Papers - Yamada, Yoshitake

Free-breathing Three-dimensional MR Cholangiopancreatography Using Centric k-space Encoding Improved Gallbladder Visualization: A Prospective Study

Junya Tsuzaki, Taiki Nozaki, Daiki Ito, Tetsushi Habe, Sayaka Miyazaki, Manabu Arai, Manabu Hase, Hiroki Sakata, Ryo Tsukada, Yoshitake Yamada, Masahiro Jinzaki

Magnetic Resonance in Medical Sciences  2026.02

Accepted,  ISSN  1347-3182

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Three-dimensional analysis of shoulder hand-behind-back motion in patients with frozen shoulder

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

Journal of Shoulder and Elbow Surgery  2026.02

Accepted,  ISSN  1058-2746

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Comparison of supine and upright postures in carbon ion radiotherapy for pancreatic cancer: An in silico planning study.

Nomura Y, Inaniwa T, Isozaki T, Kurosaki H, Shinoto M, Yamada Y, Yamada M, Yokoyama Y, Mizuno H, Yonai S, Iwata Y, Takeda A, Ishikawa H, Jinzaki M

Medical physics 53 ( 2 ) e70325 2026.02

ISSN  0094-2405

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Background: Conducting carbon ion radiotherapy (CIRT) in upright posture has several technical advantages over that in conventional supine posture for pancreatic cancer treatment. However, few studies have investigated effects of upright positioning on anatomy and CIRT dose distributions. Purpose: This study compared anatomy and dose distributions in CIRT for pancreatic cancer between supine and upright postures. Methods: Fourteen pairs of computed tomography (CT) images obtained from asymptomatic volunteers in these postures were analyzed. Clinical target volume (CTV), organs-at-risk (OARs), and gastrointestinal gas contours were delineated within a planning volume for each CT image, and a CIRT dose distribution was calculated. The anatomical differences between these postures were evaluated by comparing volumes and 3D rendered images of the contours, while the dosimetric differences were assessed with 12 dosimetric metrics. Moreover, a proximal overlap volume of the OARs and possible change in water-equivalent path length due to gastrointestinal gas were calculated for all coplanar beam angles to compare ranges of applicable beam angles and potential range uncertainty between these postures. Results: The bowel contour volumes in the upright posture were more than 46% smaller than those in the supine posture because the bowel was shifted. The upright posture provided a smaller dose to the bowel and higher dose coverage to the CTV than the supine posture. The possible water-equivalent path length changes due to the stomach and duodenum gas decreased at most beam angles in the upright posture. Conclusions: The upright CIRT had several anatomical and dosimetric advantages for pancreatic cancer treatment over conventional supine CIRT. This technique will be useful in applying the patient-specific beam angle arrangement and precise dose delivery with reduced range uncertainty.

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Three-dimensional in vivo kinematics of the subtalar joint during weight-bearing standing on coronal-wedge surfaces using upright computed tomography.

Naomichi Ogihara, Hiroyuki Seki, Asahi Sujino, Akimasa Ito, Yuka Matsumoto, Gen Suwa, Takeo Nagura, Yoichi Yokoyama, Minoru Yamada, Yoshitake Yamada, Masahiro Jinzaki

Gait & posture 123   110021 - 110021 2026.01

Accepted,  ISSN  0966-6362

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BACKGROUND: The human subtalar joint is crucial for bipedal posture and locomotion, providing stability, adaptability, and force dissipation. While its kinematics have been studied, most research has been under non-weight-bearing conditions, leaving its function under physiological loading unclear. RESEARCH QUESTION: What is the three-dimensional kinematics of the human subtalar joint during weight-bearing postures, as quantified by the helical axis? METHODS: This study analyzed three-dimensional in vivo subtalar joint kinematics during weight-bearing using upright CT. Fifteen healthy elderly adults (11 females, 4 males; mean age: 64.9 ± 5.0 years) underwent CT scans in neutral, inverted, and everted postures using 10° coronal wedges. Kinematics were quantified via helical axis representation relative to two talar coordinate systems: the foot longitudinal axis and the talus principal axis. RESULTS: The helical axis ran obliquely from anterior-medial-dorsal to posterior-lateral-plantar, with inclination and deviation angles of 22.4° ± 9.6° and 35.2° ± 5.6° in the former system, and 36.5° ± 10.7° and 12.0° ± 7.1° in the latter. Rotation along the axis was 9.9° ± 3.8°, with minimal translation (0.5 ± 0.5 mm). SIGNIFICANCE: These findings suggest subtalar joint movement is more constrained under weight-bearing conditions than in non-weight-bearing studies. This study underscores the importance of weight-bearing analyses for clinical applications and understanding human foot adaptations for bipedalism.

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Quantitative airway evaluation using supine and upright computed tomography in patients with non-cystic fibrosis bronchiectasis and nontuberculous mycobacterial pulmonary disease.

Masanori Kaji, Takanori Asakura, Yoshitake Yamada, Hiromu Tanaka, Ho Namkoong, Shotaro Chubachi, Minoru Yamada, Takuya Ozawa, Yoichi Yokoyama, Shin Iizuka, Keiichi Narita, Genta Nagao, Ryoichi Kato, Naoki Fukunaga, Shunsuke Nakamura, Shuhei Azekawa, Sayaka Miyazaki, Kensuke Nakagawara, Hirofumi Kamata, Richard C Boucher, Koichi Fukunaga, Naoki Hasegawa, Masahiro Jinzaki

European journal of radiology 195   112626 - 112626 2025.12

Accepted,  ISSN  0720-048X

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INTRODUCTION: Bronchiectasis, closely associated with nontuberculous mycobacterial pulmonary disease (NTM-PD), exhibits unevenly distributed lesions, yet their spatial features remain unclear. We hypothesized that upright CT, which may better depict distal airways due to gravity-induced lung expansion, might more accurately reflect disease severity and its relationship with pulmonary function tests (PFTs). METHODS: In this prospective study, twenty patients underwent low-dose inspiratory and expiratory CT scans in standing and supine positions. Airways were segmented with Vincent® software and classified as bronchiectatic or non-bronchiectatic. Generation-specific quantitative CT (QCT) parameters, including inspiratory airway total area (ITA), inspiratory airway lumen area (ILA), wall thickness, and wall area percentage (WA%), were measured and correlated with PFTs. RESULTS: Bronchiectatic lesions were primarily identified in the 8th-10th generation airways (anatomically the 7th-9th generations), the transition from distal bronchi to proximal bronchioles. Standing CT detected more distal airways than supine CT. Mixed-effect models revealed significantly larger ITA and higher WA% in bronchiectatic airways (8th-10th generations) on standing CT. In non-bronchiectatic airways (trachea to 6th generation), ITA and ILA were significantly larger in the standing position, except for the main bronchus ITA. ITA, ILA, and WA% were moderate to strongly correlated with %FVC, %FEV1, and FEF25-75%, reflecting airway obstruction, with stronger correlations in the standing position. ITA in bronchiectatic airways was moderately negatively correlated with diffusing capacity of the lungs for carbon monoxide, indicating potential alveolar disease. CONCLUSION: Upright CT offers useful structural biomarkers associated with airflow limitation and possible alveolar impairment in bronchiectasis with NTM-PD. REGISTRATION: University Hospital Medical Information Network (UMIN 000026587). URL: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000030456.

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Integrated assessment of total airway count and pneumonia volume on chest computed tomography as a prognostic biomarker for coronavirus disease.

Kensuke Nakagawara, Naoya Tanabe, Shotaro Chubachi, Tomoki Maetani, Yusuke Shiraishi, Takanori Asakura, Ho Namkoong, Hiromu Tanaka, Takashi Shimada, Shuhei Azekawa, Shiro Otake, Takahiro Fukushima, Mayuko Watase, Hideki Terai, Mamoru Sasaki, Soichiro Ueda, Yukari Kato, Norihiro Harada, Shoji Suzuki, Shuichi Yoshida, Hiroki Tateno, Yoshitake Yamada, Masahiro Jinzaki, Toyohiro Hirai, Yukinori Okada, Ryuji Koike, Makoto Ishii, Akinori Kimura, Seiya Imoto, Satoru Miyano, Seishi Ogawa, Takanori Kanai, Koichi Fukunaga

European radiology  2025.12

Accepted,  ISSN  0938-7994

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OBJECTIVES: The clinical relevance of computed tomography (CT)-based airway tree structure is unclear. Herein, we used artificial intelligence to segment the airway tree and pneumonia regions, measuring total airway count (TAC) and pneumonia volume to examine whether their combination is more closely associated with clinical outcomes in patients with coronavirus disease (COVID-19) than pneumonia volume alone. MATERIALS AND METHODS: We examined clinical data and chest CT from 781 hospitalized COVID-19 patients in a multicenter retrospective cohort in Japan, focusing on the percentage of critical outcomes (high-flow oxygen, invasive mechanical ventilation, or death). Additionally, 197 patients were followed up for 3 months to monitor TAC and pneumonia volume. RESULTS: Critical outcomes were observed in 63 (8.8%) patients, with higher TAC in those patients. Patients were divided into four groups based on cutoff values of 17.6% for pneumonia volume percent and 255 for TAC: Group A (low TAC, low pneumonia volume), Group B (high TAC, low pneumonia volume), Group C (low TAC, high pneumonia volume), and Group D (high TAC, high pneumonia volume). Group D had the worst outcomes, highest levels of inflammation, fibrosis markers, and complications, as well as a significantly higher risk of critical outcomes after adjusting for age, body mass index, sex, total lung volume and comorbidities. In the 3-month longitudinal analysis, pneumonia volume, but not TAC, improved in critical cases. CONCLUSIONS: The integrated assessment of TAC and pneumonia volume effectively predicted critical outcomes in COVID-19 patients and may be useful for various respiratory diseases, including infectious or interstitial pneumonia. KEY POINTS: Question Total airway counts (TAC) on computed tomography (CT) scan is associated with respiratory disease progression, but clinical relevance of CT-based airway tree structure is unclear. Findings The integrated assessment of TAC and pneumonia volume effectively predicted critical outcomes in COVID-19 patients. Clinical relevance This metric can potentially be applied to various respiratory diseases, including infectious or interstitial pneumonia.

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Elevated 18F-FDG uptake in non-metastatic lymph nodes of POLE-mutated endometrial cancer on PET/CT.

Maho Kurihara, Yu Iwabuchi, Yoshitake Yamada, Atsushi Shimizu, Takuma Yoshimura, Kensuke Sakai, Tatsuyuki Chiyoda, Kohei Nakamura, Hiroshi Nishihara, Wataru Yamagami, Masahiro Jinzaki

European journal of radiology 195   112620 - 112620 2025.12

Accepted,  ISSN  0720-048X

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PURPOSE: DNA polymerase epsilon (POLE) exonuclease domain-mutated endometrial cancer (EC) is associated with a favorable prognosis and significant immune cell infiltration. Cancers with significant immune cell infiltration often exhibit higher maximum standardized uptake value (SUVmax) on 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT). This study aimed to evaluate the correlation between POLE status and FDG-PET/CT imaging in patients with EC. METHODS: This retrospective study enrolled 102 patients (mean age, 56.2 ± 11.8 years) with EC who underwent preoperative FDG-PET/CT between July 2018 and August 2023. Patients were categorized into molecular subtypes based on molecular profiling. SUVmax of the primary tumor and lymph nodes was measured, and correlations with molecular subtypes were examined. RESULTS: The SUVmax in the primary tumor of POLE-mutated ECs was higher than that in non-POLE-mutated ECs (mean ± SD, 13.21 ± 4.78 vs 9.82 ± 3.78; p = 0.001). Multiple regression analysis showed that POLE status was associated with SUVmax in primary tumors (B = 2.30, p = 0.031). The SUVmax in non-metastatic lymph nodes of POLE-mutated ECs was higher than that in non-POLE-mutated ECs (median SUVmax, 1.31 [IQR, 1.05-2.21] vs. 1.06 [IQR, 0.91-1.20]; p = 0.003). Multiple regression analysis revealed that POLE status was the only factor associated with SUVmax in non-metastatic lymph nodes (B = 0.339, p = 0.046), while age, BMI, blood glucose level, histological type, and primary tumor size showed no significant association. CONCLUSION: Patients with POLE-mutated EC exhibit high SUVmax in primary tumors and also tend to show elevated uptake in non-metastatic lymph nodes.

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Consolidation-to-ground-glass opacity ratio on chest CT as a prognostic marker for critical outcomes in COVID-19: a retrospective cohort study.

Hiromu Tanaka, Naoya Tanabe, Shotaro Chubachi, Tomoki Maetani, Yusuke Shiraishi, Ho Namkoong, Takanori Asakura, Takashi Shimada, Shuhei Azekawa, Shiro Otake, Kensuke Nakagawara, Takahiro Fukushima, Mayuko Watase, Hideki Terai, Mamoru Sasaki, Soichiro Ueda, Yukari Kato, Norihiro Harada, Shoji Suzuki, Shuichi Yoshida, Hiroki Tateno, Yoshitake Yamada, Masahiro Jinzaki, Toyohiro Hirai, Yukinori Okada, Ryuji Koike, Makoto Ishii, Naoki Hasegawa, Akinori Kimura, Seiya Imoto, Satoru Miyano, Seishi Ogawa, Takanori Kanai, Koichi Fukunaga

BMC pulmonary medicine 25 ( 1 ) 550 - 550 2025.12

Accepted

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BACKGROUND: Computed tomography (CT)-based quantification of coronavirus disease 2019 (COVID-19) pneumonia is widely performed, and total pneumonia volume, ground-glass opacity (GGO), and consolidation affect disease severity. However, there is insufficient information on how consolidation to GGO (C/G) ratio correlates with clinical characteristics including disease severity and complications in COVID-19 patients. METHODS: This retrospective cohort study included 1,194 hospitalized patients with COVID-19 from four member hospitals of the Japan COVID-19 Task Force. Critical outcomes were defined as conditions requiring high-flow oxygen or invasive mechanical ventilation, or death. Patients were divided into two groups based on %pneumonia (percentage of pneumonia volume divided by total lung volume) using receiver operating characteristic curve, and those with high %pneumonia were further divided into two groups based on C/G ratio. Critical outcomes and complications were then compared between high and low C/G ratio groups. RESULTS: The optimal cutoff value of %pneumonia to predict critical outcomes was 17.1%, classifying the included patients into low (Group 1, n = 900) and high (n = 294) %pneumonia groups. The optimal cutoff value of C/G ratio was 0.202, classifying patients in the high %pneumonia group into two groups: low (Group 2, n = 192) and high C/G (Group 3, n = 102) ratio groups. The incidence of critical outcomes was stair-step high in all three groups (2.1%, 21.4%, and 37.3%, respectively). Multivariable analysis revealed an independent relationship between C/G ratio and critical outcomes from other known risk factors (adjusted odds ratio: 1.92, 95% confidential interval: 1.03-3.59, P = 0.040). Group 3 also showed significantly higher serum C-reactive protein (Group 1: 2.96 mg/dL, Group 2: 8.90 mg/dL, Group 3: 11.4 mg/dL) and procalcitonin (Group 1: 0.16 ng/mL, Group 2: 0.25 ng/mL, Group 3: 1.19 ng/mL) levels and incidence of bacterial infection (Group 1: 5.6%, Group 2: 10.4%, Group 3: 20.3%), compared with other groups. CONCLUSIONS: CT-density analysis of COVID-19 pneumonia in a large patient population showed that C/G ratio was a significant predictor of critical outcomes and useful for prognosis evaluation.

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Diaphragmatic curvature analysis using dynamic digital radiography.

Takuya Hino, Akinori Tsunomori, Noriaki Wada, Akinori Hata, Taiki Fukuda, Yusei Nakamura, Yoshitake Yamada, Tomoyuki Hida, Mizuki Nishino, Masako Ueyama, Atsuko Kurosaki, Takeshi Kubo, Shoji Kudoh, Kousei Ishigami, Hiroto Hatabu

European journal of radiology open 15   100676 - 100676 2025.12

Accepted,  ISSN  2352-0477

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PURPOSE: To investigate area under diaphragm (AUD) obtained by dynamic digital radiography (DDR) for the differentiation between normal subjects and chronic obstructive pulmonary disease (COPD) patients. METHODS: This retrospective study included healthy volunteers and COPD patients recruited from 2009 to 2014 at Fukujuji Hospital, who received DDR and pulmonary functional test. AUD was defined as an area under a hemidiaphragm and above the line connecting the ipsilateral costophrenic angle to the top of the hemidiaphragm on DDR image. AUD in full inspiration minus AUD in full expiration (ΔAUD) was also calculated. The diaphragmatic surface was demarcated manually on DDR image to calculate AUD. Three-group comparison of AUD and ΔAUD among normal, mild COPD, and severe COPD subjects was tested with one-way analysis of variance, followed by multiple comparison with Tukey-Kramer method. The diagnostic accuracy of COPD by ΔAUD was assessed using receiver-operating-characteristics (ROC) curve. RESULTS: Sixty-eight participants (36 men, 29 COPD patients) were enrolled. AUD in full inspiration was larger in healthy volunteers than in COPD patients (right, p < 0.001; left, p = 0.02). ΔAUD were different in the three-group comparison (right, normal, 208.7 ± 184.6 mm2, mild COPD, -18.1 ± 117.5 mm2, severe COPD -97.5 ± 150.0 mm2, p < 0.001; left, normal, 254.9 ± 131.5 mm2, mild COPD, -12.5 ± 136.5 mm2, severe COPD, -100.7 ± 134.1 mm2, p < 0.001). ROC curve showed high diagnostic performance of COPD by unilateral ΔAUD (right, area-under curve 0.942; left, area-under-curve 0.965). CONCLUSION: The value of ΔAUD was smaller according to the severity of COPD. ΔAUD can be helpful in distinguishing healthy subjects from COPD patients.

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Effects of perirenal fat accumulation on cardiometabolic and renal functions and mineralocorticoid receptor activation in primary aldosteronism.

Ryunosuke Mitsuno, Toshifumi Nakamura, Kengo Nakamura, Kenji Kaneko, Daiki Kojima, Yosuke Mizutani, Yoshitake Yamada, Masahiro Jinzaki, Tatsuhiko Azegami, Takeshi Kanda, Kenichiro Kinouchi, Hiroshi Itoh, Jun Yoshino, Kaori Hayashi

Hypertension research : official journal of the Japanese Society of Hypertension 48 ( 12 ) 3244 - 3256 2025.12

Accepted,  ISSN  0916-9636

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Perirenal fat (PRF), an ectopic fat depot lying adjacent to kidneys, is a risk factor for cardiometabolic and renal dysfunctions in patients with obesity and type 2 diabetes. We aimed to investigate the involvement of PRF in the pathophysiology and treatment of primary aldosteronism (PA). To this end, we measured PRF volume by abdominal CT and evaluated the relationships among PRF volume, cardiometabolic and renin-angiotensin-aldosterone system (RAAS) parameters, and therapeutic response to mineralocorticoid receptor antagonist (MRA) treatment in well-phenotyped PA patients. In addition, we evaluated the effects of MRA treatment on inflammation and fibrosis, potential downstream targets of MR signaling, by analyzing PRF obtained from obese (db/db) mice. PRF volume (PRF%) and visceral fat volume (VFV) were associated with various cardiometabolic and renal risk markers and RAAS parameters, such as body mass index, creatinine, triglyceride, high-density lipoprotein cholesterol, uric acid, fasting glucose, C-reactive protein, 24-h urine aldosterone, and 24-h urine normetanephrine (all P < 0.05). PRF%, but not VFV, positively correlated with changes in systolic and diastolic blood pressure and initial estimated glomerular filtration rate (eGFR) fall following MRA treatment after adjusting for confounders (all P < 0.05). In addition, MRA treatment decreased PRF expression of markers of macrophage infiltration and fibrosis in db/db mice (all P < 0.05). In conclusion, our results suggest that PRF accumulation is involved in the mechanisms linking MR activation to cardiometabolic and renal dysfunctions in PA patients. Moreover, PRF could be not only a prognostic factor but also a new therapeutic target for MRA-resistant hypertension.

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Adipose-Muscle Crosstalk in COPD Cachexia: Early Adipose Atrophy Drives Subsequent Muscle Wasting.

Takashi Shimada, Shotaro Chubachi, Keisuke Nishikawa, Tetsuya Arai, Hideto Iizuka, Shiro Otake, Kaori Sakurai, Junko Hamamoto, Mamoru Sasaki, Tomoki Maetani, Naoya Tanabe, Katsunori Masaki, Hiroki Kabata, Jun Miyata, Yoshitake Yamada, Masahiro Jinzaki, Hidetoshi Nakamura, Koichiro Asano, Koichi Fukunaga

Journal of cachexia, sarcopenia and muscle 16 ( 6 ) e70154 2025.12

Accepted,  ISSN  2190-5991

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BACKGROUND: Chronic obstructive pulmonary disease (COPD) is frequently associated with cachexia, leading to poor prognoses and reduced quality of life. However, the mechanisms underlying adipose tissue atrophy, its pathological significance and its interaction with skeletal muscle remain poorly understood. We hypothesised that adipose tissue atrophy precedes muscle wasting in COPD-associated cachexia, and muscle atrophy progresses through adipose-muscle crosstalk. METHODS: We analysed chest computed tomography scans of 185 patients with COPD to quantify the cross-sectional areas of the pectoralis muscle (PM), subcutaneous adipose tissue (SAT) and epicardial adipose tissue (EAT), and the percentage of low attenuation area (LAA%) as an index of emphysema. To elucidate the pathophysiological mechanisms underlying cachexia in COPD, we performed histological and molecular analyses of the lung, muscle and adipose tissues over time in a cigarette smoke-induced emphysema mouse model. Further, we used an in vitro culture system of differentiated adipocytes (3T3-L1) and myotubes (C2C12) to study the effects of cigarette smoke extract (CSE) on adipose-muscle interaction. RESULTS: In patients with COPD, the areas of PM, SAT and EAT all demonstrated significant negative correlations with LAA%; notably, PM and EAT were independently associated with the extent of emphysematous changes. In the smoke-exposed murine model, adipose tissue atrophy was observed after 1 month of exposure, accompanied by increased expressions of IL-6 and IL-1β, macrophage infiltration and the upregulation of the lipolytic enzymes ATGL and HSL. The adipose atrophy had further progressed after 3 months of exposure, and the high expression of UCP1 was sustained, which suggested the browning of adipose tissue. Conversely, muscle atrophy was not evident at 1 month but became apparent after 3 months, coinciding with emphysema development. This was associated with the downregulation of the myogenic markers MyoD and Myogenin and the upregulation of the muscle degradation marker Atrogin-1. In vitro experiments revealed that CSE exposure reduced lipid droplet content and induced IL-6 and IL-1β expressions in adipocytes. Conditioned media from CSE-treated adipocytes triggered myotube atrophy and downregulated MyoD and Myogenin but upregulated Atrogin-1. CONCLUSIONS: Our findings indicate that cigarette smoke-induced adipose tissue atrophy precedes muscle wasting, and alterations in adipose tissue may contribute to muscle atrophy progression. Adipose tissue dysfunction may be implicated in the development of cachexia in patients with COPD, highlighting its potential as a therapeutic target.

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Intraabdominal fat-free volume, but not fat volume, predicts the development of peritonitis in patients on peritoneal dialysis: a retrospective cohort study

Ryunosuke Mitsuno, Kohkichi Morimoto, Kenji Kaneko, Daiki Kojima, Toshifumi Nakamura, Takashin Nakayama, Eriko Yoshida Hama, Shun Tonomura, Yoshitake Yamada, Masahiro Jinzaki, Kiyotaka Uchiyama, Naoki Washida, Takeshi Kanda, Tatsuhiko Azegami, Tadashi Yoshida, Jun Yoshino, Kaori Hayashi

Renal Replacement Therapy (Springer Science and Business Media LLC)  11 ( 1 )  2025.12

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Abstract

Introduction

Increased intraabdominal fat volume (IAFV) is associated with systemic inflammation and various cardiometabolic diseases. However, the clinical implication of IAFV in patients on peritoneal dialysis (PD) is unclear. In addition, the association of intraabdominal fat-free volume (IAFFV), which could mainly reflect the volume of visceral organs that serve as a potential source of inflammatory uremic toxins, with PD-associated clinical outcomes remains unknown.

Methods

We retrospectively measured IAFV and IAFFV in the 108 patients on PD using abdominal computed tomography at initiation of PD. The participants were followed up until PD cessation, death, or study completion. We investigated the relationships between IAFV and IAFFV and the risks of peritonitis and PD discontinuation (defined by a composite endpoint of death or transfer to hemodialysis).

Results

The median follow-up period was 46 (interquartile range 24–82) months. The baseline obesity-related traits significantly (P &lt; 0.05) differed between high-IAFV (≥ 2935 cm³) and low-IAFV (&lt; 2935 cm³) groups. However, the log-rank tests found no differences in the incidence of peritonitis and PD discontinuation between groups. In contrast, both peritonitis-free survival and time on PD therapy were shorter in high-IAFFV (≥ 4796 cm³) group than in low-IAFFV (&lt; 4796 cm³) group (all P &lt; 0.05). In the Cox regression models, IAFFV remained a strong risk factor for peritonitis even after adjusting for confounders (hazard ratio: 2.16, 95% confidence interval: 1.07–4.38).

Conclusions

We demonstrate that IAFFV is an independent risk factor of peritonitis in patients o nPD. Additional studies are needed to identify specific intraabdominal component(s) involved in the pathogenesis of PD-associated adverse events.

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CT-based phenotyping of COVID-19: cluster analysis of pulmonary and extrapulmonary imaging markers from a multicentre retrospective cohort study.

Shiro Otake, Naoya Tanabe, Shotaro Chubachi, Tomoki Maetani, Yusuke Shiraishi, Takanori Asakura, Ho Namkoong, Hiromu Tanaka, Takashi Shimada, Shuhei Azekawa, Kensuke Nakagawara, Takahiro Fukushima, Mayuko Watase, Hideki Terai, Mamoru Sasaki, Soichiro Ueda, Yukari Kato, Norihiro Harada, Shoji Suzuki, Shuichi Yoshida, Hiroki Tateno, Yoshitake Yamada, Masahiro Jinzaki, Toyohiro Hirai, Yukinori Okada, Ryuji Koike, Makoto Ishii, Akinori Kimura, Seiya Imoto, Satoru Miyano, Seishi Ogawa, Takanori Kanai, Koichi Fukunaga

Scientific reports 15 ( 1 ) 42116 - 42116 2025.11

Accepted

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Coronavirus disease 2019 (COVID-19) displays a highly variable clinical course despite advancements in vaccination and antiviral therapies. Chest computed tomography (CT) has become a valuable tool for diagnosing and predicting COVID-19 severity; however, limited studies have explored integrating pulmonary and extrapulmonary CT markers to identify distinct clinical phenotypes. In this study, we aimed to evaluate the utility of cluster analysis, using quantitative pulmonary and extrapulmonary CT indicators, to classify patients with COVID-19 into distinct phenotypic clusters and assess their clinical relevance in predicting disease severity and outcomes. The primary outcome was the rate of critical outcomes (requiring high-flow oxygen therapy or invasive ventilator support or death). In this multicentre, retrospective cohort study, we analysed 1,034 patients with COVID-19 from four hospitals in Japan. Hierarchical cluster analysis was performed using age, sex, and seven imaging markers: pneumonia volume, muscle area, muscle density, subcutaneous and visceral fat indices, bone density, and coronary artery calcification score. Clinical characteristics, laboratory findings, and outcomes were compared across the identified clusters. Four distinct clusters were identified. Cluster 1 consisted of younger individuals with minimal pneumonia and favourable extrapulmonary organ markers, exhibiting the best clinical outcomes. Cluster 2 included younger patients with high pneumonia volume and visceral fat accumulation, exhibiting poor respiratory outcomes. Cluster 3 comprised older individuals with mild fat accumulation and low bone density, with intermediate severity. Cluster 4 presented the highest pneumonia volume, extensive visceral fat, and coronary artery calcification, resulting in the worst overall prognosis, including the highest mortality and in-hospital complications. Clustering based on pulmonary and extrapulmonary CT indicators enabled the precise classification of patients with COVID-19 into clinically significant subgroups with distinct outcomes. This study highlights the importance of integrating multiple imaging markers for disease phenotyping and prognosis.

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Three-dimensional simulation of wall impingement and graft bending in anatomical double-bundle ACL reconstruction using weight-bearing upright multi-detector CT.

Ryo Sasaki, Yasuo Niki, Kazuya Kaneda, Yoshitake Yamada, Kengo Harato, Shu Kobayashi, Takeo Nagura, Masaya Nakamura, Masahiro Jinzaki

The Knee 58   104277 - 104277 2025.11

Accepted,  ISSN  0968-0160

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PURPOSE: Graft-notch impingement and large graft bending angle (GBA) in anterior cruciate ligament reconstruction (ACLR) carry a risk of graft failure and subsequent poor postoperative outcomes. Most studies have analyzed the impingement rate and GBA using computed tomography (CT) in the supine position, but not in the standing condition. This study aimed to assess the graft impingement and GBA using upright multi-detector CT (MDCT). METHODS: We analyzed 43 knee joints of 23 healthy volunteers (women, n = 13; men, n = 10) in a single-leg standing position using an upright 320-detector-row CT. We defined the putative position of the graft tunnel in three-dimensional models and assessed the impingement rate and GBA of both the anteromedial (AMB) and posterolateral bundles (PLB). RESULT: The impingement rate for the AMB with a 6-mm graft diameter (81.4 %) was significantly higher than that for the PLB (0.7 %; P < 0.001). The modified AMB tunnel position, which connects the midpoint between the traditional AM and PL tunnel apertures of the femur to the most medial point within the tibial AM footprint, reduced the impingement rate by 14.0 % (P < 0.001). The impingement rate of the modified AMB with a 10-mm graft diameter (32.6 %) was significantly lower than that of the traditional AMB with a 6-mm graft diameter (81.4 %; P < 0.001). The GBA of the modified AMB was significantly smaller than that of the traditional AMB (P < 0.001). CONCLUSION: This study indicated high graft-notch impingement rates and large GBA for traditional AMB in the standing position, highlighting potential biomechanical challenges associated with traditional double-bundle ACLR configurations.

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Extent of pulmonary involvement on admission predicts long-term pulmonary and muscular sequelae of COVID-19: A longitudinal computed tomography study.

Takashi Shimada, Naoya Tanabe, Shotaro Chubachi, Takanori Asakura, Ho Namkoong, Hiromu Tanaka, Shuhei Azekawa, Shiro Otake, Kensuke Nakagawara, Takahiro Fukushima, Mayuko Watase, Tomoki Maetani, Yusuke Shiraishi, Hideki Terai, Mamoru Sasaki, Soichiro Ueda, Yukari Kato, Norihiro Harada, Shoji Suzuki, Shuichi Yoshida, Hiroki Tateno, Yoshitake Yamada, Masahiro Jinzaki, Toyohiro Hirai, Yukinori Okada, Ryuji Koike, Makoto Ishii, Akinori Kimura, Seiya Imoto, Satoru Miyano, Seishi Ogawa, Takanori Kanai, Koichi Fukunaga

Respiratory investigation 63 ( 6 ) 1215 - 1220 2025.11

Accepted,  ISSN  2212-5345

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BACKGROUND: Studies on the association between chest computed tomography (CT) findings of extensive pulmonary involvement and long-term pulmonary and extrapulmonary coronavirus disease 2019 (COVID-19) sequelae are lacking. This study aimed to investigate the relationship between the severity of pneumonia on admission and residual pulmonary and extrapulmonary complications at three months post-hospitalization. METHODS: Using data from the Japan COVID-19 Task Force database, we conducted quantitative analysis of CT scans of 164 patients obtained at admission and three months later. The parameters included pneumonia volume, total lung volume, and area and density of the pectoralis muscle (PM), subcutaneous and epicardial adipose tissue, and vertebral bone density. RESULTS: Patients with extensive pneumonia on admission had high residual pneumonia volumes, reduced lung volumes, and decreased area and density of PM at three months. No significant differences were observed in the adipose tissue or bone parameters. The severity of pneumonia at admission was independently associated with PM atrophy. CONCLUSIONS: CT-based quantification of pneumonia extent during the acute phase of COVID-19 may be useful in predicting long-term pulmonary sequelae and muscle wasting. This approach may allow the objective evaluation of Long COVID and facilitate the identification of potential therapeutic targets.

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Japanese Radiology 2025 Updates.

Mami Iima, Tsukasa Saida, Yoshitake Yamada, Ryo Kurokawa, Daiju Ueda, Maya Honda, Kentaro Nishioka, Rintaro Ito, Keitaro Sofue, Shinji Naganawa

Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes    8465371251374557 - 8465371251374557 2025.10

Accepted,  ISSN  0846-5371

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This review provides a comprehensive overview of recent transformative advancements in diagnostic imaging that position Japan at the forefront of radiological innovation. We highlight pivotal innovations that enhance diagnostic capabilities and redefine clinical workflows. The article begins with upright multidetector computed tomography (MDCT), a groundbreaking technology offering novel insights into posture-dependent anatomical and physiological changes. We then explore significant progress in breast and gynecologic imaging, including advancements in artificial intelligence computer-aided (AI-CAD) synthesized mammograms, automated breast ultrasound (ABUS), and abbreviated MRI protocols. These innovations address unique regional challenges in early cancer detection. Significant innovations in abdominal radiology, spanning advanced CT (including photon-counting detector CT), accelerated MRI, and AI applications, are also discussed. The review further delves into glymphatic system research, where advanced MRI techniques, particularly DTI-ALPS, are unraveling new insights into brain waste clearance and neurological disorders. Finally, we examine the future of Japanese radiology through the lens of AI, with a focus on Large Language Models (LLMs). We discuss their growing role in diagnostic support, report generation, and information extraction, as well as important societal and ethical considerations. These collective advancements underscore Japan's dynamic contributions to radiological innovation, poised to significantly impact global healthcare practices by improving disease detection, optimizing workflows, and extending healthy life expectancy in an aging society.

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Kinematic and Kinetic Effects of 10-Degree Coronal Wedge Floors on Lower Limb Joints During Static Standing: An Upright Multidetector-Row CT Study.

Hiroyuki Seki, Naomichi Ogihara, Akimasa Ito, Asahi Sujino, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Masaya Nakamura, Takeo Nagura, Masahiro Jinzaki

Foot & ankle international 46 ( 10 ) 10711007251361132 - 1202 2025.09

Accepted,  ISSN  1071-1007

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BACKGROUND: Coronal wedge insoles are commonly prescribed to mitigate musculoskeletal disorders, yet their static-standing kinematic and kinetic effects on lower extremity joints remain insufficiently understood. METHODS: This cross-sectional experimental study included 15 healthy older adults (mean 64.9 ± 6.0 y; 11 females, 4 males) who underwent CT imaging of the entire lower limbs during static standing. Ground reaction forces (GRFs) were simultaneously recorded using right and left force plates, with their sum equal in magnitude and opposite in direction to the body weight vector. Three floor conditions were tested: a 10-degree medial wedge, a flat surface, and a 10-degree lateral wedge. Lower limb alignment, GRF vector inclinations, projected GRF location at the height of the joint center, and external joint moments were assessed under 3 floor conditions. RESULTS: Coronal wedges altered hip and subtalar joint angles, with medial wedges inducing hindfoot supination and hip abduction, whereas lateral wedges promoted hindfoot pronation and hip internal rotation. The GRF vector was found to generally pass lateral to the tibiotalar and subtalar joints and medial to the hip joint, generating eversion and adduction moments, respectively. Notably, these moments increased on the lateral wedge but were reduced on the medial wedge. In contrast, projected GRF location at joint height remained near the knee joint center across all conditions, resulting in minimal varus/valgus knee moments. CONCLUSION: This study provides the first quantifications of the 3-dimensional GRF vector concerning joint centers during static standing; these exploratory findings warrant confirmation during gait and in symptomatic cohorts. Our study suggests that lateral wedges tend to increase external joint moments at the hip and tibiotalar. Although further investigation is needed, these mechanical effects at the hip may have potential relevance and should be considered with caution when prescribing lateral wedge insoles.

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Comparison of supine and upright postures for liver respiratory motion management in radiotherapy.

Yusuke Nomura, Taku Inaniwa, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Sodai Tanaka, Shunsuke Yonai, Hideyuki Mizuno, Yoshiyuki Iwata, Atsuya Takeda, Hitoshi Ishikawa, Masahiro Jinzaki

Medical physics 52 ( 9 ) e18111 2025.09

Accepted,  ISSN  0094-2405

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BACKGROUND: Understanding respiratory motions of liver and its surrogate organs is crucial for precise dose delivery in liver cancer radiotherapy. Although these motions have been studied for respiratory motion management in the supine posture, few studies have quantified them and evaluated their correlations in the upright posture. PURPOSE: This study quantified the respiratory motions of liver and surrogate organs and evaluated the correlations between the liver motions and surrogate signals for respiratory motion monitoring in both the supine and upright postures. METHODS: 4D dynamic volume computed tomography (CT) images were acquired from 13 asymptomatic volunteers in both supine and upright postures while free breathing. The 4D liver motions were calculated by performing deformable image registration. Subsequently, superior-inferior (SI) motion at the right diaphragm apex and anterior-posterior (AP) motion at the abdominal skin surface were obtained as surrogate signals from the 4D CT images. The average displacements and maximum magnitudes of liver motions and surrogate signals were compared between the postures. Moreover, the correlations between the liver motions and surrogate signals were evaluated based on correlation models. RESULTS: The average liver displacements from the end-exhalation along the SI, AP, and left-right directions were -6.1, 2.1, and -0.4 mm in the supine posture and -4.6, 2.5, and 0.1 mm in the upright posture, respectively. The maximum motion range along the SI direction significantly decreased from 16.3 ± 6.6 mm in the supine posture to 11.0 ± 2.7 mm in the upright posture. Similar to the supine posture, the correlation models also reproduced the liver motions with high fitting accuracy in the upright posture. CONCLUSIONS: Compared to the conventional supine posture, the liver SI motion became smaller in the upright posture while keeping evident correlations with the surrogate signals, which suggests the upright posture will allow precise dose delivery with reduced internal target margins.

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Upright multidetector CT with 320-row gantry: a technical innovation providing insights into human anatomy under gravity and potential clinical implications.

Masahiro Jinzaki, Minoru Yamada, Yoichi Yokoyama, Takehiro Nakahara, Takeo Nagura, Yoko Inamoto, Fumiko Yagi, Orito Ikeda, Mohammed Alshahri, Katsuhiro Mizutani, Yoshitake Yamada

The British journal of radiology 98 ( 1175 ) 1754 - 1765 2025.08

Accepted,  ISSN  0007-1285

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CT performed in the supine position has been highly effective in diagnosing organic diseases such as cancer, arteriosclerosis, and infections, significantly contributing to increased life expectancy. In an aging society, extending healthy life expectancy becomes more critical, requiring early diagnosis of functional disorders. We have led the industry-academia collaboration in developing an upright MDCT system. Although this system maintains the same physical specifications as conventional MDCT, it differs significantly in imaging configuration-allowing supine, upright, and sitting positions-and offers improved workflow while requiring only two-thirds of the installation space. Unlike conventional MDCT, it allows for the assessment of anatomical changes under gravity. It also enables the objective diagnosis and grading of functional diseases, in which findings were not apparent on conventional CT, and enable the study of the pathogenesis of functional diseases which worsen symptoms in the upright position. Furthermore, it allows for noninvasive evaluation of dynamic functions such as swallowing and voiding, which can only be assessed in standing or sitting positions.

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Distinctive features of upright CT myelography in patients with lumbar spine degenerative diseases.

Soya Kawabata, Yuki Akaike, Sota Nagai, Takaya Imai, Hiroki Takeda, Kei Ito, Shinjiro Kaneko, Kota Watanabe, Takeo Nagura, Morio Matsumoto, Masaya Nakamura, Yoshitake Yamada, Masahiro Jinzaki, Yoshiharu Ohno, Masanori Inoue, Nobuyuki Fujita

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 34 ( 10 ) 4496 - 4504 2025.08

Accepted,  ISSN  0940-6719

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PURPOSE: Recently, a full-body upright computed tomography (CT) scanner has been developed, which when combined with myelography, is expected to provide valuable insights into the pathology of lumbar spine degenerative diseases (LSDD). This study aims to elucidate the distinctive features of upright CT myelography (CTM) in LSDD by comparing it with supine magnetic resonance imaging (MRI). METHODS: This study included 110 patients who underwent both supine MRI and upright CTM for LSDD. The anteroposterior diameter (APD), transverse diameter (TD), and area of the dural sac were measured from L1/2 to L5/S1. Lumbar lordosis (LL) was also measured in both modalities. RESULTS: The APD of the dural sac was significantly smaller at L2/3 and L4/5, while the TD was significantly larger at L1/2 and L2/3 on upright CTM compared to supine MRI. The dural sac area was significantly larger at L1/2 and smaller at L4/5 on upright CTM. Subgroup analysis divided patients into Group I (LL greater in upright CTM, n = 56) and Group D (LL smaller in upright CTM, n = 54). The dural sac area was significantly smaller at L3/4 and L4/5 in Group I and larger at L1/2 in Group D on upright CTM. CONCLUSIONS: Changes in the APD, TD and area of the dural sac during the transition from supine to standing were markedly dependent on the intervertebral level. These parameters were also influenced by patterns of change in LL between the two positions. Upright CTM revealed diverse position-related morphological changes in the lumbar dural sac in LSDD patients.

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【腹部の最新画像情報2025】胆管内乳頭状腫瘍　原発性硬化性胆管炎の経過中に肝破裂と腹膜播種を起こした1例

屋代 香絵, 山田 祥岳, 津崎 盾哉, 池田 織人, 新妻 雄介, 山田 実加, 城谷 良太, 真杉 洋平, 上野 彰久, 田中 真之, 平田 賢郎, 陣崎 雅弘

臨床放射線 (金原出版(株))  70 ( 4 ) 559 - 566 2025.07

ISSN  0009-9252

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＜文献概要＞今回我々は,原発性硬化性胆管炎(primary sclerosing cholangitis:PSC)の経過観察中に胆管内乳頭状腫瘍(intraductal papillary neoplasm of the bile duct:IPNB)を生じ,肝破裂と腹膜播種をきたしたと考えられるまれな症例を経験したので報告する。

Interstitielle Lungenerkrankungen im Kindesalter: Aktuelles Verständnis von Klassifikation und bildgebenden Befunden

Yuko Tsujioka, Gen Nishimura, Eugene Nishi, Tatsuo Kono, Taiki Nozaki, Masahiro Hashimoto, Yoshitake Yamada, Masahiro Jinzaki

Kompass Pneumologie  2025.06

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Future Applications of Cardiothoracic CT.

Mark L Schiebler, Masahiro Jinzaki, Masahiro Yanagawa, Amir Pourmorteza, Yoshitake Yamada, Yoko Kato, Noriaki Wada, Cornelia Schaefer-Prokop, Vincent Dousset, Noriyuki Tomiyama, Mathias Prokop, João A Lima, Hiroto Hatabu

Radiology 315 ( 3 ) e240085 2025.06

Accepted,  ISSN  0033-8419

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Radiologists are witnessing astonishing innovation and advancement of CT technologies and their clinical applications. This review highlights how photon-counting CT (PCCT), upright CT, and artificial intelligence (AI) may impact cardiothoracic CT applications for imaging and diagnosis. PCCT relies on new detectors that can bin the separate photon energies and allow for lower radiation dose and better spatial resolution. The clinical applications of PCCT in the coronary arteries are becoming the new standard for cardiac CT imaging. New upright CT has shown the benefits of imaging in the upright position and offers new insight into how the upright position affects biomechanics and physiology. Four-dimensional CT, which can be used to directly image perfusion, is challenging MRI and MR angiography for primacy in this area. The burgeoning role of AI and informatics is changing the way radiologists interpret and report many imaging examinations. The future is bright and promises lower radiation and intravenous contrast agent doses and higher spatial resolution, and will further incorporate deep learning to improve the effectiveness of CT.

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Imaging of the umbilicus.

Fumiko Yagi, Hirotaka Akita, Yoshitake Yamada, Masahiro Jinzaki

Abdominal radiology (New York) 50 ( 12 ) 6201 - 6213 2025.05

Accepted,  ISSN  2366004X

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The umbilicus is a scar of the umbilical cord containing various embryonic remnants that can lead to postnatal diseases. It is the collection point for blood and lymphatic flow and other structures. Hence, various diseases and conditions can occur. In this review, we aimed to categorize umbilical diseases based on the embryonic remnants, including urachal remnants, omphalomesenteric duct anomalies, and complications of the umbilical arteries and veins. The urachus, formed from the allantois, can result in anomalies such as patent urachus and urachal cysts, with infections being the most common complication. Radiologists must note that urachal carcinoma is a rare complication presenting with characteristic imaging findings. The omphalomesenteric duct can lead to Meckel's diverticulum, the most prevalent gastrointestinal anomaly. In addition, obliterated umbilical arteries and veins can cause various conditions, including hernias and abscesses. This review also summarizes the umbilical ring lesions, such as gastroschisis and omphalocele, and iatrogenic lesions associated with laparoscopic procedures and catheter placement. Imaging techniques such as ultrasound, computed tomography, and magnetic resonance imaging are crucial for diagnosing and managing these conditions. Understanding the embryological basis and imaging features of umbilical diseases is vital for timely diagnosis and treatment.

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原発性アルドステロン症における腎周囲脂肪蓄積の臨床的意義の検証

満野 竜ノ介, 中村 俊文, 金子 賢司, 児島 大輝, 中村 健吾, 水谷 洋佑, 山田 祥岳, 陣崎 雅弘, 畔上 達彦, 神田 武志, 木内 謙一郎, 吉野 純, 林 香

日本内分泌学会雑誌 ((一社)日本内分泌学会)  101 ( Suppl.Update ) 42 - 44 2025.05

ISSN  0029-0661

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原発性アルドステロン症患者81例のCT画像から腎周囲脂肪(PAT)容量を計測し、心代謝疾患の危険因子やミネラルコルチコイド受容体拮抗薬による治療開始後初期の腎機能の変化との関連について検討した。その結果、%PAT(腎周囲脂肪容量-内臓脂肪容量比)は原発性アルドステロン症の診断時のbody mass index(BMI)、血清クレアチニン濃度、eGFR値、血清尿酸濃度、血清中性脂肪濃度などの心代謝疾患の危険因子と有意な相関関係を認めた。年齢、性別、BMI、病型・局在などの交絡因子で調整した線形重回帰分析でも、PATの蓄積はミネラルコルチコイド受容体拮抗薬による治療開始後初期の腎機能低下と有意に相関した。原発性アルドステロン症において、PAT蓄積は心代謝機能障害およびミネラルコルチコイド受容体拮抗薬による治療開始後初期の腎機能低下に関与することが示唆された。

Simulation Study of Upright Prostate Radiation Therapy: Comparison of Upright and Supine Anatomy and Dose-Volumetric Factors.

Kohei Oguma, Yoshitake Yamada, Naoyoshi Koike, Junichi Fukada, Minoru Yamada, Yoichi Yokoyama, Atsuya Takeda, Naoyuki Shigematsu, Masahiro Jinzaki

Practical radiation oncology 15 ( 5 ) 497 - 508 2025.04

Accepted,  ISSN  1879-8500

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PURPOSE: This study aimed to assess the feasibility of upright radiation therapy for prostate cancer, compared to conventional supine radiation therapy, by quantitatively evaluating anatomic changes and their dosimetric impact through treatment planning simulations based on paired upright and supine positioning computed tomography (CT) images. METHODS AND MATERIALS: This study compared pelvic organ anatomies and dose distributions, in hypothetical prostate cancer patients, between upright and supine prostate radiation therapy using paired CT images from asymptomatic volunteers. Anatomic changes in pelvic organ position, shape, volume, and rectal gas were quantitatively evaluated. Prostate radiation therapy was simulated on these CT images for volumetric modulated arc therapy with a prescribed dose of 60 Gy in 20 fractions. Dosimetric comparisons were performed using dose-volume histogram parameters based on a clinical protocol. RESULTS: Fifty-one asymptomatic volunteers were registered. Compared to the supine position, pelvic organs in the upright position moved inferiorly (prostate: 2.8 mm ± 5.2, rectum: 2.9 mm ± 5.8, bladder: 3.7 mm ± 6.9, bowel: 25.2 mm ± 18.6; all P < .001). Rectal gas moved superiorly (4.8 mm ± 11.9; P = .004) and posteriorly (10.7 mm ± 23.5; P = .008). All dose-volume histogram parameters met the dose constraints, and the dose distributions of the upright and supine plans were clinically comparable in terms of organ-at-risk sparing and target coverage (P > .05). In some cases, the rectum curved more posteriorly in the upright position, allowing better sparing of high-dose areas, and the bladder moved inferiorly while expanding in the anterior-posterior direction in the upright position, preventing the small bowel from dropping into the radiation field. CONCLUSIONS: Our treatment planning simulation showed that upright radiation therapy for prostate cancer is feasible with a dose distribution comparable to that of conventional supine radiation therapy, despite significant anatomic changes in pelvic organ positioning between the upright and supine patient positions.

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Long-Term Impact of Early Subclinical Leaflet Thrombosis After Transcatheter Aortic Valve Implantation.

Juri Iwata, Kentaro Hayashida, Ryo Arita, Tomonari Moriizumi, Akiyoshi Kajino, Shingo Sakata, Toshinobu Ryuzaki, Keitaro Shinada, Hikaru Tsuruta, Yoshitake Yamada, Jungo Kato, Tatsuo Takahashi, Masataka Yamazaki, Masahiro Jinzaki, Hideyuki Shimizu, Masaki Ieda

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 105 ( 5 ) 1161 - 1170 2025.04

Accepted,  ISSN  1522-1946

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BACKGROUND: Hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve implantation (TAVI) detected on multidetector computed tomography (MDCT) is considered leaflet thrombosis. However, its impact on long-term clinical outcomes remains unclear. This study aimed to investigate the impact of early HALT detection after TAVI on long-term clinical outcomes and structural valve deterioration beyond 6 years. METHODS: Of the 672 consecutive patients who underwent TAVI between 2013 and 2018, 448 were treated with either SAPIEN XT or SAPIEN 3 and underwent MDCT analysis within 30 days after TAVI. MDCT results and echocardiographic data were analyzed annually. RESULTS: HALT was detected in 68 (15.2%) of 448 eligible patients within 30 days after TAVI. No significant difference in effective orifice area was observed by echocardiography within 30 days after TAVI between the HALT and the non-HALT groups in SAPIEN XT (HALT vs. non-HALT: 1.62 ± 0.66 cm2 vs. 1.72 ± 0.43 cm2; p = 0.26) and in SAPIEN 3 (1.42 ± 0.35 cm2 vs. 1.45 ± 0.34 cm2; p = 0.63). No significant differences in all-cause mortality (52.9% vs. 60.0%; hazard ratio (HR): 1.19; 95% confidence interval (CI): 0.83-1.70; p = 0.3), stroke incidence (5.9% vs. 7.1%; HR: 1.06; 95% CI: 0.08-13.7; p = 0.97), heart failure rehospitalization (10.3% vs. 15.0%; HR: 2.3; 95% CI: 0.89-5.99; p = 0.09), and structural valve deterioration (14.7% vs. 17.9%; HR: 0.89; 95% CI: 0.45-1.73; p = 0.73) were observed between the HALT and the non-HALT groups during the median follow-up of 1872 (interquartile range; 1203-2468) days. CONCLUSIONS: HALT within 30 days was not associated with clinical outcomes or hemodynamic performance during long-term follow-up.

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Imaging findings of thyroid diseases in children.

Yuko Tsujioka, Yoshitake Yamada, Tomonobu Hasegawa, Masahiro Hashimoto, Masahiro Jinzaki

Clinical pediatric endocrinology : case reports and clinical investigations : official journal of the Japanese Society for Pediatric Endocrinology 34 ( 2 ) 89 - 104 2025.04

Accepted,  ISSN  0918-5739

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We review the imaging findings in pediatric thyroid diseases that necessitate prompt diagnosis and timely medical intervention. Congenital hypothyroidism particularly represents a critical pediatric emergency. Ultrasonography stands as the primary modality for accurately assessing thyroid morphology and identifying thyroid dysgenesis. 123I-scintigraphy mirrors iodine metabolism and thyroid hormone synthesis, and the concurrent application of perchlorate (perchloride discharge test) elucidates the pathogenesis of thyroid dyshormonogenesis. Nonetheless, radioiodine scintigraphy has seen limited utilization due to the intricacies of pre-test preparation. 99mTc-pertechnetate scintigraphy demonstrates high sensitivity in delineating thyroid tissues with minimal radiation exposure, facilitating the diagnosis of thyroid dysgenesis. Additionally, we have included brief insights on the imaging characteristics of central hypothyroidism, thyroiditis, and thyroid masses.

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Simultaneous quantification of lower limb skeletal posture and ground reaction forces using upright computed tomography: Potential implications for osteoarthritis assessment and treatment.

Akimasa Ito, Hiroyuki Seki, Asahi Sujino, Takeo Nagura, Yoichi Yokoyama, Minoru Yamada, Yoshitake Yamada, Masahiro Jinzaki, Naomichi Ogihara

Journal of biomechanics 183   112630 - 112630 2025.04

Accepted,  ISSN  0021-9290

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Understanding the transmission of forces through the joints of the lower limb under weight-bearing conditions is critical for assessing the progression of knee and ankle osteoarthritis, as well as for developing effective surgical and preventive strategies. This study presents the first simultaneous quantification of three-dimensional skeletal posture and ground reaction force vectors during quiet standing, utilizing upright computed tomography and a custom-made force plate. We constructed the force plate using two six-axis force sensors, and the coordinate system of the CT was aligned with that of the force plate using metal spheres attached to the edges of the force plate. This system enabled precise measurement of ground reaction force vectors relative to the skeletal posture. The present study demonstrated that the load-bearing axis (the line connecting the femoral head center to the midpoint of the distal tibial plafond) in healthy subjects during quiet standing is not identical to the actual line of force application. The analysis revealed that the force vectors generally pass slightly medioposterior to the femoral head center. By providing a detailed view of how force is transmitted through the lower limb joints, this system potentially offers new insights into joint loading patterns that possibly contribute to osteoarthritis development.

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立位・臥位CTにより肺容積の体位性変化を評価できた横隔膜ヘルニアの1例

杉野 功祐, 鈴木 嵩弘, 山田 祥岳, 横山 陽一, 山田 稔, 大久保 祐, 政井 恭兵, 加勢田 馨, 菱田 智之, 朝倉 啓介, 陣崎 雅弘

日本呼吸器外科学会雑誌 ((一社)日本呼吸器外科学会)  39 ( 3 ) P31 - 7 2025.04

ISSN  0919-0945

Pearls and pitfalls in imaging of axial spondyloarthritis for rheumatologists.

Taiki Nozaki, Yuko Tsujioka, Hideharu Sugimoto, Yoshitake Yamada, Minoru Yamada, Youichi Yokoyama, Hitomi Fujishiro, Akimoto Nimura, Junya Tsuzaki, Manabu Hase, Masato Okada, Yuko Kaneko, Masahiro Jinzaki

Modern rheumatology 35 ( 4 ) 612 - 625 2025.03

Accepted,  ISSN  1439-7595

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This review provides key insights into sacroiliitis imaging, covering anatomy, imaging techniques, and interpretation. It focuses on normal physiological changes in young to middle-aged women, children, and the elderly that can resemble sacroiliitis. We emphasize the importance of distinguishing between active and structural lesions, as highlighted in the recent ASAS-SPARTAN standardized magnetic resonance imaging protocol. Physicians should be aware that bone marrow oedema signals on magnetic resonance imaging, a hallmark of active inflammation in axial spondyloarthritis, can also be observed in young to middle-aged women, especially postpartum, even without spondyloarthritis. Paediatric sacroiliac joints may show changes mimicking inflammation due to ongoing bone growth. Furthermore, degenerative changes in the sacroiliac joint are common with advancing age and can be mistaken for sacroiliitis or interpreted as structural changes. The presence of accessory sacroiliac joints, prone to degeneration, further complicates diagnosis. Accurate interpretation requires considering these normal variations to avoid misdiagnosing spondyloarthritis. Collaboration between clinicians and radiologists is crucial, especially when encountering atypical or clinically inconsistent findings.

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Exploring the pathophysiology of anemia in COPD: Insights from chest CT and longitudinal clinical data.

Aya Takizawa, Takashi Shimada, Shotaro Chubachi, Tetsuya Arai, Akira Miyakawa, Hideto Iizuka, Shiro Otake, Kaori Sakurai, Naoya Tanabe, Yoshitake Yamada, Masahiro Jinzaki, Hidetoshi Nakamura, Koichiro Asano, Koichi Fukunaga

Respiratory medicine 240   108046 - 108046 2025.03

Accepted,  ISSN  0954-6111

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BACKGROUND: Although anemia has been associated with chronic obstructive pulmonary disease (COPD) severity, the underlying risk factors, such as chest imaging indicators, remain poorly understood. In this study, we aimed to investigate the relationship between anemia and clinical features, including pulmonary and extrapulmonary indicators on chest computed tomography (CT), and to clarify the pathophysiology of anemia in COPD. METHODS: A total of 400 patients with COPD were prospectively followed for 3 years. Anemia was defined as hemoglobin <13 g/dl in males and <12 g/dl in females. Patients were categorized into the anemia and non-anemia groups, and their clinical characteristics were compared. RESULTS: The anemia group exhibited lower percentage of predicted forced expiratory volume in 1 s (%FEV1) and body mass index (BMI) measurements, worse COPD assessment test (CAT) scores, and more frequent exacerbations. Imaging revealed more severe emphysema, lower cross-sectional areas of the pectoralis and erector spinae muscles, decreased subcutaneous fat, and more severe coronary artery calcification in this group. Additionally, echocardiography demonstrated a higher prevalence of pulmonary hypertension and reduced left ventricular ejection fraction in patients with anemia. Three-year longitudinal data analysis further showed that declining hemoglobin levels correlated with the worsening of nutritional status, a deterioration in bone mineral density (BMD), and an increase in CAT scores. CONCLUSION: Anemia in COPD is a multifactorial comorbidity resulting in emphysema, decreased fat and muscle mass, and reduced BMD.

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Discrepancies in long-leg alignment and knee joint line obliquity between two- and three-dimensional measurements under weight-bearing conditions: Effects on coronal plane alignment of the knee classification.

Ryo Sasaki, Yasuo Niki, Kazuya Kaneda, Yoshitake Yamada, Shu Kobayashi, Kengo Harato, Takeo Nagura, Masaya Nakamura, Masahiro Jinzaki

The Knee 53   237 - 245 2025.03

Accepted,  ISSN  0968-0160

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BACKGROUND: Long-leg alignment and joint line obliquity have traditionally been assessed using two-dimensional (2D) radiography, but the accuracy of this measurement has remained unclear. This study aimed to evaluate the accuracy of 2D measurements of lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) using upright three-dimensional (3D) computed tomography (CT). METHODS: This study involved 66 knees from 38 patients (34 women, four men) with knee osteoarthritis (OA), categorized by Kellgren-Lawrence (KL) grade. Patients underwent standing long-leg radiography (LLR) and upright CT. Flexion and rotation angles of the femur and tibia were measured from upright CT data, and knees were classified by coronal plane alignment of the knee (CPAK) according to 2D- and 3D-LDFA/MPTA. RESULTS: Overall, as KL grade increased, femoral external rotation and flexion increased significantly (P < 0.05). Regarding the tibia, flexion increased (P < 0.05) while rotation remained unchanged with increasing KL grade. In mild OA (KL1 or KL2), 2D-LDFA (86.5 ± 1.8°) was significantly larger than 3D-LDFA (85.0 ± 2.5°; P < 0.05), and this difference was also observed in severe OA (KL3 or KL4) (88.7 ± 2.5° vs. 87.7 ± 3.2°; P < 0.05). However, MPTA was comparable between 2D and 3D. The consistency between 2D and 3D CPAK classifications was 48.5% for the entire sample, 25.0% for mild OA, and 61.9% for severe OA. CONCLUSION: Based on 3D-LDFA/MPTA data gained from upright CT, 2D radiographic LDFA tended to be inaccurate, which may significantly affect the CPAK classification.

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Coronary Artery Calcification on Chest Computed Tomography as a Predictor of Cardiovascular Adverse Events in Patients With COVID-19 - A Multicenter Retrospective Study in Japan.

Mayuko Watase, Yusuke Shiraishi, Shotaro Chubachi, Naoya Tanabe, Tomoki Maetani, Takanori Asakura, Ho Namkoong, Hiromu Tanaka, Takashi Shimada, Shuhei Azekawa, Shiro Otake, Takahiro Fukushima, Kensuke Nakagawara, Katsunori Masaki, Hideki Terai, Takao Mochimaru, Mamoru Sasaki, Soichiro Ueda, Yukari Kato, Norihiro Harada, Shoji Suzuki, Shuichi Yoshida, Hiroki Tateno, Yoshitake Yamada, Masahiro Jinzaki, Yukinori Okada, Ryuji Koike, Makoto Ishii, Akinori Kimura, Seiya Imoto, Satoru Miyano, Seishi Ogawa, Takanori Kanai, Koichi Fukunaga

Circulation journal : official journal of the Japanese Circulation Society 89 ( 3 ) 373 - 381 2025.02

Accepted,  ISSN  1346-9843

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BACKGROUND: Coronary artery calcification (CAC) detected through chest computed tomography (CT) strongly predicts cardiovascular events in asymptomatic individuals undergoing primary prevention. Few studies with limited sample sizes have investigated the predictive value of CAC for cardiovascular complications in COVID-19. This study examined the impact of CAC on cardiovascular complications using a large-scale COVID-19 database. METHODS AND RESULTS: This multicenter retrospective cohort study used data from the Japan COVID-19 Task Force database. After exclusion based on missing information, 1,109 patients with COVID-19 were included. The Agatston score was used to evaluate CAC, dividing the population into 3 groups based on calcification degree (no, moderate, and severe CAC). The primary outcome was cardiovascular complications; the secondary outcome was critical outcomes. The severe CAC group had a higher rate of cardiovascular complications than the other groups. Multivariable analysis, considering COVID-19 severity factors, identified severe CAC as independently associated with cardiovascular complications but not with critical outcomes. Subgroup analysis revealed that, in patients without hypertension, diabetes, cardiovascular disease, or chronic kidney disease, severe CAC was significantly correlated with cardiovascular complications, whereas this association was not observed in patients with these underlying conditions. CONCLUSIONS: Patients with COVID-19 and severe CAC had increased cardiovascular complications, and identifying cardiovascular and pulmonary findings on chest CT is essential. Measuring CAC via non-electrocardiogram-gated CT helps predict patient risk.

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Erector Spinae Muscle to Epicardial Visceral Fat Ratio on Chest CT Predicts the Severity of Coronavirus Disease 2019.

Takashi Shimada, Tomoki Maetani, Shotaro Chubachi, Naoya Tanabe, Takanori Asakura, Ho Namkoong, Hiromu Tanaka, Shuhei Azekawa, Shiro Otake, Kensuke Nakagawara, Takahiro Fukushima, Mayuko Watase, Yusuke Shiraishi, Hideki Terai, Mamoru Sasaki, Soichiro Ueda, Yukari Kato, Norihiro Harada, Shoji Suzuki, Shuichi Yoshida, Hiroki Tateno, Kaoruko Shimizu, Susumu Sato, Yoshitake Yamada, Masahiro Jinzaki, Toyohiro Hirai, Yukinori Okada, Ryuji Koike, Makoto Ishii, Akinori Kimura, Seiya Imoto, Satoru Miyano, Seishi Ogawa, Takanori Kanai, Koichi Fukunaga

Journal of cachexia, sarcopenia and muscle 16 ( 1 ) e13721 2025.02

Accepted,  ISSN  2190-5991

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BACKGROUND: Chest computed tomography (CT) is a valuable tool for diagnosing and predicting the severity of coronavirus disease 2019 (COVID-19) and assessing extrapulmonary organs. Reduced muscle mass and visceral fat accumulation are important features of a body composition phenotype in which obesity and muscle loss coexist, but their relationship with COVID-19 outcomes remains unclear. In this study, we aimed to investigate the association between the erector spinae muscle (ESM) to epicardial adipose tissue (EAT) ratio (ESM/EAT) on chest CT and disease severity in patients with COVID-19. METHODS: We analysed data from 1074 COVID-19 patients enrolled in the Japan COVID-19 Task Force database. The primary outcome was the rate of critical outcomes (requiring high-flow oxygen therapy, invasive ventilator support or death). The incidence of critical outcomes was compared between patients with high and low ESM/EAT ratios. RESULTS: The low ESM/EAT group (n = 353) had a higher incidence of critical outcomes (13.3% vs. 5.13%, p < 0.001) and mortality (2.55% vs. 0.69%, p = 0.019) than the high ESM/EAT group (n = 721). In multivariable analysis, the low ESM/EAT ratio was associated with critical outcomes (adjusted odds ratio [aOR] 2.11, 95% confidence interval [CI] 1.22-3.66) independently of the known COVID-19 severity factors including age, sex, body mass index (BMI), smoking history, lifestyle-related comorbidities and pneumonia volume. CONCLUSION: The low ESM/EAT ratio in COVID-19 patients can be obtained on chest CT and used to predict critical outcomes after disease onset, demonstrating the importance of detailed body composition assessments in COVID-19 practice.

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Recent trends in scientific research in chest radiology: What to do or not to do? That is the critical question in research.

Hiroto Hatabu, Masahiro Yanagawa, Yoshitake Yamada, Takuya Hino, Yuzo Yamasaki, Akinori Hata, Daiju Ueda, Yusei Nakamura, Yoshiyuki Ozawa, Masahiro Jinzaki, Yoshiharu Ohno

Japanese journal of radiology 43 ( 6 ) 883 - 902 2025.01

Accepted,  ISSN  1867-1071

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Hereby inviting young rising stars in chest radiology in Japan for contributing what they are working currently, we would like to show the potentials and directions of the near future research trends in the research field. I will provide a reflection on my own research topics. At the end, we also would like to discuss on how to choose the themes and topics of research: What to do or not to do? We strongly believe it will stimulate and help investigators in the field.

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Validation of musculoskeletal segmentation model with uncertainty estimation for bone and muscle assessment in hip-to-knee clinical CT images.

Mazen Soufi, Yoshito Otake, Makoto Iwasa, Keisuke Uemura, Tomoki Hakotani, Masahiro Hashimoto, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Masahiro Jinzaki, Suzushi Kusano, Masaki Takao, Seiji Okada, Nobuhiko Sugano, Yoshinobu Sato

Scientific reports 15 ( 1 ) 125 - 125 2025.01

Accepted

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Deep learning-based image segmentation has allowed for the fully automated, accurate, and rapid analysis of musculoskeletal (MSK) structures from medical images. However, current approaches were either applied only to 2D cross-sectional images, addressed few structures, or were validated on small datasets, which limit the application in large-scale databases. This study aimed to validate an improved deep learning model for volumetric MSK segmentation of the hip and thigh with uncertainty estimation from clinical computed tomography (CT) images. Databases of CT images from multiple manufacturers/scanners, disease status, and patient positioning were used. The segmentation accuracy, and accuracy in estimating the structures volume and density, i.e., mean HU, were evaluated. An approach for segmentation failure detection based on predictive uncertainty was also investigated. The model has improved all segmentation accuracy and structure volume/density evaluation metrics compared to a shallower baseline model with a smaller training database (N = 20). The predictive uncertainty yielded large areas under the receiver operating characteristic (AUROC) curves (AUROCs ≥ .95) in detecting inaccurate and failed segmentations. Furthermore, the study has shown an impact of the disease severity status on the model's predictive uncertainties when applied to a large-scale database. The high segmentation and muscle volume/density estimation accuracy and the high accuracy in failure detection based on the predictive uncertainty exhibited the model's reliability for analyzing individual MSK structures in large-scale CT databases.

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Resection of a Giant Middle Mediastinal Tumor Using a Transaortopulmonary Arterial Approach.

Kaito Yano, Tsutomu Ito, Keisuke Asakura, Yuriko Tanabe, Yorihiko Matsumoto, Kaoru Kaseda, Yutaka Kurebayashi, Yoshitake Yamada, Tomoyuki Hishida, Hideyuki Shimizu

Annals of thoracic surgery short reports 3 ( 4 ) 936 - 939 2025

Accepted

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Surgical approaches for giant middle mediastinal tumors are challenging owing to the surrounding great vessels and vital organs. Here, we report the resection of a giant middle mediastinal tumor with feeding vessels from the coronary artery causing exertional dyspnea. Surgical resection involved a clamshell incision and temporary transection of the ascending aorta and right pulmonary artery under cardiopulmonary bypass to achieve optimal visualization. The tumor, diagnosed as unicentric Castleman disease, was safely excised with good postoperative outcomes. This method-the transaortopulmonary arterial approach-offers a favorable surgical tool for giant mediastinal tumors.

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Assessment of pulmonary function in COPD patients using dynamic digital radiography: A novel approach utilizing lung signal intensity changes during forced breathing.

Noriaki Wada, Akinori Tsunomori, Takeshi Kubo, Takuya Hino, Akinori Hata, Yoshitake Yamada, Masako Ueyama, Mizuki Nishino, Atsuko Kurosaki, Kousei Ishigami, Shoji Kudoh, Hiroto Hatabu

European journal of radiology open 13   100579 - 100579 2024.12

Accepted,  ISSN  2352-0477

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OBJECTIVES: To investigate the association of lung signal intensity changes during forced breathing using dynamic digital radiography (DDR) with pulmonary function and disease severity in patients with chronic obstructive pulmonary disease (COPD). METHODS: This retrospective study included 46 healthy subjects and 33 COPD patients who underwent posteroanterior chest DDR examination. We collected raw signal intensity and gray-scale image data. The lung contour was extracted on the gray-scale images using our previously developed automated lung field tracking system and calculated the average of signal intensity values within the extracted lung contour on gray-scale images. Lung signal intensity changes were quantified as SImax/SImin, representing the maximum ratio of the average signal intensity in the inspiratory phase to that in the expiratory phase. We investigated the correlation between SImax/SImin and pulmonary function parameters, and differences in SImax/SImin by disease severity. RESULTS: SImax/SImin showed the highest correlation with VC (rs = 0.54, P < 0.0001), followed by FEV1 (rs = 0.44, P < 0.0001), both of which are key indicators of COPD pathophysiology. In a multivariate linear regression analysis adjusted for confounding factors, SImax/SImin was significantly lower in the severe COPD group compared to the normal group (P = 0.0004) and mild COPD group (P=0.0022), suggesting its potential usefulness in assessing COPD severity. CONCLUSION: This study suggests that the signal intensity changes of lung fields during forced breathing using DDR reflect the pathophysiology of COPD and can be a useful index in assessing pulmonary function in COPD patients, potentially improving COPD diagnosis and management.

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Thoracic posture-related morphological changes in patients with pectus excavatum versus healthy controls.

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

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 66 ( 5 )  2024.11

Accepted,  ISSN  1010-7940

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OBJECTIVES: Cases of severe pectus excavatum presenting with worsening cardiopulmonary symptoms in the upright position have been reported. However, the underlying mechanism remains unclear. We evaluated posture-related morphological changes of the thorax in patients with pectus excavatum. METHODS: Chest morphology was evaluated preoperatively using upright and supine computed tomography in 21 patients with pectus excavatum and 35 healthy volunteers. The minimum anterior-posterior thoracic diameter, depression depth, and Haller index on horizontal sections, as well as the T6-12 plumb line distance on sagittal sections, were compared between the two positions. RESULTS: In patients with pectus excavatum (median age, 22 years; 18 males and 3 females), the minimum anterior-posterior diameter was smaller (4.5 vs 5.1 cm, P < 0.001) and the Haller index was greater (10.1 vs 6.4, P < 0.001) in the upright position than in the supine position. The T6-T12 plumb line distance was longer in the upright position (2.4 vs 0.8 cm, P < 0.001), while the depression depth showed no significant difference. Healthy volunteers exhibited similar changes. The degree of spinal curvature increased in the upright position due to the anterior shift of the lower thoracic vertebrae, resulting in a shorter anterior-posterior diameter, irrespective of chest wall deformity. One patient with dyspnoea only in the upright position exhibited compression of the right inferior pulmonary vein only on upright computed tomography. CONCLUSIONS: The minimum anterior-posterior diameter is shorter in the upright position. This may explain the worsening of cardiopulmonary symptoms in patients with severe pectus excavatum when in an upright position. CLINICAL TRIAL NUMBER: UMIN000036438 https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041519.

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The first Japanese case of autosomal dominant cutis laxa with a frameshift mutation in exon 30 of the elastin gene complicated by small airway disease with 8 years of follow-up.

Masanori Kaji, Ho Namkoong, Shotaro Chubachi, Hiromu Tanaka, Takanori Asakura, Mizuha Haraguchi Hashiguchi, Mamiko Yamada, Tomoko Uehara, Hisato Suzuki, Naoya Tanabe, Yoshitake Yamada, Taiki Nozaki, Takeshi Ouchi, Atsutoshi Tsuji, Kenjiro Kosaki, Naoki Hasegawa, Koichi Fukunaga

BMC pulmonary medicine 24 ( 1 ) 481 - 481 2024.10

Accepted

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BACKGROUND: Cutis laxa constitutes a diverse group of connective tissue diseases, both inherited and acquired, characterized by loose skin and varying systemic involvement, including pulmonary lesions. While cutis laxa has been linked to conditions like emphysema, asthma, and bronchiectasis, the specific pathological and radiological characteristics underlying pulmonary complications related to cutis laxa remain unclear. CASE PRESENTATION: A 36-year-old woman, diagnosed with cutis laxa at birth, presented to our outpatient clinic with severe obstructive ventilatory impairment, evident in pulmonary function tests (expiratory volume in one second (FEV1)/forced vital capacity (FVC): 34.85%; %residual volume [RV]: 186.5%; %total lung capacity [TLC]: 129.2%). Pulmonary function tests also indicated small airway disease (%FEF50%, 7.9%; %FEF75%, 5.7%; and %FEF25-75%, 6.8%). Computed tomography (CT) revealed the lack of normal increase in lung attenuation on expiratory CT scan, with no discernible emphysematous changes. Exome sequencing was performed to confirm the association between the pulmonary lesions and cutis laxa, revealing a frameshift variant in exon 30 of the elastin gene (ELN). Further analysis employing a parametric response map revealed a longitudinal increase in the percentage of functional small airway disease (fSAD) from 37.84% to 46.61% over the 8-year follow-up, despite the absence of overt changes in CT findings, specifically the lack of normal increase in lung attenuation on expiratory CT scan. Over the same follow-up interval, there was a modest reduction of 25.6 mL/year in FEV1 coupled with a significant increase in %RV. Pulmonary function test metrics, reflective of small airway disease, exhibited a continual decline; specifically, %FEF50%, %FEF75%, and %FEF25-75% diminished from 7.9% to 7.0%, 5.7% to 4.6%, and 6.8% to 5.4%, respectively. CONCLUSIONS: This case highlighted an instance of autosomal dominant cutis laxa arising from a frameshift variant in exon 30 of ELN, accompanied by small airway disease. Comprehensive investigation, utilizing quantitative CT analysis, revealed a longitudinal increase in fSAD percentage with a mild reduction in FEV1. These findings indicate that elastin deficiency may not only diminish elastic fibers in the skin but also be implicated in small airway disease by impacting components of the extracellular matrix in the lungs.

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Physiological rotation patterns of the thoracolumbar spine across different ages: A detailed analysis using upright CT.

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

Gait & posture 114   305 - 312 2024.10

Accepted,  ISSN  0966-6362

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BACKGROUND: The rotational motion of the spine plays a crucial role in daily activities. Understanding the mechanisms of spinal rotation is essential for evaluating normal spinal function, especially in standing positions due to the influence of gravity. However, previous studies on spinal rotation have been limited. RESEARCH QUESTION: What are the differences in thoracolumbar rotation during trunk rotation in a standing position among different age and gender groups? METHODS: This cross-sectional study involved 49 healthy volunteers without back pain, including 24 younger participants (13 males, 11 females) and 25 elderly participants (12 males, 13 females). Upright and trunk-rotated CT (right-rotated standing positions) scans were taken. Vertebral rotation was measured using the femoral head center as an axis. RESULTS: Analysis of spinal alignment in the standing position revealed mild rotation from the lumbar to thoracic vertebrae. The lumbar spine exhibited left rotation at apex of L3 (L3: -1.3±3.8°, p=0.01), while the lower thoracic spine showed right rotation at apex of T8 (T8: 1.9±2.4°, p<0.001) and the upper thoracic spine showed left rotation at apex of T3 (T3: -2.6±2.9°, p<0.001). The lumbar spine showed minimal rotation during maximum trunk rotation, with significant rotation noted above T10 (16 % vs 84 %). The total thoracolumbar spinal rotation at T1 showed significant differences by gender and age (male vs. female: 23.9±° vs. 30.3±°, p=0.001; young vs. elderly: 29.2±° vs. 25.0±°, p=0.028; elderly male vs. elderly female: 19.2±° vs. 30.4±°, p<0.001). Younger participants did not show significant gender differences, while elderly females retained more rotation compared to males. SIGNIFICANCE: This pioneering study provides the first detailed report on the range of spinal rotation in a physiological standing situation, highlighting significant differences by gender and age. These findings offer new insights into the natural patterns of spinal rotation and their potential implications for diagnosing and treating spinal disorders.

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Differences in lung attenuation gradients between supine and standing positions in healthy participants on conventional/supine and upright computed tomography.

Fumiko Yagi, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Atsunori Kozuka, Masahiro Hashimoto, Yoshito Otake, Yoshinobu Sato, Shotaro Chubachi, Taiki Nozaki, Hiroto Hatabu, Koichi Fukunaga, Masahiro Jinzaki

Scientific reports 14 ( 1 ) 21493 - 21493 2024.09

Accepted

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The effect of gravity on the lungs has been evaluated using computed tomography (CT) in the supine and prone positions but not the standing position. However, as humans spend most of the daytime in the standing position, we aimed to compare lung attenuation gradients between the supine and standing positions, and to assess the correlations between the lung attenuation gradients and participant characteristics, including pulmonary function test results. Overall, 100 healthy participants underwent conventional/supine and upright CT, and lung attenuation gradients were measured. Lung attenuation gradients in anteroposterior direction were greater in the supine position than in standing position (all p values < 0.0001) in both upper lobes at the level of the aortic arch (right: standing/supine, -0.02 ± 0.19/0.53 ± 0.21; left: standing/supine, -0.06 ± 0.20/0.51 ± 0.21); in the right middle (standing/supine, -0.26 ± 0.41/0.53 ± 0.39), left upper (standing/supine, -0.35 ± 0.50/0.66 ± 0.54), and lower lobes at the level of the inferior pulmonary vein (right: standing/supine, -0.22 ± 0.30/0.65 ± 0.41; left: standing/supine, -0.16 ± 0.25/0.73 ± 0.54); and in both lower lobes just above the diaphragm (right: standing/supine, -0.13 ± 0.22/0.52 ± 0.32; left: standing/supine, -0.30 ± 0.57/0.55 ± 0.37). Craniocaudal gradients were greater in the standing position (right: standing/supine, 0.41 ± 0.30/0.00 ± 0.16; left: standing/supine, 0.35 ± 0.30/-0.02 ± 0.16, all p values < 0.0001). No moderate to very high correlations were observed between age, sex, height, weight, body index mass, or pulmonary function test results and each lung attenuation gradient. Lung attenuation gradients in anteroposterior direction, which was observed in the supine position, disappeared in the standing position. However, the craniocaudal lung attenuation gradient, which was not present in the supine position, appeared in the standing position.

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Upright CT-based evaluation of the effects of posture on skull-base reconstruction after endoscopic endonasal surgery.

Kento Takahara, Katsuhiro Mizutani, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Keisuke Yoshida, Kenzo Kosugi, Ryo Ueda, Masahiro Toda, Masahiro Jinzaki

Scientific reports 14 ( 1 ) 20303 - 20303 2024.09

Accepted

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Cerebrospinal fluid (CSF) leakage is a common complication associated with endoscopic endonasal skull-base surgery (EESBS). Postoperative mobilization-associated postural changes are considered to cause CSF leakage. However, no study has demonstrated a robust relationship between postural changes and CSF leakage. We used upright computed tomography (CT) to clarify the effects of postural changes on the reconstructed skull base (RSB) after EESBS. Thirty patients who underwent EESBS at our institution were prospectively included, and their upright and supine CTs were compared to measure morphological changes in the RSB. Patient clinical data were also collected from medical charts and surgical videos, and their relationships with morphological changes were assessed. In upright CTs, the RSB shifted intracranially by 0.94 (0.0-2.9) mm on average. This shift was larger in cases with lesions extending to the sphenoid sinus, dural defects, intraoperative pulsation of the RSB, and large bone windows. The direction of the change was opposite to intuitive movement driven by gravity because of reduced intracranial pressure in the sitting position. Thus, these shifts can be directly associated with postoperative CSF leakage caused by reconstruction material displacement. Skull-base reconstruction and postoperative postural management accounting for these morphological changes may be necessary for preventing CSF leakage.

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Childhood interstitial lung diseases: current understanding of the classification and imaging findings.

Yuko Tsujioka, Gen Nishimura, Eugene Nishi, Tatsuo Kono, Taiki Nozaki, Masahiro Hashimoto, Yoshitake Yamada, Masahiro Jinzaki

Japanese journal of radiology 42 ( 9 ) 937 - 952 2024.09

Accepted,  ISSN  1867-1071

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Childhood interstitial lung diseases (chILDs) encompass a diverse group of disorders with a high mortality rate and severe respiratory morbidities. Recent investigations have revealed that the classification of adult ILDs is not valid for chILDs, particularly for ILDs of early onset. Therefore, Children's Interstitial Lung Disease Research Cooperative of North America proposed a new classification of chILDs for affected children under 2 years of age, and later another classification for affected individuals between 2 and 18 years of age. In this review, we provide an overview of the imaging findings of chILDs by classification. Most infantile ILDs have unique clinical, radiological, and molecular findings, while the manifestation of pediatric ILDs overlaps with that of adult ILDs.

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Verification of acromion marker cluster and scapula spinal marker cluster methods for tracking shoulder kinematics: a comparative study with upright four-dimensional computed tomography.

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

BMC musculoskeletal disorders 25 ( 1 ) 589 - 589 2024.07

Accepted

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BACKGROUND: This study validated the accuracy of the acromion marker cluster (AMC) and scapula spinal marker cluster (SSMC) methods compared with upright four-dimensional computed tomography (4DCT) analysis. METHODS: Sixteen shoulders of eight healthy males underwent AMC and SSMC assessments. Active shoulder elevation was tracked using upright 4DCT and optical motion capture system. The scapulothoracic and glenohumeral rotation angles calculated from AMC and SSMC were compared with 4DCT. Additionally, the motion of these marker clusters on the skin with shoulder elevation was evaluated. RESULTS: The average differences between AMC and 4DCT during 10°-140° of humerothoracic elevation were - 2.2° ± 7.5° in scapulothoracic upward rotation, 14.0° ± 7.4° in internal rotation, 6.5° ± 7.5° in posterior tilting, 3.7° ± 8.1° in glenohumeral elevation, - 8.3° ± 10.7° in external rotation, and - 8.6° ± 8.9° in anterior plane of elevation. The difference between AMC and 4DCT was significant at 120° of humerothoracic elevation in scapulothoracic upward rotation, 50° in internal rotation, 90° in posterior tilting, 120° in glenohumeral elevation, 100° in external rotation, and 100° in anterior plane of elevation. However, the average differences between SSMC and 4DCT were - 7.5 ± 7.7° in scapulothoracic upward rotation, 2.0° ± 7.0° in internal rotation, 2.3° ± 7.2° in posterior tilting, 8.8° ± 7.9° in glenohumeral elevation, 2.0° ± 9.1° in external rotation, and 1.9° ± 10.1° in anterior plane of elevation. The difference between SSMC and 4DCT was significant at 50° of humerothoracic elevation in scapulothoracic upward rotation and 60° in glenohumeral elevation, with no significant differences observed in other rotations. Skin motion was significantly smaller in AMC (28.7 ± 4.0 mm) than SSMC (38.6 ± 5.8 mm). Although there was smaller skin motion in AMC, SSMC exhibited smaller differences in scapulothoracic internal rotation, posterior tilting, glenohumeral external rotation, and anterior plane of elevation compared to 4DCT. CONCLUSION: This study demonstrates that AMC is more accurate for assessing scapulothoracic upward rotation and glenohumeral elevation, while SSMC is preferable for evaluating scapulothoracic internal rotation, posterior tilting, glenohumeral external rotation, and anterior plane of elevation, with smaller differences compared to 4DCT.

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CT-derived vertebral bone mineral density is a useful biomarker to predict COVID-19 outcome.

Shuhei Azekawa, Tomoki Maetani, Shotaro Chubachi, Takanori Asakura, Naoya Tanabe, Yusuke Shiraishi, Ho Namkoong, Hiromu Tanaka, Takashi Shimada, Takahiro Fukushima, Shiro Otake, Kensuke Nakagawara, Mayuko Watase, Hideki Terai, Mamoru Sasaki, Soichiro Ueda, Yukari Kato, Norihiro Harada, Shoji Suzuki, Shuichi Yoshida, Hiroki Tateno, Yoshitake Yamada, Masahiro Jinzaki, Toyohiro Hirai, Yukinori Okada, Ryuji Koike, Makoto Ishii, Akinori Kimura, Seiya Imoto, Satoru Miyano, Seishi Ogawa, Takanori Kanai, Koichi Fukunaga

Bone (Bone)  184   117095 - 117095 2024.07

Accepted,  ISSN  87563282

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The low vertebral bone computed tomography (CT) Hounsfield unit values measured on CT scans reflect low bone mineral density (BMD) and are known as diagnostic indicators for osteoporosis. The potential prognostic significance of low BMD defined by vertebral bone CT values for the coronavirus disease 2019 (COVID-19) remains unclear. This study aimed to assess the impact of BMD on the clinical outcome in Japanese patients with COVID-19 and evaluate the association between BMD and critical outcomes, such as high-flow nasal cannula, non-invasive and invasive positive pressure ventilation, extracorporeal membrane oxygenation, or death. We examined the effects of COVID-19 severity on the change of BMD over time. This multicenter retrospective cohort study enrolled 1132 inpatients with COVID-19 from the Japan COVID-19 Task Force database between February 2020 and September 2022. The bone CT values of the 4th, 7th, and 10th thoracic vertebrae were measured from chest CT images. The average of these values was defined as BMD. Furthermore, a comparative analysis was conducted between the BMD on admission and its value 3 months later. The low BMD group had a higher proportion of critical outcomes than did the high BMD group. In a subanalysis stratifying patients by epidemic wave according to onset time, critical outcomes were higher in the low BMD group in the 1st-4th waves. Multivariable logistic analysis of previously reported factors associated with COVID-19 severity revealed that low BMD, chronic kidney disease, and diabetes were independently associated with critical outcomes. At 3 months post-infection, patients with oxygen demand during hospitalization showed markedly decreased BMD than did those on admission. Low BMD in patients with COVID-19 may help predict severe disease after the disease onset. BMD may decrease over time in patients with severe COVID-19, and the impact on sequelae symptoms should be investigated in the future.

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Finite element analysis of hip fracture risk in elderly female: The effects of soft tissue shape, fall direction, and interventions.

Sotaro Murakami, Yuqing Zhao, Koji Mizuno, Minoru Yamada, Yoichi Yokoyama, Yoshitake Yamada, Masahiro Jinzaki

Journal of biomechanics 172   112199 - 112199 2024.07

Accepted,  ISSN  0021-9290

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This study investigates the effects of fall configurations on hip fracture risk with a focus on pelvic soft tissue shape. This was done by employing a whole-body finite element (FE) model. Soft tissue thickness around the pelvis was measured using a standing CT system, revealing a trend of increased trochanteric soft tissue thickness with higher BMI and younger age. In the lateroposterior region from the greater trochanter, the soft tissues of elderly females were thin with a concave shape. Based on the THUMS 5F model, an elderly female FE model with a low BMI was developed by morphing the soft tissue shape around the pelvis based on the CT data. FE simulation results indicated that the lateroposterior fall led to a higher femoral neck force for the elderly female model compared to the lateral fall. One reason may be related to the thin soft tissue of the pelvis in the lateroposterior region. Additionally, the effectiveness of interventions that can help mitigating hip fractures in lateroposterior falls on the thigh-hip and hip region was assessed using the elderly female model. The attenuation rate of the femoral neck force by the hip protector was close to zero in the thigh-hip fall and high in the hip fall, whereas the attenuation rate of the compliant floor was high in both falls. This study highlights age-related changes in the soft tissue shape of the pelvis in females, particularly in the lateroposterior regions, which may influence force mitigation for the hip joint during lateroposterior falls.

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Exploration of postural effects on the external jugular and diploic venous system using upright computed tomography scanning.

Katsuhiro Mizutani, Tsubasa Miyauchi, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Kenzo Kosugi, Keisuke Yoshida, Takenori Akiyama, Masahiro Toda, Masahiro Jinzaki

Neuroradiology (Neuroradiology)  66 ( 6 ) 963 - 971 2024.06

Accepted,  ISSN  0028-3940

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PURPOSE: Few studies have investigated the influence of posture on the external jugular and diploic venous systems in the head and cranial region. In this study, we aimed to investigate the effects of posture on these systems using upright computed tomography (CT) scanning. METHODS: This study retrospectively analysed an upright CT dataset from a previous prospective study. In each patient, the diameters of the vessels in three external jugular tributaries and four diploic veins were measured using CT digital subtraction venography in both supine and sitting positions. RESULTS: Amongst the 20 cases in the original dataset, we eventually investigated 19 cases due to motion artifacts in 1 case. Compared with the supine position, most of the external jugular tributaries collapsed, and the average size significantly decreased in the sitting position (decreased by 22-49% on average). In contrast, most of the diploic veins, except the occipital diploic veins, tended to increase or remain unchanged (increased by 12-101% on average) in size in the sitting position compared with the supine position. However, the changes in the veins associated with this positional shift were not uniform; in approximately 5-30% of the cases, depending on each vein, an opposite trend was observed. CONCLUSION: Compared to the supine position, the contribution of external jugular tributaries to head venous drainage decreased in the sitting position, whilst most diploic veins maintained their contribution. These results could enhance our understanding of the physiology and pathophysiology of the head region in upright and sitting positions.

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Lung volume measurement using chest CT in COVID-19 patients: a cohort study in Japan.

Shiro Otake, Yusuke Shiraishi, Shotaro Chubachi, Naoya Tanabe, Tomoki Maetani, Takanori Asakura, Ho Namkoong, Takashi Shimada, Shuhei Azekawa, Kensuke Nakagawara, Hiromu Tanaka, Takahiro Fukushima, Mayuko Watase, Hideki Terai, Mamoru Sasaki, Soichiro Ueda, Yukari Kato, Norihiro Harada, Shoji Suzuki, Shuichi Yoshida, Hiroki Tateno, Yoshitake Yamada, Masahiro Jinzaki, Toyohiro Hirai, Yukinori Okada, Ryuji Koike, Makoto Ishii, Naoki Hasegawa, Akinori Kimura, Seiya Imoto, Satoru Miyano, Seishi Ogawa, Takanori Kanai, Koichi Fukunaga

BMJ open respiratory research (BMJ Open Respiratory Research)  11 ( 1 )  2024.04

Accepted

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OBJECTIVE: This study aimed to investigate the utility of CT quantification of lung volume for predicting critical outcomes in COVID-19 patients. METHODS: This retrospective cohort study included 1200 hospitalised patients with COVID-19 from 4 hospitals. Lung fields were extracted using artificial intelligence-based segmentation, and the percentage of the predicted (%pred) total lung volume (TLC (%pred)) was calculated. The incidence of critical outcomes and posthospitalisation complications was compared between patients with low and high CT lung volumes classified based on the median percentage of predicted TLCct (n=600 for each). Prognostic factors for residual lung volume loss were investigated in 208 patients with COVID-19 via a follow-up CT after 3 months. RESULTS: The incidence of critical outcomes was higher in the low TLCct (%pred) group than in the high TLCct (%pred) group (14.2% vs 3.3%, p<0.0001). Multivariable analysis of previously reported factors (age, sex, body mass index and comorbidities) demonstrated that CT-derived lung volume was significantly associated with critical outcomes. The low TLCct (%pred) group exhibited a higher incidence of bacterial infection, heart failure, thromboembolism, liver dysfunction and renal dysfunction than the high TLCct (%pred) group. TLCct (%pred) at 3 months was similarly divided into two groups at the median (71.8%). Among patients with follow-up CT scans, lung volumes showed a recovery trend from the time of admission to 3 months but remained lower in critical cases at 3 months. CONCLUSION: Lower CT lung volume was associated with critical outcomes, posthospitalisation complications and slower improvement of clinical conditions in COVID-19 patients.

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Gender differences in spinal mobility during postural changes: a detailed analysis using upright CT.

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

Scientific reports (Scientific Reports)  14 ( 1 ) 9154 - 9154 2024.04

Accepted

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Lumbar spinal alignment is crucial for spine biomechanics and is linked to various spinal pathologies. However, limited research has explored gender-specific differences using CT scans. The objective was to evaluate and compare lumbar spinal alignment between standing and sitting CT in healthy individuals, focusing on gender differences. 24 young and 25 elderly males (M) and females (F) underwent standing and sitting CT scans to assess lumbar spinal alignment. Parameters measured and compared between genders included lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), lordotic angle (LA), foraminal height (FH), and bony boundary area (BBA). Females showed significantly larger changes in SS and PT when transitioning from standing to sitting (p = .044, p = .038). A notable gender difference was also observed in the L4-S LA among the elderly, with females showing a significantly larger decrease in lordotic angle compared to males (- 14.1° vs. - 9.2°, p = .039*). Females consistently exhibited larger FH and BBA values, particularly in lower lumbar segments, which was more prominent in the elderly group (M vs. F: L4/5 BBA 80.1 mm2 [46.3, 97.8] vs. 109.7 mm2 [74.4, 121.3], p = .019 in sitting). These findings underline distinct gender-related variations in lumbar alignment and flexibility, with a focus on noteworthy changes in BBA and FH in females. Gender differences in lumbar spinal alignment were evident, with females displaying greater pelvic and sacral mobility. Considering gender-specific characteristics is crucial for assessing spinal alignment and understanding spinal pathologies. These findings contribute to our understanding of lumbar spinal alignment and have implications for gender-specific spinal conditions and treatments.

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The tibial tubercle-to-trochlear groove distance changes in standing weight-bearing condition: An upright weight-bearing computed tomography analysis.

Ryo Sasaki, Yasuo Niki, Kazuya Kaneda, Yoshitake Yamada, Takeo Nagura, Masaya Nakamura, Masahiro Jinzaki

The Knee (Knee)  48   14 - 21 2024.03

Accepted,  ISSN  0968-0160

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BACKGROUND: The tibial tubercle-to-trochlear groove (TT-TG) distance and Insall-Salvati (I/S) ratio are widely used to determine the need for distal realignment in conjunction with medial patellofemoral ligament (MPFL) reconstruction in patients with recurrent patellar dislocation. A TT-TG distance >20 mm and an I/S ratio >1.3 are significant anatomical risk factors for patellar instability. However, these parameters have traditionally been measured using non-weight-bearing (NWB) imaging modalities. As patellar dislocation occurs during weight-bearing actions, these two parameters should be measured under weight-bearing conditions. Thus, this study aimed to measure the TT-TG distance and I/S ratio using upright full-weight-bearing (FWB) computed tomography (CT) scans and compare the data with NWB CT scans. METHODS: This study included 49 knee joints of 26 healthy volunteers. CT images were obtained under both FWB and NWB standing conditions using a 320-detector row upright CT scanner. TT-TGs in the axial plane and I/S ratios in the sagittal plane were measured and compared. RESULTS: The average FWB TT-TG distance was 20.3 ± 3.9 mm, whereas the average NWB TT-TG distance was 12.3 ± 4.7 mm. The TT-TG level was significantly higher in the FWB condition than that in the NWB condition (P < 0.001). The I/S ratios were comparable between the FWB and NWB conditions (P = 0.29). CONCLUSIONS: The TT-TG distance in the standing weight-bearing condition was larger than the conventional TT-TG distance and surpassed the historical cutoff value of TT-TG, which may affect the indication of additional distal realignment in MPFL reconstruction for patellar instability.

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Renal sinus fat is associated with intrarenal hemodynamic abnormalities independent of visceral fat in patients with chronic kidney disease.

Kenji Kaneko, Ryunosuke Mitsuno, Daiki Kojima, Tatsuhiko Azegami, Shotaro Kosugi, Toshifumi Nakamura, Akinori Hashiguchi, Yoshitake Yamada, Masahiro Jinzaki, Shintaro Yamaguchi, Hiroshi Itoh, Jun Yoshino, Kaori Hayashi

Obesity research & clinical practice (Obesity Research and Clinical Practice)  18 ( 2 ) 118 - 123 2024.03

Accepted,  ISSN  1871-403X

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OBJECTIVE: Obesity is a risk factor of chronic kidney disease (CKD), contributing to the rising incidence of cardiometabolic diseases. Renal sinus fat (RSF) is an ectopic fat depot located at the renal cavity that could impair renal function and hemodynamic through compression of renal structures. The major purpose of this study was to explore the relationship between RSF accumulation and renal dysfunction in CKD patients. METHODS: We evaluated the associations between computed tomography measured RSF volume and key clinical and histologic parameters involved in renal function and hemodynamics in 132 well-characterized CKD patients who underwent renal biopsy (median age: 62 years; 63.6% men). RESULTS: RSF volume normalized by renal volume (RSF%) positively correlated with obesity-related traits such body mass index and visceral fat volume (VFV) (all P < 0.001) whereas it negatively correlated with estimated glomerular filtration rate (eGFR) (ρ = -0.42, P < 0.001) and 24-h urinary creatinine clearance (CCr) (ρ = -0.34, P < 0.001). Notably, we found robust positive correlations between RSF% and renal resistive index (RRI) measured by the Doppler ultrasound (ρ = 0.40, P < 0.001), and the histological severity of global glomerular sclerosis (ρ = 0.48, P < 0.001) and interstitial fibrosis and tubular atrophy (IFTA) (ρ = 0.35, P < 0.001). In the multivariate linear regression models, after accounting for potential confounders including VFV, RSF% remained significantly associated with CCr (β = -0.26, P < 0.001), RRI (β = 0.17, P = 0.022), global glomerular sclerosis (β = 0.21, P = 0.002), and IFTA (β = 0.17, P = 0.012). CONCLUSION: RSF accumulation is associated with renal dysfunction and hemodynamic abnormalities independent of visceral adiposity. Our results suggest that RSF may have a potential unique role in the pathogenesis of CKD.

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Integrated assessment of computed tomography density in pectoralis and erector spinae muscles as a prognostic biomarker for coronavirus disease 2019.

Kensuke Nakagawara, Yusuke Shiraishi, Shotaro Chubachi, Naoya Tanabe, Tomoki Maetani, Takanori Asakura, Ho Namkoong, Hiromu Tanaka, Takashi Shimada, Shuhei Azekawa, Shiro Otake, Takahiro Fukushima, Mayuko Watase, Hideki Terai, Mamoru Sasaki, Soichiro Ueda, Yukari Kato, Norihiro Harada, Shoji Suzuki, Shuichi Yoshida, Hiroki Tateno, Yoshitake Yamada, Masahiro Jinzaki, Toyohiro Hirai, Yukinori Okada, Ryuji Koike, Makoto Ishii, Akinori Kimura, Seiya Imoto, Satoru Miyano, Seishi Ogawa, Takanori Kanai, Koichi Fukunaga

Clinical nutrition (Edinburgh, Scotland) (Clinical Nutrition)  43 ( 3 ) 815 - 824 2024.02

Accepted,  ISSN  0261-5614

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UNLABELLED: BACKGROUND ＆ AIMS: Muscle quantification using chest computed tomography (CT) is a useful prognostic biomarker for coronavirus disease 2019 (COVID-19). However, no studies have evaluated the clinical course through comprehensive assessment of the pectoralis and erector spinae muscles. Therefore, we compared the impact of the areas and densities of these muscles on COVID-19 infection outcome. METHODS: This multicenter retrospective cohort study was conducted by the COVID-19 Task Force. A total of 1410 patients with COVID-19 were included, and data on the area and density of the pectoralis and erector spinae muscles on chest CT were collected. The impact of each muscle parameter on the clinical outcome of COVID-19 was stratified according to sex. The primary outcome was the percentage of patients with severe disease, including those requiring oxygen supplementation and those who died. Additionally, 167 patients were followed up for changes in muscle parameters at three months and for the clinical characteristics in case of reduced CT density. RESULTS: For both muscles, low density rather than muscle area was associated with COVID-19 severity. Regardless of sex, lower erector spinae muscle density was associated with more severe disease than pectoralis muscle density. The muscles were divided into two groups using the receiver operating characteristic curve of CT density, and the population was classified into four (Group A: high CT density for both muscles, Group B: low CT density for pectoralis and high for erector spinae muscle. Group C: high CT density for pectoralis and low for erector spinae muscle, Group D: low CT density for both muscles). In univariate analysis, Group D patients exhibited worse outcomes than Group A (OR: 2.96, 95% CI: 2.03-4.34 in men; OR: 3.02, 95% CI: 2.66-10.4 in women). Multivariate analysis revealed that men in Group D had a significantly more severe prognosis than those in Group A (OR: 1.82, 95% CI: 1.16-2.87). Moreover, Group D patients tended to have the highest incidence of other complications due to secondary infections and acute kidney injury during the clinical course. Longitudinal analysis of both muscle densities over three months revealed that patients with decreased muscle density over time were more likely to have severe cases than those who did not. CONCLUSIONS: Muscle density, rather than muscle area, predicts the clinical outcomes of COVID-19. Integrated assessment of pectoralis and erector spinae muscle densities demonstrated higher accuracy in predicting the clinical course of COVID-19 than individual assessments.

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【押さえておきたい呼吸器疾患の画像診断Case-based review】多発結節,粒状影(粟粒影)の鑑別　間質性肺炎に沿って併存する石灰化病変

池田 織人, 山田 祥岳, 杉浦 弘明, 陣崎 雅弘

画像診断 ((株)Gakken)  44 ( 3 ) 302 - 302 2024.02

ISSN  0285-0524

【押さえておきたい呼吸器疾患の画像診断Case-based review】多発結節,粒状影(粟粒影)の鑑別　悪性リンパ腫に多発する粒状影

池田 織人, 山田 祥岳, 杉浦 弘明, 陣崎 雅弘

画像診断 ((株)Gakken)  44 ( 3 ) 300 - 300 2024.02

ISSN  0285-0524

【押さえておきたい呼吸器疾患の画像診断Case-based review】多発結節,粒状影(粟粒影)の鑑別　全身性の発疹に伴う多発肺結節

池田 織人, 山田 祥岳, 杉浦 弘明, 陣崎 雅弘

画像診断 ((株)Gakken)  44 ( 3 ) 294 - 295 2024.02

ISSN  0285-0524

【押さえておきたい呼吸器疾患の画像診断Case-based review】多発結節,粒状影(粟粒影)の鑑別　免疫不全患者に合併する多発粒状影

池田 織人, 山田 祥岳, 杉浦 弘明, 陣崎 雅弘

画像診断 ((株)Gakken)  44 ( 3 ) 301 - 301 2024.02

ISSN  0285-0524

【押さえておきたい呼吸器疾患の画像診断Case-based review】多発結節,粒状影(粟粒影)の鑑別　偶発的にみつかった多発結節影

池田 織人, 山田 祥岳, 杉浦 弘明, 陣崎 雅弘

画像診断 ((株)Gakken)  44 ( 3 ) 298 - 299 2024.02

ISSN  0285-0524

【押さえておきたい呼吸器疾患の画像診断Case-based review】多発結節,粒状影(粟粒影)の鑑別　偶発的にみつかった多発すりガラス結節

池田 織人, 山田 祥岳, 杉浦 弘明, 陣崎 雅弘

画像診断 ((株)Gakken)  44 ( 3 ) 296 - 297 2024.02

ISSN  0285-0524

【押さえておきたい呼吸器疾患の画像診断Case-based review】多発結節,粒状影(粟粒影)の鑑別　健常者に発症した肺結節

池田 織人, 山田 祥岳, 杉浦 弘明, 陣崎 雅弘

画像診断 ((株)Gakken)  44 ( 3 ) 303 - 303 2024.02

ISSN  0285-0524

【押さえておきたい呼吸器疾患の画像診断Case-based review】びまん性すりガラス影の鑑別　重症肺炎に合併した両肺びまん性すりガラス影

八木 文子, 杉浦 弘明, 山田 祥岳, 陣崎 雅弘

画像診断 ((株)Gakken)  44 ( 3 ) 312 - 313 2024.02

ISSN  0285-0524

【押さえておきたい呼吸器疾患の画像診断Case-based review】びまん性すりガラス影の鑑別　薬剤使用後に出現した肺野陰影

八木 文子, 杉浦 弘明, 山田 祥岳, 陣崎 雅弘

画像診断 ((株)Gakken)  44 ( 3 ) 306 - 307 2024.02

ISSN  0285-0524

【押さえておきたい呼吸器疾患の画像診断Case-based review】びまん性すりガラス影の鑑別　肺野のごくわずかなすりガラス影にFDG集積や肝脾腫を伴った症例

八木 文子, 杉浦 弘明, 山田 祥岳, 陣崎 雅弘

画像診断 ((株)Gakken)  44 ( 3 ) 308 - 309 2024.02

ISSN  0285-0524

【押さえておきたい呼吸器疾患の画像診断Case-based review】びまん性すりガラス影の鑑別　強皮症に出現したすりガラス影

八木 文子, 杉浦 弘明, 山田 祥岳, 陣崎 雅弘

画像診断 ((株)Gakken)  44 ( 3 ) 310 - 311 2024.02

ISSN  0285-0524

【押さえておきたい呼吸器疾患の画像診断Case-based review】びまん性すりガラス影の鑑別　免疫低下状態で出現したびまん性のすりガラス影

八木 文子, 杉浦 弘明, 山田 祥岳, 陣崎 雅弘

画像診断 ((株)Gakken)  44 ( 3 ) 304 - 305 2024.02

ISSN  0285-0524

Epicardial adipose tissue measured from analysis of adipose tissue area using chest CT imaging is the best potential predictor of COVID-19 severity.

Takahiro Fukushima, Tomoki Maetani, Shotaro Chubachi, Naoya Tanabe, Takanori Asakura, Ho Namkoong, Hiromu Tanaka, Takashi Shimada, Shuhei Azekawa, Shiro Otake, Kensuke Nakagawara, Mayuko Watase, Yusuke Shiraishi, Hideki Terai, Mamoru Sasaki, Soichiro Ueda, Yukari Kato, Norihiro Harada, Shoji Suzuki, Shuichi Yoshida, Hiroki Tateno, Yoshitake Yamada, Masahiro Jinzaki, Toyohiro Hirai, Yukinori Okada, Ryuji Koike, Makoto Ishii, Akinori Kimura, Seiya Imoto, Satoru Miyano, Seishi Ogawa, Takanori Kanai, Koichi Fukunaga

Metabolism: clinical and experimental (Metabolism: Clinical and Experimental)  150   155715 - 155715 2024.01

Accepted,  ISSN  0026-0495

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BACKGROUND: Computed tomography (CT) imaging is widely used for diagnosing and determining the severity of coronavirus disease 2019 (COVID-19). Chest CT imaging can be used to calculate the epicardial adipose tissue (EAT) and upper abdominal visceral adipose tissue (Abd-VAT) areas. The EAT is the main source of inflammatory cytokines involved in chest inflammatory diseases; thus, the EAT area might be a more useful severity predictor than the Abd-VAT area for COVID-19. However, to the best of our knowledge, there are no large-scale reports that sufficiently consider this issue. In addition, there are no reports on the characteristics of patients with normal body mass index (BMI) and high adipose tissue. AIM: The purpose of this study was to analyze whether the EAT area, among various adipose tissues, was the most associated factor with COVID-19 severity. Using a multicenter COVID-19 patient database, we analyzed the associations of chest subcutaneous, chest visceral, abdominal subcutaneous, and Abd-VAT areas with COVID-19 outcomes. In addition, the clinical significance of central obesity, commonly disregarded by BMI, was examined. METHODS: This retrospective cohort study evaluated patients with COVID-19 aged ≥18 years In Japan. Data including from chest CT images collected between February 2020 and October 2022 in four hospitals of the Japan COVID-19 Task Force were analyzed. Patient characteristics and COVID-19 severity were compared according to the adipose tissue areas (chest and abdominal subcutaneous adipose tissue [Chest-SAT and Abd-SAT], EAT, and Abd-VAT) calculated from chest CT images. RESULTS: We included 1077 patients in the analysis. Patients with risk factors of severe COVID-19 such as old age, male sex, and comorbidities had significantly higher areas of EAT and Abd-VAT. High EAT area but not high Abd-VAT area was significantly associated with COVID-19 severity (adjusted odds ratio (aOR): 2.66, 95 % confidence interval [CI]: 1.19-5.93). There was no strong correlation between BMI and VAT. Patients with high VAT area accounted for 40.7 % of the non-obesity population (BMI < 25 kg/m2). High EAT area was also significantly associated with COVID-19 severity in the non-obesity population (aOR: 2.50, 95 % CI: 1.17-5.34). CONCLUSIONS: Our study indicated that VAT is significantly associated with COVID-19 severity and that EAT is the best potential predictor for risk stratification in COVID-19 among adipose tissue areas. Body composition assessment using EAT is an appropriate marker for identifying obesity patients overlooked by BMI. Considering the next pandemic of the global health crisis, our findings open new avenues for implementing appropriate body composition assessments based on CT imaging.

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【循環器診療に大きく寄与する心臓CT/MRI】大動脈弁狭窄症に対するTAVI/TAVRにおける術前CT評価

山田 祥岳, 山田 稔, 松本 俊亮, 横山 陽一, 鈴木 達也, 津崎 盾哉, 橋本 正弘, 中原 健裕, 陣崎 雅弘

日独医報 (バイエル薬品(株))  67   77 - 94 2024.01

ISSN  0912-0351

Predictive modeling of submarining risk in car occupants based on pelvis angle and lap belt positioning.

Yuya Takeuchi, Yoshihiko Tanaka, Toshiharu Azuma, Yuqing Zhao, Koji Mizuno, Minoru Yamada, Yoichi Yokoyama, Yoshitake Yamada, Masahiro Jinzaki

Traffic injury prevention (Traffic Injury Prevention)  25 ( 2 ) 147 - 155 2024

Accepted,  ISSN  1538-9588

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OBJECTIVE: The engagement of the lap belt with the pelvis is critical for occupant safety during vehicle frontal crashes to prevent occupant submarining. This study aims to develop a predictive model for submarining risk based on anthropometric parameters and lap belt positioning using finite element (FE) analyses. METHODS: FE analyses were conducted using human body models representing various body shapes (a 50th percentile male, low and high BMI males, and a 5th percentile female) in three seated postures (standard, reclined, and slouched). The lap belt-ASIS overlap and the belt-pelvis angle were used as key parameters for predicting submarining risk. A logistic regression analysis was utilized to correlate submarining occurrence with the initial values of these two parameters at the beginning of impact. Subsequently, this submarining prediction model was applied to computer tomography (CT) measurements of human subjects in different seated postures (upright, reclined, and slouched), and submarining risks were calculated based on the developed model. RESULTS: FE simulations indicated that submarining was more likely to occur as the initial belt-pelvis angle approached zero and there was a smaller initial belt-ASIS overlap. The logistic regression analysis demonstrated that the initial belt-pelvis angle and belt-ASIS overlap were statistically significant for predicting submarining risk. The derived model effectively distinguished submarining occurrence based on the initial values of these two parameters. The application of the submarining model to CT measurements of human subjects showed that submarining risk was lower in the order of upright, slouched, and reclined postures. In the reclined posture, the high submarining risk was attributed to a small belt-ASIS overlap and a rearward-tilted pelvis angle; whereas in the slouched posture, the risk was mostly associated with a rearward-tilted pelvis angle. CONCLUSIONS: The submarining prediction model was developed based on the belt-pelvis angle and the belt-ASIS overlap. This predictive model may help to design restraint systems for various body types and seated postures of occupants.

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The influence of seated postures and anthropometry on lap belt fit in vehicle occupants: A 3D computed tomography study.

Yoshihiko Tanaka, Houtatsu Shu, Yuqing Zhao, Koji Mizuno, Minoru Yamada, Yoichi Yokoyama, Yoshitake Yamada, Masahiro Jinzaki

Traffic injury prevention (Traffic Injury Prevention)  25 ( 3 ) 454 - 462 2024

Accepted,  ISSN  1538-9588

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OBJECTIVE: In vehicle frontal collisions, it is crucial that the lap belt is designed to engage with the anterior superior iliac spine (ASIS) of occupants for a reliable restraint. This study aims to understand the influence of different seated postures on the geometrical relationship of the seat belt and the pelvis for various occupants using 3D upright and supine computed tomography (CT) systems. METHODS: The 3D shapes of bones and soft tissues around the pelvis were acquired through a CT scan for 30 participants. They were seated in a rigid seat equipped with a lap belt simulating the front seat of a small car, and wore a lap belt in three seated postures: upright, slouched and reclined. Parameters related to the likelihood of submarining occurrences, such as belt-ASIS overlap (an index for assessing the potential engagement of the lap belt with the ASIS) and the belt-pelvis angle (the difference between the belt angle and the normal direction of the anterior edge of the ilium) were compared. RESULTS: It was observed that the pelvis angle tilted rearward as the hip point was positioned forward and seatback angle increased. This can be seen in the slouched and reclined posture. The belt-pelvis angle was comparable between the slouched and the reclined postures, and was closer to zero (indicating that the lap belt path is closer to perpendicular to the anterior edge of the ilium) compared to the upright posture. In contrast, the belt-ASIS overlap increased with an increasing flesh margin of the ASIS and shallower belt angle. This suggests that the belt-pelvis angle is influenced by the seated posture whereas the belt-ASIS overlap is dependent more on an individual's anthropometry. The plot of belt-pelvis angle and belt-ASIS overlap exhibited significant variability among participants. CONCLUSIONS: The belt-pelvis angle and the belt-ASIS overlap of individuals will provide valuable information for understanding the current belt-fit location and predicting submarining occurrences for individuals in various postures when designing restraint systems.

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Possible Pannus Formation After Transcatheter Aortic Valve Replacement With Self-Expandable Valves.

Juri Iwata, Kentaro Hayashida, Akiyoshi Kajino, Shingo Sakata, Toshinobu Ryuzaki, Hikaru Tsuruta, Yoshitake Yamada, Masahiro Jinzaki, Hideyuki Shimizu, Masaki Ieda

JACC. Asia 5 ( 2 ) 315 - 317 2024

Accepted

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Association Between Renal Sinus Fat and Cardiometabolic and Renin-Angiotensin System Parameters in Primary Aldosteronism.

Ryunosuke Mitsuno, Kenji Kaneko, Toshifumi Nakamura, Daiki Kojima, Yosuke Mizutani, Tatsuhiko Azegami, Shintaro Yamaguchi, Yoshitake Yamada, Masahiro Jinzaki, Kenichiro Kinouchi, Jun Yoshino, Kaori Hayashi

Journal of the Endocrine Society (Journal of the Endocrine Society)  8 ( 1 ) bvad154 2023.12

Accepted

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CONTEXT: Renal sinus fat (RSF) accumulation is associated with cardiometabolic diseases, such as obesity, diabetes, hypertension, and chronic kidney disease. However, clinical implications of RSF in primary aldosteronism (PA) remain unclear. OBJECTIVE: We aimed to investigate relationships between RSF volume and key cardiometabolic and renin-angiotensin system (RAS) parameters in PA patients and clarify the differences in these relationships between unilateral and bilateral subtypes. METHODS: We analyzed data obtained from well-characterized PA patients that involved 45 unilateral (median age: 52 years; 42.2% men) and 92 bilateral patients (51 years; 42.4% men). RESULTS: RSF volume normalized by renal volume (RSF%) was greater in the unilateral group than in the bilateral group (P < .05). RSF% was greater in men than in women (P < .05). RSF% positively correlated with parameters related to cardiometabolic risk, including age, body mass index, visceral fat volume, creatinine, triglycerides/high-density lipoprotein cholesterol ratio, uric acid, fasting glucose, and C-reactive protein regardless of PA subtypes (all P < .05). Intriguingly, RSF% positively correlated with plasma aldosterone concentration (PAC), aldosterone-to-renin ratio, and intact parathyroid hormone (iPTH) (all P < .05) in bilateral patients but did not correlate with RAS parameters and even showed an opposite trend in unilateral patients. In subgroup analyses by sex, these distinctions became more evident in women. After adjustment for potential confounders, RSF% remained positively correlated with PAC and iPTH in bilateral patients. CONCLUSION: Our results indicate that RSF accumulation is involved in cardiometabolic dysfunction associated with PA. However, there were distinct correlations between RSF volume and RAS parameters according to sex and PA subtypes.

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Anatomical cardiac and electrocardiographic axes correlate in both upright and supine positions: an upright/supine CT study.

Togo Norimatsu, Takehiro Nakahara, Yoshitake Yamada, Yoichi Yokoyama, Minoru Yamada, Keiichi Narita, Masahiro Jinzaki

Scientific reports (Scientific Reports)  13 ( 1 ) 18170 - 18170 2023.10

Accepted

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The correlation between the anatomical cardiac and electrocardiographic axes has been discussed for several years. Using upright computed tomography, this study aimed to reveal the relationship between the anatomical cardiac and electrocardiographic axes in both the supine and upright positions. Upright CT and standard supine CT were performed for healthy volunteers, following electrocardiography in both upright and supine position. On CT images, the coordinates of apex, the center of aortic valve (AV) and mitral valve (MV) were recorded, and the vectors and angles were calculated. Subcutaneous and visceral fat volume were semi-automatically calculated in a workstation. From a total 190 volunteers, 41 males were performed electrocardiography and included for this study. The QRS and anatomical axes (AV-apex and MV-apex axis) were significantly correlated in both supine and upright positions, while the angle of the AV-apex to Z axis was the most correlated (supine: r = - 0.54, p = 0.0002, upright: r = - 0.47, p = 0.0020). The anatomical axis moved in the dorsal and caudal directions from the supine to upright position. Multiple regression analysis revealed that the anatomical axis from the AV-apex to the Z-axis was determined according to age, body height, subcutaneous and visceral fat volumes.

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Clinical utilization of artificial intelligence-based COVID-19 pneumonia quantification using chest computed tomography - a multicenter retrospective cohort study in Japan.

Hiromu Tanaka, Tomoki Maetani, Shotaro Chubachi, Naoya Tanabe, Yusuke Shiraishi, Takanori Asakura, Ho Namkoong, Takashi Shimada, Shuhei Azekawa, Shiro Otake, Kensuke Nakagawara, Takahiro Fukushima, Mayuko Watase, Hideki Terai, Mamoru Sasaki, Soichiro Ueda, Yukari Kato, Norihiro Harada, Shoji Suzuki, Shuichi Yoshida, Hiroki Tateno, Yoshitake Yamada, Masahiro Jinzaki, Toyohiro Hirai, Yukinori Okada, Ryuji Koike, Makoto Ishii, Naoki Hasegawa, Akinori Kimura, Seiya Imoto, Satoru Miyano, Seishi Ogawa, Takanori Kanai, Koichi Fukunaga

Respiratory research (Respiratory Research)  24 ( 1 ) 241 - 241 2023.10

Accepted,  ISSN  1465-9921

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BACKGROUND: Computed tomography (CT) imaging and artificial intelligence (AI)-based analyses have aided in the diagnosis and prediction of the severity of COVID-19. However, the potential of AI-based CT quantification of pneumonia in assessing patients with COVID-19 has not yet been fully explored. This study aimed to investigate the potential of AI-based CT quantification of COVID-19 pneumonia to predict the critical outcomes and clinical characteristics of patients with residual lung lesions. METHODS: This retrospective cohort study included 1,200 hospitalized patients with COVID-19 from four hospitals. The incidence of critical outcomes (requiring the support of high-flow oxygen or invasive mechanical ventilation or death) and complications during hospitalization (bacterial infection, renal failure, heart failure, thromboembolism, and liver dysfunction) was compared between the groups of pneumonia with high/low-percentage lung lesions, based on AI-based CT quantification. Additionally, 198 patients underwent CT scans 3 months after admission to analyze prognostic factors for residual lung lesions. RESULTS: The pneumonia group with a high percentage of lung lesions (N = 400) had a higher incidence of critical outcomes and complications during hospitalization than the low percentage group (N = 800). Multivariable analysis demonstrated that AI-based CT quantification of pneumonia was independently associated with critical outcomes (adjusted odds ratio [aOR] 10.5, 95% confidence interval [CI] 5.59-19.7), as well as with oxygen requirement (aOR 6.35, 95% CI 4.60-8.76), IMV requirement (aOR 7.73, 95% CI 2.52-23.7), and mortality rate (aOR 6.46, 95% CI 1.87-22.3). Among patients with follow-up CT scans (N = 198), the multivariable analysis revealed that the pneumonia group with a high percentage of lung lesions on admission (aOR 4.74, 95% CI 2.36-9.52), older age (aOR 2.53, 95% CI 1.16-5.51), female sex (aOR 2.41, 95% CI 1.13-5.11), and medical history of hypertension (aOR 2.22, 95% CI 1.09-4.50) independently predicted persistent residual lung lesions. CONCLUSIONS: AI-based CT quantification of pneumonia provides valuable information beyond qualitative evaluation by physicians, enabling the prediction of critical outcomes and residual lung lesions in patients with COVID-19.

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Post-Traumatic Pulmonary Hematoma Presenting as Multiple Ring-shaped Spherical Nodules.

Orito Ikeda, Kunihiko Shimizu, Yoshitake Yamada, Hiroaki Sugiura, Miki Takahashi, Tokuhiro Kimura, Hideaki Suzuki, Kozo Sato, Masahiro Jinzaki

American journal of respiratory and critical care medicine (American Journal of Respiratory and Critical Care Medicine)  208 ( 11 ) 1227 - 1230 2023.09

Accepted,  ISSN  1073-449X

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Pre-existing Interstitial Lung Abnormalities and Immune Checkpoint Inhibitor-Related Pneumonitis in Solid Tumors: A Retrospective Analysis.

Kohei Horiuchi, Shinnosuke Ikemura, Takashi Sato, Keitaro Shimozaki, Satoshi Okamori, Yoshitake Yamada, Yoichi Yokoyama, Masahiro Hashimoto, Masahiro Jinzaki, Ikuko Hirai, Takeru Funakoshi, Ryuichi Mizuno, Mototsugu Oya, Kenro Hirata, Yasuo Hamamoto, Hideki Terai, Hiroyuki Yasuda, Ichiro Kawada, Kenzo Soejima, Koichi Fukunaga

The oncologist (Oncologist)  29 ( 1 ) e108 - e117 2023.08

Accepted,  ISSN  1083-7159

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BACKGROUND: Immune checkpoint inhibitors (ICIs) have demonstrated efficacy over previous cytotoxic chemotherapies in clinical trials among various tumors. Despite their favorable outcomes, they are associated with a unique set of toxicities termed as immune-related adverse events (irAEs). Among the toxicities, ICI-related pneumonitis has poor outcomes with little understanding of its risk factors. This retrospective study aimed to investigate whether pre-existing interstitial lung abnormality (ILA) is a potential risk factor for ICI-related pneumonitis. MATERIALS AND METHODS: Patients with non-small cell lung cancer, malignant melanoma, renal cell carcinoma, and gastric cancer, who was administered either nivolumab, pembrolizumab, or atezolizumab between September 2014 and January 2019 were retrospectively reviewed. Information on baseline characteristics, computed tomography findings before administration of ICIs, clinical outcomes, and irAEs were collected from their medical records. Pre-existing ILA was categorized based on previous studies. RESULTS: Two-hundred-nine patients with a median age of 68 years were included and 23 (11.0%) developed ICI-related pneumonitis. While smoking history and ICI agents were associated with ICI-related pneumonitis (P = .005 and .044, respectively), the categories of ILA were not associated with ICI-related pneumonitis (P = .428). None of the features of lung abnormalities were also associated with ICI-related pneumonitis. Multivariate logistic analysis indicated that smoking history was the only significant predictor of ICI-related pneumonitis (P = .028). CONCLUSION: This retrospective study did not demonstrate statistically significant association between pre-existing ILA and ICI-related pneumonitis, nor an association between radiologic features of ILA and ICI-related pneumonitis. Smoking history was independently associated with ICI-related pneumonitis. Further research is warranted for further understanding of the risk factors of ICI-related pneumonitis.

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Impact of patient characteristic factors on the dynamics of liver glucose metabolism: Evaluation of multiparametric imaging with dynamic whole-body 18 F-fluorodeoxyglucose-positron emission tomography.

Kai Tonda, Yu Iwabuchi, Tohru Shiga, Yoshiki Owaki, Arashi Fujita, Takehiro Nakahara, Ryosuke Sakurai, Atsushi Shimizu, Yoshitake Yamada, Masahiro Okada, Masahiro Jinzaki

Diabetes, obesity & metabolism (Diabetes, Obesity and Metabolism)  25 ( 12 ) 3521 - 3528 2023.08

Accepted,  ISSN  1462-8902

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AIMS: To assess the impact of various patient characteristics on the dynamics of liver glucose metabolism using automated multiparametric imaging with whole-body dynamic 18 F-fluorodeoxyglucose (FDG)-positron emission tomography (PET). MATERIALS AND METHODS: We retrospectively enrolled 540 patients who underwent whole-body dynamic FDG-PET. Three quantitative indices representing hepatic glucose metabolism [mean standardized uptake value normalized by lean body mass (SULmean), metabolic glucose rate (kinetic index) and distribution volume (DV)] were measured from multiparametric PET images produced automatically based on the Patlak plot model. Patient characteristics including age, sex, body mass index, fasting time, blood glucose level, and the presence of diabetes mellitus (DM) or hepatic steatosis (HS) were collected. We examined the correlations between the characteristic factors and three quantitative indices using multiple regression analysis. RESULTS: The success rate of kinetic analysis using multiparametric PET imaging was 93.3% (504/540). Hepatic SULmean was significantly correlated with age (p < .001), sex (p < .001) and blood glucose level (p = .002). DV was significantly correlated with age (p = .033), sex (p < .001), body mass index (p = .002), fasting time (p = .043) and the presence of HS (p = .002). The kinetic index was significantly correlated with age (p < .001) and sex (p = .004). In the comparison of the healthy, DM and HS groups, patients with DM had a significantly increased SULmean, whereas patients with HS had a significantly decreased DV. CONCLUSIONS: Our results showed that liver glucose metabolism was influenced by various patient characteristic factors. Multiparametric FDG-PET imaging can be used to analyse the kinetics of liver glucose metabolism in routine clinical practice.

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Extra-articular location of the three-dimensional mechanical axis in advanced knee osteoarthritis: an upright computed tomography study.

Ryo Sasaki, Kazuya Kaneda, Yoshitake Yamada, Yasuo Niki, Masaya Nakamura, Takeo Nagura, Masahiro Jinzaki

Japanese journal of radiology (Japanese Journal of Radiology)  41 ( 12 ) 1405 - 1413 2023.07

Accepted,  ISSN  1867-1071

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PURPOSE: One of the most widely used benchmarks of lower-limb alignment is the mechanical axis (MA), which passes through the centers of the femoral head and the ankle in the weight-bearing position. However, where the MA passes through three-dimensionally (3D) is unclear. We investigated the MA in 3D (3D-MA) in knee osteoarthritis (OA) using upright computed tomography (CT). MATERIALS AND METHODS: This study included 66 varus OA knees from 38 patients [age 70.0 (64.8-77.0) years; median (interquartile range)]. The 3D-MA was determined using upright CT data and compared among Kellgren-Lawrence (KL) grades. Further, correlations between the 3D-MA and other parameters were evaluated. RESULTS: The 3D-MA was located at 5.3 (1.3-14.4)% medially and 7.1 (0.7-15.3)% posteriorly on the tibial plateau in KL-1, and was translated medioposteriorly with increased KL grade. The 3D-MA in KL-3 [30.6 (22.6-42.6)% medially and 50.9 (45.8-80.2)% posteriorly] and KL-4 [56.7 (48.5-62.9)% medially and 92.3 (50.2-127.1)% posteriorly] was located extra-articularly. The mediolateral position of the 3D-MA correlated with the femorotibial angle [correlation coefficient (CC) = - 0.85, p < 0.001], and the anteroposterior position of the 3D-MA correlated with the knee flexion angle (CC = - 0.93, p < 0.001). CONCLUSION: Our analysis demonstrated that the 3D-MA in low-grade OA knees passes slightly medial and posterior to the knee center, and the 3D-MA is translated medioposteriorly with the progression of knee OA. Further, the 3D-MA is translated medially with varus progression and posteriorly with the progression of knee flexion contracture.

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Dynamic evaluation of the sternoclavicular and acromioclavicular joints using an upright four-dimensional computed tomography.

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

Journal of biomechanics (Journal of Biomechanics)  157   111697 - 111697 2023.06

Accepted,  ISSN  0021-9290

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In the analysis of the shoulder complex, the sequential changes occurring in the sternoclavicular and acromioclavicular joints during active shoulder motion are challenging to track. This study aimed to investigate the in vivo sternoclavicular and acromioclavicular joint motions during active elevation, including the sequential changes in these joint spaces using upright four-dimensional computed tomography (4DCT). Bilateral shoulders of 12 healthy volunteers upright 4DCT were obtained during active elevation similar to a "hands up" motion. The sternoclavicular and acromioclavicular rotation angles, joint distances, and closest points on the clavicle relative to the thorax and scapula were evaluated during 10°-140° of humerothoracic elevation. During humerothoracic elevation, the clavicle elevated, retracted, and rotated posteriorly relative to the thorax, whereas the scapula rotated upwardly, internally, and posteriorly relative to the clavicle. All the sternoclavicular and acromioclavicular joint rotation angles were significantly different at ≥ 30°-50° of humerothoracic elevation compared with 10° of humerothoracic elevation. The mean sternoclavicular and acromioclavicular joint distances were 2.2 ± 1.1 mm and 1.6 ± 0.9 mm, respectively. The closest points were located on the anteroinferior part of the medial and lateral clavicle in the sternoclavicular and acromioclavicular joints, respectively. Significant differences were observed in the acromioclavicular joint distance and anterior/posterior movements of the closest points in the sternoclavicular and acromioclavicular joints compared with 10° of humerothoracic elevation. Our sternoclavicular and acromioclavicular closest point results indicate that the impingement tends to occur at the anteroinferior part of the medial and lateral aspects of the clavicle and may be related to osteoarthritis.

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Three-dimensional joint surface orientation does not correlate with two-dimensional coronal joint line orientation in knee osteoarthritis: Three-dimensional analysis of upright computed tomography.

Ryo Sasaki, Yasuo Niki, Kazuya Kaneda, Yoshitake Yamada, Takeo Nagura, Masaya Nakamura, Masahiro Jinzaki

The Knee (Knee)  43   10 - 17 2023.05

Accepted,  ISSN  0968-0160

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BACKGROUND: Two-dimensional (2D) coronal joint line orientation on radiography under weight-bearing conditions has been widely used in evaluating knee osteoarthritis (OA). However, the effects of tibial rotation remain unknown. The present study aimed to newly define three-dimensional (3D) joint surface orientation relative to the floor as an unchangeable 3D angle unaffected by tibial rotation using upright computed tomography (CT), and to investigate correlations between 3D and 2D parameters in knee OA. METHODS: Sixty-six knees in 38 patients with varus knee OA underwent standing hip-to-ankle digital radiography and upright CT. The 2D parameters measured on radiographs included femorotibial angle (FTA), tibial joint line angle (TJLA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA). The 3D inner product angle between vectors of the tibial joint surface and the floor from CT was defined as the 3D joint surface-floor angle. RESULTS: Mean 3D joint surface-floor angle was 6.0 ± 3.6°. No correlation was identified between 3D joint surface-floor angle and 2D joint line parameters, even though FTA correlated substantially with 2D joint line parameters. No significant differences in 3D joint surface-floor angle were identified among Coronal Plane Alignment of the Knee (CPAK) types. CONCLUSIONS: The 3D joint surface orientation did not correlate with 2D coronal joint line orientation and was unaffected by CPAK classification types. This finding suggests that current 2D evaluations should be reconsidered for a better understanding of true knee joint line orientation.

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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

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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

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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

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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

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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

　View Summary

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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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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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

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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

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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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A novel anteroposterior axis of the tibia for total knee arthroplasty: An upright weight-bearing computed tomography analysis.

Ryo Sasaki, Yasuo Niki, Kazuya Kaneda, Yoshitake Yamada, Takeo Nagura, Masaya Nakamura, Masahiro Jinzaki

The Knee (Knee)  36   80 - 86 2022.05

Accepted,  ISSN  0968-0160

　View Summary

BACKGROUND: The traditional anteroposterior (AP) axis (i.e., Akagi's line) has been widely used as the tibial component AP axis during total knee arthroplasty (TKA). However, this AP axis has been defined based on computed tomography (CT) in a non-weight-bearing supine position. In this study, AP axes of the tibial plateau from upright CT in weight-bearing and non-weight-bearing positions were determined and compared. METHODS: This study included 43 knees from 23 healthy volunteers. CT images were obtained in weight-bearing and non-weight-bearing standing positions using a 320-detector row upright CT scanner. The line perpendicular to surgical transepicondylar axis projected onto the tibia plateau was determined as the AP axis in upright weight-bearing and non-weight-bearing conditions. Angular differences between these two conditions were measured. RESULTS: The upright weight-bearing AP axis was positioned in a mean of 7.4 ± 4.3° of internal rotation relative to the traditional AP axis. Distance between the traditional and upright weight-bearing AP axis was 2.9 ± 1.6 mm at the edge of the tibial plateau. The upright non-weight-bearing AP axis was positioned in a mean of 3.5 ± 4.1° of internal rotation relative to the traditional AP axis. Mean angular difference between weight-bearing and non-weight-bearing conditions was 3.9 ± 4.1°. CONCLUSIONS: The upright weight-bearing AP axis was positioned in 7.4° of internal rotation relative to the traditional AP axis, showing one-seventh of the tibial tuberosity away from the medial border of the tibial tubercle, which represents a practical landmark for the tibial component AP axis during TKA.

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Three-dimensional shoulder kinematics: Upright four-dimensional computed tomography in comparison with an optical three-dimensional motion capture system.

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

Journal of orthopaedic research : official publication of the Orthopaedic Research Society (Journal of Orthopaedic Research)  41 ( 1 ) 196 - 205 2022.04

Accepted,  ISSN  0736-0266

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Although shoulder kinematics have been analyzed by various methods, dynamic shoulder motion is difficult to track. This study aimed to validate the shoulder kinematic analysis using upright four-dimensional computed tomography (4DCT) and to compare the results with optical three-dimensional motion capture. During active elevation, bilateral shoulders of 10 healthy volunteers were tracked using 4DCT and motion capture. The scapulothoracic and glenohumeral rotations and the scapulohumeral rhythm (SHR) at each position were calculated, and the differences between 4DCT and motion capture were compared. During 10°-140° of humerothoracic elevation, the scapulothoracic joint showed upward rotation, internal rotation, and posterior tilting, and the glenohumeral joint showed elevation, external rotation, and anterior plane of elevation in both analyses. In scapulothoracic rotations, the mean differences between the two analyses were -2.6° in upward rotation, 13.9° in internal rotation, and 6.4° in posterior tilting, and became significant with humerothoracic elevation ≥110° in upward rotation, ≥50° in internal rotation, and ≥100° in posterior tilting. In glenohumeral rotations, the mean differences were 3.7° in elevation, 9.1° in internal rotation, and -8.8° in anterior plane of elevation, and became significant with humerothoracic elevation ≥110° in elevation, ≥90° in internal rotation, and ≥100° in anterior plane of elevation. The mean overall SHRs were 1.8 in 4DCT and 2.4 in motion capture, and the differences became significant with humerothoracic elevation ≥100°. The 4DCT analysis of in vivo shoulder kinematics using upright CT scanner is feasible, but the values were different from those by skin-based analysis at the elevated arm positions. This article is protected by copyright. All rights reserved.

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Three-dimensional alignment of the upper extremity in the standing neutral position in healthy subjects.

Yuki Yoshida, Noboru Matsumura, Yoshitake Yamada, Satoshi Hiraga, Kazunori Ishii, Satoshi Oki, Yoichi Yokoyama, Minoru Yamada, Masaya Nakamura, Takeo Nagura, Masahiro Jinzaki

Journal of orthopaedic surgery and research (Journal of Orthopaedic Surgery and Research)  17 ( 1 ) 239 - 239 2022.04

Accepted

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BACKGROUND: Though alignment of the spine and lower extremities in the standing neutral position has been evaluated, a few studies evaluating the alignment of the upper extremities have also been made. This study assessed the normal alignment of the upper extremities in the standing neutral position and clarified the three-dimensional angular rotations of the upper extremity joints. METHODS: Computed tomography (CT) images of 158 upper extremities from 79 healthy volunteers were prospectively acquired in the standing neutral position using an upright CT scanner. Three-dimensional coordinate systems of the thorax, scapula, humerus, and forearm were designated, and three-dimensional angular rotations of the scapulothoracic, glenohumeral, and elbow joints were calculated. RESULTS: The median angle of the scapulothoracic joint was 9.2° (interquartile range [IQR], 5.2°-12.5°) of upward rotation, 29.0° (IQR, 24.9°-33.3°) of internal rotation, and 7.9° (IQR, 4.3°-11.8°) of anterior tilt. The median angle of the glenohumeral joint was 4.5° (IQR, 0.9°-7.8°) of abduction, 9.0° (IQR, 2.2°-19.0°) of internal rotation, and 0.3° (IQR, - 2.6°-3.1°) of extension. The median angle of the elbow joint was 9.8° (IQR, 6.9°-12.4°) of valgus, 90.2° (IQR, 79.6°-99.4°) of pronation, and 15.5° (IQR, 13.2°-18.1°) of flexion. Correlations in angular rotation values were found between the right and left upper extremities and between joints. CONCLUSIONS: This study clarified the three-dimensional angular rotation of upper extremity joints in the standing neutral position using an upright CT scanner. Our results may provide important insights for the functional evaluation of upper extremity alignment.

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Knee varus alters three-dimensional ankle alignment in standing- a study with upright computed tomography.

Satoshi Hakukawa, Kazuya Kaneda, Satoshi Oki, Kengo Harato, Yoshitake Yamada, Yasuo Niki, Takeo Nagura, Masaya Nakamura, Masahiro Jinzaki

BMC musculoskeletal disorders (BMC Musculoskeletal Disorders)  23 ( 1 ) 321 - 321 2022.04

Accepted

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BACKGROUND: For knee osteoarthritis (OA) treatment, it is important to correct the lower limb alignment including the foot. However, in the upright position, lower limb alignment is generally assessed from the body surface or radiographs, and it is a challenge to capture the exact characteristics of three-dimensional lower limb alignment. The purpose of the study was to measure lower limb alignment in patients with knee OA using upright computed tomography (CT) and radiography, and to identify features of knee joint deformity. METHODS: A total of 45 limbs in 25 patients with knee OA were enrolled. The subjects underwent both upright CT and radiography for the whole lower limb in the standing position. The joint angles were calculated on both images. The degree of knee OA was classified according to Kellgren-Lawrence (KL) grade by referring to radiography, which is mainly based on the degree of articular cartilage loss and severity of osteophytes, and the characteristics or correlation between knee and ankle joint in each group was investigated. RESULTS: In KL-I, there was an association between varus of the knee joint and internal rotation of the talocrural joint (r = 0.76, P < 0.05). In KL-II, there was an association between varus of the knee joint and eversion of the subtalar joint (r = 0.63, P < 0.05) and talocrural joint (r = - 0.65, P < 0.05). In KL-III, there was an association between varus of the knee joint and internal rotation of the subtalar joint (r = - 0.62, P < 0.05), and in KL-IV, there was an association between varus of the knee joint and internal rotation of the subtalar joint (r = - 0.58, P < 0.05). CONCLUSIONS: The lower limb alignment of patients with knee OA in the standing position was found that as knee OA worsened, it became apparent that compensatory knee joint alignment depended on the ankle joint rather than the subtalar joint. The results may help in the rehabilitation of patients with knee OA, since the ankle joint alignment has a significant impact on the knee joint during coarse movements involving load.

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Increase in tibial internal rotation due to weight-bearing is a key feature to diagnose early-stage knee osteoarthritis: a study with upright computed tomography.

Kazuya Kaneda, Kengo Harato, Satoshi Oki, Yoshitake Yamada, Masaya Nakamura, Takeo Nagura, Masahiro Jinzaki

BMC musculoskeletal disorders (BMC Musculoskeletal Disorders)  23 ( 1 ) 253 - 253 2022.03

Accepted

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BACKGROUND: The classification of knee osteoarthritis is an essential clinical issue, particularly in terms of diagnosing early knee osteoarthritis. However, the evaluation of three-dimensional limb alignment on two-dimensional radiographs is limited. This study evaluated the three-dimensional changes induced by weight-bearing in the alignments of lower limbs at various stages of knee osteoarthritis. METHODS: Forty five knees of 25 patients (69.9 ± 8.9 years) with knee OA were examined in the study. CT images of the entire leg were obtained in the supine and standing positions using conventional CT and 320-row detector upright CT, respectively. Next, the differences in the three-dimensional alignment of the entire leg in the supine and standing positions were obtained using 3D-3D surface registration technique, and those were compared for each Kellgren-Lawrence grade. RESULTS: Greater flexion, adduction, and tibial internal rotation were observed in the standing position, as opposed to the supine position. Kellgren-Lawrence grades 1 and 4 showed significant differences in flexion, adduction, and tibial internal rotation between two postures. Grades 2 and 4 showed significant differences in adduction, while grades 1 and 2, and 1 and 3 showed significant differences in tibial internal rotation between standing and supine positions. CONCLUSIONS: Weight-bearing makes greater the three-dimensional deformities in knees with osteoarthritis. Particularly, greater tibial internal rotation was observed in patients with grades 2 and 3 compared to those with grade 1. The greater tibial internal rotation due to weight-bearing is a key pathologic feature to detect early osteoarthritic change in knees undergoing osteoarthritis.

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

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

European journal of radiology 149   110198 2022.02

ISSN  0720-048X

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Vector-field dynamic x-ray (VF-DXR) using optical flow method in patients with chronic obstructive pulmonary disease.

Takuya Hino, Akinori Tsunomori, Akinori Hata, Tomoyuki Hida, Yoshitake Yamada, Masako Ueyama, Tsutomu Yoneyama, Atsuko Kurosaki, Takeshi Kamitani, Kousei Ishigami, Takenori Fukumoto, Shoji Kudoh, Hiroto Hatabu

European radiology experimental (European Radiology Experimental)  6 ( 1 ) 4 - 4 2022.01

Accepted

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BACKGROUND: We assessed the difference in lung motion during inspiration/expiration between chronic obstructive pulmonary disease (COPD) patients and healthy volunteers using vector-field dynamic x-ray (VF-DXR) with optical flow method (OFM). METHODS: We enrolled 36 COPD patients and 47 healthy volunteers, classified according to pulmonary function into: normal, COPD mild, and COPD severe. Contrast gradient was obtained from sequential dynamic x-ray (DXR) and converted to motion vector using OFM. VF-DXR images were created by projection of the vertical component of lung motion vectors onto DXR images. The maximum magnitude of lung motion vectors in tidal inspiration/expiration, forced inspiration/expiration were selected and defined as lung motion velocity (LMV). Correlations between LMV with demographics and pulmonary function and differences in LMV between COPD patients and healthy volunteers were investigated. RESULTS: Negative correlations were confirmed between LMV and % forced expiratory volume in one second (%FEV1) in the tidal inspiration in the right lung (Spearman's rank correlation coefficient, rs = -0.47, p < 0.001) and the left lung (rs = -0.32, p = 0.033). A positive correlation between LMV and %FEV1 in the tidal expiration was observed only in the right lung (rs = 0.25, p = 0.024). LMVs among normal, COPD mild and COPD severe groups were different in the tidal respiration. COPD mild group showed a significantly larger magnitude of LMV compared with the normal group. CONCLUSIONS: In the tidal inspiration, the lung parenchyma moved faster in COPD patients compared with healthy volunteers. VF-DXR was feasible for the assessment of lung parenchyma using LMV.

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Accuracy of ultra-high-resolution computed tomography with a 0.3-mm detector for quantitative assessment of coronary artery stenosis grading in comparison with conventional computed tomography: A phantom study.

Minoru Yamada, Yoshitake Yamada, Takehiro Nakahara, Shigeo Okuda, Takayuki Abe, Sachio Kuribayashi, Masahiro Jinzaki

Journal of cardiovascular computed tomography (Journal of Cardiovascular Computed Tomography)  16 ( 3 ) 239 - 244 2021.11

Accepted,  ISSN  1934-5925

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BACKGROUND: The development of ultra-high-resolution CT (U-HRCT) is expected to improve the accuracy of coronary stenosis evaluation. This study aimed to evaluate the accuracy of the stenosis severities of coronary artery phantoms estimated using U-HRCT by comparing them to those estimated with conventional CT. METHODS: Coronary artery phantoms with non-calcified and calcified lesions were scanned with conventional CT (64-row ​× ​0.625 ​mm) and U-HRCT (32-row ​× ​0.3125 ​mm). The coronary artery phantoms had lumen diameters of 2.0, 3.0, and 4.0 ​mm with non-calcified lesions representing 0%, 25%, 50%, and 75% stenosis and 3.0 and 4.0 ​mm with calcified lesions representing 0%, 25%, 50%, and 75% stenosis. The lumen diameters at the stenotic and non-stenotic regions were measured, and the stenosis severities were compared with the true values. RESULTS: For non-calcified lesions, conventional CT significantly underestimated the stenosis severity in the phantom showing 75% stenosis with lumen diameters of 2.0 and 3.0 ​mm (p ​< ​0.05), while the estimated stenosis severities were not significantly different from the true values at all settings with U-HRCT. For the calcified lesions, conventional CT overestimated the stenosis severities at all settings (p ​< ​0.05), while U-HRCT yielded estimations closer to the true values, although still with some overestimation (p ​< ​0.05). CONCLUSION: By using U-HRCT, the estimated stenosis severities of the coronary artery with non-calcified lesion become almost equal to the true value, while those with calcified lesion are still overestimated although they become closer to the true value.

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Clinical Utility of the Electrocardiographic P-Wave Axis in Patients with Chronic Obstructive Pulmonary Disease.

Shiro Otake, Shotaro Chubachi, Shingo Nakayama, Kaori Sakurai, Hidehiro Irie, Mizuha Hashiguchi, Yuji Itabashi, Yoshitake Yamada, Masahiro Jinzaki, Mitsuru Murata, Hidetoshi Nakamura, Koichiro Asano, Koichi Fukunaga

Respiration; international review of thoracic diseases (Respiration)  101 ( 4 ) 1 - 8 2021.11

Accepted,  ISSN  0025-7931

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BACKGROUND: The vertical P-wave axis on electrocardiography (ECG) is a useful criterion for screening patients with chronic obstructive pulmonary disease (COPD). This study aimed to investigate the clinical characteristics of patients with COPD with a vertical P-wave axis as they have not yet been elucidated. METHODS: Keio University and its affiliated hospitals conducted an observational COPD cohort study over 3 years. We analyzed 201 patients using ECG and chest computed tomography. RESULTS: The severity of airflow limitation was higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. Patients with a P-wave axis >75° exhibited significantly higher total COPD assessment test scores and increased St. George's Respiratory Questionnaire total, activity, and impact scores than those with a P-wave axis ≤75°. The incidence of exacerbations over 1 and 3 years was significantly higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. The optimal cutoff for the P-wave axis for a percentage of the predicted forced expiratory volume in 1 s <50% and future exacerbations over 3 years was 70° (the areas under the curve [AUC]: 0.788; sensitivity: 65.3%; specificity: 78.3%) and 79° (AUC: 0.642; sensitivity: 36.7%; specificity: 92.6%). The ratio of the low attenuation area was also significantly higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. However, the ratio of the airway wall area did not differ between the 2 groups. CONCLUSIONS: Patients with COPD with a vertical P-wave axis exhibited severe airflow limitation and emphysema, a worse health status, and more frequent exacerbation than patients without a vertical P-wave. Detection of the vertical P-wave axis by ECG is beneficial for the management of patients with COPD.

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Analysis of Lap Belt Fit to Human Subjects using CT Images.

Yoshihiko Tanaka, Atsushi Nakashima, Haijie Feng, Koji Mizuno, Minoru Yamada, Yoshitake Yamada, Yoichi Yokoyama, Masahito Jinzaki

Stapp car crash journal (Stapp car crash journal)  65   49 - 90 2021.11

Accepted,  ISSN  1532-8546

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In vehicle collisions, the lap belt should engage the anterior superior iliac spine (ASIS). In this study, threedimensional (3D) shapes of bones and soft tissues around the pelvis were acquired using a computed tomography (CT) scan of 10 male and 10 female participants wearing a lap belt. Standing, upright sitting, and reclined postures were scanned using an upright CT and a supine CT scan system. In the upright sitting posture, the thigh height was larger with a higher BMI while the ASIS height did not change significantly with BMI. As a result, the height of the ASIS relative to the thigh (ASIS-thigh height) became smaller as the BMI increased. Because the thigh height of females was smaller than that of males, the ASIS-thigh height was larger for females than for males. As the ASIS-thigh height was larger, the overlap of the lap belt with the ASIS increased. Thus, the lap belt overlapped more with the ASIS for the females than for the males. The abdomen outer shape is characterized by the trouser cord formed valley, the torso/thigh junction, and the anterior convexity formed between them depending on the adipose tissues. The abdomen outer shapes changed from the standing, the reclined posture to the upright sitting posture. In the reclined sitting posture, the lap belt is positioned upward and rearward relative to the ASIS, and the overlap of the lap belt with the ASIS was smaller compared to the upright posture.

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

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

BMC musculoskeletal disorders (BMC Musculoskeletal Disorders)  22 ( 1 ) 899 - 899 2021.10

Accepted

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

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

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

Clinical anatomy (New York, N.Y.) (Clinical Anatomy)  34 ( 8 ) 1150 - 1156 2021.07

Accepted,  ISSN  0897-3806

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

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

田村 全, 山田 祥岳, 陣崎 雅弘

画像診断 ((株)Gakken)  41 ( 9 ) 984 - 985 2021.07

ISSN  0285-0524

【CT再入門-新技術で何がわかる?-】面検出器CTの活用　関節動態

山田 稔, 山田 祥岳, 横山 陽一, 石井 和典, 名倉 武雄, 陣崎 雅弘

画像診断 ((株)Gakken)  41 ( 9 ) 952 - 953 2021.07

ISSN  0285-0524

【CT再入門-新技術で何がわかる?-】立位CTの活用　鼠径ヘルニア

山田 祥岳, 山田 稔, 横山 陽一, 陣崎 雅弘

画像診断 ((株)Gakken)  41 ( 9 ) 1008 - 1009 2021.07

ISSN  0285-0524

【CT再入門-新技術で何がわかる?-】立位CTの活用　骨盤臓器脱

横山 陽一, 山田 祥岳, 山田 稔, 陣崎 雅弘

画像診断 ((株)Gakken)  41 ( 9 ) 1010 - 1011 2021.07

ISSN  0285-0524

【CT再入門-新技術で何がわかる?-】立位CTの活用　脊椎すべり症

山田 祥岳, 山田 稔, 横山 陽一, 名倉 武雄, 陣崎 雅弘

画像診断 ((株)Gakken)  41 ( 9 ) 1006 - 1007 2021.07

ISSN  0285-0524

Quantification of Adipose Tissue Around the Aortic Aneurysm　- At the Dawn of a New Era.

Okuda S, Yamada Y, Nakahara T, Jinzaki M

Circulation journal : official journal of the Japanese Circulation Society (一般社団法人 日本循環器学会)  85 ( 12 ) 2181 - 2183 2021.06

ISSN  1346-9843

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A rare case of COVID-19 infection with laryngeal involvement.

Masato Asaoka, Shotaro Chubachi, Yoshitake Yamada, Koichi Fukunaga

BMJ case reports (BMJ Case Reports)  14 ( 6 )  2021.06

Accepted

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

Takehiro Nakahara, Minoru Yamada, Yoichi Yokoyama, Yoshitake Yamada, Keiichi Narita, Nobuaki Imanishi, Masataka Yamazaki, Hideyuki Shimizu, Jagat Narula, Masahiro Jinzaki

Scientific reports (Scientific Reports)  11 ( 1 ) 11602 - 11602 2021.06

Accepted

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

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

Itsuko Okuda, Minoru Yamada, Yoshitake Yamada, Yoichi Yokoyama, Natnicha Kampan, Keiichi Akita, Masahiro Jinzaki

Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI) (Skin Research and Technology)  27 ( 6 ) 1057 - 1063 2021.05

Accepted,  ISSN  0909-752X

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

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

Akihiro Tsutsumi, Shotaro Chubachi, Hidehiro Irie, Mamoru Sasaki, Yoshitake Yamada, Hiroaki Sugiura, Masahiro Jinzaki, Hidetoshi Nakamura, Koichiro Asano, Tomoko Betsuyaku, Koichi Fukunaga

Scientific reports (Scientific Reports)  11 ( 1 ) 9548 - 9548 2021.05

Accepted

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

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

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

Respiratory research (Respiratory research)  22 ( 1 ) 95 - 95 2021.03

Accepted,  ISSN  1465-9921

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

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

Fumiko Yagi, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Kiyoko Mukai, Takehiro Nakahara, Keiichi Narita, Masahiro Jinzaki

Scientific reports (Scientific Reports)  11 ( 1 ) 6886 - 6886 2021.03

Accepted,  ISSN  2045-2322

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

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Intramyocardial Transplantation of Human iPS Cell-Derived Cardiac Spheroids Improves Cardiac Function in Heart Failure Animals.

Shinji Kawaguchi, Yusuke Soma, Kazuaki Nakajima, Hideaki Kanazawa, Shugo Tohyama, Ryota Tabei, Akinori Hirano, Noriko Handa, Yoshitake Yamada, Shigeo Okuda, Shuji Hishikawa, Takumi Teratani, Satoshi Kunita, Yoshikazu Kishino, Marina Okada, Sho Tanosaki, Shota Someya, Yuika Morita, Hidenori Tani, Yujiro Kawai, Masataka Yamazaki, Akira Ito, Rei Shibata, Toyoaki Murohara, Yasuhiko Tabata, Eiji Kobayashi, Hideyuki Shimizu, Keiichi Fukuda, Jun Fujita

JACC. Basic to translational science (JACC: Basic to Translational Science)  6 ( 3 ) 239 - 254 2021.03

Accepted,  ISSN  2452302X

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The severe shortage of donor hearts hampered the cardiac transplantation to patients with advanced heart failure. Therefore, cardiac regenerative therapies are eagerly awaited as a substitution. Human induced pluripotent stem cells (hiPSCs) are realistic cell source for regenerative cardiomyocytes. The hiPSC-derived cardiomyocytes are highly expected to help the recovery of heart. Avoidance of teratoma formation and large-scale culture of cardiomyocytes are definitely necessary for clinical setting. The combination of pure cardiac spheroids and gelatin hydrogel succeeded to recover reduced ejection fraction. The feasible transplantation strategy including transplantation device for regenerative cardiomyocytes are established in this study.

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JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases.

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

Circulation journal : official journal of the Japanese Circulation Society (一般社団法人 日本循環器学会)  85 ( 4 ) 402 - 572 2021.02

ISSN  1346-9843

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• CiNii Research

Treatment effect prediction using CT after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension.

Jitsuro Tsukada, Yoshitake Yamada, Takashi Kawakami, Shunsuke Matsumoto, Masanori Inoue, Seishi Nakatsuka, Masahiro Okada, Keiichi Fukuda, Masahiro Jinzaki

European radiology (European Radiology)  31 ( 8 ) 5524 - 5532 2021.02

Accepted,  ISSN  0938-7994

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OBJECTIVE: To evaluate whether the change in computed tomography pulmonary angiography (CTPA) metrics after balloon pulmonary angioplasty (BPA) can predict treatment effect in chronic thromboembolic pulmonary hypertension (CTEPH) patients. METHODS: This study included 82 CTEPH patients who underwent both CTPA and right heart catheterization (RHC) before and at the scheduled time of 6 months after BPA. The diameters of the main pulmonary artery (dPA), ascending aorta (dAA), right atrium (dRA), right ventricular free wall thickness (dRVW), and right and left ventricles (dRV, dLV) were measured on CTPA. The correlation of the New York Heart Association functional class (NYHA FC), 6-minute walking distance (6MWD), brain natriuretic peptide (BNP) level, and calculated CT metrics with a decrease in mean pulmonary artery pressure (ΔmPAP) using RHC (used as the reference for BPA effect) was investigated. Using multiple regression analysis, independent variables were also identified. RESULTS: In univariate analysis, clinical indicators (NYHA FC, 6MWD, and BNP level) improved significantly after BPA and were significantly correlated with ΔmPAP (p < 0.01). In the univariate analysis of CTPA parameters, dPA, dRA, dPA/dAA ratio, dRVW, and dRV/dLV ratio decreased significantly and were significantly correlated with ΔmPAP (p < 0.01). Multivariate analysis demonstrated that decreased dPA (p = 0.001) and decreased dRA (p = 0.039) on CTPA were independent predictive factors of ΔmPAP. CONCLUSIONS: Decreased dPA and dRA on CTPA could predict a decrease in mPAP after BPA, thus potentially eliminating unnecessary invasive catheterization. KEY POINTS: • The reduction in mean pulmonary artery pressure after balloon pulmonary angioplasty in CTEPH patients was significantly correlated with the clinical indices improvement and CTPA parameter decrease. • The decreased diameter of the main pulmonary artery and the decreased diameter of the right atrium on CTPA were independent predictors of mean pulmonary artery pressure reduction.

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

八木 文子, 栗原 泰之, 山田 祥岳, 杉浦 弘明, 陣崎 雅弘

臨床放射線 (金原出版(株))  66 ( 2 ) 137 - 146 2021.02

ISSN  0009-9252

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

Yoichi Yokoyama, Yoshitake Yamada, Kenzo Kosugi, Minoru Yamada, Keiichi Narita, Takehiro Nakahara, Hirokazu Fujiwara, Masahiro Toda, Masahiro Jinzaki

Scientific reports (Scientific Reports)  11 ( 1 ) 392 - 392 2021.01

Accepted,  ISSN  2045-2322

　View Summary

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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A diagnostic strategy for Parkinsonian syndromes using quantitative indices of DAT SPECT and MIBG scintigraphy: an investigation using the classification and regression tree analysis.

Yu Iwabuchi, Masashi Kameyama, Yohji Matsusaka, Hidetoshi Narimatsu, Masahiro Hashimoto, Morinobu Seki, Daisuke Ito, Hajime Tabuchi, Yoshitake Yamada, Masahiro Jinzaki

European journal of nuclear medicine and molecular imaging (European Journal of Nuclear Medicine and Molecular Imaging)  48 ( 6 ) 1833 - 1841 2021.01

Accepted,  ISSN  1619-7070

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PURPOSE: We aimed to evaluate the diagnostic performances of quantitative indices obtained from dopamine transporter (DAT) single-photon emission computed tomography (SPECT) and 123I-metaiodobenzylguanidine (MIBG) scintigraphy for Parkinsonian syndromes (PS) using the classification and regression tree (CART) analysis. METHODS: We retrospectively enrolled 216 patients with or without PS, including 80 without PS (NPS) and 136 with PS [90 Parkinson's disease (PD), 21 dementia with Lewy bodies (DLB), 16 progressive supranuclear palsy (PSP), and 9 multiple system atrophy (MSA). The striatal binding ratio (SBR), putamen-to-caudate ratio (PCR), and asymmetry index (AI) were calculated using DAT SPECT. The heart-to-mediastinum uptake ratio (H/M) based on the early (H/M [Early]) and delayed (H/M [Delay]) images and cardiac washout rate (WR) were calculated from MIBG scintigraphy. The CART analysis was used to establish a diagnostic decision tree model for differentiating PS based on these quantitative indices. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 87.5, 96.3, 93.3, 92.9, and 93.1 for NPS; 91.1, 78.6, 75.2, 92.5, and 83.8 for PD; 57.1, 95.9, 60.0, 95.4, and 92.1 for DLB; and 50.0, 98.0, 66.7, 96.1, and 94.4 for PSP, respectively. The PCR, WR, H/M (Delay), and SBR indices played important roles in the optimal decision tree model, and their feature importance was 0.61, 0.22, 0.11, and 0.05, respectively. CONCLUSION: The quantitative indices showed high diagnostic performances in differentiating NPS, PD, DLB, and PSP, but not MSA. Our findings provide useful guidance on how to apply these quantitative indices in clinical practice.

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

Takuya Hino, Tomoyuki Hida, Mizuki Nishino, Junwei Lu, Rachel K Putman, Elias F Gudmundsson, Akinori Hata, Tetsuro Araki, Vladimir I Valtchinov, Osamu Honda, Masahiro Yanagawa, Yoshitake Yamada, Takeshi Kamitani, Masahiro Jinzaki, Noriyuki Tomiyama, Kousei Ishigami, Hiroshi Honda, Raul San Jose Estepar, George R Washko, Takeshi Johkoh, David C Christiani, David A Lynch, Vilmundur Gudnason, Gunnar Gudmundsson, Gary M Hunninghake, Hiroto Hatabu

European journal of radiology open (European Journal of Radiology Open)  8   100334 - 100334 2021.01

Accepted,  ISSN  2352-0477

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

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

Keisuke Yoshida, Masahiro Toda, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Hirokazu Fujiwara, Kenzo Kosugi, Hikaru Sasaki, Masahiro Jinzaki

World neurosurgery (Elsevier {BV})  145   256 - 259 2021.01

Accepted,  ISSN  1878-8750

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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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Outcomes of the Nuss procedure for pectus excavatum in adults.

Yoshiaki Sakamoto, Yoichi Yokoyama, Tomohisa Nagasao, Yoshitake Yamada, Minoru Yamada, Masahiro Jinzaki, Kazuo Kishi

Journal of plastic, reconstructive & aesthetic surgery : JPRAS (Journal of Plastic, Reconstructive and Aesthetic Surgery)  74 ( 9 ) 2279 - 2282 2020.12

Accepted,  ISSN  1748-6815

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Limited data exist with regard to the outcome of the Nuss procedure for pectus excavatum repair in adults. Here, we analysed changes in lung capacity and thoracic morphology based on computed tomography (CT) imaging in adults with pectus excavatum before surgery, during bar insertion and after bar removal. Patients who underwent the Nuss procedure for pectus excavatum after the age of 20 were included in this study. Chest CT scans of the included participants were taken before the Nuss procedure, immediately before removal of the pectus bar and 6 months after removal of the pectus bar. Lung capacity and thoracic morphology measurements were made from the CT scans. Six patients aged 24-43 years were included in this study. After the Nuss procedure, lung capacity was decreased in all patients. Although the pectus bar was removed, lung capacity had not significantly increased and was almost the same volume as before the Nuss procedure. After the Nuss procedure, the funnel chest shape had improved in all cases, patients' thoracic spine had also moved forward as the thorax moved forward and patients' stoop had improved. Despite a lack of change in lung capacity, surgical modification should be considered to reduce stress on the thoracic spine and in turn, reduce pain in patients with pectus excavatum. However, further long-term observation seems necessary.

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Dynamic Chest X-Ray Using a Flat-Panel Detector System: Technique and Applications.

Akinori Hata, Yoshitake Yamada, Rie Tanaka, Mizuki Nishino, Tomoyuki Hida, Takuya Hino, Masako Ueyama, Masahiro Yanagawa, Takeshi Kamitani, Atsuko Kurosaki, Shigeru Sanada, Masahiro Jinzaki, Kousei Ishigami, Noriyuki Tomiyama, Hiroshi Honda, Shoji Kudoh, Hiroto Hatabu

Korean journal of radiology (Korean Journal of Radiology)  22 ( 4 ) 634 - 651 2020.11

Accepted,  ISSN  1229-6929

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

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

Shunsuke Kikuchi, Daisuke Nakashima, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Arihiko Kanaji, Masaya Nakamura, Takeo Nagura, Masahiro Jinzaki

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (European Spine Journal)  31 ( 2 ) 215 - 224 2020.11

Accepted,  ISSN  0940-6719

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

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

Hiroo Kimura, Kazuki Sato, Noboru Matsumura, Taku Suzuki, Takuji Iwamoto, Kuniaki Ohori, Yoshitake Yamada, Morio Matsumoto, Masaya Nakamura, Masahiro Jinzaki, Takeo Nagura

Journal of hand and microsurgery (Journal of Hand and Microsurgery)  13 ( 3 ) 138 - 142 2020.11

Accepted,  ISSN  0974-3227

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

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Posture-induced changes in the vessels of the head and neck: evaluation using conventional supine CT and upright CT.

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

Scientific reports (Scientific Reports)  10 ( 1 ) 16623 - 16623 2020.10

Accepted,  ISSN  2045-2322

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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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Comparison of inspiratory and expiratory lung and lobe volumes among supine, standing, and sitting positions using conventional and upright CT.

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

Scientific reports (Scientific Reports)  10 ( 1 ) 16203 - 16203 2020.10

Accepted,  ISSN  2045-2322

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© 2020, The Author(s). Currently, no clinical studies have compared the inspiratory and expiratory volumes of unilateral lung or of each lobe among supine, standing, and sitting positions. In this prospective study, 100 asymptomatic volunteers underwent both low-radiation-dose conventional (supine position, with arms raised) and upright computed tomography (CT) (standing and sitting positions, with arms down) during inspiration and expiration breath-holds and pulmonary function test (PFT) on the same day. We compared the inspiratory/expiratory lung/lobe volumes on CT in the three positions. The inspiratory and expiratory bilateral upper and lower lobe and lung volumes were significantly higher in the standing/sitting positions than in the supine position (5.3–14.7% increases, all P < 0.001). However, the inspiratory right middle lobe volume remained similar in the three positions (all P > 0.15); the expiratory right middle lobe volume was significantly lower in the standing/sitting positions (16.3/14.1% decrease) than in the supine position (both P < 0.0001). The Pearson’s correlation coefficients (r) used to compare the total lung volumes on inspiratory CT in the supine/standing/sitting positions and the total lung capacity on PFT were 0.83/0.93/0.95, respectively. The r values comparing the total lung volumes on expiratory CT in the supine/standing/sitting positions and the functional residual capacity on PFT were 0.83/0.85/0.82, respectively. The r values comparing the total lung volume changes from expiration to inspiration on CT in the supine/standing/sitting positions and the inspiratory capacity on PFT were 0.53/0.62/0.65, respectively. The study results could impact preoperative CT volumetry of the lung in lung cancer patients (before lobectomy) for the prediction of postoperative residual pulmonary function, and could be used as the basis for elucidating undetermined pathological mechanisms. Furthermore, in addition to morphological evaluation of the chest, inspiratory and expiratory upright CT may be used as an alternative tool to predict lung volumes such as total lung capacity, functional residual capacity, and inspiratory capacity in situation in which PFT cannot be performed such as during an infectious disease pandemic, with relatively more accurate predictability compared with conventional supine CT.

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Evaluation of three-dimensional acromiohumeral distance in the standing position and comparison with its conventional measuring methods.

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

Journal of orthopaedic surgery and research 15 ( 1 ) 436 - 436 2020.09

Accepted,  ISSN  1749-799X

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Background: Narrowing of the acromiohumeral distance (AHD) implies a rotator cuff tear. However, conventional AHD measurements using two-dimensional (2D) imaging or with the patient in the supine position might differ from that while standing during daily activity. This study aimed to evaluate the three-dimensional (3D) actual distance between the acromion and humeral head in the standing position and compare the AHD values with those obtained using conventional measuring methods. Methods: Computed tomography (CT) images of 166 shoulders from 83 healthy volunteers (31 male and 52 female; mean age 40.1 ± 5.8 years; age range, 30-49 years) were prospectively acquired in the supine and standing positions using conventional and upright CT scanners, respectively. The minimum distance between the acromion and humeral head on the 3D surface models was considered as the 3D AHD. We measured the 2D AHD on anteroposterior digitally reconstructed radiographs. The AHD values were compared between the supine and standing positions and between the 2D and 3D measurements. Results: The mean values of 2D AHD were 8.8 ± 1.3 mm (range, 5.9-15.4 mm) in the standing position and 8.1 ± 1.2 mm (range, 5.3-14.3 mm) in the supine position. The mean values of 3D AHD were 7.3 ± 1.4 mm (range, 4.7-14.0 mm) in the standing position and 6.6 ± 1.2 mm (range, 4.4-13.7 mm) in the supine position. The values of 3D AHD were significantly lower than those of 2D AHDs in both the standing and supine positions (P < 0.001). The values of 2D and 3D AHDs were significantly lower in the supine position than in the standing position (P < 0.001). Conclusions: This study evaluated the 3D AHD of normal shoulders in the standing position using an upright CT scanner. The present results indicated that assessments in the supine position can underestimate the value of the AHD compared with those made in the standing position and that assessments using 2D analysis can overestimate the value.

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Three-dimensional alignment changes of the shoulder girdle between the supine and standing positions.

Noboru Matsumura, Yoshitake Yamada, Satoshi Oki, Yuki Yoshida, Yoichi Yokoyama, Minoru Yamada, Takeo Nagura, Masahiro Jinzaki

Journal of orthopaedic surgery and research (Journal of orthopaedic surgery and research)  15 ( 1 ) 411 - 411 2020.09

Accepted,  ISSN  1749-799X

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BACKGROUND: Although humans spend most of their day in a standing or sitting position, it is difficult to accurately evaluate the alignment of the shoulder girdle during daily activity, and its alignment changes between positions. The purpose of this study was to evaluate the 3-dimensional alignment of the shoulder girdle in the supine and standing positions by computed tomography (CT) and to assess the alignment changes of the shoulder girdle between these two positions. METHODS: CT scans of both shoulders of 100 healthy volunteers were prospectively taken in both supine and standing positions on the same day. The local 3-dimensional coordinate systems of the thorax, clavicle, and scapula were defined from the specific bony landmarks, and 3-dimensional angular rotations and positions of the clavicle and scapula were calculated. Differences in rotations and positions of the clavicle and scapula were evaluated between the supine and standing positions. RESULTS: Compared with the supine position, the clavicle showed significantly less elevation and greater retraction, and the scapula showed significantly less upward rotation, anterior tilting, and internal rotation in the standing position. Compared with the supine position, the clavicle center was located more inferiorly, posteriorly, and laterally, and the scapula center was located more inferiorly, posteriorly, and medially in the standing position. CONCLUSIONS: The present study showed that angular rotations and positions of the clavicle and scapula change significantly with position due to the effect of gravity.

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【Q&Aでまとめる! 予後予測・治療効果予測の画像検査】胸部(呼吸器・循環器・乳腺)　慢性血栓塞栓性肺高血圧症の画像的予後因子は何か?

奥田 茂男, 田村 全, 山田 祥岳, 岩渕 雄, 松本 俊亮, 川上 崇史, 陣崎 雅弘

臨床放射線 (金原出版(株))  65 ( 8 ) 847 - 857 2020.08

ISSN  0009-9252

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

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

Respiration; international review of thoracic diseases (Respiration)  99 ( 7 ) 1 - 8 2020.07

Accepted,  ISSN  0025-7931

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

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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)   2020.06

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0001-6268

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

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

Keiichi Narita, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Takehiro Nakahara, Masahiro Jinzaki

International urogynecology journal (Springer Science and Business Media {LLC})  31 ( 11 ) 2387 - 2393 2020.06

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0937-3462

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

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Traction Bronchiectasis/Bronchiolectasis is Associated with Interstitial Lung Abnormality Mortality.

Hida T, Nishino M, Hino T, Lu J, Putman RK, Gudmundsson EF, Araki T, Valtchinov VI, Honda O, Yanagawa M, Yamada Y, Hata A, Jinzaki M, Tomiyama N, Honda H, Estepar RSJ, Washko GR, Johkoh T, Christiani DC, Lynch DA, Gudnason V, Gudmundsson G, Hunninghake GM, Hatabu H

European journal of radiology (European Journal of Radiology)  129   109073 - 109073 2020.05

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0720-048X

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© 2020 Elsevier B.V. Purpose: To investigate if the presence and severity of traction bronchiectasis/bronchiolectasis are associated with poorer survival in subjects with ILA. Method: The study included 3,594 subjects (378 subjects with ILA and 3,216 subjects without ILA) in AGES-Reykjavik Study. Chest CT scans of 378 subjects with ILA were evaluated for traction bronchiectasis/bronchiolectasis, defined as dilatation of bronchi/bronchioles within areas demonstrating ILA. Traction bronchiectasis/bronchiolectasis Index (TBI) was assigned as: TBI = 0, ILA without traction bronchiectasis/bronchiolectasis: TBI = 1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion: TBI = 2, ILA with mild to moderate traction bronchiectasis: TBI = 3, ILA and severe traction bronchiectasis and/or honeycombing. Overall survival (OS) was compared among the subjects in different TBI groups and those without ILA. Results: The median OS was 12.93 years (95%CI; 12.67 – 13.43) in the subjects without ILA; 11.95 years (10.03 – not reached) in TBI-0 group; 8.52 years (7.57 – 9.30) in TBI-1 group; 7.63 years (6.09 – 9.10) in TBI-2 group; 5.40 years (1.85 – 5.98) in TBI-3 group. The multivariable Cox models demonstrated significantly shorter OS of TBI-1, TBI-2, and TBI-3 groups compared to subjects without ILA (P < 0.0001), whereas TBI-0 group had no significant OS difference compared to subjects without ILA, after adjusting for age, sex, and smoking status. Conclusions: The presence and severity of traction bronchiectasis/bronchiolectasis are associated with shorter survival. The traction bronchiectasis/bronchiolectasis is an important contributor to increased mortality among subjects with ILA.

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Spatial resolution compensation by adjusting the reconstruction kernels for iterative reconstruction images of computed tomography.

Koichi Sugisawa, Katsuhiro Ichikawa, Atsushi Urikura, Kazuya Minamishima, Shota Masuda, Takashi Hoshino, Akiko Nakahara, Yoshitake Yamada, Masahiro Jinzaki

Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) (Elsevier {BV})  74   47 - 55 2020.05

Research paper (scientific journal), Joint Work, Accepted,  ISSN  1120-1797

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PURPOSE: Hybrid iterative reconstruction (IR) is useful to reduce noise in computed tomography (CT) images. However, it often decreases the spatial resolution. The ability of high spatial resolution kernels (harder kernels) to compensate for the decrease in the spatial resolution of hybrid IRs was investigated. METHODS: An elliptic cylindrical phantom simulating an adult abdomen was used. Two types of rod-shaped objects with ~330 and ~130 HU were inserted to simulate contrasts of arteries in CT angiography. Two multi-slice CT systems were used to scan the phantoms with 120 kVp and scan doses of 20 and 10 mGy. The task transfer functions (TTFs) were measured from the circular edges of the rod images. The noise power spectrum (NPS) was measured from the images of the water-only section. The CT images were reconstructed using a filtered back projection (FBP) with baseline kernels and two levels of hybrid IRs with harder kernels. The profiles of the clinical images across the aortic dissection flaps were measured to evaluate actual spatial resolutions. RESULTS: The TTF degradation of each hybrid IR was recovered by the harder kernels, whereas the noise reduction effect was retained, for both the 20 and 10 mGy. The profiles of the dissection flaps for the FBP were maintained by using the harder kernels. Even with the best combination of hybrid IR and harder kernel, the noise level at 10 mGy was not reduced to the level of FBP at 20 mGy, suggesting no capability of a 50% dose reduction while maintaining noise.

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Calcium density of the coronary artery: multi-image analysis using human cadaver

Minoru Yamada, Takehiro Nakahara, Yoshitake Yamada, Nobuaki Imanishi, Toshiyuki Nishimaki, Motoyuki Ogawa, Masahiro Jinzaki

JOURNAL OF ANATOMY 236   358 - 358 2020.04

ISSN  0021-8782

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

Masashi Tamura, Takashi Kawakami, Yoshitake Yamada, Masaharu Kataoka, Seishi Nakatsuka, Keiichi Fukuda, Masahiro Jinzaki

Pulmonary circulation (Pulmonary Circulation)  10 ( 2 ) 2045894019881065 - 2045894019881065 2020.04

Accepted,  ISSN  2045-8932

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

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Ultrasound evaluation of complications after cardiovascular surgery in pediatric patients: A case series.

Takahiro Hosokawa, Sio Suzuki, Yutaka Tanami, Yumiko Sato, Yoshihiro Ko, Koji Nomura, Eiji Oguma, Yoshitake Yamada

Medical ultrasonography (Medical Ultrasonography)  22 ( 1 ) 110 - 115 2020.03

Joint Work, Accepted,  ISSN  1844-4172

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In contrast to computed tomography, ultrasound can be performed without radiation exposure, repeatedly performed by the patients' bedside. Hence, in this case series, we describe the evaluation of complications including hematoma, superficialsurgical site infection, mediastinitis, and pseudoaneurysm associated mediastinitis using ultrasound in pediatric patients after cardiovascular surgery. To our knowledge, no previous reports have evaluated such complications using ultrasound. Ultrasound may be useful for the early diagnosis of these complications, and in the selection of subsequent examinations such as computed tomography, resulting in the early initiation of intervention.

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

松本 晋作, 杉浦 弘明, 南 康大, 山田 祥岳, 渡辺 理沙, 福永 興壱, 陣崎 雅弘

臨床放射線 (金原出版(株))  65 ( 1 ) 67 - 70 2020.01

ISSN  0009-9252

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

Projected lung areas using dynamic X-ray (DXR).

Takuya Hino, Akinori Hata, Tomoyuki Hida, Yoshitake Yamada, Masako Ueyama, Tetsuro Araki, Takeshi Kamitani, Mizuki Nishino, Atsuko Kurosaki, Masahiro Jinzaki, Kousei Ishigami, Hiroshi Honda, Hiroto Hatabu, Shoji Kudoh

European journal of radiology open (European Journal of Radiology Open)  7   100263 - 100263 2020

Accepted,  ISSN  2352-0477

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

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Complications after surgical correction of anorectal malformations

Hosokawa T., Yamada Y., Tanami Y., Sato Y., Tanaka Y., Kawashima H., Oguma E.

Hong Kong Journal of Radiology (Hong Kong Journal of Radiology)  23 ( 3 ) 176 - 184 2020

ISSN  22236619

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© 2020 Hong Kong Academy of Medicine Press. All rights reserved. Radiologists are often unfamiliar with anorectal malformations and have limited knowledge of the surgical procedures for their repair. In this article, we provide a comprehensible description of the surgical procedures for radiologists, review previous literature, and summarise the incidence of the complications. Moreover, we detail major postoperative complications consequent to the use of various imaging techniques, including anorectal prolapse, anal stenosis, urethral injury, posterior urethral diverticulum, neurogenic bladder, adhesion of reconstructed vagina, leakage from suture lines, and trocar site hernia. Knowledge of these complications and surgical procedures is important to radiologists for diagnosis and determination of a treatment strategy.

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Peripheral pulmonary stenosis with Noonan syndrome treated by balloon pulmonary angioplasty.

Seien Ko, Jin Komuro, Yoshinori Katsumata, Yasuyuki Shiraishi, Takashi Kawakami, Yoshitake Yamada, Shinsuke Yuasa, Takashi Kohno, Kenjiro Kosaki, Keiichi Fukuda

Pulmonary circulation (Pulmonary Circulation)  10 ( 4 ) 2045894020954310 - 2045894020954310 2020

Accepted,  ISSN  20458932

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© The Author(s) 2020. Noonan syndrome is known to have various cardiovascular defects, which include pulmonary artery stenosis. Pulmonary artery stenosis is characterized by obstruction of pulmonary artery blood flow that can cause elevated pulmonary artery pressure and ventilation-perfusion inequality, which can cause dyspnea on exertion and eventually, heart failure. Although the etiology of pulmonary artery stenosis related to congenital diseases is still unknown, balloon pulmonary angioplasty has being reported to be effective to selected patients with Alagille and Williams syndromes, but not from Noonan syndrome despite of modest prevalence of pulmonary artery stenosis. Here, we report the first Noonan syndrome patient with pulmonary artery stenosis who underwent successful balloon pulmonary angioplasty. The strategy used in balloon pulmonary angioplasty was planned with careful morphologic evaluation by computed tomographic angiography, and performed with scoring balloons in a graded approach with multiple sessions. After balloon pulmonary angioplasty, we confirmed maintained dilation of lesions and symptom alleviation, suggesting that balloon pulmonary angioplasty can be performed safely on pulmonary artery stenosis in a Noonan syndrome patient.

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Computed tomography findings of mediastinitis after cardiovascular surgery.

Takahiro Hosokawa, Yoshitake Yamada, Yutaka Tanami, Yumiko Sato, Yoshihiro Ko, Koji Nomura, Eiji Oguma

Pediatrics international : official journal of the Japan Pediatric Society (Wiley)  62 ( 2 ) 206 - 213 2019.12

Research paper (scientific journal), Joint Work, Accepted,  ISSN  1328-8067

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BACKGROUND: To our knowledge, no systematic study has been conducted on computed tomography (CT) imaging of mediastinitis in children post-cardiovascular surgery. We aimed to assess the CT findings of pediatric patients diagnosed with mediastinitis after cardiovascular surgery. METHODS: We included 28 pediatric patients with suspected mediastinitis after undergoing cardiovascular surgery and who underwent CT. Patients were divided into a group with mediastinitis requiring antibiotic therapy (n = 15) confirmed by positive bacterial culture from the mediastinum and a group without mediastinitis (n = 13). Fisher's exact test was used to compare the following CT findings between the two groups: (i) mediastinal fluid collection; (ii) free gas bubble within fluid collection; (iii) sternal destruction; and (iv) capsular ring enhancement. The enhancement extent was categorized into the following four grades: whole rim enhancement, >50% of the rim enhancement, <50% of the rim enhancement, and no rim enhancement. A receiver operating characteristic curve analysis was performed to establish a cut-off point for obtaining the maximum diagnostic accuracy. RESULTS: A significant difference was observed between patients, with and without mediastinitis in sternal destruction (73.6% vs 0%, P = <0.0001) and capsular ring enhancement (100.0% vs 38.5%, P = 0.0004). By using a cut-off grade of the whole rim enhancement, the estimated sensitivity and specificity for mediastinitis diagnosis were 100% and 92.3%, respectively. CONCLUSION: Computed tomography findings of sternal destruction and capsular ring enhancement were observed more in patients with mediastinitis than in those without mediastinitis, and should be assessed carefully to diagnose mediastinitis accurately in pediatric patients who have undergone cardiac surgery.

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Ultrasound Evaluation of Dermal Sinuses/Fistulas in Pediatric Patients.

Hosokawa T, Takahashi H, Miyasaka Y, Ohira K, Tanami Y, Sato Y, Ishimaru T, Kawashima H, Hosokawa M, Oguma E, Yamada Y

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine (Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine)  38 ( 12 ) 3107 - 3122 2019.12

ISSN  0278-4297

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© 2019 by the American Institute of Ultrasound in Medicine. A dermal sinus/fistula is a common condition; the relevant department should be consulted for appropriate treatment. It is important for radiologists to have adequate knowledge of these conditions to provide the correct diagnosis and recommend subsequent management. This review describes the following lesions: preauricular sinus, midline sinus of the upper lip, nasal dermoid sinus cyst, cheek fistula, first branchial cleft anomaly/sublingual branchial cleft anomaly, thyroglossal duct cyst/fistula, lateral cervical sinus/fistula, congenital dermal sinus/fistula of the anterior chest region, congenital skin sinus/fistula with a sternal cleft, and congenital prepubic sinus. On the basis of the skin orifice location and ultrasound images, radiologists can provide useful information to physicians.

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Four-Dimensional CT Analysis Using Sequential 3D-3D Registration.

Satoshi Oki, Kazuya Kaneda, Yoshitake Yamada, Minoru Yamada, Yutaro Morishige, Kengo Harato, Noboru Matsumura, Takeo Nagura, Masahiro Jinzaki

Journal of visualized experiments : JoVE (Journal of visualized experiments : JoVE)  2019 ( 153 )  2019.11

Research paper (scientific journal), Joint Work, Accepted,  ISSN  1940-087X

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

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

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

Journal of orthopaedic surgery and research (Journal of orthopaedic surgery and research)  14 ( 1 ) 355 2019.11

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

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

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

Medicine 98 ( 47 ) e18053 2019.11

ISSN  0025-7974

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

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

Heart and vessels (Heart and Vessels)  34 ( 11 ) 1889 - 1894 2019.11

ISSN  0910-8327

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

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

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

Journal of plastic, reconstructive & aesthetic surgery : JPRAS  2019.10

ISSN  1748-6815

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Use of computed tomography in an upright position for preoperative planning in orbital wall fracture treatment: A pilot study.

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

Journal of plastic, reconstructive & aesthetic surgery : JPRAS  2019.10

ISSN  1748-6815

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

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

Journal of shoulder and elbow surgery (Journal of Shoulder and Elbow Surgery)  28 ( 10 ) 1903 - 1910 2019.10

ISSN  1058-2746

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

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Periosteal Reaction Possibly Induced by Pazopanib: A Case Report and Literature Review.

Hosokawa T, Hara T, Arakawa Y, Oguma E, Yamada Y

Journal of pediatric hematology/oncology  2019.09

ISSN  1077-4114

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

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

Investigative radiology  2019.09

ISSN  0020-9996

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

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

EJNMMI research (EJNMMI Research)  9 ( 1 ) 85 2019.09

ISSN  2191-219X

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

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Poor outcomes in carriers of the RNF213 variant (p.Arg4810Lys) with pulmonary arterial hypertension.

Hiraide T, Kataoka M, Suzuki H, Aimi Y, Chiba T, Isobe S, Katsumata Y, Goto S, Kanekura K, Yamada Y, Moriyama H, Kitakata H, Endo J, Yuasa S, Arai Y, Hirose N, Satoh T, Hakamata Y, Sano M, Gamou S, Kosaki K, Fukuda K

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (Journal of Heart and Lung Transplantation)   2019.09

ISSN  1053-2498

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© 2019 International Society for Heart and Lung Transplantation BACKGROUND: A variant of c.14429G>A (p.Arg4810Lys, rs112735431) in the ring finger protein 213 gene (RNF213; NM_001256071.2) has been recently identified as a risk allele for pulmonary arterial hypertension (PAH). PAH can be added as a new member of RNF213-associated vascular diseases, which include Moyamoya disease and peripheral pulmonary stenosis. Our aim was to identify the clinical features and outcomes of PAH patients with this variant. METHODS: Whole-exome sequencing was performed in 139 idiopathic (or possibly heritable) PAH patients. RESULTS: The RNF213 p.Arg4810Lys variant was identified in a heterozygous state in 11 patients (7.9%). Time-course changes in hemodynamics after combination therapy in the patients with the RNF213 p.Arg4810Lys variant were significantly poorer compared with those carrying the bone morphogenic protein receptor type 2 (BMPR2) mutation (n = 36) (comparison of changes in mean pulmonary arterial pressure, p = 0.007). The event-free rate of death or lung transplantation was significantly poorer in RNF213 p.Arg4810Lys variant carriers than in BMPR2 mutation carriers (5-year event-free rate since the introduction of prostaglandin I2 infusion, 0% vs 93%, respectively; p < 0.001). CONCLUSIONS: Idiopathic PAH patients with the RNF213 p.Arg4810Lys variant are associated with poor clinical outcomes even in recent times. Earlier consideration of lung transplantation might be required for RNF213 p.Arg4810Lys variant carriers who are developing PAH. Documentation of the RNF213 p.Arg4810Lys variant, as well as already known pathogenic genes, such as BMPR2, can provide clinically relevant information for therapeutic strategies, leading to a personalized approach for the treatment of PAH.

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Postnatal Ultrasound to Determine the Surgical Strategy for Congenital Diaphragmatic Hernia.

Hosokawa T, Yamada Y, Takahashi H, Tanami Y, Sato Y, Ishimaru T, Tanaka Y, Kawashima H, Hosokawa M, Oguma E

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine (Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine)  38 ( 9 ) 2347 - 2358 2019.09

ISSN  0278-4297

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© 2019 by the American Institute of Ultrasound in Medicine. OBJECTIVES: To compare defect sizes in congenital diaphragmatic hernia (CDH) measured by postnatal ultrasound (US) between neonates who underwent thoracoscopic surgery and neonates who underwent open surgery and between neonates who underwent primary repair and those who underwent patch repair; additionally, to compare the accuracy of US diagnosis with that of surgical diagnosis for the location of the diaphragmatic hernia and the hernial contents. METHODS: We included 8 neonates who underwent preoperative US evaluations of CDH. We compared anterior-to-posterior diaphragm defect sizes between thoracoscopic and open surgery approaches and between primary and patch repair by using the Mann-Whitney U test. The diaphragm was divided into 3 segments: anterior, lateral, and posterior. We evaluated the location of the diaphragmatic hernia and the hernial contents. RESULTS: Four neonates who underwent open surgery had larger diaphragmatic hernias than those who underwent thoracoscopic surgery (mean ± SD, 30.5 ± 5.6 versus 16.3 ± 3.3 mm; P = .030). They were also larger in neonates who underwent patch repair than in those who underwent primary repair (33.0 ± 3.0 versus 17.6 ± 4.2 mm; P = .037). Detection of anterior and lateral diaphragm segments was consistent between US and surgical findings. Three of 4 neonates who underwent open surgery and all 3 neonates who underwent patch repair did not show the lateral segment. The hernial contents were also consistent between US and surgical findings. CONCLUSIONS: Postnatal US examinations of neonates with CDH could provide surgeons with useful information to determine the surgical approach and repair method. However, since our study cohort was small, further studies are needed with a larger number of neonates with CDH.

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Impact of fusion for adolescent idiopathic scoliosis on lung volume measured with computed tomography.

Fujita N, Yagi M, Michikawa T, Yamada Y, Suzuki S, Tsuji O, Nagoshi N, Okada E, Tsuji T, Nakamura M, Matsumoto M, Watanabe K

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (European Spine Journal)  28 ( 9 ) 2034 - 2041 2019.09

ISSN  0940-6719

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© 2019, The Author(s). Purpose: Although lung volume (LV) can be measured directly by computed tomography (CT), the literature regarding CT-assessed LV in adolescent idiopathic scoliosis (AIS) patients is limited, and the influence of posterior spinal fusion with instrumentation (PSF) on LV has not been established. This study aimed to identify factors associated with decreased LV after PSF in AIS patients. Methods: We retrospectively reviewed 111 consecutive AIS patients who were between 10 and 20 years of age and were treated by PSF at our facility. We assessed age at surgery, sex, height, body weight, Risser stage, Lenke classification, radiographic parameters, pulmonary function tests, and LV. Factors associated with a postoperative decrease in LV were identified by multivariable analysis. Results: The mean total LV had increased at the 2-year follow-up, although marginally significant (p =.06), and there was a significant increase in the left LV (p =.01) but not the right LV (p =.25). We observed a postoperative reduction in total LV, defined as a total LV postoperative/preoperative ratio < 0.9, in 20 of the 111 patients (18.0%). Univariable analysis showed a significant correlation between ≥ 11 fusion levels and postoperative LV reduction (OR 3.11, 95% CI 1.13–8.57). This factor remained significant in the multivariable analysis, which yielded an adjusted OR of 2.82 (95% CI 1.01–7.93) for postoperative LV reduction in patients with ≥ 11 fusion levels. Conclusion: Our data suggest that a longer fusion area is associated with postoperative LV reduction. Therefore, avoidance of a longer fusion area of ≥ 11 will be preferable for preserving LV. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].

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Diagnostic performance of ultrasound without any colon preparation for detecting colorectal polyps in pediatric patients.

Hosokawa T, Hosokawa M, Tanami Y, Sato Y, Nambu R, Iwama I, Oguma E, Yamada Y

Pediatric radiology (Pediatric Radiology)  49 ( 10 ) 1306 - 1312 2019.09

ISSN  0301-0449

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© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Background: There are limited data on the sensitivity, specificity and accuracy of ultrasound for detecting colorectal polyps in children and young adults. Objective: To evaluate the diagnostic accuracy of ultrasound, without any colon preparation, for detecting colorectal polyps in pediatric patients and to determine the causes of false-negative results. Materials and methods: We included 74 children with clinical signs like rectal bleeding, abdominal pain or diarrhea who underwent both ultrasound and colonoscopy. We evaluated the diagnostic performance of ultrasound for detecting colorectal polyps before colonoscopy, which served as the reference standard. We used Fisher exact and Student’s t-tests for statistical analyses. Results: Fifteen pediatric patients were diagnosed with colorectal polyps in the transverse (n=3), descending (n=1) and sigmoid (n=6) colon, and rectum (n=5) by colonoscopy. The sensitivity, specificity and accuracy of ultrasound to detect colorectal polyps were 47% (7/15, 95% confidence interval [CI] 21–73%), 100% (59/59, 95% CI 94–100%) and 89% (66/74, 95% CI 80–95%), respectively. The volume (mean ± standard deviation) of polyps not detected by ultrasound was significantly smaller than that detected (270±380 mm3 vs. 4,600±3,900 mm3, P=0.0124). We observed a significant difference in the location between the polyps detected and not detected by ultrasound (rectal/non-rectal=0/7 vs. 5/3, P=0.0256). No significant age or gender difference was observed. Conclusion: The accuracy for detecting colorectal polyps by ultrasound was 89% (95% CI, 80–95%) in our cohort. Polyps found in the rectum and relatively smaller polyps accounted for several false-negative cases.

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【救急疾患の鑑別診断のポイント】(第11章)肺野異常陰影　肺間質影の鑑別

杉浦 弘明, 南 康大, 山田 祥岳, 陣崎 雅弘

画像診断 ((株)Gakken)  39 ( 11 ) A210 - A215 2019.09

ISSN  0285-0524

【救急疾患の鑑別診断のポイント】(第11章)肺野異常陰影　肺野空洞性病変の鑑別

南 康大, 山田 祥岳, 杉浦 弘明, 陣崎 雅弘

画像診断 ((株)Gakken)  39 ( 11 ) A204 - A209 2019.09

ISSN  0285-0524

Diagnostic Accuracy of Ultrasound for the Directionality of Testicular Rotation and the Degree of Spermatic Cord Twist in Pediatric Patients With Testicular Torsion.

Hosokawa T, Takahashi H, Tanami Y, Sato Y, Ishimaru T, Tanaka Y, Kawashima H, Oguma E, Yamada Y

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine  2019.07

ISSN  0278-4297

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

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

Clinical anatomy (New York, N.Y.) (Clinical Anatomy)  32 ( 5 ) 715 - 721 2019.07

ISSN  0897-3806

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

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Ultrasound of portal venous gas in a child with short bowel syndrome.

Hosokawa T, Yamada Y, Tanami Y, Sato Y, Oguma E

Pediatrics international : official journal of the Japan Pediatric Society (Pediatrics International)  61 ( 7 ) 733 - 735 2019.07

Research paper (scientific journal), Joint Work, Accepted,  ISSN  1328-8067

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全身撮影可能な立位CTの開発　ファントムスタディ、人体に対する重力の影響

横山 陽一, 山田 祥岳, 名倉 武雄, 中原 健裕, 成田 啓一, 山田 稔, 南島 一也, 荻原 直道, 陣崎 雅弘

日本医用画像工学会大会予稿集 ((一社)日本医用画像工学会)  38回   471 - 475 2019.07

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

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

奥田 茂男, 山田 祥岳, 陣崎 雅弘

循環器ジャーナル ((株)医学書院)  67 ( 3 ) 420 - 426 2019.07

ISSN  2432-3284

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＜文献概要＞Point　・右室容積計測や肺動脈弁逆流の評価は経胸壁エコーでは難しく,MRIにより行われる.・右室容積計測に際しては輪郭描画,血流速度・血流量の計測に当たっては撮像断面とVENC設定の最適化が重要である.・肺動脈弁閉鎖不全がある場合には,渦流やらせん流により血流量の計測値が影響を受けることがあり,大動脈と肺動脈血流の整合性を確認する必要がある.

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

山田 祥岳, 松本 俊亮, 山田 稔, 中原 健裕, 陣崎 雅弘

循環器ジャーナル ((株)医学書院)  67 ( 3 ) 388 - 401 2019.07

ISSN  2432-3284

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＜文献概要＞Point　・重症大動脈弁狭窄症に対する外科的な大動脈弁置換術のリスクが高い症例に対し,TAVIが施行されるようになった.・CTは,TAVI術前精査において重要な役割を担い,大動脈基部,大動脈弁輪,アクセス経路などに関する有用な情報をもたらす.・CT画像から,大動脈弁の断面に対して直交する適切な透視角度(perpendicular view)を予測することが可能である.

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

田村 全, 杉浦 弘明, 山田 祥岳, 川上 崇史, 陣崎 雅弘

循環器ジャーナル ((株)医学書院)  67 ( 3 ) 410 - 419 2019.07

ISSN  2432-3284

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＜文献概要＞Point　・肺循環疾患の画像診断は従来肺血管造影,シンチグラフィによって行われてきたが,多列化・高速化によるCT angiographyの画質向上やDual Energy CTやsubtraction技術によるCT perfusionの日常臨床導入により,CTの役割は大きくなってきている.・CTは肺高血圧症診療においてスクリーニングから分類,CT perfusionを利用した重症度評価・治療効果判定にまで広く用いることができるが,特に慢性血栓塞栓性肺高血圧症(CTEPH)を確実に拾い上げることが非常に重要である.・CT perfusionでは従来の肺血流シンチグラフィに比べて短時間で空間分解能の高い血流画像を取得することが可能であり,最近ではCTEPHにおける肺血流評価においても肺血流シンチグラフィとほぼ同等の成績が報告されている.

Postnatal ultrasonography for evaluation of hernia sac of neonate with congenital diaphragmatic hernia.

Hosokawa T, Tanami Y, Sato Y, Oguma E, Omata K, Kawashima H, Yamada Y

Radiology case reports (Radiology Case Reports)  14 ( 6 ) 683 - 686 2019.06

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© 2019 The Authors Congenital diaphragmatic hernia (CDH) is one of the most common major congenital anomalies. The presence of a hernia sac is associated with additional benefits in terms of improved neonatal survival. Here, we report a case of CDH with a hernia sac detected via postnatal ultrasonography. Our literature search did not find other cases where CDH with hernia sac was found by postnatal ultrasound in neonates. In prenatal imaging, the diagnosis of CDH with a hernia sac is challenging. In our case, the meniscus of the thymus was clearly noted, and smooth convexity between the hernia contents and thymus was detected. Although evaluation of the presence of a hernia sac with postnatal ultrasonography might be difficult, our findings suggest that a hernia sac could be evaluated with postnatal ultrasonography.

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Difference in Detection Rate of Portal Venous Gas via Computed Tomography and Ultrasonography in Pediatric Patients.

Hosokawa T, Yamada Y, Tanami Y, Sato Y, Hosokawa M, Oguma E

Ultrasound quarterly (Ultrasound Quarterly)  35 ( 2 ) 181 - 185 2019.06

ISSN  0894-8771

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© Wolters Kluwer Health, Inc. All rights reserved. This study was performed to compare computed tomography (CT)- and ultrasonography (US)-derived detection rates of portal venous gas (PVG) in pediatric patients and investigate whether discrepancies between these modalities were influenced by patient age and interval between examinations. We included 25 children who underwent both CT and US within 2 days for evaluation of intestinal ischemia. McNemar test was used to compare the detection of PVG between the 2 modalities. The cohort was retrospectively divided into 2 groups based on whether comparable results were obtained via both modalities; the Mann-Whitney U test was used to compare patient age and interval between CT and US between these 2 groups. Among 25 children, CT and US yielded similar results in 17 patients regarding the presence or absence of PVG (median age/interval, 2 years [range, 0-17 years]/51 minutes [range, 2-1196 minutes]; 3/14 detected via both/not both modalities) and different results in 8 (median age/interval, 0 years [range, 0-15 years]/171.5 minutes [range, 64-1486 minutes]; 7/1 detected via US only/via CT only). There was a significant difference in PVG detection rate between US and CT (P = 0.034). Patient age did not differ significantly between the 2 groups (P = 0.206), but the interval between CT and US did (P = 0.025). In conclusion, the detection rate of PVG was higher with US, compared with CT, although the timings of the examinations could have influenced this finding. Ultrasonography could be useful for PVG detection in pediatric patients because it can be performed repeatedly at the bedside without radiation exposure.

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Size of the Tonsil on Ultrasound in Children Without Tonsil-Associated Symptoms.

Hosokawa T, Yamada Y, Takahashi H, Tanami Y, Sato Y, Hosokawa M, Oguma E

Ultrasound quarterly  2019.05

ISSN  0894-8771

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Comparison of diagnostic accuracy for fistulae at ultrasound and voiding cystourethrogram in neonates with anorectal malformation.

Hosokawa T, Yamada Y, Tanami Y, Sato Y, Ishimaru T, Tanaka Y, Kawashima H, Oguma E

Pediatric radiology (Pediatric Radiology)  49 ( 5 ) 609 - 616 2019.05

ISSN  0301-0449

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© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Background: Recently, it has been reported that anorectal malformation with rectourethral fistula in male neonates can be managed by primary neonatal reconstruction without colostomy. To prevent urethral injury during anorectoplasty, the fistula’s location is important. To date, the use of voiding cystourethrograms to determine the presence and location of fistulas in neonates with anorectal malformations has not been studied. Objective: To compare the accuracy of ultrasound (US) and voiding cystourethrogram for determining the presence and location of fistulas in neonates with anorectal malformation. Materials and methods: We included 21 male neonates with anorectal malformation with rectourethral fistula (n=16), rectovesical fistula (n=1) or no fistula (n=4) who underwent US and voiding cystourethrogram preoperatively on the day of surgery. Fistula imaging was classified into three grades (0–2), and grades 1–2 were considered fistula positive. We compared the imaging-based location of the fistula with surgical findings. Results: US performed significantly better than voiding cystourethrogram for determining the presence of fistulas (area under the receiver operating characteristic curve, 0.90 vs. 0.71, respectively; P=0.044) (diagnostic accuracy 85.7%, 95% confidence interval [95% CI] 63.7–97.0% and 52.4%, 95% CI 29.8–74.3%, respectively). In cases with fistulas detected by either modality, the accuracy of locating the fistula by US was 50.0% (95% CI 24.7–75.3%) and by voiding cystourethrogram was 100% (95% CI: 59.0–100%). Conclusion: US accurately detected, but did not accurately locate, fistulas in neonates with anorectal malformation. When planning primary neonatal reconstruction of anorectal malformation without colostomy, voiding cystourethrogram could provide additional information about fistula location.

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

杉浦 弘明, 南 康大, 山田 祥岳, 陣崎 雅弘

臨床放射線 (金原出版(株))  64 ( 6 ) 777 - 786 2019.05

ISSN  0009-9252

Associations Between Sonographic Findings and Operative Time of Transumbilical Laparoscopic-Assisted Appendectomy for Acute Appendicitis in Children.

Hosokawa T, Yamada Y, Tanami Y, Sato Y, Ishimaru T, Kawashima H, Oguma E

AJR. American journal of roentgenology (American Journal of Roentgenology)  213 ( 1 ) 1 - 9 2019.04

ISSN  0361-803X

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© American Roentgen Ray Society OBJECTIVE. The purpose of this study is to evaluate the association between sonographic findings and the operative time of transumbilical laparoscopic-assisted appendectomy (TULAA) for appendicitis in children. MATERIALS AND METHODS. We included 131 children who underwent ultrasound within 24 hours before TULAA. We evaluated the associations between operative time and patients’ demographics, as well as the following sonographic findings: maximum outer wall diameter of the appendix, appendicolith, ascites (not echogenic), echogenic ascites, abscess formation, increased intraabdominal fat echo in the right lower quadrant (RLQ; 3-point scale), and the location of the appendix (three locations). The results were analyzed using simple linear regression or the t test and a multiple liner regression model. RESULTS. The mean (± SD) patient age was 9.50 ± 2.92 years (range, 3–15 years), and the mean operative time was 73.04 ± 36.56 minutes (range, 25–210 minutes). Univariate analysis showed that higher body mass index, greater maximum outer wall diameter of the appendix, higher grade of intraabdominal fat echo in the RLQ, presence of appendicolith, presence of echogenic ascites, abscess formation, and location of the appendix in the pelvis were associated with increased operative time. Multivariate analysis found that abscess formation and higher grade of increased intraabdominal fat echo in the RLQ were independently associated with operative time (both p < 0.05). CONCLUSION. Preoperative sonographic findings of abscess formation and increased intraabdominal fat echo in the RLQ were factors independently associated with prolonged operative time for TULAA. On the basis of these sonographic findings, surgeons may predict additional surgical procedures, including abscess aspiration or adhesiolysis, and operative time before beginning the operation.

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

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

European journal of radiology (European Journal of Radiology)  113   59 - 65 2019.04

ISSN  0720-048X

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

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

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

Surgical and radiologic anatomy : SRA (Surgical and Radiologic Anatomy)  41 ( 4 ) 423 - 429 2019.04

ISSN  0930-1038

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

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【マルチモダリティによるCardiac Imaging 2019[臨床編]個別化循環器診療のフロンティア:進化し続ける心臓画像診断】CTのベネフィット&ポテンシャル　TAVI術前CT

山田 祥岳, 山田 稔, 松本 俊亮, 中原 健裕, 鈴木 達也, 橋本 正弘, 林田 健太郎, 陣崎 雅弘

INNERVISION ((株)インナービジョン)  34 ( 5 ) 21 - 25 2019.04

ISSN  0913-8919

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

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

Journal of cardiovascular computed tomography (Journal of Cardiovascular Computed Tomography)   2019.03

ISSN  1934-5925

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

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

European journal of radiology (European Journal of Radiology)  112   28 - 36 2019.03

ISSN  0720-048X

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

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Predictors of prognosis in children with portal venous gas detected by ultrasound.

Hosokawa T, Yamada Y, Tanami Y, Sato Y, Hosokawa M, Oguma E

Medical ultrasonography (Medical Ultrasonography)  21 ( 1 ) 30 - 36 2019.02

ISSN  1844-4172

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© 2019 Societatea Romana de Ultrasonografie in Medicina si Biologie. All Rights Reserved. Aims: To evaluate ultrasound findings in order to determine potential predictors of prognosis in pediatric patients with portal venous gas (PVG) detected by ultrasound. Materials and methods: Thirty-nine children were included and divided into two groups: benign PVG (n=24) and life-threatening PVG (n=15; 6 surgical interventions and 9 deaths). Possible predictors, i.e., the location of PVG in the liver, the distribution of intestinal pneumatosis, ascites and free air were compared between the two groups. Results: A significant difference was noted between the two groups in terms of the distribution of intestinal pneumatosis (limited to the large bowel, benign vs life-threatening = 60.9% (14/23):21.4% (3/14), p=0.040), the absence of ascites (benign vs life-threatening = 79.1% (19/24):40.0% (6/15), p=0.019) and patient age (benign vs life-threatening = 52.5±65.3 months vs 19.7±44.0 months, p=0.019). No significant difference was observed in the location of PVG in the liver, the presence of free air, and sex between the two groups. Conclusions: In pediatric patients with PVG, including various ages and underlying diseases, intestinal pneumatosis limited to the large bowel and absence of ascites were predictors of a benign prognosis. However, despite the presence of these predictors, some patients with PVG required surgical intervention, thereby suggesting that the cause of PVG, such as necrotizing enterocolitis, volvulus, or pancreatitis, must be also carefully evaluated.

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

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

EJNMMI research (EJNMMI Research)  9 ( 1 ) 7 2019.01

ISSN  2191-219X

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

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

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

Respiratory medicine (Respiratory Medicine)  145   66 - 72 2018.12

ISSN  0954-6111

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

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Comparison Between the Pouch-Perineum Distance in Neonates With a Low-Type Anorectal Malformation With and Without an Opened Fistula: Pitfall of Measuring the Pouch-Perineum Distance on Sonography.

Hosokawa T, Takahashi H, Tanami Y, Sato Y, Tanaka Y, Kawashima H, Hosokawa M, Oguma E, Yamada Y

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine (Journal of Ultrasound in Medicine)  37 ( 12 ) 2797 - 2802 2018.12

ISSN  0278-4297

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© 2018 by the American Institute of Ultrasound in Medicine. Objective—An anorectal malformation (ARM) in neonates requires urgent surgery, with the type of surgery being dependent on the type of malformation (low, intermediate, or high). Distal rectal pouch and perineum (pouch-perineum) distance is reported to be useful for differentiating the type of ARM; however, the impact of an opened fistula on pouch-perineum distance is not well known. The purpose of this study was to evaluate the difference in pouch-perineum distance between neonates with a low-type ARM with and without an opened fistula. Methods—We included 24 neonates with low-type ARM who underwent sonography before surgery. Eight neonates already had an opened fistula before sonography, and 16 did not. The pouch-perineum distance was measured using the perineal approach. Mann-Whitney U and Spearman’s correlation coefficient tests were used for statistical analysis. Results—The mean pouch-perineum distance in all neonates with a low-type ARM was 8.3 ± 2.9 mm. The pouch-perineum distance was substantially longer for an ARM with than without an opened fistula (10.6 ± 3.4 mm vs. 7.1 ± 1.7 mm; P =.02). No appreciable correlation was identified between the pouch-perineum distance and the postnatal day of examination (ρ =-.23, P =.26) or birth weight (ρ =.15, P =.47). Conclusion—The pouch-perineum distance is substantially longer in neonates with an ARM with an opened fistula than in those without an opened fistula. Caution should be exercised by the sonographic examiner in evaluating pouch-perineum distance in neonates with an opened fistula to prevent an incorrect surgical procedure based on misdiagnosis of the type of ARM.

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Genomic Comparison With Supercentenarians Identifies RNF213 as a Risk Gene for Pulmonary Arterial Hypertension.

Suzuki H, Kataoka M, Hiraide T, Aimi Y, Yamada Y, Katsumata Y, Chiba T, Kanekura K, Isobe S, Sato Y, Satoh T, Gamou S, Fukuda K, Kosaki K

Circulation. Genomic and precision medicine (Circulation. Genomic and precision medicine)  11 ( 12 ) e002317 2018.12

Joint Work, Accepted,  ISSN  2574-8300

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Optimal Timing of the First Barium Swallow Examination for Diagnosis of Pyriform Sinus Fistula.

Hosokawa T, Yamada Y, Takahashi H, Tanami Y, Sato Y, Hosokawa M, Oguma E

AJR. American journal of roentgenology (American Journal of Roentgenology)  211 ( 5 ) 1122 - 1127 2018.11

ISSN  0361-803X

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© 2018 American Roentgen Ray Society. OBJECTIVE. Observation of a sinus tract during a barium swallow examination is important for the diagnosis of pyriform sinus fistula; however, to our knowledge, no reports have existed regarding the optimal timing of the examination in relation to the onset of symptoms. The purpose of this study was to compare the timing of the examination, patient age, the number of inflammatory episodes that occurred before the examination, and the barium concentration used for examinations with true-positive results versus those with false-negative results for the diagnosis of pyriform sinus fistula. MATERIALS AND METHODS. Twenty-three children with pyriform sinus fistula were included. The timing of the examination, patient age, the number of the inflammatory episodes that occurred before examination, and the barium concentration used were compared between examinations with true-positive results and examinations with false-negative results, by use of the Mann-Whitney U test. RESULTS. The examination had true-positive results for 60.9% (14/23) of patients and false-negative results for 39.1% (9/23) of patients. The mean (± SD) interval since the onset of symptoms was significantly shorter for patients with false-negative examination results than for those with true-positive examination results (26.33 ± 21.17 days vs 48.57 ± 17.67 days; p = 0.020). By 6 weeks after the onset of symptoms, more than half of the examinations had false-negative results. No significant difference in patient age (p = 0.238) or number of previous inflammatory episodes (p = 0.431) existed between examinations with true-positive and false-negative results; however, a significant difference was noted in the mean barium concentration used (88.57% ± 31.53% vs 52.86% ± 18.68% weight/volume, respectively; p = 0.014). CONCLUSION. Barium swallow examinations with false-negative results were significantly more likely when the examination was performed soon after the onset of symptoms. Therefore, early first examinations would not be recommended for the diagnosis of pyriform sinus fistula, especially in terms of radiation exposure. A higher barium concentration may be useful.

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The diagnostic accuracy of DAT SPECT using DaTQUANT software: discrimination among patients with non-Parkinsonian disease, Parkinson's disease, and atypical Parkinsonian syndromes

Iwabuchi Y., Nakahara T., Kameyama M., Yamada Y., Hashimoto M., Matsusaka Y., Jinzaki M.

EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 45   S401 - S401 2018.10

ISSN  1619-7070

Ultrasound imaging of the anorectal malformation during the neonatal period: a comprehensive review.

Hosokawa T, Yamada Y, Hsokawa M, Kikuchi S, Ohira K, Tanami Y, Sato Y, Oguma E

Japanese journal of radiology (Japanese Journal of Radiology)  36 ( 10 ) 581 - 591 2018.10

ISSN  1867-1071

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© 2018, Japan Radiological Society. Anorectal malformation (ARM) is classified as low, intermediate, or high; accurate diagnosis of the type during the early neonatal period is important to determine the appropriate initial surgical approach. This review assesses the role of ultrasound examination in the classification of ARM during the neonatal period, with a focus on landmarks on the sonogram, the approach used for sonography, and the optimal examination timing. The following three factors on the sonogram are used for the classification: location of the fistula, the distance between the distal rectal pouch and the anal dimple (perineum) (P–P distance), and the relationship between the puborectalis muscle and the distal rectal pouch. Three approaches can be used to evaluate ARM by ultrasonography, namely, suprapubic, perineal, and infracoccygeal approaches. Each approach has its own advantages and disadvantages. Optimal timing of the ultrasound examination is also important with respect to each factor to classify ARM. We have described the pitfalls of ultrasound in diagnosis of cases, namely ARM with Down syndrome (which tends to be without fistula), ARM with low birth weight, ARM with unusual location of fistula, ARM with opened fistula (where the P–P distance is unreliable), and cloacal malformation (variation of the high-type ARM).

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Perfusion Defect-Concordant Progression of Unilateral Refractory Pulmonary Mycobacterium avium Complex Disease.

Asakura T, Yamada Y, Ishii M, Ebisudani T, Ueda S, Betsuyaku T, Hasegawa N

American journal of respiratory and critical care medicine (American Journal of Respiratory and Critical Care Medicine)  198 ( 6 ) 803 - 804 2018.09

ISSN  1073-449X

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

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

The British journal of radiology (British Journal of Radiology)  91 ( 1087 ) 20180115 2018.07

ISSN  0007-1285

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

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

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

Annals of nuclear medicine (Annals of Nuclear Medicine)  32 ( 5 ) 363 - 371 2018.06

ISSN  0914-7187

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

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Bilateral upper lobe Pneumocystis pneumonia during aerosolized pentamidine prophylaxis

Ohara Y., Asakura T., Ueda S., Yamada Y., Ishii M., Betsuyaku T.

QJM (QJM)  111 ( 5 ) 337 - 338 2018.05

ISSN  14602725

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

Minamishima K, Sugisawa K, Yamada Y, Jinzaki M

Journal of applied clinical medical physics (Journal of Applied Clinical Medical Physics)  19 ( 3 ) 318 - 325 2018.05

ISSN  1526-9914

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

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Value of a Computer-aided Detection System Based on Chest Tomosynthesis Imaging for the Detection of Pulmonary Nodules.

Yamada Y, Shiomi E, Hashimoto M, Abe T, Matsusako M, Saida Y, Ogawa K

Radiology (Radiology)  287 ( 1 ) 333 - 339 2018.04

ISSN  0033-8419

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© 2017 RSNA. Purpose: To assess the value of a computer-Aided detection (CAD) system for the detection of pulmonary nodules on chest tomosynthesis images. Materials and Methods: Fifty patients with and 50 without pulmonary nodules underwent both chest tomosynthesis and multidetector computed tomography (CT) on the same day. Fifteen observers (five interns and residents, five chest radiologists, and five abdominal radiologists) independently evaluated tomosynthesis images of 100 patients for the presence of pulmonary nodules in a blinded and randomized manner, first without CAD, then with the inclusion of CAD marks. Multidetector CT images served as the reference standard. Free-response receiver operating characteristic analysis was used for the statistical analysis. Results: The pooled diagnostic performance of 15 observers was significantly better with CAD than without CAD (figure of merit [FOM], 0.74 vs 0.71, respectively; P = .02). The average true-positive fraction and false-positive rate per all cases with CAD were 0.56 and 0.26, respectively, whereas those without CAD were 0.47 and 0.20, respectively. Subanalysis showed that the diagnostic performance of interns and residents was significantly better with CAD than without CAD (FOM, 0.70 vs 0.62, respectively; P = .001), whereas for chest radiologists and abdominal radiologists, the FOM with CAD values were greater but not significantly: 0.80 versus 0.78 (P = .38) and 0.74 versus 0.73 (P = .65), respectively. Conclusion: CAD significantly improved diagnostic performance in the detection of pulmonary nodules on chest tomosynthesis images for interns and residents, but provided minimal benefit for chest radiologists and abdominal radiologists.

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Distance Between the Distal Rectal Pouch and Perineum in Neonates of Low-Birth Weight With Imperforate Anus.

Hosokawa T, Hosokawa M, Tanami Y, Takahashi H, Hattori S, Sato Y, Tanaka Y, Kawashima H, Oguma E, Yamada Y

Ultrasound quarterly (Ultrasound Quarterly)  34 ( 1 ) 18 - 22 2018.03

ISSN  0894-8771

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© 2018 Wolters Kluwer Health, Inc. All rights reserved. This study was to evaluate the correlation between birth weight and the distance between distal rectal pouch and perineum (P-P distance) and to determine a cutoff value for P-P distance to diagnose low-type imperforate anus in neonates with low-birth weight (LBW). We included 15 neonates with LBW (mean weight, 2012 ± 470 g; range, 906-2452 g) and imperforate anus (surgically confirmed: 11 low type and 3/1 intermediate/high type), who underwent ultrasonography on the day after birth. Type of imperforate anus was defined based on the International Classification of Anorectal Anomalies. The P-P distances on ultrasonograms were measured. Pearson correlation coefficient test and receiver operating characteristic curve were used for statistical analyses. Among all 15 neonates, nonsignificant correlation was observed between the birth weight and P-P distance (r = 0.36; P = 0.18). Mean P-P distance was 9.0 ± 6.6 mm (range, 1.0-24.0 mm) in all neonates, 5.7 ± 2.8 mm (range, 1.0-11.0 mm) in the 11 neonates with low-type imperforate anus, and 18.3 ± 9.1 mm (range, 14.0-24.0 mm) in the 4 neonates with intermediate-/high-type imperforate anus. Using cutoff P-P distance of 12.5 mm, sensitivity and specificity for diagnosis of low-type imperforate anus were 100% (11/11) and 100% (4/4), respectively. In conclusion, nonsignificant correlation was observed between P-P distance and birth weight, and cutoff P-P distance to diagnose low-type imperforate anus was 12.5 mm. Despite the very small sample size in our study, and only 4 neonates with intermediate-/high-type imperforate anus, these findings are important because surgical management whether transperineal anoplasty or diverting colostomy is decided based on the type of imperforate anus, and P-P distance to diagnose the type of imperforate anus was feasible even in neonates with LBW.

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【シリーズ新潮流-The Next Step of Imaging Technology<Vol.8>Dual Energy Imagingの可能性　新たな価値をもたらすDECTの技術的特徴から臨床的有用性まで】Dual Energy Imagingの原理と特徴　Dual energy imagingの技術と撮影法

山田 祥岳, 山田 稔, 横山 陽一, 岡村 哲平, 陣崎 雅弘

INNERVISION ((株)インナービジョン)  33 ( 3 ) 6 - 9 2018.02

ISSN  0913-8919

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dual energy CTとは、管電圧の異なる2種類のX線で撮影する技術である。近年、CTメーカー各社が独自のdual energy CTの技術開発を進めており、臨床現場での認知・普及も進みつつある。CT画像は、被写体のX線減弱の情報を、水を基準としたCT値として可視化するものであるが、通常のCTでは多色エネルギーのX線を使用しているため、X線が被写体を通過する過程で低エネルギーの成分が吸収され、高エネルギーの成分が残る「ビームハードニング効果」が起こり、アーチファクトの原因となる。また、「線減弱係数」は「質量減弱係数」×「密度」で表され、「質量減弱係数」は本来物質固有の数値だが、撮影対象の密度状態によって、異なる物質のCT値が同じになる場合がある。X線エネルギーによるCT値の変化は物質に固有であることから、2種類の管電圧でCTを撮影することで、物質弁別(material decomposition)を行うことが可能となる(図1)。また、2種類のX線のデータを処理することで、さまざまなエネルギーの単色X線画像を仮想的に合成することが可能である。これにより、前述のビームハードニング効果を減弱させることができる。そのほか、dual energy CT撮影で得られる画像情報に、仮想単純画像、実効原子番号画像、電子密度画像などがある。本稿では、dual energy CTの解析方法、撮影法、原理と取得できる画像について解説する。(著者抄録)

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

Okamura, Teppei, Yamada, Yoshitake, Yamada, Minoru, Yamazaki, Akihisa, Shiraga, Nobuyuki, Jinzaki, Masahiro

EUROPEAN JOURNAL OF RADIOLOGY (European Journal of Radiology)  95   212 - 221 2017.10

Research paper (scientific journal), Accepted,  ISSN  0720-048X

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© 2017 Elsevier B.V. Objectives To compare the image quality between virtual monochromatic spectral (VMS) images obtained using 320-row detector CT and polychromatic 120-kVp images reconstructed with or without iterative reconstruction using various phantom sizes. Materials and methods Torso phantoms simulating three patient sizes and containing four syringes filled with water or different contrast media (5, 10, 15 mgI/mL15 mgI/ml) were used. The phantoms were scanned using dual-energy (80/135-kVp) and single-energy (120-kVp) protocols at different settings (20 mGy, 12 mGy, and 6 mGy). VMS images were generated at 1-keV intervals (range, 35–135 keV). Both the VMS images and the single-energy 120-kVp images were reconstructed using filtered back projection (FBP) and adaptive iterative dose reduction 3D (AIDR-3D). The signal-to-noise ratio (SNR), and the contrast-to-noise ratio (CNR) were assessed. Results Using FBP reconstruction, the SNR and CNR of the VMS images were lower than or similar to those of the 120-kVp images for most dose settings. Using AIDR-3D reconstruction, however, the 70-keV VMS images had higher SNRs and CNRs than the 120-kVp images at most settings. Conclusions The image quality of VMS images with FBP reconstruction tended to be lower than that of the 120-kVp images. With the use of AIDR-3D, however, approximately 70-keV VMS images had a higher image quality than the 120-kVp images.

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Diagnostic Accuracy of Sonography for Detection of a Fistula on the Birth Day in Neonates With an Imperforate Anus: Comparison of Diagnostic Performance Between Suprapubic and Perineal Approaches.

Takahiro Hosokawa, Yoshitake Yamada, Yutaka Tanami, Shinya Hattori, Yumiko Sato, Yujiro Tanaka, Hiroshi Kawashima, Mayumi Hosokawa, Eiji Oguma

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine (Journal of Ultrasound in Medicine)  36 ( 10 ) 1989 - 1995 2017.10

Accepted,  ISSN  0278-4297

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© 2017 by the American Institute of Ultrasound in Medicine. Objectives: To evaluate the diagnostic accuracy of sonography for detection of an internal fistula on the birth day in neonates with an imperforate anus and to compare the diagnostic performance between the suprapubic and perineal approaches. Methods: We included 46 neonates with an imperforate anus (29 low type and 17 intermediate/high type) who underwent sonography by both the suprapubic and perineal approaches on the birth day. Thirty-nine neonates had internal fistulas, and 12 did not, as surgically proven. Two blinded radiologists evaluated the suprapubic and perineal sonograms for the presence of the internal fistula in consensus. A final diagnosis of the internal fistula was determined on the basis of the findings of both approaches. A receiver operating characteristic analysis was used to compare the diagnostic performance for detection of an internal fistula between the suprapubic and perineal approaches. Results: The sensitivity, specificity, and accuracy of the final diagnosis based on the findings of suprapubic, perineal, and both approaches were 52.9%, 79.4%, and 79.4%; 75.5%, 75.5%, and 75.5%; and 58.7%, 78.3%, and 78.3%, respectively. The diagnostic performance of the perineal approach was significantly better than that of the suprapubic approach (P <.0001). Conclusions: The diagnostic accuracy of sonography for detection of an internal fistula on the birth day exceeded 75% in neonates with an imperforate anus, and sonography on the birth day is feasible. The perineal approach had superior diagnostic performance over the suprapubic approach. Thus, when evaluating an internal fistula by sonography, we recommend using the perineal approach in addition to the suprapubic approach.

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Sonography for an Imperforate Anus: Approach, Timing of the Examination, and Evaluation of the Type of Imperforate Anus and Associated Anomalies.

Takahiro Hosokawa, Yoshitake Yamada, Yutaka Tanami, Shinya Hattori, Yumiko Sato, Yujiro Tanaka, Hiroshi Kawashima, Mayumi Hsokawa, Eiji Oguma

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine (Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine)  36 ( 9 ) 1747 - 1758 2017.09

Accepted,  ISSN  0278-4297

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© 2017 by the American Institute of Ultrasound in Medicine. This systematic review outlines the role of sonography in an imperforate anus. The diagnostic performance for type of imperforate anus is superior on the day after birth than that on the day of birth by using the pouch-perineum distance. Three approaches can be used (suprapubic, infracoccygeal, and perineal). The pouch-perineum distance, fistula location, and relationship between the puborectalis muscle and distal rectal pouch are useful for classifying the type of imperforate anus. However, the pouch-perineum distance measured has an overlap between the low and high/intermediate types of imperforate anus. Sonography can be useful for some of the associated anomalies and helpful for surgeons in some cases.

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The MUC5B promoter polymorphism is associated with specific interstitial lung abnormality subtypes

Putman, Rachel K., Gudmundsson, Gunnar, Araki, Tetsuro, Nishino, Mizuki, Sigurdsson, Sigurdur, Gudmundsson, Elias F., Eiriksdottir, Gudny, Aspelund, Thor, Ross, James C., Estepar, Raul San Jose, Miller, Ezra R., Yamada, Yoshitake, Yanagawa, Masahiro, Tomiyama, Noriyuki, Launer, Lenore J., Harris, Tamara B., El-Chemaly, Souheil, Raby, Benjamin A., Cho, Michael H., Rosas, Ivan O., Washko, George R., Schwartz, David A., Silverman, Edwin K., Gudnason, Vilmundur, Hatabu, Hiroto, Hunninghake, Gary M.

EUROPEAN RESPIRATORY JOURNAL (European Respiratory Journal)  50 ( 3 ) 1989 - 1995 2017.09

Research paper (scientific journal), Accepted,  ISSN  0903-1936

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© ERS 2017. The MUC5B promoter polymorphism (rs35705950) has been associated with interstitial lung abnormalities (ILA) in white participants from the general population; whether these findings are replicated and influenced by the ILA subtype is not known. We evaluated the associations between the MUC5B genotype and ILA in cohorts with extensive imaging characterisation. We performed ILA phenotyping and MUC5B promoter genotyping in 5308 and 9292 participants from the AGES-Reykjavik and COPDGene cohorts, respectively. We found that ILA was present in 7% of participants from the AGES-Reykjavik, 8% of non-Hispanic white participants from COPDGene and 7% of African-American participants from COPDGene. Although the MUC5B genotype was strongly associated (after correction for multiple testing) with ILA (OR 2.1, 95% CI 1.8-2.4, p=1×10-26), there was evidence of significant heterogeneity between cohorts (I2=81%). When narrowed to specific radiologic subtypes, (e.g. subpleural ILA), the MUC5B genotype remained strongly associated (OR 2.6, 95% CI 2.2-3.1, p=1×10-30) with minimal heterogeneity (I2=0%). Although there was no evidence that the MUC5B genotype influenced survival, there was evidence that MUC5B genotype improved risk prediction for possible usual interstitial pneumonia (UIP) or a UIP pattern in non-Hispanic white populations. The MUC5B promoter polymorphism is strongly associated with ILA and specific radiologic subtypes of ILA, with varying degrees of heterogeneity in the underlying populations.

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The efficacy, safety and feasibility of inhaled amikacin for the treatment of refractory non-tuberculous mycobacterial lung diseases

Kazuma Yagi, Makoto Ishii, Ho Namkoong, Takahiro Asami, Osamu Iketani, Takanori Asakura, Shoji Suzuki, Satoshi Okamori, Hiroaki Sugiura, Yoshitake Yamada, Tomoyasu Nishimura, Hirofumi Kamata, Hiroshi Fujiwara, Yohei Funatsu, Yoshifumi Uwamino, Tomoko Betsuyaku, Naoki Hasegawa

EUROPEAN RESPIRATORY JOURNAL 50 2017.09

ISSN  0903-1936

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The efficacy, safety, and feasibility of inhaled amikacin for the treatment of difficult-to-treat non-tuberculous mycobacterial lung diseases

Yagi Kazuma, Ishii Makoto, Namkoong Ho, Asami Takahiro, Iketani Osamu, Asakura Takanori, Suzuki Shoji, Sugiura Hiroaki, Yamada Yoshitake, Nishimura Tomoyasu, Fujiwara Hiroshi, Funatsu Yohei, Uwamino Yoshifumi, Kamo Tetsuro, Tasaka Sadatomo, Betsuyaku Tomoko, Hasegawa Naoki

BMC Infectious Diseases (BMC Infectious Diseases)  17 ( 1 ) 558 - 558 2017.08

Accepted,  ISSN  1471-2334

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<p>Background: In multidrug regimens, including an intravenous aminoglycoside (e.g. amikacin [AMK]) is recommended for difficult-to-treat non-tuberculous mycobacterial (NTM) lung diseases. We aimed to evaluate the efficacy, safety, and feasibility of inhaled AMK therapy in patients with difficult-to-treat NTM lung diseases in a retrospective chart review. Methods: The study population consisted of patients with NTM lung diseases who received combination therapy, including inhaled AMK therapy, at Keio University Hospital (Tokyo, Japan), from January 2014 through May 2016. A total of 26 cases, consisting of 23 Mycobacterium avium complex (MAC) and three Mycobacterium abscessus complex (MABC) infections cases, were included in this study. The efficacy, safety, and feasibility of inhaled AMK therapy were retrospectively investigated. The Research Ethics Committee of Keio University Hospital approved this study, and informed consent was obtained from all patients. Results: All 26 patients were culture-positive at enrolment. Twenty-three of the 26 patients (88.5%), including 21/23 MAC patients (91.3%) and 2/3 MABC patients (66.7%), were administered inhaled AMK therapy for &gt;3months. The proportion of patients who had clinical symptoms, including, cough and sputum, declined after inhalation AMK therapy. Ten of the 23 patients (43.5%) who received AMK inhalation, including 8/21 MAC (38.1%) and 2/2 MABC patients (100%), showed sputum conversion, defined as at least three consecutive negative sputum cultures. Seven of the 23 patients, including, 5/21 MAC and 2/2 MABC patients, showed improvements in high-resolution computed tomography imaging of the chest. In addition, the serum AMK trough levels before the second inhalation were &lt;1.2μg/mL in all 26 patients, with no occurrence of severe adverse events, such as renal toxicity. One patient (3.8%) experienced auditory toxicity, in the form of tinnitus. However, this symptom was reversible, after temporary interruption of AMK, the patient was able to safely resume the therapy. Conclusions: Inhaled AMK therapy is an effective and feasible therapy for difficult-to-treat NTM lung disease.</p>

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Comparison of Diagnostic Accuracy for the Low-Type Imperforate Anus Between Prone Cross-Table Radiography and Sonography.

Takahiro Hosokawa, Mayumi Hosokawa, Yutaka Tanami, Shinya Hattori, Yumiko Sato, Yujiro Tanaka, Hiroshi Kawashima, Eiji Oguma, Yoshitake Yamada

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine (Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine)  36 ( 8 ) 1679 - 1686 2017.08

Accepted,  ISSN  0278-4297

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© 2017 by the American Institute of Ultrasound in Medicine. OBJECTIVES: To compare the diagnostic accuracy for the low-type imperforate anus between prone cross-table radiography and sonography.METHODS: We included 20 neonates with imperforate anus: 13 with a surgically proven low type and 7 with an intermediate or high type. The distance between the distal rectal pouch and the perineum (pouch-perineum distance) was measured by both sonography and prone cross-table radiography. A previously established pouch-perineum distance of 10 mm was used as the cutoff for diagnosis of a low-type imperforate anus. The fistula location was also determined with sonography. We then compared the diagnostic accuracy of the imaging methods for a low-type imperforate anus using the cutoff value of the pouch-perineum distance alone and both the cutoff value of the pouch-perineum distance and fistula location. The McNemar test was used for statistical analysis.RESULTS: With the use of only the pouch-perineum distance, the diagnostic accuracy for the low-type imperforate anus based on sonographic measurements was comparable with the accuracy achieved by prone cross-table radiographic measurements (60.0% [12 of 20] versus 45.0% [9 of 20]; P = .625). With the use of the pouch-perineum distance and fistula location, the diagnostic accuracy of sonography was significantly better than the accuracy of prone cross-table radiography (90.0% [18 of 20] versus 45% [9 of 20]; P = .012).CONCLUSIONS: The diagnostic accuracy of sonography for the low-type imperforate anus based on both the pouch-perineum distance and fistula location is better than that of prone cross-table radiography. If the pouch-perineum distance on prone cross-table radiography is greater than 10 mm, a sonographic examination to determine the fistula location could be recommended.

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

杉澤 浩一, 市川 勝弘, 南島 一也, 長谷川 雅一, 山田 祥岳, 陣崎 雅弘

日本放射線技術学会雑誌 ((公社)日本放射線技術学会)  73 ( 8 ) 636 - 645 2017.08

ISSN  0369-4305

診断に難渋した播種性ヒストプラズマ症の一例

栗原 真帆, 杉浦 弘明, 南 康大, 松本 俊亮, 山田 祥岳, 蔵本 純子, 川田 一郎, 別役 智子, 陣崎 雅弘

日本医学放射線学会秋季臨床大会抄録集 ((公社)日本医学放射線学会)  53回   S523 - S523 2017.08

ISSN  0048-0428

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

Yamada Yoshitake, Ueyama Masako, Abe Takehiko, Araki Tetsuro, Abe Takayuki, Nishino Mizuki, Jinzaki Masahiro, Hatabu Hiroto, Kudoh Shoji

European Journal of Radiology (European Journal of Radiology)  92   37 - 44 2017.07

Accepted,  ISSN  0720-048X

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

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

Katagiri, Mari, Nakahara, Tadaki, Murata, Mitsushige, Ogata, Yuji, Matsusaka, Yohji, Iwabuchi, Yu, Yamada, Yoshitake, Fukuda, Keiichi, Jinzaki, Masahiro

ANNALS OF NUCLEAR MEDICINE (Annals of Nuclear Medicine)  31 ( 5 ) 399 - 406 2017.06

Research paper (scientific journal), Accepted,  ISSN  0914-7187

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© 2017, The Japanese Society of Nuclear Medicine. Purpose: Apical wall thickening with an “ace-of-spades” configuration is a unique sign of apical hypertrophic cardiomyopathy (AHCM). We investigated spade-shaped FDG uptake around the left ventricular apex (SSUA) incidentally found in routine oncological FDG PET. Methods: Cases showing SSUA were selected based on retrospective review. The pattern or intensity of SSUA was compared with the results of electrocardiogram (ECG), echocardiography, and stress myocardial perfusion SPECT. The diagnosis of ACHM was based on the presence of giant negative T wave in ECG, thickness of spade-shaped hypertrophy in the apex in echocardiography, and increased tracer uptake in the apex in rest SPECT. Results: Among the 34 patients in 36 PET scans showing SSUA, SSUA was weak in 17 and intense in 17. There were isolated SSUA (n = 29) and SSUA with diffuse or other focal left ventricular uptake (n = 5). Three patients with the latter uptake pattern turned out to have coexistence of AHCM and asymmetric septal hypertrophy. Of the 16 SSUA-positive patients who underwent echocardiography, 13 (81%) were diagnosed as AHCM and the remaining 3 were regarded as borderline AHCM (apical wall thickness, 14–15 mm). There were 16 patients with SSUA who also underwent PET scans after the study period among which 11 (69%) had persistent SSUA in the follow-up PET. In the remaining 5, follow-up PET scans showed diffuse left ventricular uptake and SSUA was barely visible. The intensity of SSUA was significantly or marginally associated with giant negative T wave (p < 0.01), apical asynergy (p = 0.08), and impaired coronary flow reserve (p < 0.05). There were no other factors correlated with the pattern or intensity of SSUA. Conclusion: SSUA incidentally found in oncological FDG PET appeared to be associated with AHCM, especially in ischemic conditions. The moderate repeatability of SSUA was probably due to obscurity by physiological uptake.

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Evaluation of the Normal Tonsils in Pediatric Patients with Ultrasonography

Hosokawa Takahiro, Yamada Yoshitake, Tanami Yutaka, Hattori Shinya, Sato Yumiko, Hosokawa Mayumi, Oguma Eiji

Journal of Ultrasound in Medicine (Journal of Ultrasound in Medicine)  36 ( 5 ) 1029 - 1036 2017.05

Accepted,  ISSN  0278-4297

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<p>Objectives: To evaluate how well the tonsils can be viewed, in addition to echogenicity, using ultrasound, and to compare these results between children younger and older than the age of 3. Methods: We evaluated the tonsils of 99 patients (72.0 ± 59.1 months) by ultrasound. Ultrasound scans of both the left and right side, in both the transverse and longitudinal planes, were obtained. Images were scored with one of four grades according to how well the tonsil border could be distinguished, 0 being the worst and 3 being the best. Grades 2 or 3 (&gt;50% of the tonsil border was detectable) in both tonsils, in either the transverse or longitudinal image, were considered "evaluable." Echogenicity was designated as imperceptible, low echoic, or striated in appearance. Statistical analysis was performed using the Mann-Whitney U test. Results: Bilateral tonsils were evaluable in 96.0% (96/99) of cases. The mean grades were 2.44 ± 0.65/2.03 ± 0.68 in the right transverse/longitudinal images, and 2.40 ± 0.59/2.12 ± 0.73 in the left transverse/longitudinal images. The grades in children older than the age of 3 were significantly higher than those in younger patients (all P &lt;.05). Echogenicity classification on the right and left side revealed a striated appearance in 97.0% (96/99) and 90.0% (89/99) of cases, respectively. Conclusions: The tonsils of almost all pediatric patients could be evaluated by ultrasound, particularly for patients older than 3 years. Additionally, a striated pattern of the tonsils was observed in most cases.</p>

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

Matsumoto, Shunsuke, Yamada, Yoshitake, Hashimoto, Masahiro, Okamura, Teppei, Yamada, Minoru, Yashima, Fumiaki, Hayashida, Kentaro, Fukuda, Keiichi, Jinzaki, Masahiro

EUROPEAN RADIOLOGY (European Radiology)  27 ( 5 ) 1963 - 1970 2017.05

Research paper (scientific journal), Accepted,  ISSN  0938-7994

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© 2016, European Society of Radiology. Objectives: To evaluate the effectiveness of CT before TAVI using variable helical pitch (VHP) scanning and its diagnostic performance for coronary artery disease (CAD). Methods: Sixty patients (84.4 ± 4.6 years) scheduled for TAVI underwent CT using VHP scanning with the contrast material (CM) volume calculated as scanning time × weight [kg] × 0.06 mL. Retrospective electrocardiography (ECG)-gated scanning was utilized to examine the thorax, and non-ECG-gated scanning of the abdomen immediately followed. We analyzed CT attenuation values of the coronary arteries, aorta, iliac and femoral arteries. The coronary CT angiography images were evaluated for the presence of stenosis (≥50 %); invasive coronary angiography served as a reference standard. Results: The average attenuations of all of the arteries were greater than 400 HU. We could evaluate the peripheral access vessels and dimensions of the ascending aorta, aortic root, and aortic annulus in all patients. The average volume of CM was 38.7 ± 8.5 mL. On per-patient and vessel analysis, CT showed 91.7 % and 89.5 % sensitivity, and 91.3 % and 97.4 % negative predictive value (NPV). Conclusions: CT using VHP scanning with an average CM volume of 38.7 mL is useful before TAVI and had a high sensitivity and NPV in excluding obstructive CAD. Key Points: • TAVI-planning CT using variable helical pitch (VHP) scanning is useful. • The average volume of contrast material was 38.7 ± 8.5 mL. • The average attenuations of all the arteries were >400 HU. • This CT had a high sensitivity and NPV for excluding obstructive CAD.

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

Asakura, Takanori, Yamada, Yoshitake, Namkoong, Ho, Suzuki, Shoji, Niijima, Yuki, Kamata, Hirofumi, Funatsu, Yohei, Yagi, Kazuma, Okamori, Satoshi, Sugiura, Hiroaki, Ishii, Makoto, Jinzaki, Masahiro, Betsuyaku, Tomoko, Hasegawa, Naoki

RESPIRATORY MEDICINE (Respiratory Medicine)  126   9 - 16 2017.05

Research paper (scientific journal), Accepted,  ISSN  0954-6111

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© 2017 Elsevier Ltd Background and objectives Pulmonary Mycobacterium avium complex (pMAC) disease manifests as various types of lesions, such as infiltrates, nodules, cavities, and bronchiectasis. However, the important determinants for clinical parameters in lung involvement are poorly understood. The objective of this study was to obtain quantitative parameters by 3-dimensional CT, and investigate the relationship between these parameters and the pulmonary function tests (PFTs) and health-related quality of life. Material and methods Quantitative analysis using CT was performed in 67 pMAC patients. The relationship between new quantitative parameters for evaluating lung involvement using 3-dimensional CT and PFTs or St George's Respiratory Questionnaire (SGRQ) was evaluated. Results The ratio of infiltration to total lung volume showed significant correlation with the PFT results, especially the percent-predicted forced vital capacity (%FVC; ρ = −0.52), residual volume (ρ = −0.51), and total lung capacity (ρ = −0.59). The cavity volume was strongly correlated with the %FVC (ρ = −0.78) in the cavity group, while the ratio of infiltration to total lung volume was strongly correlated with the %FVC (ρ = −0.53) in the non-cavity group. The ratio of infiltration to total lung volume was significantly correlated with all SGRQ parameters (ρ = 0.41–0.52) in the non-cavity group. Conclusions Infiltration was an important parameter for the PFTs and SGRQ in pMAC patients according to the 3-dimensional CT analysis. Moreover, cavity volume was an important parameter of the PFTs in the cavity group. Therefore, infiltration and cavity volume are key features for the management of pMAC disease.

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Late Recoil of Balloon-expandable Transcatheter Aortic Bioprosthesis: Insights from the OCEAN-TAVI Registry

Yanagisawa, Ryo, Tanaka, Makoto, Yashima, Fumiaki, Yamada, Yoshitake, Arai, Takahide, Shimizu, Hideyuki, Jinzaki, Masahiro, Fukuda, Keiichi, Watanabe, Yusuke, Yamamoto, Masanori, Kozuma, Ken, Suzuki, Takahiko, Hayashida, Kentaro

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 69 ( 16 ) S85 - S86 2017.04

Research paper (scientific journal),  ISSN  0735-1097

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

Kakefuda, Yuki, Hayashida, Kentaro, Yamada, Yoshitake, Yashima, Fumiaki, Inohara, Taku, Yanagisawa, Ryo, Tanaka, Makoto, Arai, Takahide, Kawakami, Takashi, Maekawa, Yuichiro, Tsuruta, Hikaru, Itabashi, Yuji, Murata, Mitsushige, Sano, Motoaki, Okamoto, Kazuma, Yoshitake, Akihiro, Shimizu, Hideyuki, Jinzaki, Masahiro, Fukuda, Keiichi

AMERICAN JOURNAL OF CARDIOLOGY (American Journal of Cardiology)  119 ( 7 ) 1100 - 1105 2017.04

Research paper (scientific journal), Accepted,  ISSN  0002-9149

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© 2017 Elsevier Inc. Complications after transcatheter aortic valve implantation (TAVI) remain an important issue. This study aimed to evaluate the impact of systematic postprocedural multidetector computed tomography (MDCT) to detect subclinical complications after TAVI. From October 2013 to August 2015, a total of 135 patients who underwent transfemoral TAVI (n = 116) or transapical TAVI (n = 19) with Sapien XT and MDCT preprocedure and postprocedure were enrolled. Postprocedural MDCT findings were compared with the preprocedural MDCT findings. Cardiovascular complications were observed in 25.9% of patients, including 6 cases (4.5%) with major complications. Of those, clinically apparent major complications were reported in 2 cases including rupture of the sinus of Valsalva and iliac rupture. The complications in the remaining 4 cases (3.0%) included aortic dissection, aortic intramural hematoma, and left ventricular apical pseudoaneurysm, which were totally asymptomatic and only detected by MDCT. The apical pseudoaneurysm required surgical repair. Minor complications were observed in 21.5% of patients, 50% of which were subclinical. Only 1 case with femoral pseudoaneurysm required an additional procedure. Noncardiovascular findings were detected in 27.4% of patients; the most frequent were pleural effusions and atelectasis, which were predominantly observed in those treated through a transapical approach. Contrast-induced acute kidney injury after postprocedural MDCT was reported in 1 patient whose clinical course was complicated by sepsis. In conclusion, postprocedural MDCT was useful in detecting important subclinical complications that may affect the clinical course without deterioration of renal function.

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

Yamada, Yoshitake, Ueyama, Masako, Abe, Takehiko, Araki, Tetsuro, Abe, Takayuki, Nishino, Mizuki, Jinzaki, Masahiro, Hatabu, Hiroto, Kudoh, Shoji

ACADEMIC RADIOLOGY (Academic Radiology)  24 ( 2 ) 393 - 400 2017.04

Research paper (scientific journal), Accepted,  ISSN  1076-6332

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© 2017 The Association of University Radiologists Rationale and Objectives Diaphragmatic motion in a standing position during tidal breathing remains unclear. The purpose of this observational study was to evaluate diaphragmatic motion during tidal breathing in a standing position in a health screening center cohort using dynamic chest radiography in association with participants’ demographic characteristics. Materials and Methods One hundred seventy-two subjects (103 men; aged 56.3 ± 9.8 years) underwent sequential chest radiographs during tidal breathing using dynamic chest radiography with a flat panel detector system. We evaluated the excursions of and peak motion speeds of the diaphragms. Associations between the excursions and participants’ demographics (gender, height, weight, body mass index [BMI], smoking history, tidal volume, vital capacity, and forced expiratory volume) were investigated. Results The average excursion of the left diaphragm (14.9 ± 4.6 mm, 95% CI 14.2–15.5 mm) was significantly larger than that of the right (11.0 ± 4.0 mm, 95% CI 10.4–11.6 mm) (P < 0.001). The peak motion speed of the left diaphragm (inspiratory, 16.6 ± 4.2 mm/s; expiratory, 13.7 ± 4.2 mm/s) was significantly faster than that of the right (inspiratory, 12.4 ± 4.4 mm/s; expiratory, 9.4 ± 3.8 mm/s) (both P < 0.001). Both simple and multiple regression models demonstrated that higher BMI and higher tidal volume were associated with increased excursions of the bilateral diaphragm (all P < 0.05). Conclusions The average excursions of the diaphragms are 11.0 mm (right) and 14.9 mm (left) during tidal breathing in a standing position. The diaphragmatic motion of the left is significantly larger and faster than that of the right. Higher BMI and tidal volume are associated with increased excursions of the bilateral diaphragm.

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Pleural abnormalities in the Framingham Heart Study

Araki Tetsuro, Yanagawa Masahiro, Sun Fangui Jenny, Dupuis v., Nishino Mizuki, Yamada Yoshitake, Washko George R., Christiani David C., Tomiyama Noriyuki, O'Connor George T., Hunninghake Gary M., Hatabu Hiroto

Occupational and Environmental Medicine (Occupational and Environmental Medicine)  74 ( 10 ) 756 - 761 2017.03

Accepted,  ISSN  1351-0711

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<p>Background The prevalence of pleural abnormalities in the general population is an epidemiologically important index of asbestos exposure, which has not been investigated since a radiography-based study in 1980. Methods We examined 2633 chest CT scans (mean 59.2 years, 50% female) from the Framingham Heart Study (FHS) for the presence and image characteristics of pleural plaques and diffuse pleural thickening. Demographics and pulmonary function were stratified by the presence of pleural abnormalities in association with interstitial lung abnormalities. Results Pleural abnormalities were present in 1.5% (95% CI 1.1% to 2.1%). Pleural lesions were most commonly bilateral (90.0%), multiple (77.5%), calcified (97.5%) and commonly involved posterior (lower: 92.5%, middle: 87.5%), anterior (upper: 77.5%, middle: 77.5%) and diaphragmatic areas (72.5%). Participants with pleural abnormalities were significantly older (75.7 years, p &lt;0.0001), male (92.5%, p &lt;0.0001), former or current smokers (80.0%, p &lt;0.001) with higher packyears (33.3, p &lt;0.0001). No significant reduction was noted in pulmonary function measures (p=0.07-0.94) when adjusted for the associated covariates, likely due to small number of cases with pleural abnormalities. Information about prior history of asbestos exposure and occupation was not available. Conclusions Pleural plaques and diffuse pleural thickening are present on CT in 1.5% of the FHS cohort. The current prevalence of the pleural abnormalities is smaller than that reported in the previous populationbased study using chest radiography, likely representing lower asbestos exposure in recent decades. The posterior portion of the pleura is most frequently involved but the anterior portion is also commonly involved.</p>

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Changes in the Distance Between the Distal Rectal Pouch and Perineum From the Birth Day to the Next Day in Neonates With an Imperforate Anus.

Takahiro Hosokawa, Yoshitake Yamada, Yumiko Sato, Yutaka Tanami, Yujiro Tanaka, Hiroshi Kawashima, Eiji Oguma

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine (Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine)  36 ( 3 ) 601 - 606 2017.03

Accepted,  ISSN  0278-4297

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© 2017 by the American Institute of Ultrasound in Medicine. OBJECTIVES: To evaluate changes in the distance between the distal rectal pouch and the perineum (pouch-perineum distance) from the birth day to the next day and to determine which day is better for diagnosis of a low-type imperforate anus in neonates.METHODS: We reviewed medical records at our hospital from May 2003 to August 2015 and identified 9 neonates with a radiographically and surgically proven low-type imperforate anus and 9 with high/intermediate types of imperforate anus who had undergone sonography on both the birth day and the next day before the first surgical treatment. The sonograms were reviewed to measure the pouch-perineum distance at both examinations. The Wilcoxon signed rank sum test and a receiver operating characteristic curve analysis were used for the statistical analyses.RESULTS: The pouch-perineum distance on the next day (mean ± SD, 9.37 ± 4.89 mm; range, 2.1-20.9 mm) was significantly shorter than on the birth day (15.75 ± 6.67 mm; range, 8.1-37.2 mm; P = .001). The receiver operating characteristic analysis showed significantly better diagnostic performance (P < .001) of the pouch-perineum distance on the next day (area under the curve, 0.864) versus the birth day (0.420) for the low-type imperforate anus.CONCLUSIONS: The pouch-perineum distance was shorter on the next day than on the birth day, and the diagnostic performance of the pouch-perineum distance on the next day was significantly superior to that on the birth day for the diagnosis of a low-type imperforate anus. We recommend sonography on the next day in neonates with an imperforate anus when possible.

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【心臓イメージング2017】心血管MRIの新しい展開

奥田 茂男, 山田 祥岳, 松本 俊亮, 鈴木 達也, 陣崎 雅弘, 布川 嘉信, 藤代 力也, 本松 沙理, 渡部 敏男

映像情報Medical (産業開発機構(株))  49 ( 3 ) 10 - 15 2017.03

ISSN  1346-1354

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

Yamada, Yoshitake, Ueyama, Masako, Abe, Takehiko, Araki, Tetsuro, Abe, Takayuki, Nishino, Mizuki, Jinzaki, Masahiro, Hatabu, Hiroto, Kudoh, Shoji

EUROPEAN JOURNAL OF RADIOLOGY (European Journal of Radiology)  87   76 - 82 2017.02

Research paper (scientific journal), Accepted,  ISSN  0720-048X

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© 2016 The Authors Objectives To quantitatively compare diaphragmatic motion during tidal breathing in a standing position between chronic obstructive pulmonary disease (COPD) patients and normal subjects using dynamic chest radiography. Materials and methods Thirty-nine COPD patients (35 males; age, 71.3 ± 8.4 years) and 47 normal subjects (non-smoker healthy volunteers) (20 males; age, 54.8 ± 9.8 years) underwent sequential chest radiographs during tidal breathing using dynamic chest radiography with a flat panel detector system. We evaluated the excursions and peak motion speeds of the diaphragms. The results were analyzed using an unpaired t-test and a multiple linear regression model. Results The excursions of the diaphragms in COPD patients were significantly larger than those in normal subjects (right, 14.7 ± 5.5 mm vs. 10.2 ± 3.7 mm, respectively, P < 0.001; left, 17.2 ± 4.9 mm vs. 14.9 ± 4.2 mm, respectively, P = 0.022). Peak motion speeds in inspiratory phase were significantly faster in COPD patients compared to normal subjects (right, 16.3 ± 5.0 mm/s vs. 11.8 ± 4.2 mm/s, respectively, P < 0.001; left, 18.9 ± 4.9 mm/s vs. 16.7 ± 4.0 mm/s, respectively, P = 0.022). The multivariate analysis demonstrated that having COPD and higher body mass index were independently associated with increased excursions of the bilateral diaphragm (all P < 0.05), after adjusting for other clinical variables. Conclusions Time-resolved quantitative evaluation of the diaphragm using dynamic chest radiography demonstrated that the diaphragmatic motion during tidal breathing in a standing position is larger and faster in COPD patients than in normal subjects.

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Cryoinjury-induced acute myocardial infarction model and ameroid constrictor-induced ischemic heart disease model in adult micro-mini pigs for preclinical studies.

Hirano A, Fujita J, Kanazawa H, Kawaguchi S, Handa N, Yamada Y, Okuda S, Hishikawa S, Teratani T, Kunita S, Tohyama S, Seki T, Tabei R, Nakajima K, Kishino Y, Okada M, Okamoto K, Shimizu H, Kobayashi E, Fukuda K

Translational Medicine Communications 2 ( 1 )  2017.02

Accepted

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

Yanagisawa, Ryo, Hayashida, Kentaro, Yamada, Yoshitake, Tanaka, Makoto, Yashima, Fumiaki, Inohara, Taku, Arai, Takahide, Kawakami, Takashi, Maekawa, Yuichiro, Tsuruta, Hikaru, Itabashi, Yuji, Murata, Mitsushige, Sano, Motoaki, Okamoto, Kazuma, Yoshitake, Akihiro, Shimizu, Hideyuki, Jinzaki, Masahiro, Fukuda, Keiichi

JACC-CARDIOVASCULAR IMAGING (JACC: Cardiovascular Imaging)  10 ( 1 ) 1 - 11 2017.01

Research paper (scientific journal), Accepted,  ISSN  1936-878X

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© 2017 American College of Cardiology Foundation Objectives This study sought to clarify the incidence and predictors of hypoattenuated leaflet thickening (HALT) and mid-term outcomes after transcatheter aortic valve replacement. Background HALT detected on multidetector computed tomography (MDCT) scanning raised concerns about possible subclinical leaflet thrombosis. Methods We studied 70 of 100 consecutive patients from a single-center registry who underwent implantation with the Edwards SAPIEN-XT device. MDCT results, echocardiographic data, and laboratory findings obtained at the 6-month and 1-year follow-ups were analyzed. Results Of 70 patients, MDCT scans revealed HALT in 1 patient (1.4%) at discharge, 7 (10.0%) at 6 months, and 10 (14.3%) at 1 year post–transcatheter aortic valve replacement cumulatively. The degree of leaflet immobility correlated with the HALT area on 4-dimensional MDCT (r = 0.68) on the basis of data from 10 patients. HALT was associated with male sex (70% vs. 25%; p = 0.008) and larger sinus of Valsalva (31.0 ± 2.0 mm vs. 28.6 ± 2.6 mm; p = 0.005). HALT was found in 3 of 49 patients with a 23-mm bioprosthesis and in 7 of 21 patients with a 26-mm bioprosthesis (6.1% vs. 33.3%; p = 0.006). D-dimer levels were significantly increased in the HALT group at the 6-month (2.3 μg/ml [interquartile range (IQR): 2.1 to 6.1 μg/ml] vs. 1.1 μg/ml [IQR: 0.8 to 2.2 μg/ml]; p = 0.002) and 1-year (2.7 μg/ml [IQR: 1.7 to 4.8 μg/ml] vs. 1.2 μg/ml [IQR: 0.9 to 2.1 μg/ml]; p = 0.006) follow-ups, despite no differences at discharge. The pressure gradient was decreased in the HALT group at the 1-year follow-up (8.3 ± 0.8 mm Hg vs. 11.1 ± 4.9 mm Hg; p = 0.005). After detecting HALT, additional anticoagulation therapy was not administered. Clinical outcomes, including all-cause mortality (0% vs. 1.7%; p = 1.00) and stroke (0% vs. 0%; p = 1.00), were similar between the groups. Conclusions HALT with reduced leaflet motion was not rare but usually subclinical. Valve hemodynamics and mid-term outcomes were uneventful even without additional anticoagulant therapy in our limited number of cases. Male sex, larger sinus and bioprosthesis size, and elevated D-dimer levels during follow-up were associated with this phenomenon.

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Congenital dermoid fistulas of the anterior chest region (CDFACR)

Hosokawa Takahiro, Yamada Yoshitake, Takahashi Hiroaki, Sato Yumiko, Tanami Yutaka, Suzuki Keisuke, Kawashima Hiroshi, Oguma Eiji

Radiology Case Reports (Elsevier Inc)  12 ( 3 ) 628 - 631 2017

Accepted,  ISSN  1930-0433

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<p>Congenital dermoid fistulas of the anterior chest regions (CDFACRs) consist of a skin orifice at the anterior border of the sternocleidomastoid muscle with fistulas extending caudally in the subcutaneous tissue near the sternoclavicular joint. We report 2 pediatric CDFACR cases with pathognomonic sonography findings. By using sonography, we could diagnose the fistulas as CDFACRs by focusing on their location and direction and could reveal the distal side for complete resection. We suggest that sonography, which does not involve radiation or require sedation, is a better choice for the initial examination of CDFACRs than computed tomography or MRI.</p>

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Evaluation of the CT Parameters to Suppress Renal Cysts Pseudoenhancement Effect: Influence of the Virtual Monochromatic Spectral Images, the Model-based Iterative Reconstruction Algorithm and the Aperture Size in Phantom Model

Sugisawa Koichi, Ichikawa Katsuhiro, Minamishima Kazuya, Hasegawa Masakazu, Yamada Yoshitake, Jinzaki Masahiro

Japanese Journal of Radiological Technology (Japanese Society of Radiological Technology)  73 ( 8 ) 636 - 645 2017

ISSN  0369-4305

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<p><i>Purpose</i>: The purpose of this study was to evaluate the effect of the virtual monochromatic spectral images (VMSI) and the model-based iterative reconstruction (MBIR) images, to evaluate the influence of the aperture size (40- and 20-mm beam) on renal pseudoenhancement (PE) compared with the filtered back projection (FBP) images. <i>Methods</i>: The renal compartment-CT phantom was filled with iodinated contrast material diluted to the attenuation of 180 Hounsfield units (HU) at 120 kV. The water-filled spherical structures, which simulate cyst, were inserted into the renal compartment. Those diameters were 7, 15 and 25 mm. These were scanned by conventional mode (helical scan, 120 kV-FBP) and dual energy mode. 70 keV-VMSI were reconstructed from the dual energy mode, and MBIR images were reconstructed from conventional mode at 40- and 20-mm aperture. Additionally, the phantom was scanned using non-helical mode with 20-mm aperture, and FBP images were reconstructed. The CT value of the PE for cyst areas was measured for these images. <i>Results</i>: The CT values of the cysts were 20.0–14.3 HU on the FBP images, 12.8–12.7 HU on the 70 keV-VMSI (PE-inhibition ratio was 36.0–11.2%) and 16.2–14.0 HU on the MBIR images (19.0–2.1%), respectively, at 40-mm aperture. The PE-inhibition ratio scanned by 20-mm aperture was improved by 28.0% with FBP, 32.8% with 70 keV-VMSI and 29.6% with MBIR compared with 40-mm aperture. One of the FBP images with non-helical mode was 11.6 HU. <i>Conclusions</i>: The best CT technique to minimize PE was the combination of 70 keV-VMSI and 20-mm aperture.</p>

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• CiNii Research

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

Tamura Masashi, Yamada Yoshitake, Kawakami Takashi, Kataoka Masaharu, Iwabuchi Yu, Sugiura Hiroaki, Hashimoto Masahiro, Nakahara Tadaki, Okuda Shigeo, Nakatsuka Seishi, Sano Fumiya, Abe Takayuki, Maekawa Yuichiro, Fukuda Keiichi, Jinzaki Masahiro

International Journal of Cardiology (International Journal of Cardiology)  243   538 - 543 2016.12

Accepted,  ISSN  0167-5273

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

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Role of Sonography for Evaluation of Gastrointestinal Foreign Bodies

Hosokawa, Takahiro, Yamada, Yoshitake, Sato, Yumiko, Tanami, Yutaka, Nanbu, Ryosuke, Hagiwara, Shin-Ichiro, Oguma, Eiji

JOURNAL OF ULTRASOUND IN MEDICINE (Journal of Ultrasound in Medicine)  35 ( 12 ) 2723 - 2732 2016.12

Research paper (scientific journal), Accepted,  ISSN  0278-4297

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©2016 by the American Institute of Ultrasound in Medicine. Foreign body ingestion is frequently encountered in children. The locations of the foreign bodies and the period during which they have been present in the thorax and abdomen are important for determining the method and timing of treatment. Although plain radiography and computed tomography are primarily used for assessment of foreign bodies, sonography without radiation is also useful for diagnosis of foreign bodies. This report describes 5 cases of foreign bodies in the digestive tract and the usefulness of sonography for real-time evaluation of foreign bodies with high spatial resolution. Physicians can use sonography along with radiography and computed tomography in cases involving foreign bodies.

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Subperiosteal new bone and callus formations in neonates with femoral shaft fracture at birth

Hosokawa Takahiro, Yamada Yoshitake, Sato Yumiko, Tanami Yutaka, Oguma Eiji

Emergency Radiology (Springer New York LLC)  24 ( 2 ) 1 - 6 2016.11

Accepted,  ISSN  1070-3004

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<p>To compare the timing of subperiosteal new bone formation (SPNBF) and callus formation in femoral shaft fractures that occurred at birth between neonates with and without an underlying disease, we retrospectively evaluated the radiographs of 12 neonates with femoral fractures on birth day. Seven had no underlying disease, 3 had osteogenesis imperfecta, 1 had myotonic dystrophy, and 1 had arthrogryposis. We evaluated the timing of initial SPNBF/soft callus/hard callus formation. In neonates without an underlying disease, SPNBF and callus formation were not detected by day 6 on radiographs; SPNBF/soft callus/hard callus formation was first observed at day 14.29 ± 5.35/15.85 ± 4.49/21.43 ± 5.41, respectively (range 9–23/10–23/16–32). The three neonates with osteogenesis imperfecta had SPNBF/soft callus/hard callus formation on day 0/0/0, which was significantly earlier than in neonates without an underlying disease (all P = 0.017). In the neonate with myotonic dystrophy, SPNBF/soft callus/hard callus formation was first seen by day 14/14/14 and was first seen by day 20/43/68 in the neonate with arthrogryposis. In our restricted cohort, all neonates with femoral shaft fractures from birth trauma without an underlying disease showed SPNBF and soft callus formation by day 23. If SPNBF or callus formation is detected within 6 days, an underlying disease (e.g., osteogenesis imperfecta) may be considered. If these are not detected by day 23, injury after birth or other underlying diseases may be considered.</p>

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Impact of underfilling and overfilling in balloon-expandable transcatheter aortic valve implantation assessed by multidetector computed tomography

Yashima Fumiaki, Yamamoto Masanori, Watanabe Yusuke, Takagi Kensuke, Yamada Yoshitake, Inohara Taku, Yanagisawa Ryo, Tanaka Makoto, Arai Takahide, Shimizu Hideyuki, Jinzaki Masahiro, Kozuma Ken, Fukuda Keiichi, Suzuki Takahiko, Hayashida Kentaro

International Journal of Cardiology (International Journal of Cardiology)  222   738 - 744 2016.11

Accepted,  ISSN  0167-5273

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<p>Background Underfilling or overfilling of balloon-expandable transcatheter heart valves (THVs) during transcatheter aortic valve implantation (TAVI) is commonly used to improve conformity to small or calcified annuli in order to avoid serious complications. However, little is known about this technique. This study assessed the effects of underfilling and overfilling of THVs. Methods and results Data from 213 consecutive TAVI patients treated with balloon-expandable THVs in 4 Japanese centers between October 2013 and December 2014 were prospectively analyzed; 23-mm and 26-mm THVs were implanted in 96 cases (56 underfilling, 22 nominal filling, and 18 overfilling) and 38 cases (23 underfilling and 15 nominal filling), respectively. Pre/postprocedural multidetector computed tomography (MDCT) and echocardiographic data were compared. MDCT revealed that the minimum area of the underfilled 23-mm THVs was significantly decreased compared to that of nominal filled and overfilled THVs (308.3 SD 26.1 vs. 333.9 SD 14.7 vs. 347.8 SD 21.3 mm², respectively, p 2, respectively, p = 0.0004). The postprocedural transvalvular gradient of underfilled 23-mm THVs was significantly higher than that of nominal filled and overfilled THVs, while there were no differences for 26-mm THVs. Conclusions Underfilling or overfilling of THVs is safe and feasible, conforming to the original annulus and covering a continuous range of annular sizes with limited THV size options. However, care should be taken when underfilling 23-mm THVs due to the potential for increased transvalvular gradient.</p>

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【Multislice CT 2016 BOOK】臨床　面検出器CT　慢性血栓塞栓性肺高血圧症の診断・治療におけるMultislice CTの役割　Lung Subtraction法を中心に

田村 全, 山田 祥岳, 杉浦 弘明, 川上 崇史, 陣崎 雅弘

映像情報Medical (産業開発機構(株))  48 ( 10 ) 65 - 71 2016.09

ISSN  1346-1354

Postnatal sellar spine growth

Hosokawa Takahiro, Yamada Yoshitake, Sato Yumiko, Tanami Yutaka, Kurihara Jun, Oguma Eiji

Medicine (United States) (Medicine (United States))  95 ( 33 ) e4579 2016.08

Accepted,  ISSN  0025-7974

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<p>Background: A sellar spine is a bony spur protruding anteriorly from the central portion of the dorsum sellae. Its etiology is an ossified notochordal remnant of the cephalic end of the notochord. It is presumed to be a congenital malformation based on magnetic resonance imaging (MRI) findings of sellar spine in a 4-year-old boy. A sellar spine should therefore be detectable at birth with or without ossification, and the posterior pituitary lobe should be displaced. Methods and Results: Here we review the literature and report the first case of typical sellar spine in an 8-year-old girl who presented with precocious puberty, but her MRI taken at age 4 months for a febrile convulsion did not show a sellar spine or posterior pituitary lobe deformation. T1-weighted sagittal images at 8 years old showed a bony structure protruding anteriorly from the central portion of the dorsum sellae. The length of this lesion was 3.8 mm on computed tomography (CT) scanning at 9 years old, and it elongated to 4.7 mm on CT at 12 years old. Conclusions: Based on the present case, we speculate that the sellar spine would be too small to detect early in development and would grow in size after birth. In this case, a sellar spine and precocious puberty were potentially associated due to deformation of the growing pituitary gland.</p>

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Clinical efficacy and safety of multidrug therapy including thrice weekly intravenous amikacin administration for Mycobacterium abscessus pulmonary disease in outpatient settings: a case series

Namkoong, Ho, Morimoto, Kozo, Nishimura, Tomoyasu, Tanaka, Hiromu, Sugiura, Hiroaki, Yamada, Yoshitake, Kurosaki, Atsuko, Asakura, Takanori, Suzuki, Shoji, Fujiwara, Hiroshi, Yagi, Kazuma, Ishii, Makoto, Tasaka, Sadatomo, Betsuyaku, Tomoko, Hoshino, Yoshihiko, Kurashima, Atsuyuki, Hasegawa, Naoki

BMC INFECTIOUS DISEASES (BMC Infectious Diseases)  16 ( 1 ) 738 - 744 2016.08

Research paper (scientific journal), Accepted,  ISSN  1471-2334

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© 2016 Namkoong et al. Background: Mycobacterium abscessus (M. abscessus) pulmonary disease is a refractory chronic infectious disease. Options for treating M. abscessus pulmonary disease are limited, especially in outpatient settings. Among parenteral antibiotics against M. abscessus, intravenous amikacin (AMK) is expected to be an effective outpatient antimicrobial therapy. This study evaluated the clinical efficacy and safety of intravenous AMK therapy in outpatients with M. abscessus pulmonary disease. Methods: This retrospective chart review of cases of M. abscessus pulmonary disease evaluated patient background data, AMK dosage and duration, sputum conversion, clinical symptoms radiological findings, and adverse events. M. massiliense was excluded on the basis of multiplex PCR assay. Results: Thirteen patients (2 men and 11 women) with M. abscessus pulmonary disease were enrolled at 2 hospitals. The median age at the initiation of intravenous AMK treatment was 65 years (range: 50-86 years). Patients received a median AMK dose of 12.5 mg/kg (range: 8.3-16.2 mg/kg) for a median duration of 4 months (range: 3-9 months). The addition of intravenous AMK led to sputum conversion in 10 of 13 patients, and 8 patients continued to have negative sputum status 1 year after treatment. Approximately half of the patients showed improvement on chest high-resolution computed tomography. There were no severe adverse events such as ototoxicity, vestibular toxicity, and renal toxicity. Conclusions: Thrice weekly intravenous AMK administration in outpatient settings is effective and safe for patients with M. abscessus pulmonary disease.

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The significance of early screening with echocardiography in eosinophilic granulomatosis with polyangiitis

Tsugu Toshimitsu, Nagatomo Yuji, Yamada Yoshitake, Mahara Keitaro, Miura Hiroshi, Murata Mitsushige

Journal of Medical Ultrasonics (Journal of Medical Ultrasonics)  43 ( 4 ) 1 - 5 2016.07

Accepted,  ISSN  1346-4523

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<p>Löffler endocarditis is a serious complication of idiopathic hypereosinophilic syndrome characterized by a peculiar type of fibrosing endocarditis. It results in heart failure due to restrictive cardiomyopathy and systemic embolism due to intracardiac thrombus. Here we present a case of a 57-year-old man with Löffler endocarditis concomitant with eosinophilic granulomatosis with polyangiitis. A thrombus in the left ventricular apex was noted on transthoracic echocardiography performed as a screening of left ventricular dilatation, which seemed to be a typical finding of Löffler endocarditis. But there were no findings that indicated restrictive cardiomyopathy. He was diagnosed with Löffler endocarditis at the thrombotic stage and was given methylprednisolone. The thrombus got markedly smaller within 1 month after initiation of the medical treatment. He has been doing well for more than 2 years since then without eosinophilia or left ventricular thrombosis. In the present case, we could successfully detect the thrombus in the left ventricular apex with echocardiography before the occurrence of embolism and provide early medical treatment. Early detection and initiation of medical treatment are extremely important to treat this unusual but often life-threatening condition because methylprednisolone is effective in the necrotic stage and thrombotic stage.</p>

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

Tsukada Jitsuro, Yamada Minoru, Yamada Yoshitake, Yamazaki Shun, Imanishi Nobuaki, Tamura Kentaro, Hashimoto Masahiro, Nakatsuka Seishi, Jinzaki Masahiro

Medicine (United States) (Medicine (United States))  95 ( 27 ) e4127 2016.07

Accepted,  ISSN  0025-7974

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

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精巣若年性顆粒膜細胞腫の1例

中村 幹夫, 大熊 潔, 山田 祥岳, 橋本 正弘, 陣崎 雅弘, 星野 健

Japanese Journal of Radiology ((公社)日本医学放射線学会)  34 ( Suppl. ) 22 - 22 2016.02

ISSN  1867-1071

Under-developed bronchial arteries as a risk factor for complications in balloon pulmonary angioplasty

Takei, Makoto, Kataoka, Masaharu, Kawakami, Takashi, Yamada, Yoshitake, Yamada, Minoru, Fukuda, Keiichi

INTERNATIONAL JOURNAL OF CARDIOLOGY 203   1016 - 1017 2016.01

Research paper (scientific journal),  ISSN  0167-5273

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Under-developed bronchial arteries as a risk factor for complications in balloon pulmonary angioplasty

Takei, Makoto, Kataoka, Masaharu, Kawakami, Takashi, Yamada, Yoshitake, Yamada, Minoru, Fukuda, Keiichi

INTERNATIONAL JOURNAL OF CARDIOLOGY 203   1016 - 1017 2016.01

Research paper (scientific journal),  ISSN  0167-5273

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

Shiraishi, Yutaka, Yamada, Yoshitake, Tanaka, Tomoki, Eriguchi, Takahisa, Nishimura, Shuichi, Yoshida, Kayo, Hanada, Takashi, Ohashi, Toshio, Shigematsu, Naoyuki, Jinzaki, Masahiro

BRACHYTHERAPY (Brachytherapy)  15 ( 6 ) 768 - 773 2016.01

Research paper (scientific journal), Accepted,  ISSN  1538-4721

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© 2016 American Brachytherapy Society Purpose To evaluate the effectiveness of the single-energy metal artifact reduction (SEMAR) technique for improving the accuracy of I-125 seed identification in postimplant computed tomography (CT) after prostate brachytherapy. Methods and Materials Postimplant CT images of 40 patients treated with I-125 prostate brachytherapy were acquired. For all patients, 2 data sets were reconstructed, 1 with SEMAR algorithms (SEMAR image), and the other without SEMAR algorithms (non-SEMAR image). Seed locations are automatically detected by the automatic seed finder tool, and their locations were compared between the SEMAR and non-SEMAR images. Dosimetric parameters using seed locations as detected were compared. Results The true-positive fraction of properly detected seeds on the SEMAR image as determined from a reference seed distribution defined by one investigator was significantly higher than the true-positive fraction on the non-SEMAR image (p = 0.011). The variabilities in D90 (p = 0.001), V100 (p = 0.007), and V150 (p = 0.007) were significantly reduced for seed location on the SEMAR image as compared with non-SEMAR image. Conclusions Prostate postimplant CT with SEMAR improved the accuracy of seed localization and postimplant dosimetric parameters.

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

Yuichiro Maekawa, Keitaro Akita, Hikaru Tsuruta, Yoshitake Yamada, Kentaro Hayashida, Shinsuke Yuasa, Mitsushige Murata, Masahiro Jinzaki, Keiichi Fukuda

Open heart (Open Heart)  3 ( 1 ) e000359 2016

Accepted,  ISSN  2053-3624

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OBJECTIVE: In patients with hypertrophic obstructive cardiomyopathy (HOCM), left atrial (LA) volume measurement is very important to provide prognostic information. Recent studies demonstrated that multidetector CT (MDCT) is useful to assess the changes in LA volume. Our aim was to examine the utility of a follow-up cardiac MDCT for long-term evaluation of the effect of percutaneous transluminal septal myocardial ablation (PTSMA) on LA volume. METHODS: We studied a consecutive cohort of 20 patients with drug-refractory symptomatic HOCM after PTSMA. We evaluated LA volume analyses with cardiac MDCT on patients who underwent PTSMA as compared to echocardiography. RESULTS: Before PTSMA, 75% of all patients had heart failure-associated symptoms in the New York Heart Association functional class III/IV. All patients experienced relief from heart failure-associated symptoms after PTSMA. Cardiac MDCT showed significant reduction in the index of maximum LA volume during follow-up compared to before PTSMA in the same way as in echocardiography (93.6±34.1 mL/m(2) vs 82.6±35.3 mL/m(2), p=0.035). A Bland-Altman plot showed small mean differences and limits of agreement in the measurements of the index of maximum LA volume before and after PTSMA between echocardiography and MDCT. CONCLUSIONS: The follow-up cardiac MDCT was a useful tool to evaluate the effectiveness of PTSMA on reduction of LA volume. Cardiac MDCT might provide comparable measurements of the LA volume in patients with drug-refractory symptomatic HOCM before and after PTSMA compared to echocardiography.

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Radiation-dose-lowering effects of landiolol hydrochloride in coronary angiography using computed tomography (DELIGHT)

Kido Teruhito, Mochizuki Teruhito, Hirano Masaharu, Yamada Yoshitake, Tanaka Ryoichi, Kanzaki Suzu, Higashi Masahiro, Jinzaki Masahiro, Yoshioka Kunihiro, Kuribayashi Sachio

Circulation Journal (Circulation Journal)  80 ( 5 ) 1225 - 1231 2016

ISSN  1346-9843

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<p>Background: Controlling and decreasing the heart rate (HR) of patients during coronary computed tomography angiography (CCTA) is necessary to reduce radiation exposure and improve image quality. This prospective multicenter study aimed to investigate whether HR control with landiolol hydrochloride is useful for reducing radiation exposure during CCTA. Methods and Results: We investigated 219 patients with suspected ischemic heart disease whose pretest HRs were 50–80 beats/min. We measured the HR before and after administration of landiolol hydrochloride and compared the estimated exposure inferred from the HR before administration of landiolol hydrochloride with the actual dose. After administration of landiolol hydrochloride, the mean HR (59.9 ± 6.4 beats/min) at the time of CCTA was significantly lower than before administration (69.3 ± 7.3 beats/min; P</p>

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Advance in cardiac CT

Yamada Yoshitake, Matsumoto Shunsuke, Suzuki Tatsuya, Hashimoto Masahiro, Okamura Teppei, Sugiura Hiroaki, Jinzaki Masahiro, Yamada Minoru

Respiration and Circulation 63 ( 12 ) 1199 - 1207 2015.12

ISSN  0452-3458

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

Kawakami Takashi, Kataoka Masaharu, Yamada Yoshitake, Takei Makoto, Yamada Minoru, Jinzaki Masahiro, Fukuda Keiichi

EuroIntervention (EuroPCR)  11 ( 7 ) e1 - e2 2015.11

Accepted,  ISSN  1774-024X

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

Maekawa, Yuichiro, Akita, Keitaro, Tsuruta, Hikaru, Yashima, Fumiaki, Kimura, Mai, Yamada, Yoshitake, Kawakami, Takashi, Kanazawa, Hideaki, Hayashida, Kentaro, Yuasa, Shinsuke, Murata, Mitsushige, Jinzaki, Masahiro, Fukuda, Keiichi

JACC-CARDIOVASCULAR INTERVENTIONS 8 ( 12 ) E201 - E202 2015.10

Research paper (scientific journal),  ISSN  1936-8798

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Lateral cervical sinus: specific sonographic findings in two pediatric cases

Hosokawa, Takahiro, Yamada, Yoshitake, Sato, Yumiko, Tanami, Yutaka, Amano, Hizuru, Fujiogi, Michimasa, Kawashima, Hiroshi, Oguma, Eiji

JOURNAL OF MEDICAL ULTRASONICS (Journal of Medical Ultrasonics)  42 ( 4 ) 595 - 599 2015.10

Research paper (scientific journal), Accepted,  ISSN  1346-4523

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© 2015, The Japan Society of Ultrasonics in Medicine. A lateral cervical sinus, also known as a second pharyngeal or branchial cleft fistula/sinus, occurs when the second pharyngeal arch fails to grow caudally over the third and fourth arches, leaving remnants of the second branchial clefts in contact with the surface of the neck via a narrow canal. This type of sinus is detected on the lateral aspect of the neck directly anterior to the sternocleidomastoid muscle. We report two pediatric cases with lateral cervical sinus, and pathognomonic sonographic findings to confirm the diagnosis. The first case involved a 3-month-old boy with a sinus on the lateral neck and occasional drainage from a cervical sinus opening. Sonography revealed that the sinus tract extended between the external and internal carotid arteries. In case two, a 1-month-old girl presented with a sinus on the lateral neck and signs of acute infection at the site of a pinpoint opening. Sonography revealed an oval-shaped cystic lesion and sinus tract extending between the external and internal carotid arteries. Sonography does not require radiation or sedation for children. The best choice for the first examination for lateral cervical sinus is sonography, rather than CT, MRI, or contrast fistulograms.

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Five neonatal cases of pyriform sinus fistula with cervical cystic lesion: a comparison between sonography and other modalities

Hosokawa, Takahiro, Yamada, Yoshitake, Sato, Yumiko, Tanami, Yutaka, Amano, Hizuru, Fujiogi, Michimasa, Kawashima, Hiroshi, Oguma, Eiji

JOURNAL OF MEDICAL ULTRASONICS (Journal of Medical Ultrasonics)  42 ( 4 ) 579 - 585 2015.10

Research paper (scientific journal), Accepted,  ISSN  1346-4523

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© 2015, The Japan Society of Ultrasonics in Medicine. Pyriform sinus fistulas are an unusual cause of neck cystic lesions in neonates. A definitive diagnosis requires detection of the fistula, which originates from the pyriform sinus and extends to the cystic lesion. Sonography has been reported to be useful for detecting fistulas. However, there have been no reports of neonatal cases in which sonography could detect fistulas not detected by other modalities, such as barium esophagography, computed tomography (CT), or magnetic resonance imaging (MRI). We describe five neonatal patients with pyriform sinus fistula-appearing cervical cystic lesions. All patients were examined by sonography; of these, three patients were also examined by barium esophagography, two by CT, and one by MRI. The fistula was detected by sonography but not CT in one patient and by barium esophagography but not MRI in one. Two patients whose fistulas were detected by sonography had an oval-shaped and relatively small cystic lesion. One patient whose fistula could be detected only by barium esophagography had a relatively large cystic lesion. In two patients, whose fistulas were not detected by sonography or barium esophagography, sonography revealed air bubbles within the cystic lesions, and a pyriform sinus fistula was suspected. Without requiring ionizing radiation, sonography was thus useful in diagnosing pyriform sinus fistula-appearing cervical cystic lesions in neonatal cases. On the other hand, in two patients whose fistulas were not detected by sonography, the shape of the cystic lesion was polygonal or multicystic. In two of three patients with infectious signs, a fistula could not be detected. The shape and size of the cystic lesion and the presence of infectious signs may be important factors for detecting fistulas.

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Potential association between thoracic empyema and collateral bronchial arteries in chronic thromboembolic pulmonary hypertension

Takei Makoto, Kataoka Masaharu, Kawakami Takashi, Yamada Yoshitake, Yamada Minoru, Fukuda Keiichi

Annals of the American Thoracic Society (American Thoracic Society)  12 ( 9 ) 1417 - 1419 2015.09

Accepted,  ISSN  2325-6621

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

Okuda, Shigeo, Yamada, Yoshitake, Tanimoto, Akihiro, Fujita, Jun, Sano, Motoaki, Fukuda, Keiichi, Kuribayashi, Sachio, Jinzaki, Masahiro, Nozaki, Atsushi, Lai, Peng

MAGNETIC RESONANCE IMAGING (Magnetic Resonance Imaging)  33 ( 7 ) 911 - 917 2015.09

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0730-725X

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© 2015 Elsevier Inc. Objective: Three-dimensional cardiac cine imaging has demonstrated promising clinical 1.5-Tesla results; however, its application to 3. T scanners has been limited because of the higher sensitivity to off-resonance artifacts. The aim of this study was to apply 3D cardiac cine imaging during a single breath hold in clinical patients on a 3. T scanner using the kat ARC (k- and adaptive-t auto-calibrating reconstruction for Cartesian sampling) technique and to evaluate the interchangeability between 2D and 3D cine imaging for cardiac functional analysis and detection of abnormalities in regional wall motion. Methods: Following institutional review board approval, we obtained 2D cine images with an acceleration factor of two during multiple breath holds and 3D cine images with a net scan acceleration factor of 7.7 during a single breath hold in 20 patients using a 3. T unit. Two readers independently evaluated the wall motion of the left ventricle (LV) using a 5-point scale, and the consistency in the detection of regional wall motion abnormality between 2D and 3D cine was analyzed by Cohen's kappa test. The LV volume was calculated at end-diastole and end-systole (LVEDV, LVESV); the ejection fraction (LVEF) and myocardial weight (LVmass) were also calculated. The relationship between functional parameters calculated for 2D and 3D cine images was analyzed using Pearson's correlation analysis. The bias and 95% limit of agreement (LA) were calculated using Bland-Altman plots. In addition, a qualitative evaluation of image quality was performed with regard to the myocardium-blood contrast, noise level and boundary definition. Results: Despite slight degradation in image quality for 3D cine, excellent agreement was obtained for the detection of wall motion abnormalities between 2D and 3D cine images (κ. = 0.84 and 0.94 for each reader). Excellent correlations between the two imaging methods were shown for the evaluation of functional parameters (r. >. 0.97). Slight differences in LVEDV, LVESV, LVEF and LVmass were observed, with average values of 1.6. ±. 8.9. mL, - 0.6. ±. 5.9. mL, 1.4. ±. 3.6%, and 1.3. ±. 8.7. g, respectively. Conclusions: Images obtained using the kat ARC 3D and conventional 2D cine techniques were equivalent in the detection of regional wall motion abnormalities and the evaluation of cardiac functional parameters.

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Usefulness of 3D SPECT/CT fusion image in CTEPH

Kawakami, Takashi, Kataoka, Masaharu, Nakahara, Tadaki, Yamada, Yoshitake, Takei, Makoto, Jinzaki, Masahiro, Fukuda, Keiichi

INTERNATIONAL JOURNAL OF CARDIOLOGY (International Journal of Cardiology)  194   39 - 40 2015.09

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0167-5273

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縦隔に隣接し高度な石灰化を示した若年女性の肺腫瘤の1例

堤 啓, 松本 俊亮, 成松 英俊, 浅田 久美子, 山田 祥岳, 杉浦 弘明, 林 雄一郎, 松田 信作, 陣崎 雅弘

日本医学放射線学会秋季臨床大会抄録集 ((公社)日本医学放射線学会)  51回   S537 - S537 2015.09

ISSN  0048-0428

Retroperitoneal low-flow vascular malformations: characteristic MRI findings correlated with histopathological findings

Akita, Hirotaka, Yamada, Yoshitake, Ito, Yoshiaki, Mikami, Shuji, Sugiura, Hiroaki, Okuda, Shigeo, Jinzaki, Masahiro

ABDOMINAL IMAGING (Abdominal Imaging)  40 ( 6 ) 1713 - 1720 2015.08

Research paper (scientific journal), Accepted,  ISSN  0942-8925

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© 2014, Springer Science+Business Media New York. Purpose: To evaluate the MRI findings of retroperitoneal low-flow vascular malformations (RLVMs) correlated with histopathological findings. Methods: Two radiologists reviewed the MRI findings of 4 RLVMs (3 with capillary malformations and 1 with a venous malformation). First, they evaluated the visibility, signal intensities, and signal homogeneity of each lesion on non-fat-suppressed breath-hold T2-weighted single-shot fast spin-echo (non-FS SSFSE) images and fat-suppressed T2-weighted fast spin-echo (FS T2-weighted FSE) images. Second, the kinetic patterns and the internal enhancement patterns were analyzed for each lesion on multi-phasic contrast-enhanced (CE) images. After these image analyses, the MRI findings were correlated with the histopathological findings. Result: Histopathologically, the 4 RLVMs did not exhibit remarkable degeneration and were present in the retroperitoneal fat tissue without clear capsules. On the non-FS SSFSE images, 3 of the 4 RLVMs could not be discriminated from the surrounding retroperitoneal fat tissue (invisible), and the remaining lesion was barely visible with an indistinct margin. On the FS T2-weighted FSE images, however, all the RLVMs were clearly visualized as homogeneous high-signal intensities. On the multi-phasic CE images, all the capillary malformations exhibited fast enhancement, while a venous malformation showed slow enhancement. Furthermore, the RLVMs tended to exhibit a centripetal filling pattern. Conclusion: The RLVMs blended in with the surrounding retroperitoneal fat tissue on non-FS SSFSE images, like phantoms, whereas they were clearly visualized on FS T2-weighted FSE images. On multi-phasic CE images, the RLVMs tended to exhibit a centripetal filling pattern. These imaging features may be useful diagnostic clues for RLVMs.

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CT Dose Reduction for Visceral Adipose Tissue Measurement: Effects of Model-Based and Adaptive Statistical Iterative Reconstructions and Filtered Back Projection

Yamada, Yoshitake, Jinzaki, Masahiro, Niijima, Yuki, Hashimoto, Masahiro, Yamada, Minoru, Abe, Takayuki, Kuribayashi, Sachio

AMERICAN JOURNAL OF ROENTGENOLOGY (American Journal of Roentgenology)  204 ( 6 ) W677 - W683 2015.06

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0361-803X

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© American Roentgen Ray Society. OBJECTIVE. The objective of our study was to evaluate the effects of radiation dose reduction and the reconstruction algorithm used-filtered back projection (FBP), adaptive statistical iterative reconstruction (ASIR), or model-based iterative reconstruction (MBIR)-on the measurement of abdominal visceral fat using CT. SUBJECTS AND METHODS. Standard-dose and low-dose abdominal CT examinations were performed simultaneously with automatic exposure control in 59 patients; the noise index for a 5-mm slice thickness was 12 for routine-dose CT and 24 for low-dose CT. The routine-dose CT images were reconstructed using FBP (reference standard), and the low-dose CT images were reconstructed using FBP, ASIR (so-called hybrid iterative reconstruction [IR]), and MBIR (so-called pure IR). In the 236 image series obtained, the visceral fat area was measured. Data were analyzed by the Pearson correlation coefficient test and a Bland-Altman difference analysis. RESULTS. The radiation dose of the low-dose abdominal CT examinations was 73.0% (mean) lower than that of routine-dose CT examinations. Excellent correlations were observed between the visceral fat areas measured on the routine-dose FBP images and those measured on the low-dose FBP, low-dose ASIR, and low-dose MBIR images (r = 0.998, 0.998, and 0.998, respectively; p < 0.001). A Bland-Altman difference analysis revealed excellent agreements, with mean biases of-0.47,-0.41, and 0.18 cm2 for the visceral fat area between the routine-dose FBP images and the low-dose FBP, low-dose ASIR, and low-dose MBIR images, respectively. CONCLUSION. A 73.0% reduction of the radiation dose would be possible in CT for the measurement of the abdominal visceral fat regardless of which reconstruction algorithm is used (i.e., FBP, hybrid IR, or pure IR).

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Renal Cyst Pseudoenhancement: Intraindividual Comparison Between Virtual Monochromatic Spectral Images and Conventional Polychromatic 120-kVp Images Obtained During the Same CT Examination...

Yamada, Yoshitake, Yamada, Minoru, Sugisawa, Koichi, Akita, Hirotaka, Shiomi, Eisuke, Abe, Takayuki, Okuda, Shigeo, Jinzaki, Masahiro

MEDICINE (Medicine (United States))  94 ( 15 ) e754 2015.04

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0025-7974

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© 2015 Wolters Kluwer Health, Inc. The purpose of this study was to compare renal cyst pseudoenhancement between virtual monochromatic spectral (VMS) and conventional polychromatic 120-kVp images obtained during the same abdominal computed tomography (CT) examination and among images reconstructed using filtered back projection (FBP), adaptive statistical iterative reconstruction (ASIR), and model-based iterative reconstruction (MBIR). Our institutional review board approved this prospective study; each participant provided written informed consent. Thirty-one patients (19 men, 12 women; age range, 59-85 years; mean age, 73.2±5.5 years) with renal cysts underwent unenhanced 120-kVp CT followed by sequential fast kVp-switching dual-energy (80/140kVp) and 120-kVp abdominal enhanced CT in the nephrographic phase over a 10-cm scan length with a random acquisition order and 4.5-second intervals. Fifty-one renal cysts (maximal diameter, 18.0±14.7mm [range, 4-61mm]) were identified. The CT attenuation values of the cysts as well as of the kidneys were measured on the unenhanced images, enhanced VMS images (at 70keV) reconstructed using FBP and ASIR from dual-energy data, and enhanced 120-kVp images reconstructed using FBP, ASIR, and MBIR. The results were analyzed using the mixed-effects model and paired t test with Bonferroni correction. The attenuation increases (pseudoenhancement) of the renal cysts on the VMS images reconstructed using FBP/ASIR (least square mean, 5.0/6.0Hounsfield units [HU]; 95% confidence interval, 2.6-7.4/3.6-8.4HU) were significantly lower than those on the conventional 120-kVp images reconstructed using FBP/ASIR/MBIR (least square mean, 12.1/12.8/11.8HU; 95% confidence interval, 9.8-14.5/10.4-15.1/9.4-14.2HU) (all P<.001); on the other hand, the CT attenuation values of the kidneys on the VMS images were comparable to those on the 120-kVp images. Regardless of the reconstruction algorithm, 70-keV VMS images showed a lower degree of pseudoenhancement of renal cysts than 120-kVp images, while maintaining kidney contrast enhancement comparable to that on 120-kVp images.

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Evaluation of velopharyngeal closure by 4D imaging using 320-detector-row computed tomography

Sakamoto, Yoshiaki, Soga, Shigeyoshi, Jinzaki, Masahiro, Yamada, Yoshitake, Ogata, Hisao, Kishi, Kazuo

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY (Journal of Plastic, Reconstructive and Aesthetic Surgery)  68 ( 4 ) 479 - 484 2015.03

Research paper (scientific journal), Joint Work, Accepted,  ISSN  1748-6815

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© 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved. Objective Current imaging techniques for velopharyngeal closure (VPC) evaluation are two-dimensional, static, or distressing, thus necessitating multiple procedures to understand this three-dimensional and dynamic area. We validated the use of a novel four-dimensional (4D) computed tomography (CT) technique for the morphological and kinematic evaluation of VPC in cleft palate patients based on dynamic volume scanning with 320-detector-row CT. Methods Five patients aged 4-10 years (40% males) with persistent velopharyngeal insufficiency post palatoplasty underwent conventional tests (cephalometry and video-nasal endoscopy) and 4D-CT. For each patient, complete multiplanar reconstruction, 4D airway CT, and 4D-CT endoscopy data for all scanning phases were compared with cephalometric and video-nasal endoscopy data. The movements of the velum and posterior pharyngeal walls were graded by each modality. Results 4D airway CT revealed higher anatomical detail than cephalometry, additionally providing dynamic images. 4D-CT endoscopy and video-nasal endoscopy were in agreement for all patients regarding the patterns of VPC, with complete visualization of VPC in five versus one patient, respectively. 4D airway CT and cephalometry showed a discrepancy in one case, wherein grading by cephalometry was overestimated. 4D-CT was also useful in determining the width and length of a proposed pharyngeal flap. The examination time (mean ± standard deviation (SD), seconds), including patient preparation time, was 224 ± 73, 492 ± 145, and 718 ± 123 for cephalometric radiographs, CT, and video-nasal endoscopy, respectively. The mean estimated radiation dose during 4D-CT was 4.44 ± 1.64 mSv. Conclusions 4D-CT provides detailed morphological and kinematic analysis of VPC and may offer advantages over conventional procedures.

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Improved renal function in a patient with hypertrophic obstructive cardiomyopathy after multidetector computed tomography-guided percutaneous transluminal septal myocardial ablation

Maekawa, Yuichiro, Jinzaki, Masahiro, Tsuruta, Hikaru, Akita, Keitaro, Yamada, Yoshitake, Kawakami, Takashi, Hayashida, Kentaro, Yuasa, Shinsuke, Murata, Mitsushige, Fukuda, Keiichi

INTERNATIONAL JOURNAL OF CARDIOLOGY (International Journal of Cardiology)  181   349 - 350 2015.02

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0167-5273

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Adventitial CXCL1/G-CSF Expression in Response to Acute Aortic Dissection Triggers Local Neutrophil Recruitment and Activation Leading to Aortic Rupture

Anzai, Atsushi, Shimoda, Masayuki, Endo, Jin, Kohno, Takashi, Katsumata, Yoshinori, Matsuhashi, Tomohiro, Yamamoto, Tsunehisa, Ito, Kentaro, Yan, Xiaoxiang, Shirakawa, Kosuke, Shimizu-Hirota, Ryoko, Yamada, Yoshitake, Ueha, Satoshi, Shinmura, Ken, Okada, Yasunori, Fukuda, Keiichi, Sano, Motoaki

CIRCULATION RESEARCH (Circulation Research)  116 ( 4 ) 612 - U138 2015.02

Research paper (scientific journal), Joint Work,  ISSN  0009-7330

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© 2015 American Heart Association, Inc. Rationale: In-hospital outcomes are generally acceptable in patients with type B dissection; however, some patients present with undesirable complications, such as aortic expansion and rupture. Excessive inflammation is an independent predictor of adverse clinical outcomes. Objective: We have investigated the underlying mechanisms of catastrophic complications after acute aortic dissection (AAD) in mice. Methods and Results: When angiotensin II was administered in lysyl oxidase inhibitor-preconditioned mice, AAD emerged within 24 hours. The dissection was initiated at the proximal site of the descending thoracic aorta and propagated distally into an abdominal site. Dissection of the aorta caused dilatation, and ≈70% of the mice died of aortic rupture. AAD triggered CXCL1 and granulocyte-colony stimulating factor expression in the tunica adventitia of the dissected aorta, leading to elevation of circulating CXCL1/granulocyte-colony stimulating factor levels. Bone marrow CXCL12 was reduced. These chemokine changes facilitated neutrophil egress from bone marrow and infiltration into the aortic adventitia. Interference of CXCL1 function using an anti-CXCR2 antibody reduced neutrophil accumulation and limited aortic rupture post AAD. The tunica adventitia of the expanded dissected aorta demonstrated high levels of interleukin-6 (IL-6) expression. Neutrophils were the major sources of IL-6, and CXCR2 neutralization significantly reduced local and systemic levels of IL-6. Furthermore, disruption of IL-6 effectively suppressed dilatation and rupture of the dissected aorta without any influence on the incidence of AAD and neutrophil mobilization. Conclusions: Adventitial CXCL1/granulocyte-colony stimulating factor expression in response to AAD triggers local neutrophil recruitment and activation. This leads to adventitial inflammation via IL-6 and results in aortic expansion and rupture.

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Thrombus in acute aortic dissection with atrial fibrillation: a treatment dilemma

Shiraishi, Yasuyuki, Kohno, Takashi, Egashira, Toru, Maekawa, Yuichiro, Yamada, Yoshitake, Yoshitake, Akihiro, Shimizu, Hideyuki, Sano, Motoaki, Jinzaki, Masahiro, Fukuda, Keiichi

AMERICAN JOURNAL OF EMERGENCY MEDICINE (American Journal of Emergency Medicine)  33 ( 2 ) 292 - 298 2015.02

Research paper (scientific journal), Accepted,  ISSN  0735-6757

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© 2014 Elsevier Inc. All rights reserved. Type B acute aortic dissection (AAD) is often successfully managed with medical therapy, with a lower mortality rate, compared with type A AAD. Although the number of AAD patients complicated with atrial fibrillation (AF) has increased, reflecting an aging society, there have only been a few reports regarding the association of AAD and AF. Furthermore, there is no consensus on anticoagulation therapy in ADD patients complicated with AF, despite the importance of anticoagulation therapy in AF treatment. Here, we discuss a 79-year-old man with type B AAD and chronic AF complicated with the rapid left atrial appendage (LAA) thrombus formation after discontinuation of anticoagulation therapy. Emergent contrast-enhanced computed tomography revealed type B AAD with a partially thrombosed false lumen from the bifurcation of the aorta and the left subclavian artery to above the diaphragm. Ulcer-like projection was observed in the proximal thrombosed false lumen. Ten days after discontinuation of anticoagulation therapy, LAA thrombus was detected on contrast-enhanced computed tomography, which was not observed on admission. After anticoagulation therapy was resumed, the LAA thrombus disappeared, but the partially thrombosed false lumen was enlarged. The second discontinuation of anticoagulation therapy stabilized the dissected aorta and did not cause recurrence of LAA thrombus. In conclusion, clinicians need to balance the prevention of LAA thrombus formation with the complete thrombosis of a false lumen in patients with AAD and AF.

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Abdominal CT: An intra-individual comparison between virtual monochromatic spectral and polychromatic 120-kVp images obtained during the same examination

Yamada, Yoshitake, Jinzaki, Masahiro, Hosokawa, Takahiro, Tanami, Yutaka, Abe, Takayuki, Kuribayashi, Sachio

EUROPEAN JOURNAL OF RADIOLOGY (European Journal of Radiology)  83 ( 10 ) 1715 - 1722 2014.10

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0720-048X

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Objectives To compare quantitative and subjective image quality between virtual monochromatic spectral (VMS) and conventional polychromatic 120-kVp imaging performed during the same abdominal computed tomography (CT) examination. Materials and methods Our institutional review board approved this prospective study; each participant provided written informed consent. 51 patients underwent sequential fast kVp-switching dual-energy (80/140 kVp, volume CT dose index: 12.7 mGy) and single-energy (120-kVp, 12.7 mGy) abdominal enhanced CT over an 8 cm scan length with a random acquisition order and a 4.3-s interval. VMS images with filtered back projection (VMS-FBP) and adaptive statistical iterative reconstruction (so-called hybrid IR) (VMS-ASIR) (at 70 keV), as well as 120-kVp images with FBP (120-kVp-FBP) and ASIR (120-kVp-ASIR), were generated from dual-energy and single-energy CT data, respectively. The objective image noises, signal-to-noise ratios and contrast-to-noise ratios of the liver, kidney, pancreas, spleen, portal vein and aorta, and the lesion-to-liver and lesion-to-kidney contrast-to-noise ratios were measured. Two radiologists independently and blindly assessed the subjective image quality. The results were analyzed using the paired t-test, Wilcoxon signed rank sum test and mixed-effects model with Bonferroni correction. Results VMS-ASIR images were superior to 120-kVp-FBP, 120-kVp-ASIR and VMS-FBP images for all the quantitative assessments and the subjective overall image quality (all P < 0.001), while VMS-FBP images were superior to 120-kVp-FBP and 120-kVp-ASIR images (all P < 0.004). Conclusions VMS images at 70 keV have a higher image quality than 120-kVp images, regardless of the application of hybrid IR. Hybrid IR can further improve the image quality of VMS imaging. © 2014 Elsevier Ireland Ltd.

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Successful second attempt multidetector computed tomography-guided percutaneous transluminal septal myocardial ablation for an octogenarian with hypertrophic obstructive cardiomyopathy

Maekawa, Yuichiro, Jinzaki, Masahiro, Anzai, Atsushi, Tsuruta, Hikaru, Matsumura, Keisuke, Yamada, Yoshitake, Tabei, Ryota, Kawakami, Takashi, Hayashida, Kentaro, Yuasa, Shinsuke, Murata, Mitsushige, Suzuki, Masahiro, Kuribayashi, Sachio, Fukuda, Keiichi

INTERNATIONAL JOURNAL OF CARDIOLOGY (International Journal of Cardiology)  176 ( 3 ) E131 - E132 2014.10

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0167-5273

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Successful aortic root replacement and shunt closure in a case with rare coexistence of congenital cardiac malformations: bicuspid aortic valve with annuloaortic ectasia, single coronary artery, and patent foramen ovale

Egashira, Toru, Shimizu, Hideyuki, Yamada, Yoshitake, Fukuda, Keiichi

INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING (International Journal of Cardiovascular Imaging)  30 ( 7 ) 1267 - 1268 2014.10

Research paper (scientific journal), Joint Work, Accepted,  ISSN  1569-5794

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© 2014, Springer Science+Business Media Dordrecht. This is the first report of rare simultaneous complication of three cardiac malformations: bicuspid aortic valve with annuloaortic ectasia, single coronary artery, and patent foramen ovale. We successfully operated to replace the aortic valve and ascending aorta, and to close the patent foramen ovale.

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Coexistence of two distinct fascinating cardiovascular disorders: Heterotaxy syndrome with left ventricular non-compaction and vasospastic angina

Egashira, Toru, Yuasa, Shinsuke, Kimura, Mai, Sawano, Mitsuaki, Anzai, Atsushi, Hayashida, Kentaro, Kawamura, Akio, Kimura, Takehiro, Nishiyama, Nobuhiro, Aizawa, Yoshiyasu, Takatsuki, Seiji, Tsuruta, Hikaru, Murata, Mitsushige, Yamada, Yoshitake, Kohno, Takashi, Maekawa, Yuichiro, Sano, Motoaki, Kosaki, Kenjiro, Fukuda, Keiichi

INTERNATIONAL JOURNAL OF CARDIOLOGY (International Journal of Cardiology)  174 ( 2 ) E54 - E56 2014.06

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0167-5273

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Multidetector computed tomography-guided percutaneous transluminal septal myocardial ablation in a Noonan syndrome patient with hypertrophic obstructive cardiomyopathy

Maekawa, Yuichiro, Jinzaki, Masahiro, Tsuruta, Hikaru, Yamada, Yoshitake, Kishino, Yoshikazu, Kawakami, Takashi, Hayashida, Kentaro, Yuasa, Shinsuke, Murata, Mitsushige, Kawamura, Akio, Sano, Motoaki, Kuribayashi, Sachio, Fukuda, Keiichi

INTERNATIONAL JOURNAL OF CARDIOLOGY (International Journal of Cardiology)  172 ( 1 ) E76 - E78 2014.03

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0167-5273

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Feasibility of coronary artery calcium scoring on virtual unenhanced images derived from single-source fast kVp-switching dual-energy coronary CT angiography

Yamada, Yoshitake, Jinzaki, Masahiro, Okamura, Teppei, Yamada, Minoru, Tanami, Yutaka, Abe, Takayuki, Kuribayashi, Sachio

JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY (Journal of Cardiovascular Computed Tomography)  8 ( 5 ) 391 - 400 2014.01

Research paper (scientific journal), Joint Work, Accepted,  ISSN  1934-5925

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© 2014 Society of Cardiovascular Computed Tomography. Background: Dual-energy CT technology enables acquisition of virtual unenhanced (VUE) images from contrast-enhanced scans. Objective: To assess the feasibility of coronary artery calcium (CAC) scoring on VUE images derived from fast kVp-switching dual-energy coronary CT angiography. Methods: Twenty-seven patients underwent true noncontrast CAC-scoring CT followed by routine single-energy (120-kVp) and fast kVp-switching dual-energy coronary CT angiography, in a random acquisition order on the same day. We calculated the CAC scores on true noncontrast and VUE images. The image noises and the signal-to-noise and contrast-to-noise ratios of the aorta and coronary arteries were measured on both the single-energy coronary CT angiography images and dual-energy coronary CT angiography images (70 keV virtual monochromatic spectral images). The Pearson correlation coefficient test and paired t test were used for statistical analysis. Results: Excellent correlation was observed between the CAC scores on the true noncontrast and those on the VUE images (. r = 0.88; P <001). Compared with single-energy coronary CT angiography, dual-energy coronary CT angiography showed significantly reduced image noise and increased signal-to-noise and contrast-to-noise ratios in all regions (all P <001). The effective dose of dual-energy coronary CT angiography (4.3 ± 0.3 mSv) was significantly lower than that of true noncontrast CAC-scoring CT plus single-energy coronary CT angiography (5.4 ± 0.7 mSv; P <0001). Conclusions: Excellent correlation was observed between the CAC scores on the VUE images and true noncontrast images. Thus, fast kVp-switching dual-energy coronary CT angiography could allow prediction of the true CAC scores, potentially reducing the total radiation exposure and image acquisition time by obviating the need for true noncontrast CAC-scoring CT.

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Tomosynthesis for the early detection of pulmonary emphysema: diagnostic performance compared with chest radiography, using multidetector computed tomography as reference

Yamada, Yoshitake, Jinzaki, Masahiro, Hashimoto, Masahiro, Shiomi, Eisuke, Abe, Takayuki, Kuribayashi, Sachio, Ogawa, Kenji

EUROPEAN RADIOLOGY (European Radiology)  23 ( 8 ) 2118 - 2126 2013.08

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0938-7994

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Objectives: To compare the diagnostic performance of tomosynthesis with that of chest radiography for the detection of pulmonary emphysema, using multidetector computed tomography (MDCT) as reference. Methods: Forty-eight patients with and 63 without pulmonary emphysema underwent chest MDCT, tomosynthesis and radiography on the same day. Two blinded radiologists independently evaluated the tomosynthesis images and radiographs for the presence of pulmonary emphysema. Axial and coronal MDCT images served as the reference standard and the percentage lung volume with attenuation values of -950 HU or lower (LAA-950) was evaluated to determine the extent of emphysema. Receiver-operating characteristic (ROC) analysis and generalised estimating equations model were used. Results: ROC analysis revealed significantly better performance (P < 0.0001) of tomosynthesis than radiography for the detection of pulmonary emphysema. The average sensitivity, specificity, positive predictive value and negative predictive value of tomosynthesis were 0.875, 0.968, 0.955 and 0.910, respectively, whereas the values for radiography were 0.479, 0.913, 0.815 and 0.697, respectively. For both tomosynthesis and radiography, the sensitivity increased with increasing LAA-950. Conclusions: The diagnostic performance of tomosynthesis was significantly superior to that of radiography for the detection of pulmonary emphysema. In both tomosynthesis and radiography, the sensitivity was affected by the LAA-950. Key Points: • Tomosynthesis showed significantly better diagnostic performance for pulmonary emphysema than radiography. • Interobserver agreement for tomosynthesis was significantly higher than that for radiography. • Sensitivity increased with increasing LAA -950 in both tomosynthesis and radiography. • Tomosynthesis imparts a similar radiation dose to two projection chest radiography. • Radiation dose and cost of tomosynthesis are lower than those of MDCT. © 2013 European Society of Radiology.

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Computed Tomography Multispectral Imaging

(CRC Press)     563 - 572 2013

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Dose reduction in chest CT: Comparison of the adaptive iterative dose reduction 3D, adaptive iterative dose reduction, and filtered back projection reconstruction techniques

Yamada, Yoshitake, Jinzaki, Masahiro, Hosokawa, Takahiro, Tanami, Yutaka, Sugiura, Hiroaki, Abe, Takayuki, Kuribayashi, Sachio

EUROPEAN JOURNAL OF RADIOLOGY (European Journal of Radiology)  81 ( 12 ) 4185 - 4195 2012.12

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0720-048X

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Objectives: To assess the effectiveness of adaptive iterative dose reduction (AIDR) and AIDR 3D in improving the image quality in low-dose chest CT (LDCT). Materials and methods: Fifty patients underwent standard-dose chest CT (SDCT) and LDCT simultaneously, performed under automatic exposure control with noise index of 19 and 38 (for a 2-mm slice thickness), respectively. The SDCT images were reconstructed with filtered back projection (SDCT-FBP images), and the LDCT images with FBP, AIDR and AIDR 3D (LDCT-FBP, LDCT-AIDR and LDCT-AIDR 3D images, respectively). On all the 200 lung and 200 mediastinal image series, objective image noise and signal-to-noise ratio (SNR) were measured in several regions, and two blinded radiologists independently assessed the subjective image quality. Wilcoxon's signed rank sum test with Bonferroni's correction was used for the statistical analyses. Results: The mean dose reduction in LDCT was 64.2% as compared with the dose in SDCT. LDCT-AIDR 3D images showed significantly reduced objective noise and significantly increased SNR in all regions as compared to the SDCT-FBP, LDCT-FBP and LDCT-AIDR images (all, P ≤ 0.003). In all assessments of the image quality, LDCT-AIDR 3D images were superior to LDCT-AIDR and LDCT-FBP images. The overall diagnostic acceptability of both the lung and mediastinal LDCT-AIDR 3D images was comparable to that of the lung and mediastinal SDCT-FBP images. Conclusions: AIDR 3D is superior to AIDR. Intra-individual comparisons between SDCT and LDCT suggest that AIDR 3D allows a 64.2% reduction of the radiation dose as compared to SDCT, by substantially reducing the objective image noise and increasing the SNR, while maintaining the overall diagnostic acceptability. © 2012 Elsevier Ireland Ltd© 2011 Elsevier Ireland Ltd. All rights reserved.

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Model-Based Iterative Reconstruction Technique for Ultralow-Dose Computed Tomography of the Lung A Pilot Study

Yamada, Yoshitake, Jinzaki, Masahiro, Tanami, Yutaka, Shiomi, Eisuke, Sugiura, Hiroaki, Abe, Takayuki, Kuribayashi, Sachio

INVESTIGATIVE RADIOLOGY (Investigative Radiology)  47 ( 8 ) 482 - 489 2012.08

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0020-9996

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Objectives: The aim of this study was to assess the effectiveness of a model-based iterative reconstruction (MBIR) in improving image quality and diagnostic performance of ultralow-dose computed tomography (ULDCT) of the lung. Materials and Methods: The institutional review board approved this study, and all patients provided written informed consent. Fifty-two patients underwent low-dose computed tomography (LDCT) (screening-dose, 50 mAs) and ULDCT (4 mAs) of the lung simultaneously. The LDCT images were reconstructed with filtered back projection (LDCT-FBP images) and ULDCT images were reconstructed with both MBIR (ULDCT-MBIR images) and FBP (ULDCT-FBP images). On all the 156 image series, objective image noise was measured in the thoracic aorta, and 2 blinded radiologists independently assessed subjective image quality. Another 2 blinded radiologists independently evaluated the ULDCT-MBIR and ULDCT-FBP images for the presence of noncalcified and calcified pulmonary nodules; LDCT-FBP images served as the reference. Paired t test, Wilcoxon signed rank sum test, and free-response receiver-operating characteristic analysis were used for statistical analysis of the data. Results: Compared with LDCT-FBP and ULDCT-FBP, ULDCT-MBIR had significantly reduced objective noise (both P <; 0.001). Subjective noise on the ULDCT-MBIR images was comparable with that on the LDCT-FBP images but lower than that on the ULDCT-FBP images (P <; 0.001). Artifacts on ULDCT-MBIR images were more numerous than those on the LDCT-FBP images (P = 0.007) but fewer than those on the ULDCT-FBP images (P <; 0.001). Compared with the LDCT-FBP images, ULDCT-MBIR and ULDCT-FBP images showed reduced image sharpness (both P <; 0.001). All the ULDCT-MBIR images showed a blotchy pixelated appearance; however, the performance of ULDCT-MBIR was significantly superior to that of ULDCT-FBP for the detection of noncalcified pulmonary nodules (P = 0.002). The average true-positive fractions for significantly sized noncalcified nodules (≈4 mm) and small noncalcified nodules (<4 mm) on the ULDCT-MBIR images were 0.944 and 0.884, respectively, when LDCT-FBP images were used as reference. All of the calcified nodules were detected by both the observers on both the ULDCT-MBIR and ULDCT-FBP images. Conclusion: As compared with FBP, MBIR enables significant reduction of the image noise and artifacts and also better detection of noncalcified pulmonary nodules on ULDCT of the lung. Compared with LDCT-FBP images, ULDCT-MBIR images showed significantly reduced objective noise and comparable subjective image noise. Almost all of the noncalcified nodules and all of the calcified nodules could be detected on the ULDCT-MBIR images, when LDCT-FBP images were used as the reference. © 2012 by Lippincott Williams & Wilkins.

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Prognostic Value of Cardiac Magnetic Resonance Imaging for Idiopathic Pulmonary Arterial Hypertension Before Initiating Intravenous Prostacyclin Therapy

Yamada, Yoshitake, Okuda, Shigeo, Kataoka, Masaharu, Tanimoto, Akihiro, Tamura, Yuichi, Abe, Takayuki, Okamura, Tomonori, Fukuda, Keiichi, Satoh, Toru, Kuribayashi, Sachio

CIRCULATION JOURNAL (Circulation Journal)  76 ( 7 ) 1737 - 1743 2012.07

Research paper (scientific journal), Joint Work,  ISSN  1346-9843

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Background: Because few have reported the prognostic significance of cardiac magnetic resonance imaging (CMR) for idiopathic pulmonary arterial hypertension (IPAH), in this study we evaluated the value of CMR measurements as a prognostic predictor of IPAH before starting intravenous prostacyclin therapy. Methods and Results: A total of 121 consecutive CMR studies for evaluating right ventricular (RV) function were reviewed. Forty-one patients were diagnosed with IPAH and served as the study group. Factors, such as age, sex, New York Heart Association functional class (NYHAFC), 6-min walk test, plasma brain natriuretic peptide level, serum uric acid level and CMR measurements were analyzed as predictors of first hospitalization and death. The mean follow- up period was 1,350±769 days. Nine patients were hospitalized because of heart failure, and 4 patients died from cardiopulmonary causes. The univariate analyses suggested that the left ventricular (LV) mass index, the left and right ventricular end-diastolic volume indices (LVEDVI, RVEDVI), the LV and RV end-systolic volume indices (LVESVI, RVESVI) and NYHAFC predicted the risk for hospitalization and that RVEDVI, RVESVI and NYHAFC predicted mortality. The multivariate analyses suggested that RVEDVI and NYHAFC are independent predictors of both hospitalization and mortality. The effects of RVEDVI and NYHAFC on hospitalization were not substantially affected by the concomitant medication. Conclusions: In IPAH patients, the RVEDVI predicts both hospitalization for right heart failure and mortality before initiating intravenous prostacyclin therapy.

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Virtual Monochromatic Spectral Imaging for the Evaluation of Hypovascular Hepatic Metastases The Optimal Monochromatic Level With Fast Kilovoltage Switching Dual-Energy Computed Tomography

Yamada, Yoshitake, Jinzaki, Masahiro, Tanami, Yutaka, Abe, Takayuki, Kuribayashi, Sachio

INVESTIGATIVE RADIOLOGY (Investigative Radiology)  47 ( 5 ) 292 - 298 2012.05

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0020-9996

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Objectives: The purpose of this study was to select the optimal monochromatic level for virtual monochromatic spectral (VMS) imaging to minimize the image noise of the liver parenchyma and to acquire a high contrast-to-noise ratio (CNR) of hypovascular hepatic metastases in the portal-dominant phase. Materials and Methods: This study was conducted with the approval of our institutional review board, and written informed consent was obtained from all the participating patients. Ninety patients with hepatic metastases were scanned by fast kilovoltage switching dual-energy computed tomography in the portal-dominant phase. One hundred one sets of VMS images in the range of 40 to 140 keV at 1-keV intervals were reconstructed. The image noise of the liver parenchyma in each patient and the CNR of each metastasis (n = 303) were measured on all the 101 VMS image sets. Data were analyzed by the paired t test and mixed-effects model. Bonferroni's method was used for multiple comparisons. Results: The lowest noise of the liver parenchyma was obtained in 6, 15, 31, 29, 7, 1, and 1 patient at 67, 68, 69, 70, 71, 72, and 73 keV, respectively. The mean noise of the liver parenchyma on the 69-keV VMS images in all 90 patients was significantly lower than that on the 67-, 68-, 71-, 72-, and 73-keV VMS images (P < 0.001); however, there was no significant difference in the mean noise of the liver parenchyma between the 69-keV and 70-keV VMS images (P = 0.279). For 95% of the hepatic metastases (288/303 metastases), the highest metastasis-to-liver CNR was obtained in the 66-to 71-keV VMS images. The mean metastasis-to-liver CNR for the 303 metastases was numerically highest at 68 keV; however, there was no significant difference in the mean metastasis-to-liver CNR between the 68-keV and 69-keV images (P = 0.737) or between the 68-keV and 70-keV images (P = 0.103). Conclusions: VMS imaging at approximately 70 keV (69-70 keV) yielded the lowest image noise of the liver parenchyma and a high CNR for hypovascular hepatic metastases in the portal-dominant phase. © 2012 by Lippincott Williams & Wilkins.

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Fast Scanning Tomosynthesis for the Detection of Pulmonary Nodules Diagnostic Performance Compared With Chest Radiography, Using Multidetector-Row Computed Tomography as the Reference

Yamada, Yoshitake, Jinzaki, Masahiro, Hasegawa, Ichiro, Shiomi, Eisuke, Sugiura, Hiroaki, Abe, Takayuki, Sato, Yuji, Kuribayashi, Sachio, Ogawa, Kenji

INVESTIGATIVE RADIOLOGY (Investigative Radiology)  46 ( 8 ) 471 - 477 2011.08

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0020-9996

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Objectives: To evaluate the diagnostic performance of fast scanning tomosynthesis in comparison with that of chest radiography for the detection of pulmonary nodules, using multidetector-row computed tomography (MDCT) as the reference, and to assess the association of the true-positive fraction (TPF) with the size, CT attenuation value, and location of the nodules. Materials and methods: The institutional review board approved this study, and written informed consent was obtained from all patients. Fifty-seven patients with and 59 without pulmonary nodules underwent chest MDCT, fast scanning tomosynthesis, and radiography. The images of tomosynthesis and radiography were randomly read by 3 blinded radiologists; MDCT served as the reference standard. Free-response receiver-operating characteristic (FROC) and receiver-operating characteristic (ROC) analyses, Cochran-Armitage trend or Fisher exact test, a conditional logistic regression model, and McNemar test were used. Results: Both FROC and ROC analyses revealed significantly better performance (P < 0.01) of fast scanning tomosynthesis than radiography for the detection of pulmonary nodules. For fast scanning tomosynthesis, the average TPF and false-positive rate as determined by FROC analysis were 0.80 and 0.10, respectively. For both fast scanning tomosynthesis and radiography, the average TPF increased with increasing nodule size and CT attenuation values, and was lower for subpleural nodules (all P < 0.01). Conclusions: The diagnostic performance of fast scanning tomosynthesis for the detection of pulmonary nodules was significantly superior to that of radiography. The TPF was affected by the size, CT attenuation value, and location of the nodule, in both fast scanning tomosynthesis and radiography. © 2011 Lippincott Williams & Wilkins.

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Adenocarcinoma arising in myometrium: A case report

Yamada Y., Ogawa K., Shiomi E., Masuda H., Aoki R., Yasuda M.

Japanese Journal of Clinical Radiology (Japanese Journal of Clinical Radiology)  55 ( 13 ) 1769 - 1772 2010.12

ISSN  00099252

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There have been a few reports of adenocarcinoma developing in adenomyotic areas without endometrial involvement. We report a case of adenocarcinoma arising in the myometrium, with no involvement of the surface of the endometrium. A 60-year-old woman presented with lower abdominal pain. Pelvic MRI showed a poorly demarcated mass in the myometrium with necrosis or hemorrhage. Histological diagnosis revealed adenocarcinoma. The mass was well circumscribed and localized in the myometrium. The endometrium had normal thickness throughout the cavity. The cervix was normal.

Adenocarcinoma arising in myometrium

Yamada Yoshitake, Ogawa K., Shiomi E., Masuda H., Aoki R., Yasuda M.

Japanese Journal of Clinical Radiology 55 ( 13 ) 1769 - 1772 2010.12

ISSN  0009-9252

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<p>There have been a few reports of adenocarcinoma developing in adenomyotic areas without endometrial involvement. We report a case of adenocarcinoma arising in the myometrium, with no involvement of the surface of the endometrium. A 60-year-old woman presented with lower abdominal pain. Pelvic MRI showed a poorly demarcated mass in the myometrium with necrosis or hemorrhage. Histological diagnosis revealed adenocarcinoma. The mass was well circumscribed and localized in the myometrium. The endometrium had normal thickness throughout the cavity. The cervix was normal.</p>

【泌尿生殖器　最新症例集2010】 子宮筋層からの発生が疑われた腺癌の1例

臨床放射線 55 ( 13 ) 1769 - 1772 2010.12

ISSN  0009-9252

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症例は60歳代女性で、人工妊娠中絶1回、分娩0回、閉経48歳、下腹部痛で受診しCTで子宮腫大を指摘された。約2年後同様に下腹部痛で受診し超音波検査で子宮腫大を指摘された。子宮頸部、体部細胞診陰性で婦人科外来で経過観察となった。9ヵ月後CTで子宮は更に増大し、その後、骨盤腔MRIを施行され、子宮平滑筋腫などの悪性腫瘍が疑われ入院した。血液生化学検査でCEA、CA19-9、CA125はいずれも正常範囲であった。子宮に長径9cm大のT2強調像で内部不均一な信号を呈する腫瘍性病変を認めた。T1強調像で一部高信号で、出血壊死が疑われ、拡散強調像では一部部位が拡散能低下を呈していた。子宮平滑筋腫など悪性腫瘍が疑われ、子宮腺筋症所見は画像上明らかではなかった。腹式子宮全摘・両側付属器切除術を施行した。切除標本では子宮体部に白色調、中心茶褐色、マーブル調の塊状腫瘤が含まれ、肉眼的に子宮頸部は無傷であった。肉眼的に腫瘤と固有内膜との連続性は認めなかった。病理組織所見では腫瘤は高円柱状上皮の融合腺管状、乳頭状増生よりなり、時に紡錘形細胞シート状集簇、充実性、胞巣増生像を伴っていた。間質に異型はなく肉腫、腺肉腫、癌肉腫の像は認めず腺癌の所見であった。病理組織所見上も子宮腺筋症の所見は認めなかった。

Bilateral Rectus Sheath Hematoma Developing During Anticoagulant Therapy

Yamada, Yoshitake, Ogawa, Kenji, Shiomi, Eisuke, Hayashi, Takeharu

CIRCULATION (Circulation)  121 ( 15 ) 1778 - 1779 2010.04

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0009-7322

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Coronary CT angiography; 16 slice CT vs 64 slice CT

Jinzaki Masahiro, Sato K., Tanami M., Kuribayashi Y., Yamada Y.

Japanese Journal of Clinical Radiology 51 ( 1 ) 41 - 44 2006

ISSN  0009-9252

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<p>64-slice CT enabled the improved image quality of patients with high heart rate, the stabilization of heart rate during scan, volume reduction of contrast media, and wider coverage of ECG-gated scan compared with 16-slice CT. These advantages reduce the motion artifact, increase the percentage of assessable segments, and widen its clinical application. However, evaluation of lesions with severe calcification is still the limitation, that needs to be overcome with further technical advancement.</p>

The interdependence and independence of amacrine cell dendrites: patch-clamp recordings and simulation studies on cultured GABAergic amacrine cells

Amane Koizumi, Yuki Hayashida, Teppei Kiuchi, Yoshitake Yamada, Atsunori Fujii, Tetsuya Yagi, Akimichi Kaneko

J Integr Neurosci (3)  4 ( 3 ) 363 - 80 2005.09

Accepted,  ISSN  0219-6352

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Previously we reported that cultured rat GABAergic amacrine cells can evoke subthreshold graded depolarization and action potentials. Both types of electrical signals are thought to contribute to neurotransmitter release from their dendrites, because Ca(2+) channels in amacrine cells can be activated at a subthreshold level (around -50 mV). The aim of the present study is to describe the spatiotemporal pattern of the spread of these electrical signals in an amacrine cell, using a computer simulation study. The simulation is based on physiological data, obtained by dual whole-cell patch-clamp recordings on the soma and the dendrites of cultured rat GABAergic amacrine cells. We determined passive and active properties of amacrine cells from the physiological recordings. Then, using the NEURON simulator, we conducted computer simulations on a reconstructed model of amacrine cells. We show that graded potentials and action potentials spread through amacrine cells with distinct patterns, and discuss the electrical interrelationship among the dendrites of an amacrine cell. Subthreshold graded potentials applied to a distal dendrite were sufficiently localized, so that each dendrite could behave independently (dendritic independence). However, at a suprathreshold level, once action potentials were triggered, they propagated into every dendrite, exciting the entire cell (dendritic interdependence). We also showed that GABAergic inhibitory inputs on the dendrites suppress the dendritic interdependence of amacrine cells. These results suggest that an inhibitory amacrine cell can mediate both local and wide-field lateral inhibition, regulated by the spatiotemporal pattern of excitatory and inhibitory synaptic inputs on its dendrites.

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Functional Roles of Action Potentials and Na Currents in Amacrine Cells

(Springer Japan)  11   55 - 58 2003

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Functional roles of receptors and ion channels in amacrine cells

The Keio Journal of Medicine 51 ( Suppl.1 ) 30 2002.08

ISSN  0022-9717

Propagation of action potentials from the soma to individual dendrite of cultured rat amacrine cells is regulated by local GABA input

Yamada, Y, Koizumi, A, Iwasaki, E, Watanabe, SI, Kaneko, A

JOURNAL OF NEUROPHYSIOLOGY (Journal of Neurophysiology)  87 ( 6 ) 2858 - 2866 2002.06

Research paper (scientific journal), Joint Work, Accepted,  ISSN  0022-3077

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Retinal amacrine cells are interneurons that make lateral and vertical connections in the inner plexiform layer of the retina. Amacrine cells do not possess a long axon, and this morphological feature is the origin of their naming. Their dendrites function as both presynaptic and postsynaptic sites. Half of all amacrine cells are GABAergic inhibitory neurons that mediate lateral inhibition, and their light-evoked response consists of graded voltage changes and regenerative action potentials. There is evidence that the amount of neurotransmitter release from presynaptic sites is increased by spike propagation into the dendrite. Thus understanding of how action potentials propagate in dendrites is important to elucidating the extent and strength of lateral inhibition. In the present study, we used the dual whole cell patch-clamp technique on the soma and the dendrite of cultured rat amacrine cells and directly demonstrated that the action potentials propagate into the dendrites. The action potential in the dendrite was TTX sensitive and was affected by the local membrane potential of the dendrite. Propagation of the action potential was suppressed by local application of GABA to the dendrite. Dual dendrite whole cell patch-clamp recordings showed that GABA suppresses the propagation of action potentials in one dendrite of an amacrine cell, while the action potentials propagate in the other dendrites. It is likely that the action potentials in the dendrites are susceptible to various external factors resulting in the nonuniform propagation of the action potential from the soma of an amacrine cell.

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