論文 - 藤原　広和

Non-lesional white matter changes depicted by q-space diffusional MRI correlate with clinical disabilities in multiple sclerosis

Motegi H., Kufukihara K., Kitagawa S., Sekiguchi K., Hata J., Fujiwara H., Jinzaki M., Okano H., Nakamura M., Iguchi Y., Nakahara J.

Journal of the Neurological Sciences （Journal of the Neurological Sciences）  456 2024年01月

ISSN  0022510X

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Background: We previously developed an optimized q-space diffusional MRI technique (normalized leptokurtic diffusion [NLD] map) to delineate the demyelinated lesions of multiple sclerosis (MS) patients. Herein, we evaluated the utility of NLD maps to discern the white matter abnormalities in normal-appearing white matter (NAWM) and the abnormalities' possible associations with physical and cognitive disabilities in MS. Methods: We conducted a retrospective observational study of MS patients treated at our hospital (Jan. 2012 to Dec. 2022). Clinical and MRI data were collected; Processing Speed Test (PST) data were obtained when possible. For a quantitative analysis of the NLD maps, we calculated the NLD index as GVROI/GVREF, where GV is a mean grayscale value in the regions of interest (ROIs) and the reference area (REF; cerebrospinal fluid). Results: One hundred-one individuals with MS were included. The lower corpus callosum and non-lesional WM NLD index were associated with worse Expanded Disability Status Scale (EDSS) and PST scores. The NLD indexes in the corpus callosum (p < 0.0001) and non-lesional white matter (p < 0.0001) were significantly reduced in progressive MS compared to relapsing-remitting MS. We categorized MS severity as moderate/severe (EDSS score ≥ 4 points) and mild (EDSS score < 4 points). The NLD indexes in the corpus callosum (p < 0.0001) and non-lesional white matter (p < 0.0001) were significantly lower in the moderate/severe MS group compared to the mild MS group. Conclusion: The NLD map revealed abnormalities in the non-lesional white matter, providing valuable insights for evaluating manifestations in MS patients.

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“Missing-piece” sign with dural arteriovenous fistula at craniocervical junction: A case report

Tezuka T., Nukariya T., Katsumata M., Miyauchi T., Tokuyasu D., Azami S., Izawa Y., Nagoshi N., Fujiwara H., Mizutani K., Akiyama T., Toda M., Nakahara J., Nishimoto Y.

Journal of Stroke and Cerebrovascular Diseases （Journal of Stroke and Cerebrovascular Diseases）  32 （ 7 ）  2023年07月

ISSN  10523057

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Objectives: Spinal dural arteriovenous fistula (sDAVF) is a rare and often underdiagnosed spinal disease. Early diagnosis is required because the deficits are reversible and delays in treatment cause permanent morbidity. Although the abnormal vascular flow void is a critical radiographic feature of sDAVF, they are not always present. A characteristic enhancement pattern of sDAVF has been recently reported as the “missing-piece” sign which can lead to the early and correct diagnosis. Methods: We presented imaging findings, treatment decisions, and the outcome of a rare case of sDAVF, in which the “missing-piece” sign appeared atypical. Results: A 60-year-old woman developed numbness and weakness in her extremities. Spinal MRI revealed longitudinal hyperintensity in the T2-weighted image, extending from the thoracic level to medulla oblongata. At first, myelopathy with inflammation or tumor was suspected because of the lack of flow voids and vascular abnormalities in CT-angiography and MR-DSA. However, we administered intravenous methylprednisolone and her symptom got worse with the appearance of the “missing-piece” sign. Then, we successfully diagnosed sDAVF by angiography. The “missing-piece” sign was considered to derive from inconsistency of the intrinsic venous system of spinal cord, with the abrupt segments without enhancement. The same etiology was considered in our case. Conclusions: Detecting the “missing-piece” sign can lead to the correct diagnosis of sDAVF, even if the sign appeared atypical.

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Cranial defect and pneumocephalus are associated with significant postneurosurgical positional brain shift: evaluation using upright computed tomography

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

Scientific Reports （Scientific Reports）  12 （ 1 ）  2022年12月

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Only few studies have assessed brain shift caused by positional change. This study aimed to identify factors correlated with a large postneurosurgical positional brain shift (PBS). Sixty-seven patients who underwent neurosurgical procedures had upright computed tomography (CT) scan using settings similar to those of conventional supine CT. The presence of a clinically significant PBS, defined as a brain shift of ≥ 5 mm caused by positional change, was evaluated. The clinical and radiological findings were investigated to identify factors associated with a larger PBS. As a result, twenty-one patients had a clinically significant PBS. The univariate analysis showed that supratentorial lesion location, intra-axial lesion type, craniectomy procedure, and residual intracranial air were the predictors of PBS. Based on the multivariate analysis, craniectomy procedure (p < 0.001) and residual intracranial air volume (p = 0.004) were the predictors of PBS. In a sub-analysis of post-craniectomy patients, PBS was larger in patients with supratentorial craniectomy site and parenchymal brain injury. A large craniectomy area and long interval from craniectomy were correlated with the extent of PBS. In conclusion, patients who undergo craniectomy and those with residual intracranial air can present with a large PBS. In post-craniectomy patients, the predisposing factors of a large PBS are supratentorial craniectomy, presence of parenchymal injury, large skull defect area, and long interval from craniectomy. These findings can contribute to safe mobilization among postneurosurgical patients and the risk assessment of sinking skin flap syndrome.

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Changes in cross-sectional areas of posterior extensor muscles in thoracic spine: a 10-year longitudinal MRI study

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

Scientific Reports （Scientific Reports）  12 （ 1 ）  2022年12月

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Age-related changes in the posterior extensor muscles of the cervical and lumbar spine have been reported in some studies; however, longitudinal changes in the thoracic spine of healthy subjects are rarely reported. Therefore, this study aimed to evaluate changes in the cross-sectional areas (CSAs) of posterior extensor muscles in the thoracic spine over 10 years and identify related factors. The subjects of this study were 85 volunteers (mean age: 44.7 ± 11.5) and the average follow-up period was about 10 years. The CSAs of the transversospinalis muscles, erector spinae muscles, and total CSAs of the extensor muscles from T1/2 to T11/12 were measured on magnetic resonance imaging. The extent of muscle fat infiltration was assessed by the signal intensity (luminance) of the extensor muscles’ total cross-section compared to a section of pure muscle. We applied a Poisson regression model, which is included in the generalized linear model, and first examined the univariate (crude) association between each relevant factor (age, sex, body mass index, lifestyle, back pain, neck pain, neck stiffness, and intervertebral disc degeneration) and CSA changes. Then, we constructed a multivariate model, which included age, sex, and related factors in the univariate analysis. The mean CSAs of the transversospinalis muscles, erector spinae muscles, and total CSAs of the extensor muscles significantly increased over 10 years. Exercise habit was associated with increased CSAs of the erector spinae muscles and the total area of the extensor muscles. The cross-section mean luminance significantly increased from baseline, indicating a significant increase of fat infiltration in the posterior extensor muscles. Progression of disc degeneration was inversely associated with increased fat infiltration in the total extensor muscles.

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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

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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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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

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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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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

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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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A case of neuromyelitis optica spectrum disorder in which headache preceded visual field disturbances by 2 months

Isago E., Ishizuchi K., Takizawa T., Fujiwara H., Izawa Y., Nakahara J.

Clinical Neurology （Clinical Neurology）  61 （ 11 ） 722 - 726 2021年

ISSN  0009918X

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A quinquagenarian woman visited our hospital due to experiencing headache around the right upper eyelid for the previous 2 months. T2-weighted MRI of the head showed multiple high-signal-intensity lesions in the corpus callosum and bilateral corona radiata. She was thought to have an autoimmune disease and was treated with steroid pulse therapy, but the light reflex of the right eye diminished and the patient developed inferior horizontal hemianopsia. T2-weighted orbital MRI showed an enlarged right optic nerve, a high-intensity signal in the superior half of the optic nerve, and an enhancing effect. She also tested positive for anti-aquaporin 4 antibodies, so she was diagnosed with neuromyelitis optica spectrum disorder (NMOSD). This case shows that headache can be an initial symptom of NMOSD and that clinicians should consider NMOSD when attempting to diagnose patients presenting with headaches.

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The Long-Term Impact of Whiplash Injuries on Patient Symptoms and the Associated Degenerative Changes Detected Using MRI A Prospective 20-Year follow-up Study Comparing Patients with Whiplash-Associated Disorders with Asymptomatic Subjects

Watanabe, Kota MD, PhDa; Daimon, Kenshi MD, PhDa; Fujiwara, Hirokazu MD, PhDb; Nishiwaki, Yuji MD, PhDc; Okada, Eijiro MD, PhDa; Nojiri, Kenya MD, PhDd; Watanabe, Masahiko MD, PhDi; Katoh, Hiroyuki MD, PhDi; Shimizu, Kentaro MD, PhDe; Ishihama, Hiroko MDe; Fujita, Nobuyuki MD, PhDg; Ichihara, Daisuke MD, PhDf; Tsuji, Takashi MD, PhDh; Nakamura, Masaya MD, PhDa; Matsumoto, Morio MD, PhD

Spine （Spine）  46 （ 11 ） 710 - 716 2020年12月

ISSN  03622436

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Study Design.A longitudinal, 20-year comparative study of patients with whiplash-associated disorders (WAD).Objective.The aim of this study was to clarify the long-term impact of WAD on patient symptoms and on magnetic resonance imaging (MRI) findings of the cervical spine, in comparison with asymptomatic volunteers.Summary of Background Data.The long-term impact of WAD has not been fully elucidated.Methods.Between 1993 and 1996, we conducted a cross-sectional comparative study of 508 acute WAD patients and 497 asymptomatic volunteers, all of whom underwent MRI on cervical spine and physical examinations. For this 20-year follow-up comparative study, 75 WAD patients and 181 control subjects aged <60years were recruited from the original cohort. The MRI findings, including discs' signal intensities, posterior disc protrusions, anterior dural compressions, spinal cord disc space narrowing, and foraminal stenoses, were evaluated using two to four numerical grades. The results of the WAD patients and control subjects were compared.Results.In this follow-up, the prevalence of shoulder stiffness (72.0% vs. 45.9%), headache (24.0% vs. 12.2%), and arm pain (13.3% vs. 3.9%) were significantly greater in WAD patients than in control subjects. The multiregression analysis revealed that a history of WAD was associated with shoulder stiffness (odds ratio [OR]: 3.36), headache (OR: 2.39), and arm pain (OR: 3.82). Although MRI findings in WAD patients were more degenerated than in control subjects in the initial study, all MRI findings were similar at the 20-year follow-up. There were no significant correlations between clinical cervical symptoms and progression in each MR finding in either group.Conclusion.After 20years, whiplash injuries significantly impacted the residual symptoms of shoulder stiffness, headache, and arm pain when compared with initially asymptomatic volunteers. The progression of degenerative changes in the cervical intervertebral discs after 20years revealed no association with existing whiplash injuries, neither did the residual cervical-related symptoms.Level of Evidence: 3.

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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

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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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123-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

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

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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08月

ISSN  00016268

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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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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

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

Nobuhiko Arai 1, Takenori Akiyama 2, Hirokazu Fujiwara 3, Kazunari Koike 2, Satoshi Takahashi 2, Takashi Horiguchi 2, Masahiro Jinzaki 3, Kazunari Yoshida 2

Neuroradiology （Neuroradiology）  62 （ 4 ） 455 - 461 2020年01月

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Residual lumbar curvature that developed during adolescence accelerates intervertebral disc degeneration in adulthood

Suzuki S., Fujiwara H., Nori S., Tsuji O., Nagoshi N., Okada E., Fujita N., Yagi M., Nohara A., Kawakami N., Michikawa T., Nakamura M., Matsumoto M., Watanabe K.

Spine Deformity （Spine Deformity）  9 （ 3 ） 711 - 720 2020年

ISSN  2212134X

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Purpose: To elucidate the influence of spinal deformity in adolescent idiopathic scoliosis (AIS) on lumbar intervertebral disc (IVD) degeneration in adulthood using magnetic resonance imaging (MRI). Methods: A total of 102 patients (8 men, 94 women; mean age, 31.4 years) who had developed idiopathic scoliosis at the age of 10–18 years and underwent preoperative lumbar spine MRI at the age of ≥ 20 were included in the study. Twenty volunteers (3 men, 17 women; mean age, 33.6 years) without scoliosis were assessed as controls. We divided the adult scoliosis patients into two groups: Group A consisted of patients with lumbar modifier A, and Group BC consisted of those with modifiers B and C. IVD degeneration from L1/2 to L5/S1 was assessed by MRI. The Scoliosis Research Society-22 (SRS-22) patient questionnaire was used in the patients’ clinical assessment. Results: There were 40 patients in the Group A and 62 in the Group BC. Compared to the control groups, significant IVD degeneration was observed at L2/3 and L3/4 in Group A, and at all levels except for L5/S1 in Group BC. The proportion of degenerated IVDs patients (Grades 1c and 2) was significantly higher in Group BC than those in Group A at L3/L4 and L4/L5. Furthermore, the severity of IVD degeneration was significantly greater in the group BC than in the group A at all levels, except for L5/S1, especially in patients aged > 30 years. The mean scores of all subdomains in the SRS-22 questionnaire were comparable between the two groups. Conclusion: Our study showed that the residual lumbar curvature from AIS may have accelerated IVD degeneration in adulthood, especially in patients aged > 30 years. Level of evidence: III.

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A VEGF receptor vaccine demonstrates preliminary efficacy in neurofibromatosis type 2

Tamura R., Fujioka M., Morimoto Y., Ohara K., Kosugi K., Oishi Y., Sato M., Ueda R., Fujiwara H., Noji S., Oishi N., Ogawa K., Kawakami Y., Ohira T., Yoshida K., Toda M.

Nature Communications （Nature Communications）  10 （ 1 ）  2019年12月

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The anti-VEGF antibody bevacizumab has shown efficacy for the treatment of neurofibromatosis type 2 (NF2). Theoretically, vascular endothelial growth factor receptors (VEGFRs)-specific cytotoxic T lymphocytes (CTLs) can kill both tumor vessel cells and tumor cells expressing VEGFRs. Here we show an exploratory clinical study of VEGFRs peptide vaccine in seven patients with progressive NF2-derived schwannomas. Hearing improves in 2/5 assessable patients (40%) as determined by international guidelines, with increases in word recognition scores. Tumor volume reductions of ≥20% are observed in two patients, including one in which bevacizumab had not been effective. There are no severe adverse events related to the vaccine. Both VEGFR1-specific and VEGFR2-specific CTLs are induced in six patients. Surgery is performed after vaccination in two patients, and significant reductions in the expression of VEGFRs in schwannomas are observed. Therefore, this clinical immunotherapy study demonstrates the safety and preliminary efficacy of VEGFRs peptide vaccination in patients with NF2.

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Ten-year Longitudinal Follow-up MRI Study of Age-related Changes in Thoracic Intervertebral Discs in Asymptomatic Subjects

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

Spine （Spine）  44 （ 22 ） E1317 - E1324 2019年11月

ISSN  03622436

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STUDY DESIGN: Prospective longitudinal study. OBJECTIVE: The aim of this study was to evaluate long-term degenerative changes in intervertebral discs in the thoracic spine in healthy asymptomatic subjects. SUMMARY OF BACKGROUND DATA: Longitudinal magnetic resonance imaging (MRI) studies of intervertebral disc degeneration have been reported for the cervical and lumbar but not the thoracic spine. METHODS: In this longitudinal study (average follow-up 10.0 ± 0.6 years), we assessed degenerative changes in the thoracic spine of 103 volunteers (58 men) of 223 healthy volunteers in the initial MRI study of the thoracic spine (follow-up rate 46.2%). The mean age at the initial study was 45.0 ± 11.5 years (24-77 years). Initial and follow-up thoracic-spine MRIs were graded for the following 4 factors of degenerative changes: decrease in signal intensity of intervertebral disc (DSI), posterior disc protrusion (PDP), anterior compression of dura and spinal cord (AC), and disc-space narrowing (DSN) from T1-2 to T12-L1. We assessed associations between changes in MRI grade and demographical factors such as age, sex, body mass index, smoking habits, sports activities, and disc degeneration in the cervical spine. RESULTS: MRIs revealed that 63.1% of the subjects had degenerative changes in the thoracic intervertebral discs that had progressed at least one grade during the follow-up period. DSI progressed in 44.7% of subjects, PDP in 21.4%, and AC in 18.4% during the 10-year period. No DSN progression was seen. DSI was frequently observed in the upper thoracic spine (T1-2 to T4-5). Disc degeneration was relatively scarce in the lower thoracic spine (T9-10 to T12-L1). PDP was frequently observed in the middle thoracic spine (T5-6 toT8-9). We found significant associations between DSI and cervical-spine degeneration (P = .004) and between AC and smoking (P = .04). CONCLUSION: Progressive thoracic disc degeneration, observed in 63.1% of subjects; was significantly associated with smoking and with cervical-spine degeneration.2.

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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

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© 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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Review of synthetic MRI in pediatric brains: Basic principle of MR quantification, its features, clinical applications, and limitations

Andica C., Hagiwara A., Hori M., Kamagata K., Koshino S., Maekawa T., Suzuki M., Fujiwara H., Ikeno M., Shimizu T., Suzuki H., Sugano H., Arai H., Aoki S.

Journal of Neuroradiology （Journal of Neuroradiology）  46 （ 4 ） 268 - 275 2019年07月

ISSN  01509861

　概要を見る

© 2019 Elsevier Masson SAS Quantitative magnetic resonance imaging (MRI)with multislice, multi-echo, and multi-delay acquisition enables simultaneous quantification of R1 and R2 relaxation rates, proton density, and the B1 field in a single acquisition, and requires only about 6 minutes for full-head coverage. Using dedicated SyMRI software, radiologists can generate any contrast-weighted image by manipulating the acquisition parameters, including repetition time, echo time, and inversion time. Moreover, automatic brain tissue segmentation, volumetry, and myelin measurement can also be performed. Using the SyMRI approach, a shorter scan time, an objective examination, and personalized MR imaging parameters can be obtained in daily clinical pediatric imaging. Here we summarize and review the use of SyMRI in imaging of the pediatric brain, including the basic principles of MR quantification along with its features, clinical applications, and limitations.

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Modic changes in the cervical spine: Prospective 20-year follow-up study in asymptomatic subjects

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

Journal of Orthopaedic Science （Journal of Orthopaedic Science）  24 （ 4 ） 612 - 617 2019年07月

ISSN  09492658

　概要を見る

© 2019 The Japanese Orthopaedic Association Background: Few studies have characterized the development of Modic changes in the cervical spine over time. We evaluated Modic changes of the cervical spine that developed over a 20-year period in a healthy cohort, and sought to clarify the relationship between Modic changes and the development of clinical symptoms. Methods: For this multicenter prospective cohort study, we recruited 193 subjects from an original cohort of asymptomatic volunteers who underwent MRI of the cervical spine between 1993 and 1996. Each cervical level from C2/3 to C7/T1 (total n = 1158 intervertebral levels) was assessed on current MRIs as normal or showing type 1, 2, or 3 Modic change, and we asked about symptoms related to the cervical spine. Relationships between the presence of Modic changes and patient characteristics, pre-existing disc degenerations or clinical symptoms were evaluated by logistic regression analysis. Results: After 20-year follow-up, Modic changes affected 31 subjects (16.1%) at 47 intervertebral disc levels. Of these 47 intervertebral disc levels, type 2, found at 30 levels (63.8%), was the most frequent, followed by type 1 at 15 levels (31.9%) and type 3 at two levels (4.3%). The most frequent changes were observed at the C5/6 segment with type 2 Modic changes. The presence of Modic changes correlated with pre-existing posterior disc protrusion (odds ratio 3.31, 95% confidence interval 1.21–9.05) and neck pain (odds ratio 2.71, 95% confidence interval 1.08–6.80). Conclusions: In the cervical spine over a 20-year period, type 2 Modic changes were most frequent at the C5/6 segment. The Modic changes were associated with pre-existing disc degeneration and neck pain but not with age, BMI, smoking, shoulder stiffness, arm pain or numbness.

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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

　概要を見る

© 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

　概要を見る

© 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

　概要を見る

© 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

　概要を見る

© 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

　概要を見る

© 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

　概要を見る

© 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

　概要を見る

© 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

　概要を見る

© 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

　概要を見る

© 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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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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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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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

　概要を見る

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

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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

　概要を見る

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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Various patterns of the middle cerebral veins and preservation of venous drainage during the anterior transpetrosal approach

Shibao, S, Toda, M, Fujiwara, H and Yoshida, K

J Neurosurg Aug 28   1 - 8 2015年

【ビギナーのための頭部画像診断-Q&Aアプローチ-】 所見別　磁化率強調像、T2*強調像の小さな低信号をみたら、(どのような鑑別を考え)どのようなコメントを書きますか? 【多発性硬化症のパラダイムシフト-病態から治療まで】 検査　画像診断

藤原, 広和, 高橋, 秀典, 藤原, 広和 and 百島, 祐貴

画像診断 35 （ 10 ） 1248 - 1249 2015年

ISSN  0285-0524

【多発性硬化症のパラダイムシフト-病態から治療まで】 検査　画像診断

高橋, 秀典, 藤原, 広和 and 百島, 祐貴

Clinical Neuroscience 32 （ 11 ） 1249 - 1252 2014年11月

ISSN  0289-0585

【脳血管構築の特異性と認知症】 血管性認知症の画像診断

百島, 祐貴 and 藤原, 広和

血管医学 15 （ 1 ） 61 - 67 2014年05月

ISSN  1345-9031

　概要を見る

血管性認知症を画像所見のみから診断することは難しい場合が多く、臨床経過、神経症状との対比が重要である。血管性認知症に認められる画像所見は、(1)Binswanger病(大脳白質の虚血性変化)、(2)ラクナ梗塞、(3)多発皮質梗塞、(4)特定の「戦略的部位」の梗塞、(5)出血性病変に大別できる。しかし、純粋な脳血管性認知症は比較的少なく、特に加齢とともにアルツハイマー病など変性認知症との合併が増加する。このほか鑑別すべきものとして、アミロイドアンギオパチー、正常圧水頭症などが重要である。(著者抄録)

【鉄と神経疾患】 脳内鉄沈着をきたす疾患の画像診断

百島, 祐貴 and 藤原, 広和

神経内科 79 （ 4 ） 435 - 438 2013年10月

ISSN  0386-9709

【頭蓋底-disease oriented anatomy-】 眼窩疾患と頭蓋底 【鉄と神経疾患】 脳内鉄沈着をきたす疾患の画像診断

藤原, 広和, 百島, 祐貴, 高橋, 秀典, 百島, 祐貴 and 藤原, 広和

画像診断 33 （ 13 ） 1397 - 1407 2013年10月

ISSN  0285-0524

Tandem age-related lumbar and cervical intervertebral disc changes in asymptomatic subjects.

Matsumoto, Morio, Okada, Eijiro, Toyama, Yoshiaki, Fujiwara, Hirokazu, Momoshima, Suketaka and Takahata, Takeshi

European spine journal 22   708 - 13 2013年

　概要を見る

PURPOSE: To investigate the frequency of tandem lumbar and cervical intervertebral disc degeneration in asymptomatic subjects. METHODS: We evaluated magnetic resonance imaging (MRI) results from 94 volunteers (48 men and 46 women; mean age 48 years) for age-related intervertebral disc degeneration in the lumbar and cervical spine. RESULTS: MRI indicated degenerative changes in the lumbar spine in 79 subjects (84 %), with decreased disc signal intensity in 74.5 %, posterior disc protrusion in 78.7 %, anterior compression of the dura in 81.9 %, disc space narrowing in 21.3 %, and spinal canal stenosis in 12.8 %. These findings were more common in older subjects at caudal levels. MRI showed degenerative changes in both the lumbar and cervical spine in 78.7 % of the volunteers. CONCLUSIONS: Degenerative findings in both the lumbar and cervical spine, suggesting tandem disc degeneration, was common in asymptomatic subjects. These results provide normative data for evaluating patients with degenerative lumbar and cervical disc diseases.

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Whole-brain CT digital subtraction angiography of cerebral dural arteriovenous fistula using 320-detector row CT.

Fujiwara, Hirokazu, Momoshima, Suketaka, Akiyama, Takenori and Kuribayashi, Sachio

Neuroradiology 55   837 - 43 2013年

　概要を見る

INTRODUCTION: The purpose of this study was to evaluate the usefulness of CT digital subtraction angiography (CTDSA) by using 320-detector row CT in the diagnosis and classification of cerebral dural arteriovenous fistula (dAVF) and comparing it with DSA as the standard reference.

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Modic changes of the cervical spine in patients with whiplash injury: a prospective 11-year follow-up study.

Matsumoto, Morio, Ichihara, Daisuke, Okada, Eijiro, Toyama, Yoshiaki, Fujiwara, Hirokazu, Momoshima, Suketaka, Nishiwaki, Yuji and Takahata, Takeshi

Injury 44   819 - 24 2013年

　概要を見る

INTRODUCTION: There are few studies on Modic changes of the cervical spine in patients suffering from whiplash. This study compared Modic changes seen in whiplash patients 10 years after the injury with those observed in asymptomatic volunteers. METHODS: This is a follow-up study of 133 patients who suffered whiplash injuries in 1994-1996 and underwent MRI with a superconductive imager (63 men, 70 women, mean age 49.6±15.3 years, mean follow-up 11.4 years). In addition, 223 healthy volunteers who underwent MRI during the same period were included as controls (123 men, 100 women, mean age 50.5±15.0 years, mean follow-up 11.6 years). All participants underwent follow-up MRI. We examined all participants for Modic changes, and investigated relationships between Modic changes and clinical symptoms or potentially related factors. RESULTS: Modic changes were observed in 4 patients (3%) and at 7 intervertebral levels in the initial study, and in 17 patients (12.8%) and at 30 intervertebral levels at the follow-up. Modic Type 2 changes were the most prevalent in the whiplash patients in both the initial and follow-up studies. There was no significant difference in the percentage of whiplash patients versus control subjects with positive Modic changes, either at the initial study or at follow-up. Modic changes were not related to clinical symptoms present at follow-up, but were associated with preexisting disc degeneration. There was no association between Modic changes and the details of the car accident that caused the injury. CONCLUSIONS: While Modic changes became more common in whiplash patients in the 10-year period after the accident, they occurred with a similar frequency in control subjects. We did not find any association between Modic changes and the nature of the car accident in which the whiplash occurred. Modic changes found in whiplash patients may be a result of the physiological ageing process rather than pathological findings relating to the whiplash injury.

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【心原性脳塞栓症と心房細動】 脳塞栓症の診断　画像診断

藤原, 広和 and 百島, 祐貴

Clinical Neuroscience 30 （ 11 ） 1250 - 1253 2012年11月

ISSN  0289-0585

Cross-sectional area of the posterior extensor muscles of the cervical spine in whiplash injury patients versus healthy volunteers--10 year follow-up MR study.

Matsumoto, Morio, Ichihara, Daisuke, Okada, Eijiro, Chiba, Kazuhiro, Toyama, Yoshiaki, Fujiwara, Hirokazu, Momoshima, Suketaka, Nishiwaki, Yuji and Takahata, Takeshi

Injury 43   912 - 6 2012年

　概要を見る

Long-term follow-up studies focusing on the posterior extensor muscles in patients suffering from whiplash injury are scarce. The purpose of this study was to elucidate the changes in the posterior extensor muscles 10 years after whiplash injury.

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Modic changes in the cervical spine: prospective 10-year follow-up study in asymptomatic subjects.

Matsumoto, M, Okada, E, Ichihara, D, Chiba, K, Toyama, Y, Fujiwara, H, Momoshima, S, Nishiwaki, Y and Takahata, T

The Journal of bone and joint surgery. British volume 94   678 - 83 2012年

　概要を見る

We conducted a prospective follow-up MRI study of originally asymptomatic healthy subjects to clarify the development of Modic changes in the cervical spine over a ten-year period and to identify related factors. Previously, 497 asymptomatic healthy volunteers with no history of cervical trauma or surgery underwent MRI. Of these, 223 underwent a second MRI at a mean follow-up of 11.6 years (10 to 12.7). These 223 subjects comprised 133 men and 100 women with a mean age at second MRI of 50.5 years (23 to 83). Modic changes were classified as not present and types 1 to 3. Changes in Modic types over time and relationships between Modic changes and progression of degeneration of the disc or clinical symptoms were evaluated. A total of 31 subjects (13.9%) showed Modic changes at follow-up: type 1 in nine, type 2 in 18, type 3 in two, and types 1 and 2 in two. Modic changes at follow-up were significantly associated with numbness or pain in the arm, but not with neck pain or shoulder stiffness. Age (≥ 40 years), gender (male), and pre-existing disc degeneration were significantly associated with newly developed Modic changes. In the cervical spine over a ten-year period, type 2 Modic changes developed most frequently. Newly developed Modic changes were significantly associated with age, gender, and pre-existing disc degeneration.

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Changes in the cross-sectional area of deep posterior extensor muscles of the cervical spine after anterior decompression and fusion: 10-year follow-up study using MRI.

Matsumoto, Morio, Okada, Eijiro, Ichihara, Daisuke, Watanabe, Kota, Chiba, Kazuhiro, Toyama, Yoshiaki, Fujiwara, Hirokazu, Momoshima, Suketaka, Nishiwaki, Yuji, Hashimoto, Takeshi, Iwanami, Akio, Ikegami, Takeshi and Takahata, Takeshi

European spine journal 21   304 - 8 2012年

　概要を見る

To evaluate changes in the transverse area of deep posterior muscles of the cervical spine 10 years after anterior cervical decompression and fusion (ACDF), in comparison with healthy volunteers.

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Hemorrhagic onset of cerebellar pilocytic astrocytoma in an adult: a case report and review of the literature implying a possible relation of degenerative vascular changes to the massive intratumoral hemorrhage.

Shibao, Shunsuke, Kimura, Tokuhiro, Sasaki, Hikaru, Fujiwara, Hirokazu, Akiyama, Takenori, Ueno, Mari, Shidoh, Satoka and Yoshida, Kazunari

Brain tumor pathology 29   96 - 102 2012年

　概要を見る

Pilocytic astrocytoma (PA) is a low-grade astrocytic tumor arising predominantly during the first two decades of life. Hemorrhagic onset of PAs is uncommon, and the etiology of hemorrhage remains unclear. Here we report a case of hemorrhagic onset of cerebellar PA in a 29-year-old man who presented with a week-long history of headache and gait instability. Computed tomography and magnetic resonance imaging revealed a hemorrhagic tumor located in the right cerebellar hemisphere, and total resection was performed. Histological examination showed bipolar glial cell proliferation in a biphasic pattern in a compact area and a loose microcystic area with Rosenthal fibers and eosinophilic granular bodies, indicating PA. Prominent changes in tumor vasculature, including aggregation of sclerotic thick-walled and ectatic thin-walled vessels, was observed, and nodules of thrombi containing complex vascular proliferation suggesting recanalized thrombi formed in partially ruptured vessels were also found. Thus, rupture of these abnormal vessels appeared to be the cause of hemorrhage. Review of the literature revealed that age distribution of patients with hemorrhagic PAs tends to be older than that of patients with general PAs. These findings imply a possibility that degenerative changes in blood vessels in long-standing PAs might be related to the mechanisms of spontaneous intratumoral hemorrhage.

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Posterior cerebral artery dissection on a serial magnetic resonance angiography.

Takenouchi, Toshiki, Shimozato, Sachiko, Fujiwara, Hirokazu, Momoshima, Suketaka and Takahashi, Takao

Brain & development 34   396 - 9 2012年

　概要を見る

Posterior cerebral artery (PCA) dissection in children seldom is reported in the literature. This is the second report of acute PCA dissection with infarct occurring in a young child. A serial magnetic resonance angiography demonstrated a delayed and transient narrowing of the arterial caliber, which was consistent with a focal PCA dissection with delayed vascular recanalization. PCA dissection should be included in the causes of infarct in children and a thorough and serial neurovascular imaging should be considered if no cause of stroke is found.

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Cross-sectional area of posterior extensor muscles of the cervical spine in asymptomatic subjects: a 10-year longitudinal magnetic resonance imaging study.

Okada, Eijiro, Matsumoto, Morio, Ichihara, Daisuke, Chiba, Kazuhiro, Toyama, Yoshiaki, Fujiwara, Hirokazu, Momoshima, Suketaka, Nishiwaki, Yuji and Takahata, Takeshi

European spine journal 20   1567 - 73 2011年

　概要を見る

There has been no prospective study on age-related changes of the extensor muscles of the cervical spine in healthy subjects. This study was conducted to elucidate any association between the changes in cross-sectional area of the extensor muscles of the cervical spine on MRIs and cervical disc degeneration or the development of clinical symptoms. Sixty-two subjects who underwent MR imaging by a 1.5-Tesla machine between 1993 and 1996 as asymptomatic volunteers in a previous study were recruited again 10 years later for this follow-up study. The mean interval between the studies was 11.0 ± 0.7 years. The cross-sectional areas of the multifidus, semispinalis cervicis, semispinalis capitis, and splenius capitis at C3-C4, C4-C5, and C5-C6 intervertebral levels were measured on T2-weighted axial images using Image J 1.42. The mean cross-sectional areas of the deep extensor muscles were 1,396.8 ± 337.6 mm(2) at the C3-C4 level, 1,514.7 ± 381.0 mm(2) at the C4-C5 level, and 1,542.8 ± 373.5 mm(2) at the C5-C6 level in the previous investigation. The cross-sectional areas were 1,498.7 ± 374.4 mm(2) at the C3-C4 level, 1,569.9 ± 390.9 mm(2) at the C4-C5 level, and 1,599.6 ± 364.3 mm(2) at the 10-year follow-up. An increase in the cross-sectional area of the muscles was more frequently observed in subjects in their tens to thirties in the initial study, while a decrease was more frequently observed in those in their forties and older in the initial study. Disc degeneration was not correlated with a change in extensor muscle volume. Development of shoulder stiffness during follow-up was significantly negatively correlated with a change in the cross-sectional area of the deep extensor muscles.

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Wedging of vertebral bodies at the thoracolumbar junction in asymptomatic healthy subjects on magnetic resonance imaging.

Matsumoto, Morio, Okada, Eijiro, Kaneko, Yasuhito, Ichihara, Daisuke, Watanabe, Kota, Chiba, Kazuhiro, Toyama, Yoshiaki, Fujiwara, Hirokazu, Momoshima, Suketaka, Nishiwaki, Yuji, Hashimoto, Takeshi and Takahata, Takeshi

Surgical and radiologic anatomy : SRA 33   223 - 8 2011年

　概要を見る

Wedging of the vertebral body on radiological examination is a valuable indicator of a vertebral compression fracture, although it can also be observed in subjects with no history of trauma. The purpose of this study was to elucidate the normative value of vertebral wedging at the thoracolumbar junction in asymptomatic healthy subjects for differential diagnosis of vertebral compression fractures using MRI.

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Disc degeneration of cervical spine on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers.

Okada, Eijiro, Matsumoto, Morio, Fujiwara, Hirokazu and Toyama, Yoshiaki

European spine journal 20   585 - 91 2011年

　概要を見る

An association between progression of cervical disc degeneration and that of lumbar disc degeneration has been considered to exist. To date, however, this association has not yet been adequately studied. Age-related changes in the cervical intervertebral discs were evaluated by magnetic resonance imaging (MRI) in patients with lumbar disc herniation, and compared with the MRI findings of healthy volunteers without lower back pain. The purpose of this study was to clarify whether the prevalence of asymptomatic cervical disc degeneration is higher in patients with lumbar disc herniation than in healthy volunteers. The study was conducted on 51 patients who were diagnosed as having lumbar disc herniation and underwent cervical spine MRI. The patients consisted of 34 males and 17 females ranging in age from 21-83 years (mean 46.9 ± 14.5 years) at the time of the study. The control group was composed of 113 healthy volunteers (70 males and 43 females) aged 24-77 years (mean 48.9 ± 14.7 years), without neck pain or low back pain. The percentage of subjects with degenerative changes in the cervical discs was 98.0% in the lumbar disc herniation group and 88.5% in the control group (p = 0.034). The presence of lumbar disc herniation was associated significantly with decrease in signal intensity of intervertebral disc and posterior disc protrusion in the cervical spine. None of the MRI findings was significantly associated with the gender, smoking, sports activities, or BMI. As compared to healthy volunteers, patients with lumbar disc herniation showed a higher prevalence of decrease in signal intensity of intervertebral disc and posterior disc protrusion on MRI of the cervical spine. The result of this study suggests that disc degeneration appears to be a systemic phenomenon.

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【知っておきたい認知症の臨床と画像】 画像診断総論　MRI　MRIによる認知症の鑑別診断

百島, 祐貴 and 藤原, 広和

臨床放射線 55 （ 11 ） 1346 - 1353 2010年10月

ISSN  0009-9252

【神経疾患と鉄沈着】 鉄沈着の画像診断

藤原, 広和 and 百島, 祐貴

神経内科 73 （ 2 ） 110 - 116 2010年08月

ISSN  0386-9709

【Multislice CT 2010 BOOK】 面検出器CTによる全脳CTDSA、perfusion CT　脳腫瘍への応用

藤原, 広和 and 百島, 祐貴

映像情報Medical 42 （ 7 ） 109 - 113 2010年06月

ISSN  1346-1354

Development of stiff shoulder in asymptomatic volunteers during ten-year follow-up in Japan.

Okada, Eijiro, Matsumoto, Morio, Ichihara, Daisuke, Chiba, Kazuhiro, Toyama, Yoshiaki, Fujiwara, Hirokazu, Momoshima, Suketaka, Nishiwaki, Yuji, Hashimoto, Takeshi, Watanabe, Masahiko, Inoue, Tomoo and Takahata, Takeshi

Journal of back and musculoskeletal rehabilitation 23   69 - 75 2010年

　概要を見る

The purpose of this study was to longitudinally evaluate relationships between the incidence of stiff shoulder and sagittal alignments of the cervical spine, age-related changes on magnetic resonance imaging (MRI) and life styles of the subjects.

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Gemcitabine and cisplatin chemotherapy induced reversible posterior leukoencephalopathy syndrome in a bladder cancer patient.

Maeda, Takahiro, Kikuchi, Eiji, Matsumoto, Kazuhiro, Yazawa, Satoshi, Hagiuda, Jun, Miyajima, Akira, Nakagawa, Ken, Fujiwara, Hirokazu, Hoshino, Haruhiko and Oya, Mototsugu

International journal of clinical oncology 15   508 - 11 2010年

　概要を見る

Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare clinical entity, the common clinical symptoms of which are headache, disturbance of consciousness, altered mental status, seizures, and visual disturbance. Recently, some cases have been reported in association with the increased use of cytotoxic and immunosuppressive agents in cancer patients, and relevant reports have increased with advances in radiological examinations. We describe here the case of a 50-year-old man with advanced bladder cancer who suddenly experienced diminished spontaneity and speech, and finally became semicomatose. Two months previously, he had received gemcitabine and cisplatin chemotherapy. Computed tomography and magnetic resonance imaging revealed symmetrical edema of the posterior occipital lobe and thalamus. Based on these findings, we made a diagnosis of RPLS and treated him with supportive measures. His mental status gradually improved in 2 weeks, although slight neurological symptoms persisted. When the level of consciousness of a cancer patient worsens rapidly, this syndrome should be included in the differential diagnosis and recognized at an early stage. Early supportive management and discontinuation of the causative medication may reverse the clinical and radiological manifestations of the syndrome.

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Prospective ten-year follow-up study comparing patients with whiplash-associated disorders and asymptomatic subjects using magnetic resonance imaging.

Matsumoto, Morio, Okada, Eijiro, Ichihara, Daisuke, Chiba, Kazuhiro, Toyama, Yoshiaki, Fujiwara, Hirokazu, Momoshima, Suketaka, Nishiwaki, Yuji, Hashimoto, Takeshi, Inoue, Tomoo, Watanabe, Masahiko and Takahata, Takeshi

Spine 35   1684 - 90 2010年

　概要を見る

A prospective 10-year follow-up study of patients with whiplash-associated disorders (WAD) and asymptomatic volunteers.

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Age-related changes of thoracic and cervical intervertebral discs in asymptomatic subjects.

Matsumoto, Morio, Okada, Eijiro, Ichihara, Daisuke, Watanabe, Kota, Chiba, Kazuhiro, Toyama, Yoshiaki, Fujiwara, Hirokazu, Momoshima, Suketaka, Nishiwaki, Yuji, Hashimoto, Takeshi and Takahata, Takeshi

Spine 35   1359 - 64 2010年

　概要を見る

Magnetic resonance imaging (MRI) study on degeneration of the thoracic spine in asymptomatic subjects.

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Anterior cervical decompression and fusion accelerates adjacent segment degeneration: comparison with asymptomatic volunteers in a ten-year magnetic resonance imaging follow-up study.

Matsumoto, Morio, Okada, Eijiro, Ichihara, Daisuke, Watanabe, Kota, Chiba, Kazuhiro, Toyama, Yoshiaki, Fujiwara, Hirokazu, Momoshima, Suketaka, Nishiwaki, Yuji, Iwanami, Akio, Ikegami, Takeshi, Takahata, Takeshi and Hashimoto, Takeshi

Spine 35   36 - 43 2010年

　概要を見る

Prospective 10-year follow-up magnetic resonance imaging (MRI) study of patients who underwent anterior cervical decompression and fusion (ACDF) and healthy control subjects.

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【大脳白質をめぐって　画像と最新の知見】 大脳白質の変化・病変　放射線壊死

藤原, 広和 and 百島, 祐貴

Clinical Neuroscience 27 （ 11 ） 1240 - 1242 2009年11月

ISSN  0289-0585

【プライマリ・ケアに必要な画像診断のコツ】 頭部　複視・視覚障害の画像診断

藤原, 広和 and 百島, 祐貴

診断と治療 97 （ Suppl. ） 112 - 119 2009年04月

ISSN  0370-999X

Longitudinal magnetic resonance imaging study on whiplash injury patients: minimum 10-year follow-up.

Ichihara, Daisuke, Okada, Eijiro, Chiba, Kazuhiro, Toyama, Yoshiaki, Fujiwara, Hirokazu, Momoshima, Suketaka, Nishiwaki, Yuji, Hashimoto, Takeshi, Ogawa, Jun, Watanabe, Masahiko, Takahata, Takeshi and Matsumoto, Morio

Journal of orthopaedic science 14   602 - 10 2009年

　概要を見る

We conducted a prospective long-term follow-up study to assess associations between magnetic resonance imaging (MRI) findings and changes in clinical symptoms, as well as factors relating to the prognosis of symptoms.

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Aging of the cervical spine in healthy volunteers: a 10-year longitudinal magnetic resonance imaging study.

Okada, Eijiro, Matsumoto, Morio, Ichihara, Daisuke, Chiba, Kazuhiro, Toyama, Yoshiaki, Fujiwara, Hirokazu, Momoshima, Suketaka, Nishiwaki, Yuji, Hashimoto, Takeshi, Ogawa, Jun, Watanabe, Masahiko and Takahata, Takeshi

Spine 34   706 - 12 2009年

　概要を見る

Prospective longitudinal study, mean follow-up period; 11.7 +/- 0.8 years was conducted from 1995 to 2007.

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Does the sagittal alignment of the cervical spine have an impact on disk degeneration? Minimum 10-year follow-up of asymptomatic volunteers.

Okada, Eijiro, Matsumoto, Morio, Ichihara, Daisuke, Chiba, Kazuhiro, Toyama, Yoshiaki, Fujiwara, Hirokazu, Momoshima, Suketaka, Nishiwaki, Yuji, Hashimoto, Takeshi, Ogawa, Jun, Watanabe, Masahiko and Takahata, Takeshi

European spine journal 18   1644 - 51 2009年

　概要を見る

There have been few studies that investigated and clarified the relationships between progression of degenerative changes and sagittal alignment of the cervical spine. The objective of the study was to longitudinally evaluate the relationships among progression of degenerative changes of the cervical spine with age, the development of clinical symptoms and sagittal alignment of the cervical spine in healthy subjects. Out of 497 symptom-free volunteers who underwent MRI and plain radiography of the cervical spine between 1994 and 1996, 113 subjects (45 males and 68 females) who responded to our contacts were enrolled. All subjects underwent another MRI at an average of 11.3 years after the initial study. Their mean age at the time of the initial imaging was 36.6 +/- 14.5 years (11-65 years). The items evaluated on MRI were (1) decrease in signal intensity of the intervertebral disks, (2) posterior disk protrusion, and (3) disk space narrowing. Each item was evaluated using a numerical grading system. The subjects were divided into four groups according to the age and sagittal alignment of the cervical spine, i.e., subjects under or over the age of 40 years, and subjects with the lordosis or non-lordosis type of sagittal alignment of the cervical spine. During the 10-year period, progression of decrease in signal intensity of the disk, posterior disk protrusion, and disk space narrowing were recognized in 64.6, 65.5, and 28.3% of the subjects, respectively. Progression of posterior disk protrusion was significantly more frequent in subjects over 40 years of age with non-lordosis type of sagittal alignment. Logistic regression analysis revealed that stiff shoulder was closely correlated with females (P = 0.001), and that numbness of the upper extremity was closely correlated with age (P = 0.030) and male (P = 0.038). However, no significant correlation between the sagittal alignment of the cervical spine and clinical symptoms was detected. Sagittal alignment of the cervical spine had some impact on the progression of degenerative changes of the cervical spine with aging; however, it had no correlation with the occurrence of future clinical symptoms.

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【脳卒中の臨床　最新の実地治療・予防戦略】 脳卒中の臨床へのアプローチ　実地医家が知っておくべき基本的知識と臨床　脳卒中患者の画像診断(CT、MRI)のポイント

藤原, 広和 and 百島, 祐貴

Medical Practice 25 （ 12 ） 2126 - 2137 2008年12月

ISSN  0910-1551

脳血管障害 高血圧性脳症の画像診断

藤原, 広和 and 百島, 祐貴

Annual Review神経 2008   131 - 136 2008年01月

　概要を見る

高血圧性脳症は,悪性高血圧に伴い,頭痛,痙攣,意識障害等が引き起こされる病態として1928年にOppenheimerとFishbergにより初めて報告され,その画像所見が後頭部優位の可逆性の浮腫性変化であることは以前から知られていた.同様の臨床症状,画像所見が,妊娠子癇,免疫抑制剤の使用等でも認められ,Hanchyらはこれらの病態をまとめてreversible posterior leukoencephalopathy syndrome(RPLS)として報告した2).以来,同様の病態は多数報告され,posterior reversible encephalopathy syndrome(PRES)とも称せられる.高血圧性脳症とRPLS/PRESとは若干の異同もあるものの,病態生理,画像所見上は共通点が多く,本稿では古典的な高血圧性脳症のみならず,他の原因を含めたRPLS/PRES(以下PRES)の画像所見について概説する.(著者抄録)

【多系統萎縮症-update】 検査と診断　脳MRI

百島, 祐貴 and 藤原, 広和

Clinical Neuroscience 24 （ 9 ） 1012 - 1016 2006年09月

ISSN  0289-0585

Can selective CT angiography reduce the incidence of severe complications during transcatheter arterial embolization or infusion chemotherapy for thoracic diseases?

Tanaka, Osamu, Hashimoto, Subaru, Narimatsu, Yoshiaki, Fujiwara, Hirokazu, Kurata, Tadayoshi, Okuda, Shigeo, Yamagami, Takuji, Nishimura, Tsunehiko, Hiramatsu, Kyoichi and Kuribayashi, Sachio

Diagnostic and interventional radiology 12   201 - 5 2006年

　概要を見る

PURPOSE: To evaluate the usefulness of selective computed tomography (CT) angiography in preventing severe complications, such as spinal cord injury and broncho- esophageal fistula, during the transcatheter arterial embolization or infusion chemotherapy for thoracic diseases.

【医療環境の変化に対して放射線診療は今後どう対応すべきか　画像診断を中心に】　高度画像診断機器導入による画像診断へのインパクト　医療制度の変化を踏まえて　マルチスライスCTが放射線診療に与えるインパクト　心臓以外の領域

陣崎, 雅弘, 佐藤, 浩三, 藤原, 広和 and 栗林, 幸夫

日独医報 50 （ 3 ） 500 - 506 2005年09月

ISSN  0912-0351

【浸透圧性脱髄症候群　Pontine and extrapontine myelinolysis】　浸透圧性脱髄症候群の画像診断

百島, 祐貴 and 藤原, 広和

神経内科 63 （ 2 ） 128 - 131 2005年08月

ISSN  0386-9709

【Digital時代の脳神経画像診断】　Digital時代の画像診断　画像診断機器の進歩　CTとMRI

百島, 祐貴 and 藤原, 広和

Medicina 42 （ 3 ） 361 - 363 2005年03月

ISSN  0025-7699

PROPELLER diffusion-weighted magnetic resonance imaging of acute spinal epidural hematoma.

Fujiwara, H., Oki, K., Momoshima, S. and Kuribayashi, S.

Acta radiologica 46   539 - 42 2005年

ISSN  0284185051

　概要を見る

We present the case of an 86-year-old female with spontaneous spinal epidural hematoma. Although T1- and T2-weighted images showed the dilated posterior epidural space at the cervical spine, this finding was non-specific on conventional magnetic resonance imaging obtained 15 h after the onset of symptoms. Diffusion-weighted imaging with the use of periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER), which clearly revealed the high intensity hematoma, was useful for detection and diagnosis of acute spinal epidural hematoma.

• Access to Document (DOI)

Leptomeningeal high signal intensity (ivy sign) on fluid-attenuated inversion-recovery (FLAIR) MR images in moyamoya disease.

Fujiwara, Hirokazu, Momoshima, Suketaka and Kuribayashi, Sachio

European journal of radiology 55   224 - 30 2005年

　概要を見る

There are a few reports on leptomeningeal high signal intensity (LMHI: ivy sign) on fluid-attenuated inversion-recovery (FLAIR) images in moyamoya disease, but the feature of this finding has not been completely understood. The purpose of this study was to characterize LMHI on FLAIR images in moyamoya disease and to assess usefulness of this finding in the diagnosis of moyamoya disease in conventional MR imaging.

• Access to Document (DOI)

Hypertensive encephalopathy of brain stem with minimal supratentorial involvement: a rare manifestation of hypertensive encephalopathy.

Fujiwara, Hirokazu, Momoshima, Suketaka, Kuribayashi, Sachio and Sasamura, Hiroyuki

Radiation medicine 23   504 - 7 2005年

　概要を見る

We report a case of a 38-year-old man with brain stem hypertensive encephalopathy. MR imaging revealed diffuse hyperintensities in the brain stem. Diffusion-weighted imaging (DWI) was normal, and apparent diffusion coefficient (ADC) values were increased in the brain stem. The supratentorial regions were largely spared, and only subtle high intensities were seen. The lesions completely resolved after stabilization of blood pressure. The findings of normal DWI and high ADC values were compatible with vasogenic edema due to hypertension.

【脈管の非侵襲的画像診断　進歩と現況】　頸部頸動脈のMRA

百島, 祐貴 and 藤原, 広和

脈管学 44 （ 11 ） 721 - 726 2004年11月

ISSN  0387-1126

　概要を見る

頸部頸動脈の低侵襲性画像診断法として,MRAは広く用いられている.現状では,まだMRA単独では血管造影(DSA)を置換することはできないが,造影MRAはCTAなど他の検査法と組み合わせることで,これに匹敵する精度を得ることが可能となりつつある.不安定プラークの検出を目的とするMRIプラークイメージングには,最適な撮影法の選択が重要である.また,プラークに集積する造影剤にも期待が寄せられている

【異物のIVR】　血管内異物　CVカテーテル以外　一時的IVC filterに血栓が付着し回収に難渋した例

倉田, 忠宜, 成松, 芳明, 藤原, 広和, 橋本, 統 and 栗林, 幸夫

IVR: Interventional Radiology 19 （ 3 ） 230 2004年07月

ISSN  1340-4520

　概要を見る

19歳男.急性骨髄性白血病で加療中に左下肢の腫脹・疼痛を訴え,左総腸骨静脈から総大腿静脈の深部静脈血栓症と診断された.肺塞栓予防目的でtemporary IVC filter(TF)を右肘静脈経由で腎静脈流入部下方のIVCに留置し,血栓除去術後に抗凝固療法を継続した.留置から11日後に抜去のためTFシステムからの造影を試みたが,造影剤の注入ができなかった.経右大腿静脈でのIVC造影でTFに血栓の付着を確認した.urokinaseによる持続線溶療法を行ったが十分な血栓溶解が得られず,腎静脈流入部上方にpermanent IVC filterを留置した後,カテーテルによる血栓の吸引,ガイドワイヤーや異物除去カテーテルによる血栓除去を試みた.しかし血栓の十分な縮小は得られず,このためTFの先端をGoose Neck Snareで把持し,右大腿静脈から挿入した12Fのイントロデューサー内に引き込み,右肘部からTFにつながるワイヤーを切断して体外へ取り出した.TFには器質化した血栓が強固に付着していた

Accuracy of MR temperature measurement based on chemical shift change for radiofrequency ablation using hook-shaped electrodes.

Okuda, Shigeo, Kuroda, Kagayaki, Kainuma, Osamu, Oshio, Koichi, Fujiwara, Hirokazu and Kuribayashi, Sachio

Magnetic resonance in medical sciences : MRMS 3   95 - 100 2004年

　概要を見る

The purpose of the current study is to evaluate the accuracy of MR thermometry for radiofrequency ablation (RFA) with hook-shaped electrodes. The objects were eight extracted bovine livers. The chemical shift change was calculated from MR images acquired with a spoiled gradient echo sequence and compared with the temperature directly measured with a thermocouple. Linear regression was established between them with a coefficient of -0.0110+/-0.0007 ppm/ degrees C and errors were calculated as -0.50+/-7.50 degrees C. MR thermometry is capable of monitoring temperature for RFA.

【新しい脳の画像診断法はどのように役に立つのか?】　CT perfusion とMR perfusion

百島, 祐貴 and 藤原, 広和

画像診断 23 （ 11 ） 1258 - 1262 2003年10月

ISSN  0285-0524

　概要を見る

脳血流状態の画像化には,これまで核医学検査,Xenon CTなど,複雑な装置,設備が必要とされていたが,高速CT,高速MRIの普及に伴い,比較的簡単に灌流画像を得ることができるようになった.そこで,現在,トレーサと観察法の組合せにより,様々な灌流画像法検査があるが,最近広く用いられるようになったCT perfusion,MR perfusionについて概説した.両検査は,脳血管障害の診断,病態把握に有用な血流マップを容易に得ることができるが,まだその有用性を証明するエビデンスに乏しく,今後の研究が期待されている

測定法　CT Perfusion検査

百島, 祐貴 and 藤原, 広和

脳と循環 8 （ 3 ） 243 - 247 2003年07月

ISSN  1341-8440

　概要を見る

脳の血流状態を画像上に表示する灌流画像法にはいくつかの方法がある.比較的最近になって普及したdeconvolution法によるCT perfusion検査(CTP)は,簡便に定量性のある灌流画像を短時間で得ることができ,急性期脳梗塞を初めとする脳血管障害の病態把握に有用な検査法である.しかし,欠点としては,撮影範囲が狭いことがあり,X線被曝にも留意する必要がある

【これだけは知っておきたい臨床医の画像診断】　頭部　脳腫瘍　小脳橋角部腫瘍

藤原, 広和

臨床医 29 （ 増刊 ） 744 - 746 2003年06月

ISSN  0388-2969

【これだけは知っておきたい臨床医の画像診断】　頭部　脱髄性疾患,白質ジストロフィー　浸透圧性髄鞘融解症

藤原, 広和

臨床医 29 （ 増刊 ） 778 - 779 2003年06月

ISSN  0388-2969

【これだけは知っておきたい臨床医の画像診断】　頭部　脳腫瘍　その他の後頭蓋窩腫瘍

藤原, 広和

臨床医 29 （ 増刊 ） 747 - 749 2003年06月

ISSN  0388-2969

脳血管障害のモニタリング―CT perfusion検査

百島祐貴，藤原広和

Clinical neuroscience 20 （ 9 ） 1031-1032 2002年09月

研究論文（学術雑誌）, 共著

脳卒中の臨床評価システム―画像診断の立場からの評価システム

百島祐貴，藤原広和

Clinical neuroscience 20 （ 8 ） 891-893 2002年08月

研究論文（学術雑誌）, 共著

小児側頭骨奇形のCT診断

百島祐貴，藤原広和

小児耳鼻咽喉科 23 （ 1 ） 23-27 2002年07月

研究論文（学術雑誌）, 共著

痴呆のCT・MRI

百島祐貴，藤原広和

臨床放射線 47 （ 7 ） 861-874 2002年07月

研究論文（学術雑誌）, 共著

【痴呆の画像診断　形態と機能からのアプローチ】　痴呆のCT・MRI

百島, 祐貴 and 藤原, 広和

臨床放射線 47 （ 7 ） 861 - 874 2002年07月

ISSN  0009-9252

慢性肝疾患患者に超音波検査で指摘された10mm未満の肝内小結節の経過の検討

田波穣，小川健二，田波良子，岡田真広，松本一宏，藤原広和，陣崎雅弘，大熊潔，栗林幸夫

日本医学放射線学会雑誌 62 （ 1 ） 17-22 2002年01月

研究論文（学術雑誌）, 共著

Outcome of hepatic nodules less than 10mm 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 Igaku Hoshasen Gaakai Zasshi 62 （ 1 ） 17-22 2002年01月

研究論文（学術雑誌）, 共著

透析シヤント不全の血管造影所見

田波穣，成松芳明，藤原広和，倉田忠宜，小泉淳，中塚誠之，橋本統，小川健二，栗林幸夫，稲本元，村井勝

日本医学放射線学会雑誌 61 （ 6 ） 298-302 2001年05月

研究論文（学術雑誌）, 共著

Computed tomography during arterial portography under temporary balloon occlusion of the hepatic artery: evaluation of pseudolesions caused by arterio-portal venous shunts

Koizumi Jun, Kurata Tadayoshi, Yamashita Tomohiro, Kominami Masato, Fujiwara Hirokazu, Narimatsu Yoshiaki, Hiramatsu Kyoichi

Abdominal Imaging 25 （ 6 ） 583-586 2000年11月

研究論文（学術雑誌）, 共著

子宮頸管妊娠に対してActinomycin-D選択的動注療法を施行した1例

田波, 穣, 小川, 健二, 近藤, 善二郎, 角, 毅一郎, 和泉, 俊一郎, 藤原, 広和 and 栗林, 幸夫

IVR: Interventional Radiology 15 （ 4 ） 433 - 437 2000年10月

ISSN  1340-4520

　概要を見る

32歳.無月経を主訴とし妊娠反応陽性であったが,超音波検査で明らかな胎嚢を子宮体部に認めなかった為,子宮外妊娠が疑われた.MRIで子宮頸部にT2強調画像によりvery high intensityを示すmassが認められ,胎嚢と考えられた.尿中human chorionic gonadotropin(hCG)高値と合わせ,頸管妊娠と診断した.ただし胎児の心拍は認められず,color Dopplerでも子宮頸部の血流増加は軽度と考えられた.患者が妊孕性温存を希望した為,Actinomycin-D(ACTD)の動注による保存的治療を選択した.hCGが低下し,胎嚢の収縮が認められた後,子宮頸部内膜掻爬術を施行した.術後経過は良好で,大量出血やACTDによる明らかな副作用は認めていない

Angio-CTと肝癌のTAE

田村泰治，成松芳明，橋本統，山下智裕，藤原広和，倉田忠宜，中塚誠之，平松京一

IVR会誌 15 （ 3 ） 341-346 2000年09月

研究論文（学術雑誌）, 共著

【MR,CTの進歩とIVR】　Angio-CTと肝癌のTAE

田村, 泰治, 成松, 芳明, 橋本, 統, 山下, 智裕, 藤原, 広和, 倉田, 忠宜, 中塚, 誠之 and 平松, 京一

IVR: Interventional Radiology 15 （ 3 ） 341 - 346 2000年07月

ISSN  1340-4520

腸骨動脈閉塞性疾患に対するステント留置術

成松芳明，小川健二，橋本統，中塚誠之，竹田利明，小泉淳，奥田茂男，藤原広和，倉田忠宜，山下智裕，平松京一

日本医学放射線学会雑誌 60 （ 7 ） 372-378 2000年06月

研究論文（学術雑誌）, 共著

Computed tomography during arterial portography under temporary balloon occlusion of the hepatic artery: evaluation of pseudolesions caused by arterio-portal venous shunts.

Koizumi, J, Kurata, T, Yamashita, T, Kominami, M, Fujiwara, H, Narimatsu, Y and Hiramatsu, K

Abdominal imaging 25   583 - 6 2000年

　概要を見る

Computed tomography during arterial portography (CTAP) under temporary balloon occlusion of the hepatic artery (BOHA-CTAP) was introduced to evaluate pseudolesions caused by portal venous impairments such as arterioportal shunt and tumor thrombus.

【血栓性動静脈疾患】　血栓性動静脈疾患の臨床研究の進歩　診断学　血管造影法

藤原, 広和, 成松, 芳明, 橋本, 統 and 平松, 京一

日本臨床 57 （ 7 ） 1526 - 1530 1999年07月

ISSN  0047-1852

血栓性動静脈疾患　血管造影法

藤原広和，成松芳明，橋本統，平松京一

日本臨床 57 （ 7 ） 1526-1530 1999年07月

研究論文（学術雑誌）, 共著

透析シャント不全に対する PTAの長期成績

藤原広和，成松芳明，橋本統，小川健二，中塚誠之，竹田利明，小林成司，小泉淳，倉田忠宜，平松京一，稲本元，

IVR: Interventional Radiology 14 （ 2 ） 195-201 1999年04月

研究論文（学術雑誌）, 共著

胆管用covered stent（NTステント）の使用経験

倉田忠宜，中塚誠之，橋本統，高階経幸，竹田利明，藤原広和，松本一宏，平松京一，若林剛，大塚秋二郎

映像情報MEDICAL 31 （ 4 ） 449-452 1999年04月

研究論文（学術雑誌）, 共著

透析シャント不全に対する PTAの長期成績

藤原広和，成松芳明，橋本統，小川健二，中塚誠之，竹田利明，小林成司，小泉淳，倉田忠宜，平松京一，稲本元，

日本血管造影・インターベンショナルラジオロジー学会誌 14 （ 2 ） 195-201 1999年04月

研究論文（学術雑誌）, 共著, 査読有り

透析シャント不全に対するPTAの長期成績

藤原広和，成松芳明，橋本統，小川健二，中塚誠之，竹田利明，小林成司，小泉淳，倉田忠宣，平松京一，稲本元

Interventional Radiology 14 （ 2 ） 53-59 1999年04月

研究論文（学術雑誌）, 共著

【胆道ドレナージを考える】　Expandable Metallic Stentを用いた胆道内瘻術の適応と問題点

若林, 剛, 中塚, 誠之, 藤原, 広和 and 他

臨床外科 53 （ 1 ） 59 - 65 1998年01月

ISSN  0386-9857

Expandable Metalic Stent を用いた胆道内瘻術の適応と問題点

若林剛，中塚誠之，藤原広和，浦上秀次郎，篠田昌宏，加藤悠太郎，相浦浩一，島津元秀，平松京一，北島政樹

臨外 53 （ 1 ） 59-65 1998年01月

研究論文（学術雑誌）, 共著

Expandable Metalic Stent を用いた胆道内瘻術の適応と問題点

若林剛，中塚誠之，藤原広和，浦上秀次郎，篠田昌宏，加藤悠太郎，相浦浩一，島津元秀，平松京一，北島政樹

臨外 53 （ 1 ） 59-65 1998年01月

研究論文（学術雑誌）, 共著

膵癌の画像診断 US,CT,血管造影,MRI どこまでわかるか?

井筒, 睦, 藤原, 広和, 山内, 京子 and 他

Medical Practice 10 （ 8 ） 1527 - 1532 1993年08月

ISSN  0910-1551