Details of a Researcher - Yamada, Yoshitake

Papers - Yamada, Yoshitake

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Cystic fibrosis with multiple pulmonary arteriovenous malformations: A case report.

Orito Ikeda, Kunihiko Shimizu, Yoshitake Yamada, Hiroaki Sugiura, Hideaki Suzuki, Syuichiro Umetsu, Kozo Sato, Masahiro Jinzaki

Radiology case reports (Radiology Case Reports) 18 ( 3 ) 1033 - 1036 2023.03

Accepted, ISSN 1930-0433

Cystic fibrosis is an autosomal recessive genetic disorder that damages the exocrine function of the body, resulting in alterations of multiple organs. In the respiratory system, it is known to cause bronchiectasis, recurrent bronchitis, and pneumonia; however, to the best of our knowledge, there are no reported cases of pulmonary arteriovenous malformations associated with this disease. Herein, we report a case of cystic fibrosis with multiple pulmonary arteriovenous malformations. A 16-year-old girl, who has been monitored since childhood for pancreatitis of unknown cause, experienced respiratory symptoms and hypoxemia (PaO2 = 57 mmHg). At 13 years of age, chest computed tomography revealed bronchiectasis, bronchial wall thickening, and tree-in-bud sign. Genetic testing was performed, and the patient was diagnosed with cystic fibrosis. However, the computed tomography scan also showed incidental nodular lesions in the left superior and both the inferior pulmonary lobes, suggesting multiple arteriovenous malformations. Dynamic computed tomography was performed which, confirmed the presence of 3 pulmonary arteriovenous malformations. Coil embolization was performed on all lesions, and the hypoxemia was corrected. Marked hypoxemia in a patient with cystic fibrosis may not be explained only by the presence of bronchiectasis and/or bronchial wall thickening; in such cases, it may be necessary to examine possible additional findings on computed tomography images, such as arteriovenous malformations.

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【立位・座位での医用画像イメージングとその応用】全身用立位CTの開発と臨床応用　健康長寿の時代を見据えて

陣崎雅弘, 山田祥岳, 山田稔, 横山陽一, 中原健裕, 八木文子, 名倉武雄

MEDICAL IMAGING TECHNOLOGY ((一社)日本医用画像工学会) 41 ( 1 ) 3 - 8 2023.01

ISSN 0288-450X

われわれは全身撮影可能な立位CTを企業と共同開発した.従来の臥位CTと同等の物理特性をもち,設置面積は従来のCTの3分の2で済み,X線撮影のようなワークフローで検査が行える.健常人での検討では,これまで位置が変化しないとされてきた脳や骨盤が立位で下垂していることがわかり,重力下の人体構造が少しずつ明らかになっている.特に,静脈は立位と臥位での容量変化が部位により異なっており,画像での静脈学を構築する端緒についた.また,骨盤底の緩みや躯幹・大腿などの部位ごとの筋肉量の評価も可能であり,個々の筋萎縮に応じた運動の仕方を示唆することができる.疾患としては,ヘルニア・臓器脱などは定量的に評価可能であり,変形性膝関節症のような運動器疾患の早期発見も可能である.さらに,嚥下・呼吸・排尿・歩行機能などの動態機能の評価とそれに関連する病態の早期発見が可能である.立位CTを通して,健康長寿の時代のニーズに貢献できることを目指したい.(著者抄録)

【立位・座位での医用画像イメージングとその応用】立位CTからの筋骨格自動セグメンテーションの精度検証

箱谷知輝, 大竹義人, 崇風まあぜん, 橋本正弘, 山田祥岳, 山田稔, 横山陽一, 上村圭亮, 高尾正樹, 菅野伸彦, 陣崎雅弘, 佐藤嘉伸

MEDICAL IMAGING TECHNOLOGY ((一社)日本医用画像工学会) 41 ( 1 ) 21 - 25 2023.01

ISSN 0288-450X

医用画像から得られる被験者個別の解剖構造に忠実な筋骨格モデルは,運動障害の原因の解明用途において重要である.一方,体位によって運動器の力学的・動態的な条件は異なるため,立位で行う動作における筋骨格モデルは,臥位において撮影された医用画像ではなく立位において撮影された医用画像から作成されることが望ましい.しかし,立位における医用画像は臥位における医用画像ほど普及しておらず,扱えるデータの数は限定的である.そのためわれわれは,一般に広く普及している臥位による医用画像を有効利用するため,立位時の筋骨格変形を定量化し,臥位の医用画像から立位の医用画像を予測することを目指している.本稿ではその第一段階として,同一被験者により撮影された臥位・立位CT画像を自動セグメンテーションし,その精度を検証した結果を報告する.(著者抄録)

Estimating right atrial pressure using upright computed tomography in patients with heart failure.

Ryoma Fukuoka, Yoshitake Yamada, Masaharu Kataoka, Yoichi Yokoyama, Minoru Yamada, Keiichi Narita, Takehiro Nakahara, Keiichi Fukuda, Masahiro Jinzaki

European radiology (European Radiology) 33 ( 6 ) 4073 - 4081 2022.12

Accepted, ISSN 0938-7994

OBJECTIVES: Upright computed tomography (CT) can detect slight changes particularly in the superior vena cava (SVC) volume in healthy volunteers under the influence of gravity. This study aimed to evaluate whether upright CT-based measurements of the SVC area are useful for assessing mean right atrial pressure (mRAP) in patients with heart failure. METHODS: We performed CT in both standing and supine positions to evaluate the SVC (directly below the junction of the bilateral brachiocephalic veins) and inferior vena cava (IVC; at the height of the diaphragm) areas and analyzed their relationship with mRAP, measured by right heart catheterization in 23 patients with heart failure. RESULTS: The median age of enrolled patients was 60 (51-72) years, and 69.6% were male. The median mRAP was 3 (1-7) mmHg. The correlations between the standing position SVC and IVC areas and mRAP were stronger than those in the supine position (SVC, ρ = 0.68, p < 0.001 and ρ = 0.43, p = 0.040; IVC, ρ = 0.57, p = 0.005 and ρ = 0.46, p = 0.026; respectively). Furthermore, the SVC area in the standing position was most accurate in identifying patients with higher mRAP (> 5 mmHg) (SVC standing, area under the receiver operating characteristic curve [AUC] = 0.91, 95% confidence interval [CI], 0.77-1.00; SVC supine, AUC = 0.78, 95% CI, 0.59-0.98; IVC standing, AUC = 0.77, 95% CI, 0.55-0.98; IVC supine, AUC = 0.72, 95% CI, 0.49-0.94). The inter- and intraobserver agreements (evaluated by intraclass correlation coefficients) for all CT measurements were 0.962-0.991. CONCLUSIONS: Upright CT-based measurement of the SVC area can be useful for non-invasive estimation of mRAP under the influence of gravity in patients with heart failure. KEY POINTS: • This study showed that the superior vena cava (SVC) area in the standing position was most accurate in identifying patients with heart failure with higher mean right atrial pressure. • Upright computed tomography-based measurements of the SVC area can be a promising non-invasive method for estimating mean right atrial pressure under the influence of gravity in patients with heart failure. • Clinical management of patients with heart failure based on this non-invasive modality may lead to early assessment of conditional changes and reduced hospitalization for exacerbation of heart failure.

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Comparison of inspiratory and expiratory airway volumes and luminal areas among standing, sitting, and supine positions using upright and conventional CT.

Yoshitake Yamada, Minoru Yamada, Shotaro Chubachi, Yoichi Yokoyama, Shiho Matsuoka, Akiko Tanabe, Yuki Niijima, Mitsuru Murata, Takayuki Abe, Koichi Fukunaga, Masahiro Jinzaki

Scientific reports (Scientific Reports) 12 ( 1 ) 21315 - 21315 2022.12

Accepted

Upright computed tomography (CT) provides physiologically relevant images of daily life postures (sitting and standing). The volume of the human airway in sitting or standing positions remains unclear, and no clinical study to date has compared the inspiratory and expiratory airway volumes and luminal areas among standing, sitting, and supine positions. In this prospective study, 100 asymptomatic volunteers underwent both upright (sitting and standing positions) and conventional (supine position) CT during inspiration and expiration breath-holds and the pulmonary function test (PFT) within 2 h of CT. We compared the inspiratory/expiratory airway volumes and luminal areas on CT among the three positions and evaluated the correlation between airway volumes in each position on CT and PFT measurements. The inspiratory and expiratory airway volumes were significantly higher in the sitting and standing positions than in the supine position (inspiratory, 4.6% and 2.5% increase, respectively; expiratory, 14.9% and 13.4% increase, respectively; all P < 0.001). The inspiratory and expiratory luminal areas of the trachea, bilateral main bronchi, and average third-generation airway were significantly higher in the sitting and standing positions than in the supine position (inspiratory, 4.2‒10.3% increases, all P < 0.001; expiratory, 6.4‒12.8% increases, all P < 0.0001). These results could provide important clues regarding the pathogenesis of orthopnea. Spearman's correlation coefficients between the inspiratory airway volume on CT and forced vital capacity and forced expiratory volume in 1 s on PFT were numerically higher in the standing position than in the supine position (0.673 vs. 0.659 and 0.669 vs. 0.643, respectively); however, no statistically significant differences were found. Thus, the airway volumes on upright and conventional supine CT were moderately correlated with the PFT measurements.

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Natural History of Leaflet Thrombosis After Transcatheter Aortic Valve Replacement: A 5-Year Follow-Up Study.

Shohei Imaeda, Taku Inohara, Nobuhiro Yoshijima, Yusuke Kobari, Sosuke Myojin, Toshinobu Ryuzaki, Osamu Hattori, Keitaro Shinada, Hikaru Tsuruta, Tatsuo Takahashi, Masataka Yamazaki, Jungo Kato, Yoshitake Yamada, Masahiro Jinzaki, Hideyuki Shimizu, Keiichi Fukuda, Kentaro Hayashida

Journal of the American Heart Association (Journal of the American Heart Association) 11 ( 23 ) e026334 2022.12

Accepted

Background Subclinical leaflet thrombosis, characterized by hypoattenuated leaflet thickening (HALT) on multidetector computed tomography, is common after transcatheter aortic valve replacement (TAVR). Because little is known about the long-term natural history of subclinical HALT, we aimed to investigate this in patients who underwent TAVR without using additional anticoagulation. Methods and Results We retrospectively evaluated patients who underwent TAVR with the Edwards SAPIEN-XT at our institute between October 2013 and December 2015. Patients were grouped according to the presence or absence of HALT within 1 year after TAVR (HALT and No-HALT groups). The primary outcome, defined as the composite of all-cause mortality, heart failure readmission, and ischemic stroke, was compared. Valve performance was assessed over time by transthoracic echocardiography. Among 124 patients (men: 29.1%; median age, 85 years), 27 (21.8%) showed HALT on multidetector computed tomography within 1 year after TAVR. No patient required additional anticoagulation for treating HALT because of the absence of valve-related symptomatic deterioration. During the median follow-up period of 4.7 years (interquartile range, 4.0-5.6), the rate of primary outcome and valve performance was not statistically different between the 2 groups (37.0% versus 38.1%; log-rank test P=0.92; mean pressure gradient, 9 mm Hg [8-14 mm Hg] versus 10 mm Hg [7-15 mm Hg]; P=0.51, respectively). Conclusions Approximately 20% of patients after TAVR had HALT within 1 year; however, that did not change the risk of subsequent adverse cardiovascular events or the valve performance with statistical significance for up to 5 years despite no additional anticoagulation therapy.

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Differences in lung and lobe volumes between supine and upright computed tomography in patients with idiopathic lung fibrosis.

Shotaro Chubachi, Satoshi Okamori, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Yuki Niijima, Hirofumi Kamata, Makoto Ishii, Koichi Fukunaga, Masahiro Jinzaki

Scientific reports (Scientific Reports) 12 ( 1 ) 19408 - 19408 2022.11

Accepted

No clinical study has compared lung or lobe volumes on computed tomography (CT) between the supine and standing positions in patients with idiopathic lung fibrosis (IPF). This study aimed to compare lung and lobe volumes between the supine and standing positions and evaluate the correlations between the supine/standing lung volumes on CT and pulmonary function in patients with IPF. Twenty-three patients with IPF underwent a pulmonary function test and both low-dose conventional (supine position) and upright CT (standing position) during inspiration breath-holds. The volumes of the total lungs and lobes were larger in the standing than in the supine position in patients with IPF (all p < 0.05). Spearman's correlation coefficients between total lung volumes on chest CT in supine/standing positions and vital capacity (VC) or forced VC (FVC) were 0.61/0.79 or 0.64/0.80, respectively. CT-based volumes on upright CT were better correlated with VC and FVC than those on supine CT. Lung and lobe volumes in the standing position may be useful biomarkers to assess disease severity or therapeutic effect in patients with IPF.

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Comparison of Lung, Lobe, and Airway Volumes between Supine and Upright Computed Tomography and Their Correlation with Pulmonary Function Test in Patients with Chronic Obstructive Pulmonary Disease.

Yoshitake Yamada, Shotaro Chubachi, Minoru Yamada, Yoichi Yokoyama, Akiko Tanabe, Shiho Matsuoka, Yuki Niijima, Mitsuru Murata, Koichi Fukunaga, Masahiro Jinzaki

Respiration; international review of thoracic diseases (Respiration) 101 ( 12 ) 1 - 11 2022.11

Accepted, ISSN 0025-7931

BACKGROUND: Correlations between upright CT and pulmonary function test (PFT) measurements, and differences in lung/lobe/airway volumes between supine and standing positions in patients with chronic obstructive pulmonary disease (COPD) remain unknown. OBJECTIVES: The study aimed to evaluate correlations between lung/airway volumes on both supine and upright CT and PFT measurements in patients with COPD, and compare CT-based inspiratory/expiratory lung/lobe/airway volumes between the two positions. METHODS: Forty-eight patients with COPD underwent both conventional supine and upright CT in a randomized order during inspiration and expiration breath-holds, and PFTs within 2 h. We measured the lung/lobe/airway volumes on both CT. RESULTS: The correlation coefficients between total lung volumes on inspiratory CT in supine/standing position and PFT total lung capacity and vital capacity were 0.887/0.920 and 0.711/0.781, respectively; between total lung volumes on expiratory CT in supine/standing position and PFT functional residual capacity and residual volume, 0.676/0.744 and 0.713/0.739, respectively; and between airway volume on inspiratory CT in supine/standing position and PFT forced expiratory volume in 1 s, 0.471/0.524, respectively. Inspiratory/expiratory bilateral upper and right lower lobe, bilateral lung, and airway volumes were significantly higher in the standing than supine position (3.6-21.2% increases, all p < 0.05); however, inspiratory/expiratory right middle lobe volumes were significantly lower in the standing position (4.6%/15.9% decreases, respectively, both p < 0.001). CONCLUSIONS: Upright CT-based volumes were more correlated with PFT measurements than supine CT-based volumes in patients with COPD. Unlike other lobes and airway, inspiratory/expiratory right middle lobe volumes were significantly lower in the standing than supine position.

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【画像診断レポートここだけは落とせない!主治医に伝えるべきポイント】(第4章)心臓・大血管　肺塞栓症・深部静脈血栓症

田村全, 山田祥岳, 陣崎雅弘

臨床放射線 (金原出版(株)) 67 ( 11 ) 1327 - 1333 2022.10

ISSN 0009-9252

足の荷重CT最前線立位CTを用いた足関節アライメントの解析と展望

伯川聡志, 金田和也, 山田祥岳, 原藤健吾, 小林秀, 二木康夫, 名倉武雄, 中村雅也, 陣崎雅弘

日本足の外科学会雑誌 ((一社)日本足の外科学会) 43 ( Suppl. ) S133 - S133 2022.10

ISSN 0916-7927

Projected lung area using dynamic X-ray (DXR) with a flat-panel detector system and automated tracking in patients with chronic obstructive pulmonary disease (COPD).

Takuya Hino, Akinori Tsunomori, Takenori Fukumoto, Akinori Hata, Tomoyuki Hida, Yoshitake Yamada, Masako Ueyama, Takeshi Kamitani, Mizuki Nishino, Atsuko Kurosaki, Masahiro Jinzaki, Kousei Ishigami, Hiroshi Honda, Tsutomu Yoneyama, Sumiya Nagatsuka, Shoji Kudoh, Hiroto Hatabu

European journal of radiology (European Journal of Radiology) 157 110546 - 110546 2022.09

Accepted, ISSN 0720-048X

OBJECTIVES: To assess the association of projected lung area (PLA) measured by DXR with demographic data, pulmonary function, and COPD severity, and to generate PLA over time curves using automated tracking. METHODS: This retrospective study recruited healthy volunteers and COPD patients. Participants were classified into three groups: normal, COPD mild and COPD severe. PLA was calculated from the manually traced bilateral lung contours. PLA over time curves were produced using automated tracking, which was used to calculate slope and intercept by approximate line during forced expiration. The correlation of PLA, difference of PLA between end-inspiration and end-expiration (ΔPLA), slope, and intercept with demographic data and pulmonary function tests were investigated. The difference of PLA, ΔPLA, intercept, and slope among three groups were also evaluated. RESULTS: This study enrolled 45 healthy volunteers and 32 COPD patients. COPD severe group had larger PLA in both lungs at tidal/forced end-inspiration/expiration, smaller slope, and larger intercept than normal group (p < 0.001). PLA was correlated with % forced expiratory volume in one second (%FEV1) (rs from -0.42 to -0.31, p ≤ 0.01). ΔPLA in forced breathing showed moderate correlation with vital capacity (VC) (rs = 0.58, p < 0.001), while ΔPLA in tidal breathing showed moderate correlation with %FEV1 (rs = -0.52, p < 0.001) as well as mild correlation with tidal volume (rs = 0.24, p = 0.032). Intercept was slightly underestimated compared with manually contoured PLA (p < 0.001). CONCLUSION: COPD patients had larger PLA than healthy volunteers. PLA and ΔPLA in tidal breathing showed mild to moderate correlation with %FEV1.

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Validation of deep learning-based computer-aided detection software use for interpretation of pulmonary abnormalities on chest radiographs and examination of factors that influence readers' performance and final diagnosis.

Naoki Toda, Masahiro Hashimoto, Yu Iwabuchi, Misa Nagasaka, Ryo Takeshita, Minoru Yamada, Yoshitake Yamada, Masahiro Jinzaki

Japanese journal of radiology (Japanese Journal of Radiology) 41 ( 1 ) 38 - 44 2022.09

Accepted, ISSN 1867-1071

PURPOSE: To evaluate the performance of a deep learning-based computer-aided detection (CAD) software for detecting pulmonary nodules, masses, and consolidation on chest radiographs (CRs) and to examine the effect of readers' experience and data characteristics on the sensitivity and final diagnosis. MATERIALS AND METHODS: The CRs of 453 patients were retrospectively selected from two institutions. Among these CRs, 60 images with abnormal findings (pulmonary nodules, masses, and consolidation) and 140 without abnormal findings were randomly selected for sequential observer-performance testing. In the test, 12 readers (three radiologists, three pulmonologists, three non-pulmonology physicians, and three junior residents) interpreted 200 images with and without CAD, and the findings were compared. Weighted alternative free-response receiver operating characteristic (wAFROC) figure of merit (FOM) was used to analyze observer performance. The lesions that readers initially missed but CAD detected were stratified by anatomic location and degree of subtlety, and the adoption rate was calculated. Fisher's exact test was used for comparison. RESULTS: The mean wAFROC FOM score of the 12 readers significantly improved from 0.746 to 0.810 with software assistance (P = 0.007). In the reader group with < 6 years of experience, the mean FOM score significantly improved from 0.680 to 0.779 (P = 0.011), while that in the reader group with ≥ 6 years of experience increased from 0.811 to 0.841 (P = 0.12). The sensitivity of the CAD software and the adoption rate for the lesions with subtlety level 2 or 3 (obscure) lesions were significantly lower than for level 4 or 5 (distinct) lesions (50% vs. 93%, P < 0.001; and 55% vs. 74%, P = 0.04, respectively). CONCLUSION: CAD software use improved doctors' performance in detecting nodules/masses and consolidation on CRs, particularly for non-expert doctors, by preventing doctors from missing distinct lesions rather than helping them to detect obscure lesions.

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Changes in the lumbar intervertebral foramen between supine and standing posture in patients with adult spinal deformity: a study with upright computed tomography.

Naruhito Fujita, Mitsuru Yagi, Yoshitake Yamada, Yoichi Yokoyama, Minoru Yamada, Kota Watanabe, Masaya Nakamura, Takeo Nagura, Masahiro Jinzaki

Skeletal radiology (Skeletal Radiology) 52 ( 2 ) 215 - 224 2022.09

Accepted, ISSN 0364-2348

OBJECTIVE: To quantitatively assess the impact of supine and standing positions on the morphological changes in the lumbar intervertebral foramen (LIF) in patients with adult spinal deformity (ASD) using upright CT and conventional supine CT. MATERIALS AND METHODS: Thirty patients with ASD were prospectively enrolled in this study. All subjects underwent standing whole spine posterior/anterior radiographs, lateral radiographs, and whole spine CT, both in the supine and upright standing positions. Two orthopedic surgeons independently measured nine radiographic parameters in the radiograph and the lumbar foraminal area (FA) and height (FH) in supine and upright CT. Statistical analyses were performed to evaluate the risk of LIF decrease when standing upright compared to the supine position. The chi-squared, t test, Pearson's coefficients, intra- and inter-rater reliabilities, and ROC curves were calculated. The level of significance was set at p < 0.05. RESULTS: Among the 300 LIFs, both the lumbar FA and FH were either increased or decreased by > 5% in approximately 30% of LIFs each. The FA decreased in the lower lumbar spine. The concave side had a significantly higher rate of decreased FA and FH than the convex side (p < 0.05 and < 0.05, respectively). ROC analysis showed that narrowing of the intervertebral disc (cutoff > 0.05°) is a risk factor for decreased FA and FH. CONCLUSIONS: This study describes the details of the changes in the neuroforamen using a novel upright CT. In patients with ASD, approximately 30% of LIFs either increased or decreased in size by > 5% when standing. The risk factors for LIF decrease are the lower lumbar spine, concave side, and narrow side of the disc wedge.

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変形性膝関節症患者における扁平足の進行と膝関節アライメントの関連性三次元立位CTによる検討

伯川聡志, 金田和也, 原藤健吾, 大木聡, 山田祥岳, 小林秀, 二木康夫, 名倉武雄, 陣崎雅弘, 中村雅也

日本整形外科学会雑誌 ((公社)日本整形外科学会) 96 ( 8 ) S1867 - S1867 2022.09

ISSN 0021-5325

Three-Dimensional Quantitative Evaluation of the Scapular Skin Marker Movements in the Upright Posture.

Yuki Yoshida, Noboru Matsumura, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Azusa Miyamoto, Masaya Nakamura, Takeo Nagura, Masahiro Jinzaki

Sensors (Basel, Switzerland) (Sensors) 22 ( 17 ) 2022.08

Accepted, ISSN 14248220

Motion capture systems using skin markers are widely used to evaluate scapular kinematics. However, soft-tissue artifact (STA) is a major limitation, and there is insufficient knowledge of the marker movements from the original locations. This study explores a scapular STA, including marker movements with shoulder elevation using upright computed tomography (CT). Ten healthy males (twenty shoulders in total) had markers attached to scapular bony landmarks and underwent upright CT in the reference and elevated positions. Marker movements were calculated and compared between markers. The bone-based and marker-based scapulothoracic rotation angles were also compared in both positions. The median marker movement distances were 30.4 mm for the acromial angle, 53.1 mm for the root of the scapular spine, and 70.0 mm for the inferior angle. Marker movements were significantly smaller on the superolateral aspect of the scapula, and superior movement was largest in the directional movement. Scapulothoracic rotation angles were significantly smaller in the marker-based rotation angles than in the bone-based rotation angles of the elevated position. We noted that the markers especially did not track the inferior movement of the scapular motion with shoulder elevation, resulting in an underestimation of the marker-based rotation angles.

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Balloon pulmonary angioplasty versus riociguat in inoperable chronic thromboembolic pulmonary hypertension (MR BPA): an open-label, randomised controlled trial.

Takashi Kawakami, Hiromi Matsubara, Toshiro Shinke, Kohtaro Abe, Shun Kohsaka, Kazuya Hosokawa, Yu Taniguchi, Hiroto Shimokawahara, Yoshitake Yamada, Masaharu Kataoka, Aiko Ogawa, Mitsushige Murata, Masahiro Jinzaki, Kenichi Hirata, Hiroyuki Tsutsui, Yasunori Sato, Keiichi Fukuda

The Lancet. Respiratory medicine (The Lancet Respiratory Medicine) 10 ( 10 ) 949 - 960 2022.08

Accepted, ISSN 2213-2600

BACKGROUND: Treatment options for patients with chronic thromboembolic pulmonary hypertension ineligible for pulmonary endarterectomy (inoperable CTEPH) include balloon pulmonary angioplasty (BPA) and riociguat. However, these two treatment options have not been compared prospectively. We aimed to compare the safety and efficacy of BPA and riociguat in patients with inoperable CTEPH. METHODS: This open-label, randomised controlled trial was conducted at four high-volume CTEPH centres in Japan. Patients aged 20-80 years with inoperable CTEPH (mean pulmonary arterial pressure ≥25 to <60 mm Hg and pulmonary artery wedge pressure ≤15 mm Hg) and WHO functional class II or III were randomly assigned (1:1) to BPA or riociguat via a computer program located at the registration centre using a minimisation method with biased-coin assignment. In the BPA group, the aim was for BPA to be completed within 4 months of the initial date of the first procedure. BPA was repeated until mean pulmonary arterial pressure decreased to less than 25 mm Hg. The frequency of BPA procedures depended on the difficulty and number of the lesions. In the riociguat group, 1·0 mg riociguat was administered orally thrice daily. When the systolic blood pressure was maintained at 95 mm Hg or higher, the dose was increased by 0·5 mg every 2 weeks up to a maximum of 2·5 mg thrice daily; dose adjustment was completed within 4 months of the date of the first dose. The primary endpoint was change in mean pulmonary arterial pressure from baseline to 12 months, measured in the full analysis set (patients who were enrolled and randomly assigned to one of the study treatments, and had at least one assessment after randomisation). BPA-related complications and indices related to clinical worsening were recorded throughout the study period. Adverse events were recorded throughout the study period and evaluated in the safety analysis set (patients who were enrolled and randomely assigned to one of the study treatments, and had received part of or all the study treatments). This trial is registered in the Japan Registry of Clinical Trials (jRCT; jRCTs031180239) and is completed. FINDINGS: Between Jan 8, 2016, and Oct 31, 2019, 61 patients with inoperable CTEPH were enrolled and randomly assigned to BPA (n=32) or riociguat (n=29). Patients in the BPA group underwent an average of 4·7 (SD 1·6) BPA procedures. In the riociguat group, the mean maintenance dose was 7·0 (SD 1·0) mg/day at 12 months. At 12 months, mean pulmonary arterial pressure had improved by -16·3 (SE 1·6) mm Hg in the BPA group and -7·0 (1·5) mm Hg in the riociguat group (group difference -9·3 mm Hg [95% CI -12·7 to -5·9]; p<0·0001). A case of clinical worsening of pulmonary hypertension occurred in the riociguat group, whereas none occurred in the BPA group. The most common adverse event was haemosputum, haemoptysis, or pulmonary haemorrhage, affecting 14 patients (44%) in the BPA group and one (4%) in the riociguat group. In 147 BPA procedures done in 31 patients, BPA-related complications were observed in 17 procedures (12%) in eight patients (26%). INTERPRETATION: Compared with riociguat, BPA was associated with a greater improvement in mean pulmonary arterial pressure in patients with inoperable CTEPH at 12 months, although procedure-related complications were reported. These findings support BPA as a reasonable option for inoperable CTEPH in centres with experienced BPA operators, with attention to procedure-related complications. FUNDING: Bayer Yakuhin. TRANSLATION: For the Japanese translation of the abstract see Supplementary Materials section.

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Separate evaluation of unilateral lung function using upright/supine CT in a patient with diaphragmatic paralysis.

Takahiro Suzuki, Keisuke Asakura, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Yu Okubo, Kyohei Masai, Kaoru Kaseda, Tomoyuki Hishida, Hisao Asamura, Masahiro Jinzaki

Radiology case reports (Radiology Case Reports) 17 ( 8 ) 2826 - 2830 2022.08

Accepted, ISSN 1930-0433

Background: Unilateral diaphragmatic paralysis is a condition in which the unilateral diaphragm is paralyzed and elevated. Orthopnea due to lung compression by an elevated diaphragm in the supine position is common in patients with unilateral diaphragmatic paralysis. Although its symptom is posture-dependent, the effect of posture on lung function in unilateral diaphragmatic paralysis has not been studied. Computed tomography (CT) can be used to assess lung volume. However, conventional CT cannot be performed in the upright position. A pulmonary function test can be performed in both upright and supine positions. However, it cannot evaluate the function of each lung separately. Case presentation: We report a case of a 79-year-old man with unilateral diaphragmatic paralysis. He presented with difficulty in inspiration, specifically in the supine position, and underwent both conventional supine CT and newly developed upright CT to assess the effect of posture on the function of each lung. The difference between expiratory and inspiratory lung volumes on CT in the supine position was less than that in the upright position by 46% and 4% on affected and healthy sides, respectively. We previously reported that the difference between expiratory and inspiratory lung volumes on CT correlated with inspiratory capacity on the pulmonary function test. A 46% decline in inspiratory capacity on the affected side in the supine position likely caused orthopnea in this patient. Conclusions: Supine/upright CT is helpful to assess the influence of posture on unilateral lung function in patients with unilateral diaphragmatic paralysis.

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

Keisuke Yoshida, Masahiro Toda, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Kei Tsutsumi, Hirokazu Fujiwara, Kenzo Kosugi, Masahiro Jinzaki

Scientific reports (Scientific Reports) 12 ( 1 ) 10482 - 10482 2022.06

Accepted

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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Traction Bronchiectasis/Bronchiolectasis on CT Scans in Relationship to Clinical Outcomes and Mortality: The COPDGene Study.

Akinori Hata, Takuya Hino, Rachel K Putman, Masahiro Yanagawa, Tomoyuki Hida, Aravind A Menon, Osamu Honda, Yoshitake Yamada, Mizuki Nishino, Tetsuro Araki, Vladimir I Valtchinov, Masahiro Jinzaki, Hiroshi Honda, Kousei Ishigami, Takeshi Johkoh, Noriyuki Tomiyama, David C Christiani, David A Lynch, Raúl San José Estépar, George R Washko, Michael H Cho, Edwin K Silverman, Gary M Hunninghake, Hiroto Hatabu

Radiology (Radiology) 304 ( 3 ) 212584 - 701 2022.05

Accepted, ISSN 0033-8419

Background The clinical impact of interstitial lung abnormalities (ILAs) on poor prognosis has been reported in many studies, but risk stratification in ILA will contribute to clinical practice. Purpose To investigate the association of traction bronchiectasis/bronchiolectasis index (TBI) with mortality and clinical outcomes in individuals with ILA by using the COPDGene cohort. Materials and Methods This study was a secondary analysis of prospectively collected data. Chest CT scans of participants with ILA for traction bronchiectasis/bronchiolectasis were evaluated and outcomes were compared with participants without ILA from the COPDGene study (January 2008 to June 2011). TBI was classified as follows: TBI-0, ILA without traction bronchiectasis/bronchiolectasis; TBI-1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion; TBI-2, ILA with mild to moderate traction bronchiectasis; and TBI-3, ILA with severe traction bronchiectasis and/or honeycombing. Clinical outcomes and overall survival were compared among the TBI groups and the non-ILA group by using multivariable linear regression model and Cox proportional hazards model, respectively. Results Overall, 5295 participants (median age, 59 years; IQR, 52-66 years; 2779 men) were included, and 582 participants with ILA and 4713 participants without ILA were identified. TBI groups were associated with poorer clinical outcomes such as quality of life scores in the multivariable linear regression model (TBI-0: coefficient, 3.2 [95% CI: 0.6, 5.7; P = .01]; TBI-1: coefficient, 3.3 [95% CI: 1.1, 5.6; P = .003]; TBI-2: coefficient, 7.6 [95% CI: 4.0, 11; P < .001]; TBI-3: coefficient, 32 [95% CI: 17, 48; P < .001]). The multivariable Cox model demonstrated that ILA without traction bronchiectasis (TBI-0-1) and with traction bronchiectasis (TBI-2-3) were associated with shorter overall survival (TBI-0-1: hazard ratio [HR], 1.4 [95% CI: 1.0, 1.9; P = .049]; TBI-2-3: HR, 3.8 [95% CI: 2.6, 5.6; P < .001]). Conclusion Traction bronchiectasis/bronchiolectasis was associated with poorer clinical outcomes compared with the group without interstitial lung abnormalities; TBI-2 and 3 were associated with shorter survival. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Lee and Im in this issue.

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Effect of Ultra-High-Resolution CT on Pseudoenhancement in Renal Cysts: A Phantom Experiment and Clinical Study.

Fumiko Hamabe, Ayako Mikoshi, Hiromi Edo, Hiroaki Sugiura, Kousuke Okano, Yoshitake Yamada, Masahiro Jinzaki, Hiroshi Shinmoto

AJR. American journal of roentgenology (AJR. American journal of roentgenology) 219 ( 4 ) 1 - 10 2022.05

Accepted, ISSN 0361-803X

Background: Ultra-high resolution CT (U-HRCT) allows acquisition using a small detector element size, in turn allowing very high spatial resolutions. The high resolution may reduce partial-volume averaging and thereby renal cyst pseudoenhancement. Objective: To assess the impact of U-HRCT on renal cyst pseudoenhancement. Methods: A phantom was constructed that contained 7-, 15-, and 25-mm simulated cysts within compartments simulating unenhanced and nephrographic-phase renal parenchyma. The phantom underwent two U-HRCT acquisitions using 0.25- and 0.5-mm detector elements, with reconstruction at varying matrices and slice thicknesses. A retrospective study was performed of 36 patients (24 men, 12 women; mean age, 75.7±9.4 years) with 118 renal cysts who underwent renal-mass protocol CT using U-HRCT and the 0.25-mm detector element, with reconstruction at varying matrices and slice thicknesses; detector element size could not be retrospectively adjusted. ROIs were placed to measure cysts' attenuation increase from unenhanced to nephrographic phases (to reflect pseudoenhancement), and SD of unenhanced-phase attenuation (to reflect image noise). Results: In the phantom, attenuation increase was lower for the 0.25 mm than 0.5 mm detector element for the 15-mm cyst (4.6±2.7 HU vs 6.8±2.9 HU, p=.03) and 25-mm cyst (2.3±1.4 HU vs 3.8±1.2 HU, p=.02), but not the 7-mm cyst (p=.72). Attenuation increase was not different between 512×512 and 1024×1024 matrices for any cyst size in the phantom or patients (p>.05). Attenuation increase was not associated with slice thickness for any cyst size in the phantom or for ≥5-to-<10 mm and ≥10 mm cysts in patients (p>.05). For cysts <5 mm in patients, attenuation increase showed decreases with thinner slices (3 mm: 23.7±22.5, 2 mm: 20.2±22.7 HU, 0.5 mm: 11.6±17.5 HU, 0.25 mm: 12.6±19.7 HU; p<.001). Smaller detector element size, increased matrix size, and thinner slices all increased image noise for cysts of all sizes in the phantom and patients (p<.05). Conclusion: U-HRCT may reduce renal cyst pseudoenhancement through a smaller detector element size and, for <5 mm cysts, very thin slices; however, these adjustments result in increased noise. Clinical Impact: Although requiring further clinical evaluation, U-HRCT may facilitate characterization of small cystic renal lesions, thereby reducing equivocal interpretations and follow-up recommendations.

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