研究者詳細 - 藤原　広和

論文 - 藤原　広和

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A 20-year prospective longitudinal MRI study on cervical spine after whiplash injury: Follow-up of a cross-sectional study

Daimon K., Fujiwara H., Nishiwaki Y., Okada E., Nojiri K., Shimizu K., Ishihama H., Fujita N., Ichihara D., Tsuji T., Nakamura M., Matsumoto M., Watanabe K.

Journal of Orthopaedic Science （Journal of Orthopaedic Science） 24 （ 4 ） 579 - 583 2019年07月

ISSN 09492658

© 2018 Background: Some patients suffer from long-lasting symptoms after whiplash injury. However, there are few reports on the long-term changes in the cervical spine after whiplash injury using imaging tests. The purpose of this longitudinal study was to determine the changes on MRI of the cervical spine 20 years after whiplash injury, and to examine the relationships between changes in the cervical spine on MRI and changes in related clinical symptoms. Methods: Eighty-one subjects finally participated in this study (follow-up rate 16%). The mean follow-up duration was 21.7 years. All subjects filled out a questionnaire about their clinical symptoms. The MRI findings were assessed using numerical grading system applied in the original study. Statistic analyses were used to investigate whether the progression of each MRI finding was associated with the severity of neck pain, stiff shoulders, dizziness and tinnitus. Results: All subjects had complained of some clinical symptoms in the original study: 71 had neck pain, 53 stiff shoulders, and others. In the present study, 66 subjects (81.5%) complained of some clinical symptoms: 57 had stiff shoulders, 20 neck pain, and others. The progression of degeneration on MRI was observed in 95% of the subjects, with C4/5 and 5/6 being the most frequently involved levels. Changes in the severity of neck pain, stiff shoulders, dizziness and tinnitus over 20 years were not significantly associated with the progression of degenerative changes in the cervical spine on MRI. Conclusions: Twenty years after whiplash injury, 95% of the subjects showed a progression of degeneration in the cervical spine. The progression of the intervertebral disc degeneration in the cervical spine on MRI after whiplash injury was not significantly associated with changes in the severity of related clinical symptoms, indicating that the degenerative changes on MRI may reflect the physiological aging process rather than post-traumatic sequelae.

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Imaging scoring systems for preoperative molecular diagnoses of lower-grade gliomas

Kanazawa T., Fujiwara H., Takahashi H., Nishiyama Y., Hirose Y., Tanaka S., Yoshida K., Sasaki H.

Neurosurgical Review （Neurosurgical Review） 42 （ 2 ） 433 - 441 2019年06月

ISSN 03445607

© 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Recent advance in molecular characterization of gliomas showed that patient prognosis and/or tumor chemosensitivity correlate with certain molecular signatures; however, this information is available only after tumor resection. If molecular information is available by routine radiological examinations, surgical strategy as well as overall treatment strategy could be designed preoperatively.With the aim to establish an imaging scoring system for preoperative diagnosis of molecular status in lower-grade gliomas (WHO grade 2 or 3, LrGGs), we investigated 8 imaging features available on routine CT and MRI in 45 LGGs (discovery cohort) and compared them with the status of 1p/19q codeletion, IDH mutations, and MGMT promoter methylation. The scoring systems were established based on the imaging features significantly associated with each molecular signature, and were tested in the another 52 LrGGs (validation cohort).For prediction of 1p/19q codeletion, the scoring system is composed of calcification, indistinct tumor border on T1, paramagnetic susceptibility effect on T1, and cystic component on FLAIR. For prediction of MGMT promoter methylation, the scoring system is composed of indistinct tumor border, surface localization (FLAIR), and cystic component. The scoring system for prediction of IDH status was not established. The 1p/19q score ≥ 3 showed PPV of 96.2% and specificity of 98.1%, and the MGMT methylation score ≥ 2 showed PPV of 77.4% and specificity of 67.6% in the entire cohort.These scoring systems based on widely available imaging information may help to preoperatively design personalized treatment in patients with LrGG.

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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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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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Twenty-year Longitudinal Follow-up MRI Study of Asymptomatic Volunteers the Impact of Cervical Alignment on Disk Degeneration

Okada E., Daimon K., Fujiwara H., Nishiwaki Y., Nojiri K., Watanabe M., Katoh H., Shimizu K., Ishihama H., Fujita N., Tsuji T., Nakamura M., Matsumoto M., Watanabe K.

Clinical Spine Surgery （Clinical Spine Surgery） 31 （ 10 ） 446 - 451 2018年12月

ISSN 23800186

© 2018 Wolters Kluwer Health, Inc. All rights reserved. Study Design: A 20-year longitudinal study. Objective: To evaluate the long-term effect of sagittal alignment of the cervical spine on intervertebral disk degeneration in healthy asymptomatic subjects. Summary of Background Data: This study continues a previous 10-year longitudinal study to determine whether sagittal alignment affects disk degeneration during normal aging. Materials and Methods: We assessed 90 healthy subjects (30 men and 60 women) from among 497 volunteers who underwent magnetic resonance imaging (MRI) and plain radiographs of the cervical spine between 1994 and 1996 (follow-up rate 18.1%). The mean age at the initial study was 35.5 13.4 years (11-65 y). We compared initial MRIs and follow-up MRIs, conducted at an average of 21.6 years after the initial study, for (1) decreased signal intensity of the intervertebral disks, (2) posterior disk protrusion, and (3) disk-space narrowing from C2-3 to C7-T1. Subjects were grouped by age at follow-up (under 40 vs. 40 y and older) and by a lordotic or nonlordotic cervical sagittal alignment at baseline. We assessed neck pain, stiff shoulders, and upper-arm numbness at follow-up, and examined associations between clinical symptoms and MRI parameters. Results: Progressive changes during the 20-year period included a decrease in disk signal intensity (84.4% of subjects), posterior disk protrusion (86.7%), and disk-space narrowing (17.8%). No significant association was observed between sagittal alignment and decreased disk signal intensity, posterior disk protrusion, or disk-space narrowing. Among subjects over the age of 40, progressive degenerative changes at C7-T1 were significantly more frequent in nonlordotic subjects (90.9%) compared with those with cervical lordosis (54.2%, P= 0.032). The prevalence of clinical symptoms was similar in lordotic and nonlordotic subjects at follow-up. Conclusions: Nonlordotic cervical alignment was related to the progression of disk degeneration at C7-T1 but not other levels. Cervical alignment did not affect the development of clinical symptoms in healthy subjects.

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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 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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Fate of the three embryonic dural sinuses in infants: the primitive tentorial sinus, occipital sinus, and falcine sinus

Mizutani K., Miwa T., Akiyama T., Sakamoto Y., Fujiwara H., Yoshida K.

Neuroradiology （Neuroradiology） 60 （ 3 ） 325 - 333 2018年03月

ISSN 00283940

© 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: The primitive tentorial, occipital, and falcine sinuses are thought to attain the adult pattern or regress between the fetal stage and adulthood. The anatomy of these three primitive dural sinuses has seldom been studied in the infant population, and it remains unclear when these dural sinuses reach the adult condition. Using computed tomography digital subtraction venography (CT-DSV), we analyzed the anatomy of these embryonic dural sinuses in infants. Methods: We included 13 infants who underwent CT-DSV prior to neurosurgery and 35 cases with unruptured cerebral aneurysms as normal adult controls. Three embryonic dural sinuses, i.e., the primitive tentorial, occipital, and falcine sinuses, were retrospectively analyzed in CT-DSV images of infants and adults. We also analyzed the drainage patterns of the superficial middle cerebral vein (SMCV), determined by the connection between the primitive tentorial sinus and the cavernous sinus. Results: The primitive tentorial, occipital, and falcine sinuses were present in 15.4%, 46.2%, and none of the infants, respectively, and in 10.0, 8.6, and 2.9% of the adults, respectively. The difference in SMCV draining pattern between infants and adults was insignificant. The incidence of the occipital sinus was significantly higher in infants than in adults. Conclusions: The connection between the primitive tentorial sinus and the cavernous sinus appears to be established before birth. The occipital sinus is formed at the embryonic stage and mostly regresses after infancy. The falcine sinus is usually obliterated prenatally. Our findings form the basis for interventions by pediatric interventional neuroradiologists and neurosurgeons.

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A 20-year prospective longitudinal study of degeneration of the cervical spine in a volunteer cohort assessed using MRI follow-up of a cross-sectional study

Daimon K., Fujiwara H., Nishiwaki Y., Okada E., Nojiri K., Watanabe M., Katoh H., Shimizu K., Ishihama H., Fujita N., Tsuji T., Nakamura M., Matsumoto M., Watanabe K.

Journal of Bone and Joint Surgery - American Volume （Journal of Bone and Joint Surgery - American Volume） 100 （ 10 ） 843 - 849 2018年

ISSN 00219355

© 2018 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED Background: Few studies have addressed in detail long-term degenerative changes in the cervical spine. In this study, we evaluated the progression of degenerative changes of the cervical spine that occurred over a 20-year period in an originally healthy cohort. We also sought to clarify the relationship between the progression of cervical degenerative changes and the development of clinical symptoms. Methods: For this prospective follow-up investigation, we recruited 193 subjects from an original cohort of 497 participants who had undergone magnetic resonance imaging (MRI) of the cervical spine between 1993 and 1996. The subjects were asked about the presence or absence of cervical spine-related symptoms. Degenerative changes of the cervical spine were assessed on MRI using an original numerical grading system. The relationship between the progression of degenerative changes and the onset of clinical symptoms was evaluated by logistic regression analysis. Results: Degeneration in the cervical spine was found to have progressed in 95% of the subjects during the 20-year period. The finding of a decrease in signal intensity of the intervertebral disc progressed in a relatively high proportion of the subjects in all age groups and occurred with similar frequency (around 60%) at all intervertebral disc levels. The rate of progression of other structural failures on MRI increased with age and was highest at C5-C6. The progression of foraminal stenosis was associated with the onset of upper-limb pain (odds ratio, 4.71 [95% confidence interval, 1.02 to 21.7]). Conclusions: A progression of degenerative changes in the cervical spine on MRI over the 20-year period was detected in nearly all subjects. There was no relationship between the progression of degeneration on MRI and the development of clinical symptoms, with the exception of an association found between foraminal stenosis and upper-limb pain. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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

Arita Y1, Fujiwara H1, Kurasawa J1, Momoshima S1, Takizawa T2, Jinzaki M1

Magn Reson Med Sci 2017年06月

研究論文（学術雑誌）, 共著, 査読有り

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

Mizutani, Katsuhiro, Toda, Masahiro, Kurasawa, Jun, Akiyama, Takenori, Fujiwara, Hirokazu, Jinzaki, Masahiro, Yoshida, Kazunari

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

研究論文（学術雑誌）, 共著, ISSN 0028-3940

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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, Mariko, Nakahara, Jin, Hata, Junichi, Suzuki, Shigeaki, Fujiyoshi, Kanehiro, Fujiwara, Hirokazu, Momoshima, Suketaka, Jinzaki, Masahiro, Nakamura, Masaya, Okano, Hideyuki, Takahashi, Shinichi, Suzuki, Norihiro

JOURNAL OF THE NEUROLOGICAL SCIENCES 373 352 - 357 2017年02月

研究論文（学術雑誌）, 共著, ISSN 0022-510X

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Leukoencephalopathy, cerebral calcifications, and cysts: A clinical case involving a long-term follow-up and literature review

Tamura, Ryota, Ohira, Takayuki, Emoto, Katsura, Fujiwara, Hirokazu, Horikoshi, Tomo, Yoshida, Kazunari

JOURNAL OF THE NEUROLOGICAL SCIENCES 373 60 - 65 2017年02月

研究論文（学術雑誌）, 共著, ISSN 0022-510X

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

Kikuchi, Ryogo, Toda, Masahiro, Wakahara, Sota, Fujiwara, Hirokazu, Jinzaki, Masahiro, Yoshida, Kazunari

WORLD NEUROSURGERY 93 139 - 143 2016年10月

研究論文（学術雑誌）, 共著, ISSN 1878-8750

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【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?-】脳神経　脳動脈瘤

藤原, 広和

画像診断 36 （ 9 ） 854 - 855 2016年07月

ISSN 0285-0524

【ROUTINE CLINICAL MRI 2016BOOK】 SIGNA Pioneerの初期経験

布川, 嘉信, 岡部, 幸司, 渡部, 敏男, 朝倉, 崇, 奥田, 茂男, 藤原, 広和 and 陣崎, 雅弘

映像情報Medical 47 （ 14 ） 112 - 119 2015年12月

ISSN 1346-1354

Encountering a basal vein of Rosenthal variant during the anterior transpetrosal approach

Shibao, S., Fujiwara, H., Borghei-Razavi, H. and Yoshida, K.

World Neurosurg 2015年09月

ISSN 1878-8750

BACKGROUND: The basal vein of Rosenthal (BVR) is important in intracranial surgery, including skull base surgery. Here, we report a case of petroclival meningioma in which a BVR variant drained into the tentorial sinus. CASE DESCRIPTION: An asymptomatic 62-year-old man was found to have a left petroclival meningioma during a routine examination. A "sliding-thin-slab" maximum intensity projection (MIP) was generated preoperatively using three-dimensional computed tomographic venography. It showed that the BVR variant drained into the free edge of the tentorium around the tumor. The tumor was removed via an anterior transpetrosal approach (ATPA). It was totally resected and the vein was preserved with no detectable venous complications. CONCLUSION: To our knowledge, this is the first study to describe surgery using the ATPA and involving a BVR variant, in which the vein was successfully imaged preoperatively using sliding-thin-slab MIP.

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Upfront chemotherapy and subsequent resection for molecularly defined gliomas

Sasaki, H., Hirose, Y., Yazaki, T., Kitamura, Y., Katayama, M., Kimura, T., Fujiwara, H., Toda, M., Ohira, T. and Yoshida, K.

J Neurooncol 124 （ 1 ） 127 - 35 2015年08月

ISSN 1573-7373

Functional preservation is critical in glioma surgery, and the extent of resection influences survival outcome. Neoadjuvant chemotherapy is a promising option because of its potential to facilitate tumor shrinkage and maximum tumor resection. The object of this study was to assess the utility of the neoadjuvant strategy in a prospective series of gliomas with favorable molecular status. Twenty-six consecutive cases of diffuse gliomas of WHO grade II or III with either 1p19q codeletion or MGMT methylation were treated with upfront chemotherapy following maximal safe removal. In cases of incomplete initial surgery, second-look resection was intended after tumor volume decrease by chemotherapy. Among 22 evaluable cases, chemotherapy led to a median change in the sum of the product of perpendicular diameters of -35 %, and 14 out of the 22 cases (64 %) showed objective response. Second-look resection after tumor volume decrease was performed in 12 out of 19 cases of incomplete initial surgery (GTR/STR 9, removal of residual methionine PET uptake 3). The median progression-free survival among the 22 patients with grade II tumors was 57 months, with some cases showing durable progression-free survival after second-look resection. MIB-1 indices of the second-look resected tumors were lower than those of the initial tumors, and the methylation status of the MGMT gene was unchanged. Neoadjuvant chemotherapy based on molecular guidance often produces significant volume decrease of incompletely resected gliomas. Radical second-look resection is an optional advantage of upfront chemotherapy for chemosensitive gliomas compared with initial radiotherapy.

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Intraosseous Schwannoma of the Petrous Apex

Tamura, R., Takahashi, S., Kohno, M., Kameyama, K., Fujiwara, H. and Yoshida, K.

J Neurol Surg Rep 76 （ 1 ） e135 - 9 2015年07月

ISSN 2193-6358

Background and Importance Intraosseous schwannoma is a relatively rare clinical entity that typically arises in vertebral and mandibular bone. Intraosseous schwannoma located entirely within the petrous bone is exceedingly rare, and only two cases have been reported to date. Clinical Presentation A 47-year-old Asian man was referred to our hospital with a chief complaint of double vision. Neurologic examination revealed left abducens nerve palsy. Radiologic imaging showed a 35-mm osteolytic expansive lesion located in the left petrous apex. We made a preoperative diagnosis of chondrosarcoma and performed surgical resection. Surgery was performed via a left subtemporal epidural approach with anterior petrosectomy. The histopathologic diagnosis of the tumor was schwannoma. Schwannoma arising from cranial nerves was excluded from intraoperative findings in conjunction with the results for cranial nerves, and intraosseous schwannoma was diagnosed. Postoperative course was uneventful, and abducens nerve palsy resolved immediately after surgery. Conclusion The differential diagnosis of intraosseous schwannoma should be considered for an osteolytic mass lesion within the petrous apex. Subcapsular tumor removal was considered ideal in terms of preservation of the cranial nerves and vessels around the tumor.

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Adult-onset recurrent painful ophthalmoplegic neuropathy displaying atypical oculomotor nerve gadolinium-enhancement pattern in the orbit and cavernous sinus

Takizawa, T., Shibata, M., Fujiwara, H., Shimizu, T., Momoshima, S. and Suzuki, N.

Cephalalgia 2015年04月

ISSN 1468-2982

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