Jinzaki M., Yamada M., Jo Y., Maekawa Y., Kawamura A., Yoshikawa T., Tanami Y., Sato K., Kuribayashi S., Ogawa S.

Circulation Journal （Circulation Journal） 73 （ 10 ） 1927 - 1933 2009年10月

研究論文（学術雑誌）, 共著, ISSN 1346-9843

Background: The relationship between the epicardial fat volume measured by 64-slice multidetector computed tomography (MDCT) and the extension and severity of coronary atherosclerosis was investigated. Methods and Results: Both MDCT and conventional coronary angiography (CAG) were performed in 71 consecutive patients who presented with effort angina. The volume of epicardial adipose tissue (EAT) was measured by MDCT. The severity of coronary atherosclerosis was assessed by evaluating the extension of coronary plaques in 790 segments using MDCT data, and the percentage diameter stenosis in 995 segments using CAG data. The estimated volume of EAT indexed by body surface area was defined as VEAT. Increased VEAT was associated with advanced age, male sex, degree of metabolic alterations, a history of acute coronary syndrome (ACS) and the presence of total occlusions, and showed positive correlation with the stenosis score (r=0.28, P=0.02) and the atheromatosis score (r=0.67, P<0.0001) of the coronary arteries. Multiple logistic regression analysis revealed an increased VEAT (≥50 cm3/m2) to be the strongest independent determinant of the presence of total occlusions (odds ratio 4.64, P=0.02). Conclusions: VEAT correlates with the degree of metabolic alterations and coronary atheromatosis. Excessive accumulation of EAT might contribute to the development of ACS and coronary total occlusions.

Percutaneous revascularization of chronic total occlusion of left anterior descending artery using contralateral injection via isolated conus artery

Kawamura Akio, Jinzaki Masahiro, Kuribayashi Sachio

Journal of Invasive Cardiology 21 （ 5 ） 2009年05月

研究論文（学術雑誌）, 共著, ISSN 1042-3931

A 74-year-old male underwent cardiac catheterization that revealed a chronic total occlusion of the proximal left anterior descending coronary artery (LAD). The right coronary artery provided only faint collateral circulation to the LAD. Multislice computed tomography (MDCT) disclosed that a conus artery took off directly from the aorta and provided good collateral circulation to the LAD. Percutaneous coronary intervention of the LAD was successfully performed using contralateral injection via the isolated conus artery. Whenever sufficient collateral filling is not visualized in a chronically occluded LAD, an isolated conus artery should be considered. MDCT is a helpful tool in this setting.

Diagnostic accuracy of angiographic view image for the detection of coronary artery stenoses by 64-detector row CT

Jinzaki Masahiro, Sato Kozo, Tanami Yutaka, Yamada Minoru, Anzai Toshihisa, Kawamura Akio, Ueno Koji, Kuribayashi Sachio

日本循環器學誌（一般社団法人日本循環器学会） 73 （ 4 ） 691 - 698 2009年04月

研究論文（学術雑誌）, 共著, ISSN 1346-9843

Background: The angiographic view (AGV) image is a new post-processing method that is similar to conventional coronary angiography (CAG). The purpose of this study was to evaluate its accuracy for coronary stenosis detection by 64-detector row computed tomography (CT). Methods and Results: CT evaluation results of 17 patients were compared with the results of invasive CAG on a coronary segment basis concerning the presence of stenoses >50% diameter reduction. All images of the 3 viewing methods (combination of conventional methods, AGV image alone, and axial images alone) were evaluated in consensus by 3 cardiovascular radiologists. Among 196 assessable segments, invasive CAG showed significant coronary artery stenoses in 44 segments. 43 of 44 lesions were detected with the AGV image, and absence of significant stenosis was correctly identified in 135 of 152 segments (sensitivity 98%; specificity 89%; accuracy 91%; positive predictive value 72%, negative predictive value 99%). The sensitivity of the AGV image was the same as that of conventional methods (98%). There was no significant difference in accuracy between the AGV image (91%) and conventional methods (94%). The accuracy of the AGV image was significantly higher than the axial images alone (78%). Conclusions: AGV image shows promise as a post-processing method for identifying coronary artery stenosis with high accuracy.

Novel three-dimensional imaging of the anatomical relationship between the pulmonary vein and left atrium

Yamada Minoru, Jinzaki Masahiro, Sato Kozo, Tanami Yutaka, Fukumoto Kotaro, Tanimoto Kojiro, Takatsuki Seiji, Ogawa Satoshi, Kuribayashi Sachio

日本循環器學誌（一般社団法人日本循環器学会） 73 （ 3 ） 573 - 574 2009年03月

研究論文（学術雑誌）, 共著, ISSN 1346-9843

Background: Visualization of the inner anatomical relationship of the pulmonary veins (PVs) and left atrium (LA) is important for achieving a better success rate and avoiding complications in circumferential LA ablation for atrial fbrillation (AF). Methods and Results: Twelve patients with AF underwent computed tomography and novel post-processing images that emphasized the boundaries of the PVs and LA were produced. Conclusions: The "Transparent View" images enabled visualization of the inner anatomical relationship of the PVs and LA in the same geometry as in pulmonary venography in all cases.

Diagnostic capacity of 64-slice multidetector computed tomography for acute coronary syndrome in patients presenting with acute chest pain

Ueno Koji, Anzai Toshihisa, Jinzaki Masahiro, Yamada Minoru, Kohno Takashi, Kawamura Akio, Yoshikawa Tsutomu, Kuribayashi Sachio, Ogawa Satoshi

Cardiology 112 （ 3 ） 211 - 218 2009年01月

研究論文（学術雑誌）, 共著, ISSN 0008-6312

Background/Aims: Early evaluations of patients presenting with acute chest pain remain difficult. We examined the diagnostic capacity of multidetector computed tomography (MDCT) for acute coronary syndrome (ACS) in patients presenting with acute chest pain. Methods/Results: We examined 36 consecutive patients presenting with acute chest pain with neither diagnostic ECG changes nor elevated biomarkers. 64-slice MDCT was performed, and we evaluated the presenceof significant coronaryartery stenosis (>50% reduction in lumen diameter). Significant stenosis was detected in 15 patients by MDCT. Among them, 11 patients were diagnosed as having ACS based on the findings of coronary angiography or myocardial perfusion single photon emission computed tomography (positive predictive value 73%). All 21 patients without significant stenosis by MDCT, except only one, were regarded as not having ACS (negative predictive value 95%). Sensitivity and specificity were 92 and 83%, respectively. In patients without a history of coronary artery disease (CAD), both the specificity and positive predictive value improved to 100% (sensitivity 90%; negative predictive value 95%). In patients with neither a history of CAD nor coronary calcification, the diagnostic accuracy of MDCT was 100%. Conclusions: MDCT has high diagnostic capacity for the early evaluation of ACS, especially in patients without a history of CAD or coronary calcification. Copyright © 2008 S. Karger AG.

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The checkpoints for the diagnosis of renal neoplasms

Jinzaki M., Oya M.

Japanese Journal of Clinical Urology （Japanese Journal of Clinical Urology） 63 （ 9 ） 671 - 678 2009年

研究論文（学術雑誌）, 共著, ISSN 0385-2393

心原性脳梗塞症における左房内血栓および血流動態の評価（第一報）

楠崎浩之, 陣崎雅弘, 栗林幸夫, 新井原泰隆, 大川伸一

日本農村医学会学術総会抄録集（一般社団法人日本農村医学会） 58 （ 0 ） 339 - 339 2009年

ISSN 1880-1749

〈背景〉心原性脳塞栓症の塞栓源検索として経食道心エ 
コー（transesophageal echography, TEE）の有用性は確 
立している。しかし，脳梗塞急性期にTEE を施行するこ 
とは，侵襲的で，しばしば鎮静が必要となり，熟練した術 
者が必要である。従来のCT やelectron beam CT では， 
少数例で左心耳内血栓の検討はされているが，TEE と 
MDCT を比較した報告は少ない。 
〈目的〉TEE とMDCT の相関，TEE をGold standard 
とした場合のMDCT の精度を評価する。 
〈対象〉２００５年１０月から２００７年１０月までに慶應義塾大学病 
院に心原性脳塞栓症の診断で入院した患者，１８例（男性１５ 
例，女性３例，平均年齢７２．９±７．８歳）を対象とした。対 
象患者は入院前または入院後に心房細動（一過性含む）が 
記録されており，発症時に心電図上心房細動が記録された 
のは１７例（９４．４％），検査時に抗凝固療法がなされていた 
のは１１例（７３．３％）であった。TEE とMDCT は１か月以 
内に施行した。脳塞栓症の発症から経食道心エコーと 
MDCT を施行するまでの期間はそれぞれ平均１２．２日（１ 
～４９日）と１２．１日（４～４９日）であった。 
〈方法〉６４列MDCT（GE : LightSpeed VCT）で，心電同 
期下，ヨード造影剤を急速静注後，造影早期相と後期相の 
２相を撮影し左房内血栓の有無および左心耳内の造影効果 
を検討した。 
〈結果〉１８例のうち１２例はMDCT とTEE の所見が一致 
しており，統計学的には有意差は認めなかったがある程度 
の相関を認めた。 
〈結語〉心房内血栓および血流動態に関して，TEE と 
MDCT の間に一定の相関があり，MDCT がTEE に代わ 
る検査となりうる可能性が示唆された。

Extrinsic Compression of the Left Main Coronary Artery by Atrial Septal Defect

Jo Yusuke, Kawamura Akio, Jinzaki Masahiro, Kohno Takashi, Anzai Toshihisa, Iwanaga Shiro, Kokaji Kiyokazu, Yoshikawa Tsutomu, Yozu Ryohei, Kuribayashi Sachio, Ogawa Satoshi

Annals of Thoracic Surgery 86 （ 6 ） 1987 - 1989 2008年12月

研究論文（学術雑誌）, 共著, ISSN 0003-4975

On rare occasions, extrinsic compression of the coronary artery can cause significant stenosis. We report a 42-year-old woman who was referred to our hospital for surgical repair of atrial septal defect. Cardiac 64-slice multi-detector computed tomography before the operation revealed the extrinsic compression of the proximal left main coronary artery by the marked dilatation of pulmonary trunk. The patient eventually underwent atrial septal defect closure and coronary artery bypass simultaneously. Four months after the operation, multi-detector computed tomographic scan revealed reduction of pulmonary trunk diameter and resolution of left main coronary artery narrowing. © 2008 The Society of Thoracic Surgeons.

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Pseudonormal position of an atrial pacemaker lead associated with a contralateral pneumothorax where is the atrial lead?

Yada Hirotaka, Sato Toshiaki, Soejima Kyoko, Jo Yusuke, Jinzaki Masahiro, Togashi Ikuko, Nakamizo Hikaru, Fukumoto Kotaro, Tanimoto Kojiro, Miyoshi Shunichiro, Kuribayashi Sachio, Ogawa Satoshi

Circulation 117 （ 17 ） 2297 - 2298 2008年04月

研究論文（学術雑誌）, 共著, ISSN 0009-7322

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Multislice CT of peripheral arterial diseases

Matsumoto Kazuhiro, Jinzaki Masahiro

Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 97 （ 2 ） 325 - 331 2008年02月

研究論文（学術雑誌）, 共著, ISSN 0021-5384

Imaging features of smoking-related interstitial lung disease

Sugiura Hiroaki, Jinzaki Mashiro, Kuribayashi Sachio

Japanese Journal of Chest Diseases 67 （ 9 ） 744 - 753 2008年

研究論文（学術雑誌）, 共著, ISSN 0385-3667

Overview image of the lumen and vessel wall in coronary CT angiography - The plaque-loaded angiographic view

Jinzaki Masahiro, Yamada Minoru, Sato Kozo, Tanami Yutaka, Anzai Toshihisa, Sasaki Kosuke, Kuribayashi Sachio

日本循環器學誌（一般社団法人日本循環器学会） 72 （ 4 ） 671 - 673 2008年

研究論文（学術雑誌）, 共著, ISSN 1346-9843

Background: There is no post-processing technique that can display an overview image of the lumen and vessel wall of a whole heart in one image. A merging coronary lumen view (Angiographic View) with a plaque image can provide a single, comprehensive image of plaque distribution. Methods and Results: A color-coded plaque image is assigned to different computed tomography attenuation ranges in the coronary artery to visualize plaques. This plaque image is re-formatted into a maximum intensity projection image and loaded onto the Angiographic View image. Conclusions: The integrated image of the coronary lumen and vessel wall of a whole heart is feasible. This image (Plaque-loaded Angiographic View) will give effective information in explaining the distribution of coronary lesions in patients as well as providing opportunities to discuss treatment strategies.

Novel post-processing image for the visualization of the coronary sinus by multidetector-row computed tomography before cardiac resynchronization therapy - Edge-enhanced image

Yamada Minoru, Jinzaki Masahiro, Kuribayashi Sachio, Sato Kozo, Tanami Yutaka, Fukumoto Kotaro, Tanimoto Kojiro, Sato Toshiaki, Soejima Kyoko, Ogawa Satoshi

日本循環器學誌（一般社団法人日本循環器学会） 72 （ 3 ） 487 - 488 2008年

研究論文（学術雑誌）, 共著, ISSN 1346-9843

Background: Before performing cardiac resynchronization therapy (CRT), it is useful to visualize the position of the coronary sinus (CS) orifice where the CS lead is inserted. Methods and Results: A raysum image was created in which the outermost 1-voxel layer of the right atrium (RA) and CS was extracted. This image enabled visualization of the positional relationship between the RA and CS ostium using the same geometry as retrograde CS venography. Conclusion: New post-processing imaging of the CS orifice will make the procedure of CRT safer.

6．マルチスライスCT

松本一宏, 陣崎雅弘

日本内科学会雑誌（一般社団法人日本内科学会） 97 （ 2 ） 325 - 331 2008年

ISSN 0021-5384

末梢動脈疾患の診断や治療方針の決定に画像検査が果たす役割は大きく，マルチスライスCTを用いた低侵襲診断が重要な役割を占めるようになっている．マルチスライスCTは簡便で低侵襲であり，3次元画像を用いた詳細な評価が可能で，末梢動脈疾患においても高い診断能が得られている．また精度の高い血管径計測も可能であり，治療のプランニングに有用である．

S3-2 腎非淡明細胞癌の術前診断 : 主に原発巣の画像の特徴、転移巣の特徴について(転移性腎非淡明細胞癌の治療戦略,第96回日本泌尿器科学会総会)

大家基嗣, 小坂威雄, 陣崎雅弘

日本泌尿器科学会雑誌（一般社団法人日本泌尿器科学会） 99 （ 2 ） 85 2008年

ISSN 0021-5287

心臓CTにおける3次元診断の最近の進歩(5.3次元画像診断の進歩,<特集>第71回日本循環器学会学術集会)

陣崎雅弘, 山田稔, 栗林幸夫

循環器専門医（一般社団法人日本循環器学会） 15 （ 2 ） 271 - 275 2007年09月

ISSN 0918-9599

Hyperattenuating renal masses

Silverman Stuart G., Mortele Koenraad J., Tuncali Kemal, Jinzaki Masahiro, Cibas Edmund S.

Radiographics 27 （ 4 ） 1131 - 1143 2007年07月

研究論文（学術雑誌）, 共著, ISSN 0271-5333

Some renal masses have higher attenuation than the surrounding renal parenchyma at computed tomography (CT). Their hyperattenuation is usually the result of proteinaceous fluid or densely packed cells. Most hyperattenuating renal masses are benign hemorrhagic or proteinaceous cysts. However, solid enhancing hyperattenuating renal masses may have malignant as well as benign causes. Possible malignant causes include renal cell carcinoma and lymphoma; benign causes include angiomyolipoma with minimal fat. It is important to identify the cause of a hyperattenuating renal mass so as to avoid unnecessary surgical resection or ablation. CT may be useful for diagnosing benign hyperattenuating renal cysts, hematomas, and vascular anomalies that appear masslike. However, some solid, enhancing, hyperattenuating masses cannot be diagnosed confidently with CT alone: Small (≤3-cm-diameter), homogeneously enhancing, hyperattenuating renal masses depicted on CT images may be either benign angiomyolipomas with minimal fat or renal cell carcinomas. Magnetic resonance (MR) imaging may be helpful for differentiating between angiomyolipomas with minimal fat and clear cell renal cell carcinomas; however, differentiation between angiomyolipomas with minimal fat and papillary renal cell carcinomas often is not possible on the basis of MR imaging. In such cases, a percutaneous biopsy may be useful for diagnosis. If the results of MR imaging and percutaneous biopsy are not definitive, surgery is warranted. ©RSNA, 2007.

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Dynamic contrast-enhanced CT of renal cell carcinoma for evaluation of tumor vascularity

Jinzaki Masahiro, Kuribayashi Sachio

AJR. American journal of roentgenology 188 （ 6 ） 2007年06月

研究論文（学術雑誌）, 共著

特集腎細胞癌診療の新しい展開小腎腫瘍の画像診断-質的診断と術前評価

陣崎雅弘, 大家基嗣, 村井勝

臨床泌尿器科（株式会社医学書院） 61 （ 5 ） 279 - 285 2007年04月

ISSN 0385-2393

Detection of bladder tumors with dynamic contrast-enhanced MDCT

Jinzaki Masahiro, Tanimoto Akihiro, Shinmoto Hiroshi, Horiguchi Yutaka, Sato Kozo, Kuribayashi Sachio, Silverman Stuart G.

American Journal of Roentgenology 188 （ 4 ） 913 - 918 2007年04月

研究論文（学術雑誌）, 共著, ISSN 0361-803X

OBJECTIVE. In a small pilot study, we assessed whether early-phase dynamic contrast-enhanced MDCT can be used to detect bladder tumors and whether thin reconstruction improves the detection rate. SUBJECTS AND METHODS. Thirty-six patients (30 with 59 cystoscopy-proven bladder cancers and six with normal bladders) underwent dynamic contrast-enhanced MDCT of the pelvis and abdomen. Images were obtained from the symphysis pubis to the diaphragm 70 seconds after injection of 100 mL of contrast medium. McNemar test was used to compare sensitivity per patient, segment, and tumor and specificity per patient and segment for each of three reconstruction methods: 5-mm sections with no overlap (i.e., 5-mm axial images), 2.5-mm sections with 1.25-mm overlap (i.e., thin-section axial images), and 2.5-mm sections with 1.25-mm overlap and multiplanar reformation (MPR) (i.e., thin-section axial images with MPR). RESULTS. MDCT with a combination of thin, overlapped sections and MPR depicted all but one of 47 bladder tumors larger than 5 mm but only five of 12 tumors 5 mm or smaller. There were no false-positive findings. Per-tumor sensitivity was significantly better with thin-section images with MPR (90%) and thin-section images alone (86%) than with 5-mm axial images (80%) (p < 0.05). Per-segment sensitivity was significantly better with thin-section images with MPR (95%) and thin-section axial images alone (87%) than with 5-mm axial images (79%) (p < 0.05). Per-patient sensitivity and per-patient and per-segment specificity did not differ with the three methods. CONCLUSION. Dynamic contrast-enhanced MDCT of the pelvis shows promise for the detection of bladder tumors. Use of thin-section images with MPR and thin-section axial images alone had a significantly better rate of detection of bladder tumors than use of 5-mm axial images. © American Roentgen Ray Society.

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今月の主題血管超音波検査話題他の検査法からみた超音波検査の使いかた-CT,MRIとの比較,超音波が有利なのはどのような点か

篠原真木子, 陣崎雅弘, 大熊潔, 栗林幸夫

臨床検査（株式会社医学書院） 51 （ 3 ） 325 - 332 2007年03月

ISSN 0485-1420

HEART's Original [Editorial Comment] 安田論文に対するEditorial Comment

陣崎雅弘

心臓（Japan Heart Foundation） 39 （ 4 ） 371 - 371 2007年

ISSN 0586-4488

Imaging findings of solitary fibrous tumor of the prostate

Oguro Sota, Tanimoto Akihiro, Jinzaki Masahiro, Akita Hirotaka, Yashiro Hideki, Okuda Shigeo, Kuribayashi Sachio, Kameyama Kaori, Mukai Makio

Magnetic Resonance Imaging 24 （ 5 ） 673 - 675 2006年06月

研究論文（学術雑誌）, 共著, ISSN 0730-725X

The imaging findings of a solitary fibrous tumor of the prostate are presented. A 35-year-old male presented with urinary retention and was found on transrectal ultrasonography to have a hypoechoic tumor of the prostate, measuring 5.5 cm in size. Magnetic resonance imaging on, the tumor showed low signal intensity on T1-weighted images and heterogeneous mixed signal intensity on T2-weighted images. Gadolinium-enhanced dynamic study showed gradual enhancement from the periphery to the center, and the enhancement is sustained. On immunohistochemistry, the spindle cells of the tumor showed positive staining for CD34 and bcl-2. Although the tumor was labeled as a low-grade malignancy on account of a low mitotic index (MIB-1 index) of about 5%, the patient developed local recurrence of the tumor with bladder wall invasion 12 months later. © 2006 Elsevier Inc. All rights reserved.

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Coronary CT angiography; 16 slice CT vs 64 slice CT

Jinzaki Masahiro, Sato K., Tanami M., Kuribayashi Y., Yamada Y.

Japanese Journal of Clinical Radiology 51 （ 1 ） 41 - 44 2006年

研究論文（学術雑誌）, 共著, ISSN 0009-9252

64-slice CT enabled the improved image quality of patients with high heart rate, the stabilization of heart rate during scan, volume reduction of contrast media, and wider coverage of ECG-gated scan compared with 16-slice CT. These advantages reduce the motion artifact, increase the percentage of assessable segments, and widen its clinical application. However, evaluation of lesions with severe calcification is still the limitation, that needs to be overcome with further technical advancement.

Novel method of displaying coronary CT angiography - Angiographic view

Jinzaki Masahiro, Sato Kozo, Tanami Yutaka, Yamada Minoru, Kuribayashi Sachio, Anzai Toshihisa, Asakura Yasushi, Ogawa Satoshi

日本循環器學誌（一般社団法人日本循環器学会） 70 （ 12 ） 1661 - 1662 2006年

研究論文（学術雑誌）, 共著, ISSN 1346-9843

Background: A method of displaying coronary computed tomography (CT) angiography, which enables evaluation of coronary artery disease (CAD) with fewer images and is understandable to the third person, is preferable. Methods and Results: A maximum intensity projection image was created in which contrast media in the ventricles is eliminated, enabling an overview of CAD in a single 3-dimensional (D) image that can be rotated to be viewed at various angles and is easily understood by a third person. Conclusions: A novel method of displaying coronary CT angiography in a single 3-D image has been developed and we believe it should become available for many workstations.

Evaluation of coronary artery lumen diameter with 16-slice multidetector-row computed tomography

Yamada Minoru, Jinzaki Masahiro, Kuribayashi Sachio, Sato Kozo, Tanami Yutaka, Yun Shen, Sasaki Kosuke

日本循環器學誌（一般社団法人日本循環器学会） 69 （ 10 ） 1230 - 1232 2005年09月

研究論文（学術雑誌）, 共著, ISSN 1346-9843

Background: When using 16-slice multidetector-row computed tomography (MDCT) to detect coronary artery stenosis, coronary arteries measuring 1.5 mm or larger in lumen diameter are usually evaluated. The purpose of this study was to investigate the frequency of the visualized lumen in each coronary artery segment measuring more than 1.5 mm in diameter. Methods and Results: Electrocardiographic-gated 16-slice MDCT was used to scan 20 patients after administration of nitroglycerin. The luminal diameter of each coronary artery segment was measured on cross-sectional images using a caliper method. The frequency of the visualized lumen of each coronary artery segment measuring larger than 1.5 mm in diameter was as follows: #1: 100%, #2: 100%, #3: 100%, #4PD:85%, #4AV:80%, #5: 100%, #6: 100%, #7: 100%, #8: 90%, #9: 85%, #10: 40%, #11: 100%, #12: 65%, #13: 100%, #14: 80%. Averaged lumen diameter± standard deviation (mm) larger than 1.5 mm in all patients was calculated as follows: #1: 3.8±0.70, #2: 3.5±0.69, #3: 3.2±0.82, #5: 4.2±1.04, #6: 3.4±0.79, #7: 2.9±0.62, #11: 2.9±0.69, #13: 2.6±0.57. Conclusion: Luminal diameter larger than 1.5 mm of each coronary artery segment can be assessed in most cases by 16-slice MDCT.

Design and development of a new pulsating cardiac coronary phantom for ECG-gated CT and its experimental characteristics

Shen Yun, Sato Munekuni, Kimura Fumiko, Jinzaki Masahiro, Horiguchi Jun, Ito Katsuhide, Kuribayashi Sachio

Nippon Acta Radiologica 65 （ 3 ） 224 - 232 2005年07月

研究論文（学術雑誌）, 共著, ISSN 0048-0428

The optimal pulsating cardiac phantom is an important tool for the evaluation of cardiac images and cardiac applications on ECG-gated MDCT. The purpose of this study was to demonstrate the design and fabrication of the pulsating cardiac coronary phantom. The newly developed pulsating cardiac coronary phantom has the following five key advantages: 1 )a driver component that uses only one servomotor to move the phantom in three dimensions (X, Y, and Z directions) with 16 presets of different heart types (heartbeat: 0-120 bpm; ejection fraction: 0-90%): 2)versatile pumping and filling phases to simulate a real heart in a cardiac cycle can be incorporated into the driver sequence including shift of patient heartbeat or irregular pulse (maximum: 200 different heart waves in one scan): 3)a cardiac coronary component constituted of an acrylic/silicon/rubber tube(2-6 mm inner diameter)with stent/in-stent restenosis/steriosis/soft plaque/ calcification parts and maximum 16 coronary arteries that can be attached to the phantom in the same scan: 4)the complete phantom can be submerged in a tank to simulate the heart and its surrounding tissues: 5)ECG gating can be from interior trigger and exterior trigger. It has been confirmed that the developed pulsating cardiac phantom is very useful to quantitatively assess imaging of the heart and coronary arteries during phantom experiments.

Correlation of effective temporal resolution and accuracy of volume ejection fraction on the ECG-gated cardiac MDCT

Shen Yun, Jinzaki Masahiro, Sato Kozo, Kuribayashi Sachio

Nippon Acta Radiologica 65 （ 3 ） 233 - 239 2005年07月

研究論文（学術雑誌）, 共著, ISSN 0048-0428

Purpose: ECG-gated cardiac MDCT offers many cardiac clinical applications. The goals of this report are 1) to introduce a new concept of effective reliability (ER) from effective temporal resolution for the evaluation of ejection fraction (EF) and evaluation of image quality (IQ)of coronary arteries, and 2)to show the correlation of ER and the accuracy of EF with different cardiac reconstruction algorithms and different rotation speeds. Methods and Materials: To assess the accuracy of EF, helical scanning was performed with a gated cardiac MDCT(GE LightSpeed, 8/16 slice)on pulsating cardiac coronary phantoms(0.5 and 0.6 sec rotation speed for each 50-110 bpm, 5-bpm step). We define effective reliability(ER)from effective temporal resolution(%)as follows: ER=(1-TR/HC)x100: TR: Effective temporal resolution, HC: time of heart cycle in each bprn. Results: From the results of the EF measurement and calculated ER, high accuracy was obtained by using optimal scan conditions (optimal rotation speed and cardiac reconstruction algorithm)in a wide range of heart rates (heart rate<90: EF & ER>81%; heart rate<110 bpm: EF & ER>73%). Results showed that the calculated ER is closely correlated with the measurement results of EF based on the phantom experiment (R ²=0.901±0. 075; Max: 0.994, Min: 0.738). Optimal reconstruction thickness can reduce total image number for the evaluation of EF. Conclusion: We concluded that the ER is useful to evaluate EF accuracy and the IQ of images of coronary arteries.

Quantitative evaluation of coronary arterial stenosis using 16-slice multidetector-row computed tomography

Yamada Minoru, Jinzaki Masahiro, Kuribayashi Sachio, Sato Kozo, Tanami Yutaka, Yun Shen, Sasaki Kosuke, Okano Yoshiyuki, Sugisawa Koichi

Journal of Computer Assisted Tomography 29 （ 3 ） 382 - 386 2005年05月

研究論文（学術雑誌）, 共著, ISSN 0363-8715

Objective: The purpose of this study is to consider the possibility of quantitative evaluation of coronary arterial stenosis by using 16-slice multidetector-row computed tomography (MDCT). Methods: Simulated coronary arteries were prepared, which consist of 5-mm-diameter acryl tubes with contrast media (270 HU). Simulated stenoses of known density (-33 HU) were created in each coronary artery (25%, 50%, and 75%). Cardiac pulsating with 0, 50, 65, 85, and 105 beats per minute (bpm) was performed. Multiplanar reformation images for each coronary artery were created. Percent stenosis was calculated using the width middle value of boundary part of the arteries. Results: The stenoses were depicted in all heart rates. Average percent stenosis ± standard deviation was 27.4 ± 3.6%, 45.8 ± 2.6%, and 69.4 ± 2.7%, respectively. For each percent stenosis, there was a significant difference (P < 0.05). Conclusion: Sixteen-slice MDCT has a potential for noninvasive quantitative evaluation of stenosis in coronary arteries. Copyright © 2005 by Lippincott Williams & Wilkins.

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Angiomyolipomas that do not contain fat attenuation at unenhanced CT [2] (multiple letters)

Jinzaki Masahiro, Silverman Stuart G., Tanimoto Akihiro, Shinmoto Hiroshi, Kuribayashi Sachio, Kim Jeong Kon, Cho Kyoung Sik

Radiology 234 （ 1 ） 311 - 312 2005年01月

研究論文（学術雑誌）, 共著, ISSN 0033-8419

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高心拍領域におけるMDCTの心臓イメージングの画質に関する評価 : 心臓動態ファントムによる検討を中心に

沈雲, 佐々木公祐, 岡野義幸, 陣崎雅弘, 新屋昌恵, 杉澤浩一, 山田稔, 永澤清, 栗林幸夫

日本放射線技術学会雑誌（公益社団法人日本放射線技術学会） 61 （ 4 ） 506 - 513 2005年

研究論文（学術雑誌）, 共著, ISSN 0369-4305

The multi-sector reconstruction (MSR) algorithm and cardiac half-reconstruction (CHR) algorithm are the main algorithms used in cardiac reconstruction. Analysis of effective temporal resolution (TR) confirmed that optimal rotation speed depends on different heart rates when using MSR. During visualization (3D/MPR image) and quantitative (EF: ejection fraction) evaluations, it was found that image quality and measurement accuracy are well correlated with effective temporal resolution (TR) by the different algorithms. The CHR algorithm resulted in less desirable image quality at TR 250 ms than that from MSR at high heart rates (>75 bpm) in the phantom experiment. We determined that the combination of the MSR algorithm and the optimal selection of gantry rotation speed is important for obtaining high-quality cardiac imaging in the high heart rate region.

Evaluation of small (≤ 3 cm) renal masses with MDCT

Jinzaki Masahiro, McTavish Jeffrey D., Zou Kelly H., Judy Philip F., Silverman Stuart G.

American Journal of Roentgenology 183 （ 1 ） 223 - 228 2004年07月

研究論文（学術雑誌）, 共著, ISSN 0361-803X

OBJECTIVE. Our purpose was to determine whether thin overlapping reconstructions using MDCT improve the detection and characterization of small renal masses. MATERIALS AND METHODS. Thirty-seven patients were scanned with MDCT using 2.5-mm collimation. Nephrographic phase data were reconstructed in two ways: a standard protocol (5-mm section thickness, no overlap) and an experimental protocol (3-mm section thickness, 50% overlap). Masses were detected and classified into three groups: group 1, measuring less than 20 H on both protocols (classified as cysts on both); group 2, measuring 20 H or greater on standard protocol and less than 20 H on experimental protocol (classified as cysts using experimental protocol only); and group 3, measuring 20 H or greater on both protocols (not classified as cysts using either protocol). Masses 10 mm or larger in group 3 were evaluated further for enhancement. Statistically significant differences between protocols were assessed using an analysis of counts and proportions. RESULTS. Of 175 detected lesions, 29 (17%) were detected only with the experimental protocol; all but one were smaller than 5 mm. Using the experimental protocol, of 45 masses between 5 and 10 mm, the number of masses that could be characterized as cysts increased from 13 (29%) to 38 (84%). The overall number of indeterminate lesions was reduced from 101 (69%) of 146 lesions detected with the standard protocol to 86 (53%) of 161 lesions detected with the experimental protocol. CONCLUSION. Using MDCT and thin overlapping reconstructions, renal cysts as small as 5 mm can be diagnosed with more confidence than is possible with standard reconstructions, and the overall number of indeterminate renal masses is reduced.

特集冠動脈病変の画像診断-CT,MRIは冠動脈造影にどこまで迫れるかマルチスライスCTによる冠動脈の画像化

栗林幸夫, 陣崎雅弘, 佐藤浩三, 田波穣, 山田稔

呼吸と循環（株式会社医学書院） 52 （ 7 ） 667 - 675 2004年07月

研究論文（学術雑誌）, 共著, ISSN 0452-3458

今月の主題血栓症の予防と治療血栓症を診断する血栓症を画像で診断する-CT・MR

松本一宏, 陣崎雅弘, 栗林幸夫

medicina （株式会社医学書院） 41 （ 6 ） 942 - 944 2004年06月

ISSN 0025-7699

マルチスライスCTによる冠動脈プラークの診断

陣崎雅弘、栗林幸夫

Clinician 51 （ 528 ） 309-313 2004年03月

研究論文（学術雑誌）, 共著

１６スライスCTによる冠動脈プラークの診断

陣崎雅弘、佐藤浩三、田波穣、栗林幸夫

映像情報 36 （ 2 ） 22-25 2004年01月

研究論文（学術雑誌）, 共著

The usefulness of multidetector-row CT urography - Comparison with intravenous urography

Jinzaki Masahiro, Tanimoto Akihiro, Sato Kozo, Kuribayashi Sachio

Nishinihon Journal of Urology 66 （ 5 ） 350 - 354 2004年

研究論文（学術雑誌）, 共著, ISSN 0029-0726

We compared multidetector-row CT urography and intravenous urography (IVU) for the detection of pelvic tumors. CT images (axial image, MIP image and MPR image) and IVU images of three cases were evaluated with the consensus of two radiologists. The usefulness of CTU was as follows. 1) The MIP image is very similar to the IVU image. 2) The images of CTU are free from the overlying bowel gas, whereas IVU images are obscured by it. 3) Although the spatial resolution of CT is lower than that of IVU, pelvic tumors sized 10 mm can be demonstrated on CTU, but not on IVU.

CP4-3 CT urography and MR urography(総合企画4「泌尿器科画像診断 : 新旧交替はあるのか」)

陣崎雅弘

日本泌尿器科学会雑誌（一般社団法人日本泌尿器科学会） 95 （ 2 ） 141 2004年

ISSN 0021-5287

RSNA'03レビュー座談会

石垣武男, 煎本正博, 高原太郎, 今岡いずみ, 早川克己, 大野良治, 陣崎雅弘, 小寺吉衞

日本放射線技術学会雑誌（公益社団法人日本放射線技術学会） 60 （ 2 ） 233 - 244 2004年

ISSN 0369-4305

P-459 当施設における小型肺癌に対するCTガイド下生検の検討(診断/適応4)(一般示説47)

塚田紀理, 石本裕子, 山本純, 竹内健, 木下圭一, 藤本博之, 泉陽太郎, 江口圭介, 渡辺真純, 堀之内宏久, 川村雅文, 陣崎雅弘, 中塚誠之, 栗林幸夫, 小林紘一

日本呼吸器外科学会雑誌（特定非営利活動法人日本呼吸器外科学会） 18 （ 3 ） 451 2004年

ISSN 0919-0945

腎腫瘤性病変の鑑別における各画像診断の役割

陣崎雅弘

癌の臨床 49 （ 9 ） 815-825 2003年11月

研究論文（学術雑誌）, 単著

マルチスライスCTによる Coronary Angiography の現状

陣崎雅弘、佐藤浩三、田波穣、栗林幸夫

日獨医報 48 （ 2 ） 178-188 2003年07月

研究論文（研究会，シンポジウム資料等）, 共著

マルチスライスCT時代の腹部画像診断−腎・尿管−

陣崎雅弘、佐藤浩三、杉浦弘明、谷本伸弘、栗林幸夫

画像診断 23 （ 4 ） 392-399 2003年03月

研究論文（学術雑誌）, 共著

心臓

陣崎雅弘

Clinician 51 （ 518 ） 147-154 2003年02月

研究論文（学術雑誌）, 単著

マルチスライスCTによる非侵襲的血管計測：ファントム実験による基礎的研究

松本一宏，陣崎雅弘，佐藤浩三，栗林幸夫，新屋昌恵

脈管学 43 （ 2 ） 35-39 2003年02月

研究論文（学術雑誌）, 共著

小腎腫瘤の鑑別診断

陣崎雅弘

泌尿器外科 16 （ 2 ） 103-112 2003年02月

研究論文（学術雑誌）, 単著

肺血栓塞栓症のCT診断

佐藤浩三，陣崎雅弘，栗林幸夫

Annual review　呼吸器2003 177-183 2003年01月

研究論文（学術雑誌）, 共著

Lung scintigraphy and CT. MRI

Sato Kozo, Jinzaki Masahiro, Kuribayashi Sachio

Nippon rinsho. Japanese journal of clinical medicine 61 （ 10 ） 1739 - 1743 2003年

研究論文（学術雑誌）, 共著, ISSN 0047-1852

Helical CT became a reliable tool for diagnosing acute pulmonary thromboembolism (APTE) together with lower extremity ultrasound, though lung scintigraphy is still popular test for surveying and following the patients for APTE. Novel technology of multi-slice CT enabled us to obtain images on thinner slice thickness with better contrast. Development of workstation helped us to analyzing 3-dimensionally as well as providing useful 3D images quickly. CT venography, additional scan for surveying deep venous thrombosis, was utilized as an effective and time-saving technique. These condition should improve diagnostic accuracy of CT. MRI was proposed to be a promising tool for diagnosing APTE in a noninvasive manner.

Coronary angiography on multi detector-row CT; optimization for imaging method

Sato Kozo, Jinzaki M., Tanami Y., Kuribayashi S.

Japanese Journal of Clinical Radiology 48 （ 13 ） 1627 - 1638 2003年

研究論文（学術雑誌）, 共著, ISSN 0009-9252

A case of coccidioidomycosis with multiple thin-walled cavities

Yamamoto Ayumi, Sugiura H., Nakano K., Nomura A., Yamamoto S., Sato K., Jinzaki M., Kuribayashi S.

Japanese Journal of Clinical Radiology 48 （ 5 ） 635 - 639 2003年

研究論文（学術雑誌）, 共著, ISSN 0009-9252

Coccidioidomycosis is a disease known for its endemicity to the Southwest United States, Central America, and South America. However, with the current trend of increase tourist, the frequency of Coccidioidomycosis infections is increasing also. We reported a Japanese case of coccidioidomycosis with multiple thin-walled cavities in 35-year-old woman, and reviewed an update on the diagnosis, management, and treatment of the disease with pulmonary lesions caused by coccidioidomycosis infection.

285 動態心臓冠動脈ファントムによる冠動脈ステントの描出能の定量評価(CT検査心臓(解析 III))

沈雲, 佐々木公祐, 山田稔, 岡野義幸, 陣崎雅弘, 佐藤浩三, 栗林幸夫

日本放射線技術学会雑誌（公益社団法人日本放射線技術学会） 59 （ 9 ） 1092 2003年

ISSN 0369-4305

286 Soft Plaqueの定量評価に向けた動態心臓冠動脈ファントムを用いた基礎的検討(CT検査心臓(解析 III))

山田稔, 陣崎雅弘, 佐藤浩三, 田波穣, 栗林幸夫, 杉澤浩一, 岡崎義幸, 沈雲, 佐々木公祐

日本放射線技術学会雑誌（公益社団法人日本放射線技術学会） 59 （ 9 ） 1092 2003年

ISSN 0369-4305

Multi-detector row CT urography: comparison of strategies for depicting the normal urinary collecting system

Mc Tavish D Jeffrey, Jinzaki Masahiro, Zou H Kelly, Nawfel D Richard, Silverman G Stuart

Radiology 225 （ 3 ） 783-790 2002年12月

研究論文（学術雑誌）, 共著

マルチスライスCTによる心臓領域の画像診断

陣崎雅弘，佐藤浩三，田波穣，栗林幸夫

新医療 29 （ 12 ） 148-151 2002年12月

研究論文（学術雑誌）, 共著

今月の主題消化管のvirtual endoscopy 主題 virtual endoscopyの現状と展望-大腸微細病変の描出能について

杉野吉則, 白神伸之, 松川英彦, 山下大介, 陣崎雅弘, 佐藤浩三, 栗林幸夫, 熊井浩一郎, 日比紀文, 渡邊昌彦, 北島政樹

胃と腸（株式会社医学書院） 37 （ 11 ） 1387 - 1394 2002年10月

ISSN 0536-2180

Virtual endoscopy の現状と展望　大腸微細病変の描出能について

杉野吉則，白神伸之，松川英彦，山下大介，陣崎雅弘，佐藤浩三，栗林幸夫，熊井浩一郎，日比紀文，渡邊昌彦，北島政樹

胃と腸 37 （ 11 ） 1387-1394 2002年10月

研究論文（学術雑誌）, 共著

MDCTによる心大血管造影検査法

佐藤浩三，陣崎雅弘，田波穣，松本一宏，栗林幸夫

Innervision 17 （ 11 ） 64-69 2002年10月

研究論文（学術雑誌）, 共著

泌尿器画像診断のすべて―腎腫瘤―

陣崎雅弘，谷本伸弘，大熊潔，新本弘，栗林幸夫

臨床放射線 47 （ 10 ） 1349-1366 2002年09月

研究論文（学術雑誌）, 共著

泌尿器画像診断のすべて：腎腫瘤

陣崎雅弘，谷本伸弘，大熊潔，新本弘，栗林幸夫

臨床放射線 47 （ 10 ） 1349-1366 2002年09月

研究論文（学術雑誌）, 共著

画像に基づく病期診断-腎癌-

陣崎雅弘，谷本伸弘，栗林幸夫

画像診断 22 （ 9 ） 974-983 2002年08月

研究論文（学術雑誌）, 共著

末梢動脈の閉塞性病変におけるMultidetector CTを用いた3次元画像の有用性

松本一宏，陣崎雅弘，佐藤浩三，奥田茂男，中塚誠之，谷本伸弘，橋本統，栗林幸夫

脈管学 42 （ 8 ） 505-510 2002年08月

研究論文（学術雑誌）, 共著

Routine MR imaging protocol with breath-hold fast scans

Tanimoto Akihiro, Yuasa Yuji, Jinzaki Masahiro, Nakatsuka Seishi, Takeda Toshiaki, Kurata Tadayoshi, Shinmoto Hiroshi, Kuribayashi Sachio

Radiation Medicine - Medical Imaging and Radiation Oncology 20 （ 4 ） 169 - 179 2002年07月

研究論文（学術雑誌）, 共著, ISSN 0288-2043

Purpose: To qualitatively and quantitatively evaluate the diagnostic efficacy of the breathhold magnetic resonance (MR) imaging sequences in widespread clinical use for detection and characterization of focal hepatic lesions. Materials and Methods: Fifty patients with 143 lesions [57 hepatocellular carcinomas (HCC), 10 borderline lesions, 18 metastatic tumors, 21 hemangiomas, and 37 cysts] underwent single-shot fast spin echo (SSFSE), fast spin echo (FSE), and gadolinium-enhanced dynamic fast spoiled gradient-recalled acquisition in steady state (FSPGR) breath-hold MR imaging of the liver. Alternative free receiver operating characteristic (AFROC) analysis was performed to independently and prospectively assess each sequence. Results: For solid lesions, dynamic FSPGR allowed the most sensitive lesion detection and produced the highest lesion conspicuity and lesion-liver contrast-to-noise ratio (CNR). For non-solid benign lesions, SSFSE and FSE produced better results than dynamic FSPGR. SSFSE allowed the most sensitive detection and produced the best lesion conspicuity and lesion-liver CNR. Conclusion: SSFSE and dynamic FSPGR comprise the optimal imaging protocol for breathhold MR assessment of focal hepatic lesions. This combination of sequences allows acquisition of critical diagnostic information about both inherent T2 and T1 lesion contrast and lesion vascularity.

非侵襲的冠動脈イメージング

陣崎雅弘

Views Radiology 4 （ 2 ） 6-14 2002年05月

研究論文（学術雑誌）, 単著

末梢動脈の閉塞性動脈硬化症におけるMDCTを用いた三次元画像および自動血管計測の有用性－8列MDCTの臨床経験を含めて

松本一宏，陣崎雅弘，佐藤浩三，栗林幸夫，新屋昌恵，新井清忠

Innervision 17 （ 4 ） 24-25 2002年04月

研究論文（学術雑誌）, 共著

Outcome of hepatic nodules less than 10 mm in size detected by ultrasonography in patients with chronic liver disease

Tanami Yutaka, Ogawa Kenji, Tanami Yoshiko, Okada Masahiro, Matsumoto Kazuhiro, Fujiwara Hirokazu, Jinzaki Masahiro, Ohkuma Kiyoshi, Kuribayashi Sachio

Nippon Acta Radiologica 62 （ 1 ） 17 - 22 2002年01月

研究論文（学術雑誌）, 共著, ISSN 0048-0428

The number of hepatic nodules detected by ultrasonography in patients with chronic liver disease has increased. Although it potentially is important to understand the outcome of small solitary hepatic nodules, they have not been fully investigated. In this study, we evaluated retrospectively the outcome of 35 solitary hepatic nodules smaller than 10 mm in 35 patients with chronic liver disease. The follow-up period ranged from 24 to 94 months, and, during follow-up, 8 of 35 nodules (23%) increased in size, 17 nodules (49 %) showed no change, and 10 nodules (29%) disappeared. It took less than 12 months for 5 nodules to increase in size, and less than 24 months for 3 nodules. There was no significant difference between the ultrasonographic findings (echogenicity and size) of the nodules and their outcome. We conclude that follow-up observation of at least 24 months is essential to evaluate the outcome of solitary hepatic nodules.

Superparamagnetic iron oxide-mediated hepatic signal intensity change in patients with and without cirrhosis

Tanimoto Akihiro, Yuasa Yuji, Shinmoto Hiroshi, Jinzaki Masahiro, Imai Yutaka, Okuda Shigeo, Kuribayashi Sachio

Radiology 222 （ 3 ） 661 - 666 2002年

研究論文（学術雑誌）, 共著, ISSN 0033-8419

PURPOSE: To analyze superparamagnetic iron oxide (SPIO)-mediated hepatic signal intensity change in cirrhotic and noncirrhotic liver and to investigate the relationship between pulse sequence effects in SPIO-enhanced magnetic resonance (MR) imaging for hepatic cirrhosis. MATERIALS AND METHODS: Twelve patients with and 12 patients without cirrhosis underwent T2-weighted fast spin-echo, T2*-weighted gradient-echo (GRE), and T1-weighted GRE MR imaging before and twice (early and late phase) after SPIO administration. To assess the effect of SPIO, postcontrast relative signal-to-noise ratio (SNR) changes were statistically analyzed with repeated measurements analysis of variance for each pulse sequence. RESULTS: No interaction was shown between groups and data time points for any pulse sequence. There was no significant difference in mean hepatic relative SNR change on T2-weighted fast spin-echo images between the cirrhotic group and noncirrhotic group (-38.6% and -40.7%, early phase; -42.2% and -49.6%, late phase, respectively). For GRE images, statistically significant differences in mean hepatic relative SNR change were found between the cirrhotic group and noncirrhotic group (-14.2% and -44.5%, early phase; -28.5% and -56.4%, late phase on T2*-weighted GRE images (P < .001); 31.8% and 12.9%, early phase; 23.8% and 2.2%, late phase on T1-weighted GRE images (P < .05), respectively. CONCLUSION: Decreased overall phagocytic activity in cirrhotic liver is more likely due to Kupffer cell dysfunction than to Kupffer cell depletion, since magnetic susceptibility effects on T2*-weighted GRE images depend on intracellular SPIO cluster size. © RSNA, 2002.

冠動脈のマルチスライスCT

陣崎雅弘

Circulation Insights （ 12 ） 14 -16 2001年12月

研究論文（学術雑誌）, 単著

X線CT（マルチスライスCT）における三次元画像診断

佐藤浩三，陣崎雅弘，栗林幸夫，久保敦司，白神伸之，小林成司

RADIOISOTOPES 50 （ 12月） 618-629 2001年12月

研究論文（学術雑誌）, 共著

MDCTの症例報告

佐藤浩三，陣崎雅弘，栗林幸夫

日本放射線技術学会雑誌 57 （ 7 ） 28-29 2001年07月

研究論文（学術雑誌）, 共著

Visualization of tumor vessels in renal tumors. Comparison between power Doppler ultrasonography and angiography

Tamura Yoshiko, Jinzaki Masahiro, Ohkuma Kiyoshi, Hashimoto Subaru, Tanimoto Akihiro, Hiramatsu Kyoichi

Acta Radiologica 42 （ 2 ） 239-243 2001年03月

研究論文（学術雑誌）, 共著

MR imaging-guided prostate biopsy with surgical navigation software

Hata N., Jinzaki M., Kacher D., Cormak R., Gering D., Nabavi A., Silverman S. G., D'Amico A. V., Kikinis R., Jolesz F. A., Tempany C. M C

Radiology 220 （ 1 ） 263 - 268 2001年

研究論文（学術雑誌）, 共著, ISSN 0033-8419

Ｘ線ＣＴ（マルチスライスＣＴ）による三次元画像診断

佐藤浩三, 陣崎雅弘, 栗林幸夫, 久保敦司, 白神伸之, 小林成司

ＲＡＤＩＯＩＳＯＴＯＰＥＳ（公益社団法人日本アイソトープ協会） 50 （ 12 ） 618 - 629 2001年

ISSN 0033-8303

腎血管筋脂肪腫における画像診断の進歩と限界

大家基嗣, 陣崎雅弘, 村井勝

日本泌尿器科学会雑誌（一般社団法人日本泌尿器科学会） 92 （ 2 ） 87 2001年

ISSN 0021-5287

Transperineal magnetic resonance image guided prostate biopsy

D'Amico A. V., Tempany C. M., Cormack R., Hata N., Jinzaki M., Tuncali K., Weinstein M., Richie J. P.

Journal of Urology 164 （ 2 ） 385 - 387 2000年08月

研究論文（学術雑誌）, 共著, ISSN 0022-5347

Purpose: We report the findings of a transperineal magnetic resonance image (MRI) guided biopsy of the prostate in a man with increasing prostate specific antigen who was not a candidate for a transrectal ultrasound guided biopsy. Materials and Methods: Using an open configuration 0.5 Tesla MRI scanner and pelvic coil, a random sextant sample was obtained under real time MRI guidance from the peripheral zone of the prostate gland as well as a single core from each MRI defined lesion. The patient had previously undergone proctocolectomy for ulcerative colitis and, therefore, was not a candidate for transrectal ultrasound guided biopsy. Prior attempts to make the diagnosis of prostate cancer using a transurethral approach were unsuccessful. Results: The random sextant samples contained benign prostatic hyperplasia, whereas Gleason grade 3 + 3 = 6 adenocarcinoma was confirmed in 15% and 25% of the 2 cores obtained from the MRI targeted specimens of 2 defined lesions. The procedure was well tolerated by the patient. Conclusions: Transperineal MRI guided biopsy is a new technique that may be useful in detecting prostate cancer in men with increasing prostate specific antigen who are not candidates for transrectal ultrasound guided biopsy.

内視鏡手技とっておきのコツ　胃静脈瘤の治療　Shunt Occluded Sclerotherapy (SOS)

北川雄光，大森泰，陣崎雅弘，橋本統，熊井浩一郎，日比紀文，岩男泰，小澤壯治，安藤暢敏，北島政樹

消化器内視鏡 12 （ 6 ） 780-781 2000年06月

研究論文（学術雑誌）, 共著

Double-phase helical CT of small renal parenchymal neoplasms: correlation with pathologic findings and tumor angiogenesis

Jinzaki Masahiro, Tanimoto Akihiro, Mukai Makio, Ikeda Eiji, Kobayashi Seiji, Yuasa Yuji, Narimatsu Yoshiaki, Murai Masaru

Journal of Computer Assisted Tomography 24 （ 6 ） 835 - 842 2000年

研究論文（学術雑誌）, 共著, ISSN 0363-8715

Purpose: To correlate the enhancement pattern of double-phase helical computed tomography (CT) of small renal parenchymal neoplasms with pathologic findings and tumor angiogenesis, and evaluate whether the enhancement pattern would be useful in differentiating the histomorphologic types of small renal parenchymal neoplasms. Materials and Methods: Double-phase helical CT (5 mm slice) of the cortico-medullary phase (CMP) and late nephrographic phase (NP) was performed in 40 surgically resected renal neoplasms <3.5 cm. The patterns of CT attenuation value and homogeneity were correlated with the subtypes of neoplasms, microvessel density, and the existence of intratumoral necrosis or hemorrhage. Results: Clear cell renal cell carcinomas (RCC) (n = 29) showed a peak attenuation value in the CMP of >100 HU [Hounsfield units]. Chromophobe cell RCC (n = 2) showed a peak attenuation value in the CMP of <100 HU. Papillary RCC (n = 5) showed a gradual enhancement with the attenuation value in the CMP of <100 HU. However oncocytomas (n = 2) and metanephric adenomas (n = 2) also showed patterns similar to these subtypes of RCC. The degree of enhancement in the CMP correlated with microvessel density (r = 0.87). All tumors with an homogeneous enhancement pattern did not show necrosis or hemorrhage on histologic specimen. Conclusion: The enhancement pattern in double-phase helical CT was different among the subtypes of RCC, and correlated with microvessel density or the existence of intratumoral necrosis or hemorrhage. However it did not differentiate between RCC and other solid tumors.

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Breast cancer evaluated by contrast harmonic imaging using the pulse inversion method

Matsumoto K., Ohkuma K., Jinzaki M., Hiramatsu H., Kuribayashi S., Ikeda T.

Journal of Medical Ultrasonics 27 （ 11 ） 1427 - 1430 2000年

研究論文（学術雑誌）, 共著, ISSN 1344-1388

A 54-year-old woman was admitted to this institution for further examination and treatment of a mass in the fight breast. The mass was a palpable hard lump that measured approximately 2 cm in diameter. Breast cancer was strongly suspected, and ultrasound examination was performed. The conventional B-mode image showed a well-defined, hypoechoic mass with a lobulated margin in the right mammary gland; the color Doppler image showed a penetrating feeding vessel and intralesional vessels; and the contrast-enhanced color Doppler image showed intense signals from the intralesional vessels. The feeding and intralesional vessels were clearly shown in B-mode contrast harmonic imaging with pulse inversion. It was suggested that B-mode contrast harmonic imaging with pulse inversion is suitable for detection of tumor vessels in a small, superficial organ such as a mammary gland.

パワードプラ法の臨床応用

田波穣，大熊潔，陣崎雅弘，田村良子，布袋伸一，篠原真木子，平松京一

画像診断 19 （ 11 ） 1283-1292 1999年11月

研究論文（学術雑誌）, 共著

Small solid renal lesions: Usefulness of power doppler US

Jinzaki Masahiro, Ohkuma Kiyoshi, Tanimoto Akihiro, Mukai Makio, Hiramatsu Kyoichi, Murai Masaru, Hata Jun Ichi

Radiology 209 （ 2 ） 543 - 550 1998年11月

研究論文（学術雑誌）, 共著, ISSN 0033-8419

PURPOSE: To evaluate whether the vascular pattern at power Doppler ultrasonography (US) improves diagnostic accuracy in small solid renal lesions over that at gray-scale US. MATERIALS AND METHODS: Gray-scale and power Doppler US were performed prospectively in 64 small (1.5-3.0-cm- diameter) solid renal lesions (26 renal cell carcinomas [RCCs], 34 angiomyolipomas, two oncocytomas, two pseudotumors). At gray-scale US, echogenicity and homogeneity of the lesion, an anechoic rim, intratumoral cysts, shadowing, or a central scar were sought. At power Doppler US, the vascular distribution was divided into four patterns. RESULTS: Findings at gray-scale US included an anechoic rim or intratumoral cysts in 20 of 26 RCCs (77%) and the two oncocytomas. Shadowing was seen in seven of 34 angiomyolipomas (21%). Echogenicity, homogeneity, and a central scar were not pathognomonic. At power Doppler US, pattern 3 (peripheral) or 4 (mixed penetrating and peripheral) was seen in all RCCs, seven of 34 angiomyolipomas, and the two oncocytomas. Pattern 1 (intratumoral focal) or 2 (penetrating) was seen in 27 angiomyolipomas. Pattern 1 or 2 was characteristic of angiomyolipomas. The rate of correct diagnosis was significantly increased with combined US (78%) as compared to that with gray- scale (42%) or power Doppler (45%) US alone. CONCLUSION: The vascular distribution at power Doppler US could add important information to gray- scale US findings for differential diagnosis of small solid renal lesions.

充実性腎腫瘤に対する超音波診断の新展開―Bモードとパワードプラの有用性の検討―

陣崎雅弘

慶應医学 75 （ 6 ） 441-452 1998年11月

研究論文（学術雑誌）, 単著

腎動静脈

中原理紀，大熊潔，陣崎雅弘，平松京一

臨床放射線 43 （ 11 ） 1510-1516 1998年10月

研究論文（学術雑誌）, 共著

腎のびまん性疾患

田波穣，大熊潔，陣崎雅弘，中原理紀，平松京一

臨床放射線 43 （ 11 ） 1496-1502 1998年10月

研究論文（学術雑誌）, 共著

腎の腫瘤性疾患

陣崎雅弘，大熊潔，田村良子，田波穣，中原理紀，平松京一

臨床放射線 43 （ 11 ） 1503-1509 1998年10月

研究論文（学術雑誌）, 共著

Small renal cell carcinoma: MRI with pathologic correlation

Shinmoto Hiroshi, Yuasa Yuji, Tanimoto Akihiro, Narimatsu Yoshiaki, Jinzaki Masahiro, Hiramatsu Kyoichi, Mukai Makio

Journal of Magnetic Resonance Imaging 8 （ 3 ） 690 - 694 1998年05月

研究論文（学術雑誌）, 共著, ISSN 1053-1807

The MRI features of small renal cell carcinomas (RCCs) were retrospectively reviewed and correlated with histology in 24 patients. MRI features on both T1- and T2-weighted images were classified into hypointensity, isointensity, and hyperintensity. Each tumor was pathologically classified into four types: alveolar, papillary, tubular, and cystic. These findings were correlated with MR signal intensities. Alveolar tumors showed hypointensity to isointensity on T1-weighted image and isointensity to hyperintensity on T2-weighted image. In contrast, all papillary tumors showed hypointensity on T2-weighted image. Four of six tumors with hypointensity on T2-weighted image were caused by hemosiderin deposition, hemorrhage, and necrosis. However, there were two papillary RCCs that showed hypointensity on T2-weighted image despite no hemosiderin deposition and no hemorrhage. We conclude that papillary RCC is associated with T2-hypointense appearance as well as hemosiderin deposition, hemorrhage, and necrosis.

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A case of retroperitoneal angiomyolipoma

Tamura Y., Jinzaki M., Narimatsu Y., Tanimoto A., Ohkuma K., Hiramatsu K., Murai M., Mukai M.

Japanese Journal of Clinical Radiology 43 （ 10 ） 1179 - 1182 1998年

研究論文（学術雑誌）, 共著, ISSN 0009-9252

Performance of Gd-EOB-DTPA and superparamagnetic iron oxide particles in the detection of primary liver cancer

Tanimoto A., Satoh Y., Yuasa Y., Jinzaki M., Hiramatsu K.

Journal of Magnetic Resonance Imaging 7 （ 1 ） 120 - 124 1997年

研究論文（学術雑誌）, 共著, ISSN 1053-1807

The performance of gadolinium-ethoxybenzyl- diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) and superparamagnetic iron oxide (SPIO) particles in detecting liver cancer was compared using alternative free-response receiver operating characteristic (AFROC) analysis, which allowed observers to indicate both the confidence level and the location of all perceived abnormalities. Axial T1-weighted MR images (1.5 T) pre/post Gd-EOB-DTPA (25 μmol/kg) injection were obtained for 12 rats with chemically induced liver tumors (64 tumors). T2-weighted images (T2WI) were obtained pre/post SPIO (10 μmol/kg) injection for the same animal. Liver signal-to-noise ratio (SNR), tumor liver contrast-to-noise ratio (CNR), and histopathologic sections corresponding to MR images were obtained. In AFROC, the location and the confidence level for each tumor were indicated independently on MR images by four radiologists. By plotting true-positive fraction and probability of false-positive per image, the area under the AFROC curve (A₁) was estimated and statistically analyzed between each sequence. Either drug significantly improved tumor-liver CNR (P < .001) and tumor detection (diameter ≤ 6 mm; P < .05). Gd-EOB-DTPA significantly (P < .05) improved the A₁ in T1W1. There was no A₁ difference between T2WI + SPIO and T1WI + Gd-EOB-DTPA. Gd-EOB-DTPA-enhanced T1WI showed the same performance as SPIO-enhanced T2WI in detecting liver tumors.

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Angiomyolipomas : Imaging findings in lesions with minimal fat

Jinzaki Masahiro, Tanimoto Akihiro, Narimatsu Yoshiaki, Ohkuma Kiyoshi, Kurata Tadayoshi, Shinmoto Hiroshi, Hiramatsu Kyoichi, Mukai Makio

Radiology 205 （ 11 ） 497-502 1997年

研究論文（学術雑誌）, 共著

Liver metastases from colon cancer with intra-bile duct tumor growth

Jinzaki Masahiro, Tanimoto Akihiro, Suzuki Koji, Seki Tatsuo, Satoh Yoshinori, Hiramatsu Kyoichi, Mukai Makio, Nakanishi Izumi

Journal of Computer Assisted Tomography 21 （ 4 ） 656 - 660 1997年

研究論文（学術雑誌）, 共著, ISSN 0363-8715

Purpose: Our goal was to characterize the radiologic features of liver metastases from colon cancer with intrahepatic bile duct (IHBD) dilatation. Method: Radiologic findings of liver metastases from colon cancer with IHBD dilatation of four patients were compared with pathologic findings. Results: The cause of bile duct dilatation in all cases was due to papillary tumor growth in the bile duct. In two patients, intra-bile duct tumor growth (IBDTG) was observed on imaging. In the other two patients, IBDTG was not observed, but a nontapered abrupt obstruction of a dilated bile duct was seen, corresponding to the microscopically proven papillary tumor growth in the ductal lumen. In three patients who underwent an extensive hepatic resection, there has been no recurrence. In one patient who had a nonanatomic limited resection, a recurrence was seen 1 year after surgery. Conclusion: When liver tumor with IBDTG is suspected on imaging, liver metastases should be considered in the differential diagnosis besides hepatocellular carcinoma or cholangiocellular carcinoma. Careful preoperative assessment for IBDTG by imaging is essential to determine the extent of surgical resection.

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血管造影上腫瘍の流出静脈を認めた早期再発肝癌の1例

陣崎雅弘，井戸邦雄，成松芳明，橋本統，大熊潔，竹田利明，谷本伸弘，平松京一

Liver Cancer 2 （ 2 ） 115-119 1996年10月

研究論文（学術雑誌）, 共著

Large diffuse arteriovenous malformation affecting the right cerebral and cerebellar hemispheres: case report

Sagoh M, Kodaki K, Ichikizaki K, Izumi C, Satoh T, Shiga H

Surg Neurol 46 （ 2 ） 122-128 1996年08月

研究論文（学術雑誌）, 共著

Can We Know the Frequency of True Late Adverse Reactions to Nonionic Contrast Media?

Jinzaki Masahiro, Ido Kunio, Ogawa Kenji, Hiramatsu Kyoichi

Nippon Acta Radiologica 56 （ 7 ） 520 - 522 1996年06月

研究論文（学術雑誌）, 共著, ISSN 0048-0428

We investigated the frequency and causative factors of symptoms unrelated to contrast media (false late adverse reactions) among patients who were evaluated as having late adverse reactions to contrast media. The nature and frequency of complaints stated by each 200 of patients who underwent plain CT scans and enhanced CT scans were evaluated. In the plain CT group, three patients showed false late adverse reactions. The frequency was 2.6% among respondents and 1.5% in the population. These symptoms encompassed psychological effects and diseases that developed after CT scanning. It is difficult to detect only true late adverse reactions, because of survey bias.

上部尿路系のMRI診断

谷本伸弘，湯浅祐二，陣崎雅弘，平松京一

画像診断 16 （ 2 ） 134-145 1996年02月

研究論文（学術雑誌）, 共著

Problems in surveying the incidence of delayed adverse reactions to contrast media

Jinzaki M., Hiramatsu K.

European Radiology 6 （ SUPPL. 3 ） 1996年

研究論文（学術雑誌）, 共著, ISSN 0938-7994

Advantages of intravascular ultrasound--preliminary experience in patients with peripheral and renal vascular disease

Jinzaki M., Ido K., Shinmoto H., Nakatsuka S., Hiramatsu K.

Nippon Igaku Hoshasen Gakkai zasshi. Nippon acta radiologica 53 （ 4 ） 478 - 480 1993年04月

研究論文（学術雑誌）, 共著, ISSN 0048-0428

Intravascular ultrasound (IVUS) is a new method in which endovascular images are obtained from a catheter inserted into an artery. We uses IVUS during PTA of iliac and renal artery, and examined its effectiveness. Three layers are well defined in normal arterial wall. Calcified deposits are recognized as a combination of strong echo and acoustic shadow. The absolute cross sectional area of patent lumen and atherosclerotic plaque can be calculated. IVUS is very effective for the assessment of PTA. The increased caliber of arteries following PTA is caused by the over stretching of the media rather than the compression of atheroma.

Comparative study between ultrasonographic and pathohistological findings of small renal cell carcinoma

Jinzaki M., Hisa N., Fujikura Y., Ohkuma K., Tashiro Y., Sugiura H.

Japanese Journal of Medical Ultrasonics 17 （ 3 ） 280 - 287 1990年

研究論文（学術雑誌）, 共著, ISSN 0287-0592

We evaluated 12 cases of small renal cell carcinoma without necrosis or hemorrhage, especially concerning their echogenicity in relation to cell types, grading of cellular atypia, amount of stroma, and architectural arrangement. Among the twelve cases, 4 cases were hyperechoic and 8 cases were isoechoic. No hypoechoic lesion was found in this series. There were no meaningful differences in cell types or in the grading of cellular atypia between the hyperechoic type and the isoechoic type. In regard to the amount of stroma, all cases were of the medullary type, so this factor did not contribute to the difference of echogenicity in this series. Concerning the architectural arrangement the isoechoic types consisted of only the alveolar type, while the hyperechoic types were of the tubular type, the papillary type or the alveolar type coexisting with the diffusely scattered cytic type. It is suggested that the alveolar types would be isoechoic, while the tubular, papillary or cystic types would be hyperechoic. These results suggest that cellular factors such as cell types or the grading of cellular atypia may not affect the echogenicity of renal cell carcinoma, but that structural factors such as the architectural arrangement may affect it. Cavitary components of approximately 30-60 μ in diameter were found to be common in the structure of the hyperechoic types. We propose that a standard classification of echogenicity should be determined to facilitate discussion of the relation between echogenicity and pathohistological findings.

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